Digitized by the Internet Archive in 2016 with funding from Duke University Libraries https://archive.org/details/militaryhospital01weed MEDICAL DEPARTMENT OF THE UNITED STATES ARMY IN THE WORLD WAR VOLUME V MILITARY HOSPITALS IN THE UNITED STATES PREPARED UNDER THE DIRECTION OF MAJ. GEN. M. W. IRELAND, M. D., Surgeon General of the Army By LIEUT. COL. FRANK W. WEED, M. C., U. S. ARMY WASHINGTON : : GOVERNMENT PRINTING OFFICE : : 1923 UH 6U?¥J O lr_n 3 m v. 5 ADDITIONAL COPIES OF THIS PUBLICATION MAY BE PROCURED FROM THE SUPERINTENDENT OF DOCUMENTS GOVERNMENT PRINTING OFFICE WASHINGTON, D. C. AT $2.25 PER COPY PURCHASER AGREES NOT TO RESELL OR DISTRIBUTE THIS COPY POR PROFIT.— PUB. RES. 57, APPROVED MAY 11, 1922 DUKE UNIVERSITY JUL 1 7 1975 MEDICAL, CENTER LIBRARY LETTER OF TRANSMISSION. I have the honor to submit herewith Volume V of the history of the MEDICAL DEPARTMENT OF THE UNITED STATES ARMY IN THE WORLD WAR. The volume submitted is entitled, Military Hospitals in the United States.” Meritte W. Ireland, Surgeon General, United States Army. The Secretary of War. EDITORIAL BOARD. Col. Charles Lynch, M. C., Editor in Chief. Dr. Lot McAfee, C. S., Assistant Editor in Chief. MEMBERS. Col. Bailey Iv. Ashford, M. C. Col. Frank Billings, M. C. Col. Thomas R. Boggs, M. C. Col. George E. Brewer, M. C. Col. W. P. Chamberlain, M. C. Col. C. F. Craig, M. C. Col. Haven Emerson, M. C. Brig. Gen. John M. T. Finney, M. D. Col. J. H. Ford, M. C. Lieut. Col. Fielding H. Garrison, M. C. Col. H. L. Gilchrist, M. C. Brig. Gen. Jefferson Kean, M. D. Lieut. Col. A. G. Love, M. C. Col. James F. McKernon, M. C. Col. S. J. Morris, M. C. Col. R. T. Oliver, D. C. Col. Charles R. Reynolds, M. C. Col. Thomas W. Salmon, M. C. Lieut. Col. G. E. de Schweinitz, M. C. Col. J. F. Siler, M. C. Brig. Gen. W. S. Thayer, M. D. Col. A. D. Tuttle, M. C. Col. F. W. Weed, M. C. Col. William H. Welch, M. C. Col. E. P. Wolfe, M. C. Lieut. Col. Casey A. Wood, M. C. Col. Hans Zinsser, M. C. a The highest rank held daring the World War has been used in the case oi each officer. 4 PREFACE. The purpose of this volume is twofold: to furnish a record of experiences incident not only to the actual provision of the military hospitals in the United States during the World War but to their administrative operation as well; and, in so far as it has been practicable, to record the histories of the hospitals separately in order that their individual identities might be perpetuated. The material has been arranged to deal with generalities first and then with the individual organizations. Professional activities are considered in other volumes of the history, appro- priate in each case to the particular specialty involved. The plan consistently followed here has been not to include any of these except as they intimately affected organization or administration, when, to avoid a breach in continuity or the semblance of devitalization, they have been briefly recounted. It was obviously impossible to include complete histories of all the many military hospitals in the United States, so a representative of each of the vari- ous types has been selected for description. Hospitals whose histories were most complete were chosen in each instance for this purpose. To show what each of the hospitals accomplished and the staff requirements of each, statistical tables have been prepared exhibiting, numerically, the num- ber of patients treated and the personnel provided for their treatment. These tables have been appended to the hospital concerned when that hospital has been separately considered; otherwise, they have been given in synopsis form by hospital groups. These tables are imperfect: complete data either were not furnished by the hospital during the war, or they have been misplaced since. They are not considered an end, but rather a means to an end, and for this reason it is felt that they will amply serve their purpose despite minor errors. During the earlier stages of the preparation of this volume Lieut. Col. Casey A. Wood, M. C., was in direct charge of its compilation. Colonel Wood accom- plished much valuable work on his assignment, but the exigencies of the service resulted in his separation from activities connected with the history, except as a member of the editorial board. Since Colonel Wood’s separation from the service in October, 1920, much pertinent material became available, necessitating the rearrangement of the volume. Acknowledgment is made to Col. Charles Lynch, M. C., for much of the material in Chapter XXII, on embarkation and debarkation hospitals; to Dr. Loy McAfee, for helpful advice on the general arrangement of the contents of the volume and for the condensation of a number of the individual histories of base hospitals; to Col. A. E. Truby, M. C., for the chapter on the airplane ambulance; to Lieut. Col. S. M. DeLoffre, M. C., for data on the construction of aviation hospitals; to Maj. Floyd Kramer, M. C., for the material on the construction of temporary hospitals and the procurement of hospital space in existent buildings; and to Mr. Arthur W. Hodgkins for the preparation of the illustrations from which practically all of the line cuts have been made. <*For thepurposes of the Medical Department of the United States Army in the World War, theperiod of war activities extends from April 6, 1917, to December 31, 1919. In the professional volumes, however, in which are recorded the medi- cal and surgical aspects of the conflict as applied to the actual care of the sick and wounded, this period is extended, in some instances, to the time of the completion of the history of the given service. In this way only can the results of the methods employed be followed to their logical conclusion. 5 TABLE OF CONTENTS Page. Preface 5 Introduction 13 Evolution of the military hospital 13 Section I. — Procurement. Chapter I. Evolution of hospital procurement methods 27 II. General factors underljdng the hospitalization scheme 33 III. Classification of hospitals constructed 39 Section II. — Construction and Improvement. IY. Construction 57 V. Hospitals provided and improved 102 Section III. — Organization, Administration, and Control. VI. Differentiation of general, base, and camp hospitals 117 VII. Personnel 121 VIII. Supplies and utilities 145 IX. Coordination of improvement measures 157 X. Correlated activities 164 XI. Distribution of overseas patients 171 XII. Transportation of sick and wounded 180 XIII. Demobilization 189 Section IV. — Types of Hospitals. XIV. The camp base hospital 193 XV. The general hospital (permanent) 272 XVI. The general hospital (converted) 323 XVII. The general hospital (tuberculosis) 363 XVIII. The general hospital (new) 375 XIX. Post hospitals 388 XX. Aviation hospitals 398 XXI. The airplane ambulance 416 XXII. Embarkation and debarkation hospitals 426 XXIII. The debarkation hospital 436 XXIV. The embarkation hospital 451 Section V. — Other General Hospitals. XXV. Army and Navy General Hospital; Hot Springs, Ark., Fort Bayard, N. Mex.; General Hospitals, Nos. 1, 4, 5, 6, 7, and 8 483 XXVI. General Hospitals, Nos. 9, 10, 11, 12, 13, 14, 15, 16, 17, and 18 520 XXVII. General Hospitals, Nos. 19, 20, 22, 23, 24, 25, 26, 27, 28, and 29 552 XXVIII. General Hospitals, Nos. 30, 31, 32, 33, 34, 35, 36, 37, 38, and 40 586 Section VI. — Other Base Hospitals. XXIX. Base Hospitals, Camp Beauregard, La.; Fort Bliss, Tex.; Camps Bowie, Tex.; Cody, N. Mex.; Custer, Mich.; Devens, Mass.; Dix, N. J.; Dodge, Iowa; and Doniphan, Okla 619 XXX. Base Hospitals, Camps Eustis, Va. ; Fremont, Calif. ; Gordon, Ga. ; Greene, N. C.; Hancock, Ga.; A. A. Humphreys, Va.; Jackson, S. C.; Jos. E. Johnston, Fla.; Kearny, Calif.; and Lee, Va 663 7 8 MILITARY HOSPITALS IN THE UNITED STATES. Page. Chapter XXXI. Base Hospitals, Camps Lewis, Wash.; Logan, Tex.; MacArthur, Tex.; McClellan, Ala.; Meade, Md.; Pike, Ark.; Fort Eiley, Kans.; and Sam Houston, Tex 709 XXXII. Base Hospitals, Camps Sevier, S. C.; Shelby, Miss.; Sheridan, Ala.; Sherman, Ohio; Zachary Taylor, Ky.; Travis, Tex.; Upton, N. Y.; Wadsworth, S. C.; and Wheeler, Ga 745 Section VII. — Other Embarkation and Debarkation Hospitals. XXXIII. Embarkation Hospitals, Nos. 1, 2, 3, and 4; Debarkation Hospitals, Nos. 1, 2, 4, and 5; Base Hospital, Camp Merritt, N. J.; Base Hospital, Camp Mills, N. Y.; and United States Army Auxiliary Hospital No. 1, N ew Y ork C ity 785 XXXIV. Debarkation Hospitals, Nos. 51 and 52 821 LIST OF ILLUSTRATIONS. Figure. Page. 1. Tilton’s Log Hut Hospital, New Jersey, 1780 15 2. Herbert Hospital, Woolwich, England 17 3. Lariboisiere Hospital, Paris 4. Patterson Park Hospital, Baltimore, Md 19 5. Judiciary Square Hospital, Washington, D. C 20 6. Sedgwick Hospital, Greenville, La 21 7. Mower Hospital, Chestnut Hill, Pa 22 8. Satterlee Hospital, West Philadelphia, Pa 23 9. General hospitals superimposed upon Bureau of Census population map, 1910 36 10. Chart of normal bed capacities in larger hospitals in United States 53 11. Chart showing relation of available beds to patients in general hospitals 54 12. Chart showing relation of available beds to patients in base hospitals 55 13. Types of block plans for hospitals 5S 14. Floor plan of receiving building J-3 61 15. Administration building, base hospital 62 16. Receiving building, base hospital 62 17. Floor plans of administration and receiving buildings B-9 63 18. Floor plan of administration and receiving building B-13 64 19. Floor plans of single wards Iv-1 and K-20 65 20. Floor plans of two-story ward barracks K-5 and K-105 66 21. Floor plan of two-story general ward unit K-34 67 22. Floor plans of two-story ward units K-117 and Iv-58 6S 23. Floor plan of isolation wards M and M-l 68 24. Floor plan of isolation wards M-3 and M-6 69 25. Floor plan of psychiatric wards R-2 and R-4 69 26. Interior of a typical one-story ward of temporary construction : 72 27. Floor plan of tuberculosis ward Iv-103 75 28. Floor plans of tuberculosis wards K-108 and K-107 75 29. Floor plans of laboratory buildings 77 30. Floor plans of surgical pavilions 78 31. Floor plan of a surgical department for a 1,000-bed hospital 79 32. Floor plan of a surgical building for a 2,000-bed hospital SO 33. Floor plan of of a surgical and laboratory pavilion for a 300-bed hospital SI 34. Floor plan of a physical therapy building 82 35. Floor plan of mess and kitchen, I 84 36. Interior of a base hospital general kitchen S5 37. Corridor adjacent to patients’ mess, showing equipment for transporting prepared food to wards 85 38. Floor plan of mess and kitchen I— 11 S6 39. Floor plan of mess and kitchen 1-12 S7 40. Floor plan of mess and kitchen 1-34 : SS TABLE OF CONTENTS. 9 Figure. Page 41. Floor plans of mess 1—43 and kitchen 1-39 89 42. Cafeteria equipment 91 43. Officers’ quarters 93 44. Officers’ dining room 93 45. Nurses’ quarters 94 46. Living room, nurses’ quarters 94 47. Enlisted men’s quarters 94 48. Enlisted men’s mess hall 95 49. Typical Red Cross recreation house for nurses 95 50. Typical Red Cross convalescent house 96 51. Typical Young Men’s Christian Association hut 96 52. Interior of Young Men’s Christian Association hut 97 53. Typical medical supply buildings 97 54. Floor plan of laundry building Q-3 98 55. Floor plan of laundry building Q-4 98 56. Garage and cars at base hospital 99 57. Block plan of base hospitals as originally constructed 104 58. Inclosed corridor, connecting buildings 105 59. Typical one-story ward of temporary construction 105 60. Portion of the isolation section of a base hospital 106 61. Portion of the psychiatric ward 106 62. Exterior of a typical ward-barrack 107 63. Floor plans of regimental infirmary and camp dental infirmary 108 64. Central heating plant, National Army base hospital 150 65. Method of heating National Guard hospitals 150 66. Base hospital fire station 153 67. Portion of a base hospital farm 154 68. Covered, or “umbrella’’ walk 155 69. A post exchange building 164 70. Interior of a post exchange 165 71. A base hospital bowling alley 167 72. A swimming pool at base hospital, Camp MacArthur, Tex 167 73. Semischematic map showing manner of distribution of sick 172 74. Distribution of overseas patients to general and base hospitals 179 75. Hospital Train No. 1 180 76. A 16-section patient car, Train No. 1 181 77. Car for sick officers, Train No. 1 182 78. A hospital unit car fitted with Glennan adjustable bunks, showing manner of adjust- ment 184 79. Hospital unit car interior 185 80. Hospital unit car interior in use 186 81. Laundry, Base Hospital, Camp Grant, 111 202 82. Folders for clinical records, Base Hospital, Camp Grant 222 83. Receiving office, Base Hospital, Camp Grant 235 84. Ward class in physical reconstruction, Base Hospital, Camp Grant 262 85. Cottage used by the hospital personnel for outings, Base Hospital, Camp Grant 264 86. Cover design for one of the issues of the Silver Chev ’ , Base Hospital, Camp Grant 269 87. Specimen page of the Silver Chev’ 270 88. Administration building, Walter Reed General Hospital 274 89. Hospital stewards’ quarters, Walter Reed General Hospital 275 90. Detachment barracks, W 7 alter Reed General Hospital 276 91. Officers’ quarters, Walter Reed General Hospital 277 92. Nurses’ quarters, Walter Reed General Hospital 278 93. Isolation building, Walter Reed General Hospital 279 94. Aerophotograph, Walter Reed General Hospital 280 95. Block plan, Walter Reed General Hospital 282 96 . A view of temporary buildings, Walter Reed General Hospital 284 10 MILITARY HOSPITALS IN THE UNITED STATES. Figure. Page. 97. Hospital swimming pool, Walter Reed General Hospital 315 98. Service Club No. 1, Walter Reed General Hospital 318 99. Block plan, General Hospital No. 2, Fort McHenry, Baltimore, Md 324 100. Old Post Hospital, Fort McHenry, used as first administration building and officer- patients’ quarters 325 101. Panorama of cantonment wards, the first to be erected, at General Hospital No. 2 326 102. Two-story wards, constructed of tile, General Hospital No. 2 327 103. Plaster models of maxillofacial patients, General Hospital No. 2 336 104. Orthopedic shop, General Hospital No. 2 338 105. Portion of laboratory, General Hospital No. 2 344 106. Work in basketry, General Hospital No. 2 348 107. Patients at work in printing shop, General Hospital No. 2 349 108. Blind patients learning typewriting, General Hospital No. 2 351 109. Patients’ work in jewelry class, General Hospital No. 2 352 110. Patients’ class in photography, General Hospital No. 2 356 111. A view of Camp Purnell. Patients bathing, General Hospital No. 2 358 112. Block plan of General Hospital No. 21, Denver, Colo 364 113. Wards (under construction) General Hospital No. 21 366 114. Open-air ward, General Hospital No. 21 366 115. Officers’ apartments, General Hospital No. 21 367 116. Block plan, General Hospital No. 3, Colonia, N. J 376 117. View of front of General Hospital No. 3 377 118. Convalescent wards, General Hospital No. 3 378 119. Bakery, General Hospital No. 3 379 120. Chemical laboratory, General Hospital No. 3 385 121. East garrison, Fort McDowell, Calif 390 122. Post hospital, Fort McDowell 391 123. Hospital at Love Field, showing additional wings 399 124. Front view of a 50-bed aviation hospital 399 125. Aviation hospital, Rockwell Field, Calif 400 126. A ward, Post Hospital, Eberts Field, Ark 400 127. Nurses’ quarters, Eberts Field, Ark 401 128. Enlisted men’s barracks, Post Hospital, Barron Field, Tex 402 129. Enlisted men’s barracks, Post Hospital, Wilbur Wright Field, Ohio 403 130. Medical research laboratory, Rockwell Field, Calif 403 131. Operating room, aviation hospital 405 132. Sterilizing room, aviation hospital 406 133. Dispensary, aviation hospital 406 134. Physical examining room, aviation hospital 407 135. X-ray room, aviation hospital 407 136. Low oxygen tension test room, aviation hospital 40S 137. Kitchen and mess hall, aviation hospital 408 138. Toilet room, Post Hospital, Rockwell Field, Calif 409 139. Ambulance and field equipment 409 140. Trial flight of the Rhoades-Gosman airplane, January 26, 1910 416 141. Airplane ambulance, first used at Gerst.ner Field, La., January 2S, 1918 417 142. JN-4 H airplane ambulance approaching scene of accident, Ellington Field 419 143. JN-4 H airplane ambulance, top removed from fuselage, litter being removed 420 144. JN-4 H airplane ambulance, rendering first-aid to patient, Ellington Field 420 145. JN — 4 H airplane ambulance, preparing to load patient, Ellington Field 420 146. JN-4 H airplane ambulance, placing patient in fuselage, Ellington Field 421 147. JN-4 H airplane ambulance, Ellington Field, showing empty and loaded litter 422 148. Winching Stokes litter into place in the Rockwell Field airplane ambulance 423 149. Final position of litter, Rockwell Field airplane ambulance 423 150. Stokes litter for a DH-4 airplane ambulance 424 151. Stokes litter in place in a DH-4 airplane ambulance 424 152. Chart showing relationship of available beds to patients in port hospitals 426 TABLE OF CONTENTS. 11 Figure. Page. 153. Map of Port of Embarkation, Newport News, Ya 431 154. Debarkation Hospital No. 3, Greenhut Building, N. Y 437 155. Isometric plan of first floor, Debarkation Hospital No. 3 439 156. Typical general ward floor, Debarkation Hospital No. 3 440 157. One of the large wards at Debarkation Hospital No. 3 441 158. Block plan of Embarkation Hospital, Newport News, Ya 452 159. Headquarters, Embarkation Hospital, Newport News, Ya 453 160. General view of Embarkation Hospital, Newport News, Ya., showing central heating plant 454 161. Interior of power and heating plant, Embarkation Hospital, Newport News, Va 456 162. Nurses’ recreation building, Embarkation Hospital, Newport News, Va 457 163. Nurses’ wards, Embarkation Hospital, Newport News, Va 478 164. Red Cross convalescent house, Embarkation Hospital, Newport News, Va 479 165. Army and Navy General Hospital, Hot Springs, Ark 484 166. Block plan, General Hospital, Fort Bayard, N. Mex 487 167. Block plan, Letterman General Hospital, San Francisco 491 168. General Hospital No. 1, Williamsbridge, New York City 494 169. Portion of General Hospital No. 5, Fort Ontario, N. Y 502 170. Block plan of General Hospital No. 6, Fort McPherson, Ga 506 171. Swimming pool in gymnasium, General Hospital No. 7, Baltimore 512 172. General Hospital No. 8, Otisville, N. Y 515 173. General Hospital No. 9, Lakewood, N. J 520 174. Portion of General Hospital No. 10, Boston 523 175. General Hospital No. 11, Cape May, N. J 526 176. General Hospital No. 12, Biltmore, N. C 529 177. Block plan of General Hospital No. 14, Fort Oglethorpe, Ga 535 178. Open-air tuberculosis ward, General Hospital No. 16, New Haven, Conn 539 179. General Hospital No. 17, Markleton, Pa 542 180. Block plan of General Hospital No. 19, Oteen (Azalea), N. C 553 181. Sun porch, General Hospital No. 20, Whipple Barracks, Ariz 555 182. General Hospital No. 22, Philadelphia, Pa 558 183. General Hospital No. 24, Park View, Pittsburgh 563 184. Block plan, General Hospital No. 25, Fort Benjamin Harrison, Ind 566 185. Block plan, General Hospital No. 26, Fort Des Moines, Iowa 570 186. Block plan, General Hospital No. 28, Fort Sheridan, 111 576 187. Block plan, General Hospital No. 31, Carlisle, Pa 589 188. General Hospital No. 32, Chicago, 111 592 189. Portion of General Hospital No. 34, East Norfolk, Mass 596 190. General Hospital No. 35, West Baden, Ind 598 191. General Hospital No. 36, Detroit, Mich 601 192. General Hospital No. 38, Eastview, N. Y 606 193. Recreation room, General Hospital No. 38 607 194. Block plan, General Hospital No. 40, St. Louis, Mo 610 195. General Hospital No. 40, St. Louis, Mo 612 196. Plan of Camp Dix, showing relative position of Base Hospital 647 197. View of Base Hospital, Camp Sherman, Chillicothe, Ohio 759 198. Airplane view of Debarkation Hospital No. 1, Ellis Island, N. Y 792 199. Block plan of Debarkation Hospital No. 2, Fox Hills, N. Y. (General Hospital No. 41). 796 200. Debarkation Hospital No. 2 797 201. Debarkation Hospital No. 4, Long Beach, N. Y 799 202. Debarkation Hospital No. 5, New York City 803 203. Floor plan, Debarkation Hospital No. 5 805 204. Block plan, General Hospital No. 43, Soldiers’ Home, Hampton, Va 822 12 MILITARY HOSPITALS IN THE UNITED STATES. LIST OF TABLES. 3 Table. Page. 1. Schedule showing new construction (temporary) erected at post hospitals 40 2. Schedule of hospital buildings erected at the National Army camps (base hospitals). All temporary construction 42 3. Schedule of hospital buildings erected at the National Guard camps (base hospitals). All temporary construction 44 4. Schedule of new hospital construction of the temporary type done at points other than the National Army and National Guard camps 46 5. Schedule of new construction (temporary except General Hospitals, Nos. 20 and 21) tuberculosis hospitals 50 6. Schedule of hospital buildings, semipermanent (except General Hospital No. 28), of later design than buildings at hospitals of National Army and National Guard camps 52 7. Hospital beds available on armistice day 113 8. Number of enlisted men assigned to different sized hospitals 123 9. Number of overseas patients arriving at Hoboken, Newport News, and Boston 171 10. Patients from American Expeditionary Forces transferred to general and base hospitals from ports at Hoboken and Newport News 176 11. Revised table for ratio capacity, for troops invalided home September 5, 1918, on prin- cipal naval transports 187 12. Influenza and pneumonia statistics, Base Hospital, Camp Grant, 111 249 13. Drugs used in dispensary, Base Hospital, Camp Grant, 111., during the influenza epi- demic, 1918 249 14. Figures and statistics from the influenza epidemic, compiled by the Quartermaster Department, Base Hospital, Camp Grant, 111 249 15. Average number of days lost in hospital, Walter Reed General Hospital, 1917 304 16. Surgical operations performed at Walter Reed General Hospital, 1917 304 17. Admissions to Walter Reed General Hospital, 1918 305 18. Surgical operations performed at Walter Reed General Hospital, 1918 305 19. Admissions and dispositions, Walter Reed General Hospital, 1919 305 20. Consolidated numerical reports of sick and wounded, and strengths of personnel at United States Army post hospitals 394 21. Consolidated numerical reports of sick and wounded, and strengths of personnel at United States Army aviation hospitals 412 22. Consolidated numerical reports of sick and wounded, and strengths of personnel at United States Army camp hospitals 7S3 a Tables of statistical data concerning individual hospitals have been placed at the end of the history of each hos- pital considered. INTRODUCTION. EVOLUTION OF THE MILITARY HOSPITAL. ANCIENT PERIOD. Of those who, during the World War, were patients in any of our large, especially constructed military hospitals there were probably few who reflected that they were having the unique experience of being the first soldiers in the history of the world so favored as to receive treatment in a military hospital, the perfections of which rivaled the refinements of the best contemporary civil institutions for the care of the sick. That this is irrefutable a rapid survey of medico-military history and an examination of the data set forth in this volume will substantiate. Hospital Care of Ancient Warriors. Turning back the leaves of history to the records of the earliest times we find that, throughout, it has been customary to remove wounded soldiers from the field of battle and to place them in temporary shelters where they were given such crude treatment (“wound surgery”) as the times afforded. Even in the more remote period, or the domain of unauthenticated history, as related by Homer, the wounded were transported by hand or chariot to the tents or “black ships” to the rear. 1 There was, as might be expected, no organized effort to either rescue or care for the wounded in these early times; nor was such the case until a comparatively late period. Since the improvised shelters were extremely temporary, it was the custom among the Greeks and Romans to call into use houses, temples, even stables wherein the soldiers were refreshed and their wounds budded up. 2 It was not until after the beginning of the Christian Era that organized effort was made to rescue and adequately care for the wounded in permanent buildings which had been especially constructed for that purpose. Stationary Military Hospitals. In republican Rome private hospitals and the homes of the wealthy had been utilized for the care of wounded Roman soldiers, so long as military activities remained confined to the vicinity of Rome. 3 With the extension of conquest to unknown lands, and the establishment of standing armies in occu- pied territories, it became necessary to provide special hospitals for the Roman soldiery there. Some of these hospitals, constructed of stone during the latter part of the first century or beginning of the second century of the Christian Era, 3 suggest a striking resemblance to the military hospitals planned and erected by the British and French about 17 centuries later, They consisted of series of wards built about a quadrangle and opening on both sides of longitudinal corridors; each ward only sufficiently large to accommodate approximately a dozen patients. There were such refinements as sewers, water piping, a heat- 13 14 MILITARY HOSPITALS IN THE UNITED STATES. ing plant, kitchen, and apothecary’s shop. This surprisingly excellent arrange- ment for caring for the sick and wounded continued throughout the Byzantine period (476 to 732 A. D.), but ceased with the decline of Roman influence. 4 MEDIEVAL PERIOD. Modern hospitals had their incipiency during that part of the Middle Ages when the great waves of the Crusades, breaking on the deserts of the East, carried back in their ebb a flotsam of the lame, the halt, and the blind to the cities of medieval Europe. To care for these and the plague of lepers introduced at the same time, the charitable orders of the church founded places of shelter for the poor and helpless. 5 These institutions, called hospitals, were designed merely to house their helpless inmates, and had little resemblance to the scien- tifically constructed and administered hospitals of the present day. The revival of the direct hospital care of warriors is credited to Isabella, Queen of Spain, who, during the siege of Alora (1184), sent to the camps six large tents and their furniture, together with physicians, surgeons, medicines, and attendants. These tents were called the “Queen’s Hospital.” 6 The influence of Queen Isabella on the establishment of military hospitals was afterwards seen at the siege of Metz (1552), when, under Emperor Charles the Fifth, there were included the organizations of both field and garrison hospitals. 7 EIGHTEENTH-CENTURY HOSPITALS. Toward the close of the eighteenth century, widespread attention was directed to the wretched general condition of the hospitals throughout Europe. s In the Hotel Dieu, at Paris, at that time a veritable hotbed of disease, there were approximately 1,220 beds, the most of which contained from four to six patients. In larger halls there were patients crowded on pallets or often lying about miserably on heaps of straw, which was in vile condition. Vermin and filth abounded and the ventilation was often so abominable that the attendants and inspectors would not enter in the morning without a sponge dipped in vinegar held to their faces. Although the Hotel Dieu was not a military hospital, its condition reflected the general lack of knowledge of hospital construction and management, and especially the high value of the basic principles of sanitation in connection therewith — the provision of adequate ah’ space, and means for ventilation and the admission of sunlight. The true principle of hospital construction was at first discussed bv a committee of the French Academy of Sciences, 9 which in 1788 made a final report as to conditions which a model hospital should fulfill, specifying that the wards should be in isolated pavilions; that each ward should be 24 feet wide, from 14 to 15 feet high and 115 feet long; and should contain from 34 to 36 beds; and that the windows should extend to the ceilings. A part of the com- mittee visited England, 10 and along with the ideas of the English ward utilities, they were impressed with the necessity of limiting the beds in a ward to from 12 to 13, a custom entirely at variance with that which prevailed in the Hotel Dieu. They took ideas from the plan of the pavilion hospital at Stonehouse, England, 10 in all probability the first pavilion hospital, which guided them in preparing their famous report. INTRODUCTION, 15 EARLY AMERICAN HOSPITALS. In America, the first account of a hospital in the territory now known as the United States was of the one established on Manhattan Island 11 in 1658, for sick soldiers — who had previously been billeted in private families — and for the West India Co.’s negroes. In 1679 this hospital consisted of five houses. During the American Revolution, General Washington evinced the kindest interest in the sick and wounded; but there was much suffering on account of the poverty of the Government and the meager resources of the country, pre- Fig. 1. — Tilton's Log Hut Hospital, New Jersey, 17S0. (From an old wood cut.) venting the possibility of building and conducting hospitals. Consequently, it was a necessity to make use of all kinds of houses for the purpose of locating the sick and wounded; and we find but little recorded as adding to the develop- ment of hospitals. 12 During the winter of 1779-80, Dr. James Tilton, of Delaware, was in charge of the general hospital at Trenton, N. J., and to him is to be accorded the credit of endeavoring to diminish the sickness, resulting from crowd poisoning, by a new system of hospital construction. 13 He did away with the hospital tents and private houses then in use; and caused to be constructed a large number of log 16 MILITARY HOSPITALS IK" THE UNITED STATES. huts, built roughly, so that air could penetrate the crevices. These huts were without wooden floors, the ground being hardened or baked by heat, and each hut was intended to accommodate about 8 to 12 men. During the War of 1812 the general hospital, established at Burlington* Vt., 14 consisted of 40 wards containing between 700 and 800 patients. Wards were appropriated to infectious or contagious diseases, surgical cases had rooms separate from the febrile, and venereal and itch patients were assigned to their separate wards and not intermixed with men of different diseases. In an adjoining house the surgeons were accommodated with comfortable rooms where one or more always remained. INFLUENCE OF THE CRIMEAN WAR ON HOSPITALS. The next progressive step after the report of the French Academy’s commit- tee, in the development of hospitals, was brought about by the fearful death rate of the English and French armies in the beginning of the Crimean War. So great was the mortality that the English people as a whole were aroused to the neces- sity of better provision being made for the sick and wounded. Miss Florence Nightingale, who had had training as a nurse at Kaiserworth, and a selected band of 37 nurses were sent to the seat of the war, on October 24, 1854. 15 In 1855, the British Government appointed a sanitary commission to proceed at once to Crimea and Scutari. 15 Miss Nightingale and the commission suc- ceeded in introducing many valuable sanitary reforms in the British army in the East. 16 In 1855 the sanitary inspectors of the British army in Crimea suggested the use of wooden huts or barracks for hospitals, 17 and at the same time proposed a permanent tent hospital. It was found by experience that simple wooden huts raised from the ground, with double walls to protect from the heat in summer and cold in winter, made with ridge ventilation, and heated by means of open fires or stoves, gave far better results than any other kind of building. The practical results of the interest in hospitals brought about by the Crimean War were the building of the famous Herbert Hospital at Woolwich, 1S and establishing on a sure basis the detached plan of hospital construction which had been proposed and a small one erected (Plymouth Naval Hospital), just 100 years before. The Herbert Hospital was an improvement on the Lariboisiere, in Paris, finished in 1854; but like it was modeled after the plan proposed by the French Academy’s committee in 1786 — the improvements being mainly in the details of internal arrangements. 10 PTntil the building of the Herbert Hospital, the Lariboisiere Avas the model hospital of the world. 10 The influence of the Crimean experience did not do so much for France; nothing better than the Lariboisiere was proposed. Before the interest in sanitary and hospital reform, caused by the Cr im ean War, had quieted down, the American people had the opportunity offered them to make use of the valuable suggestions published in the reports of the English commission, and in doing so succeeded in developing the most perfect system of army hospitals ever known to the Avorld. INTRODUCTION. 17 100 50 0 10 0 SO 0 300 400 1— LLLLi UU-LJ ( . I ■ — L_ - i Herbert Hospital. Fig. 2. — Herbert Hospital, Woolwich, England. Fig. 3. — Lariboisiere Hospital, Paris. 45269°— 23 2 18 MILITARY HOSPITALS IN THE UNITED STATES. CIVIL WAR HOSPITALS. 0 Prior to the Civil War the troops composing the United States Army were chiefly distributed at garrisons of the various units of the general system of our coast defense, or for the protection of the Indian frontier. Each of these sta- tions was provided with a small post hospital in which serious cases of illness were treated. When the troops began to go into camp, at the commencement of war, each regiment established a regimental hospital on the same general plan. Hospital tents or buildings, temporarily occupied, afforded shelter for the more serious cases. When small regiments were grouped together as brigades it was often found convenient to establish a congeries of regimental hospitals at one point, and this led to their consolidation in many instances as brigade hospitals. At a later period, the same tendency to consolidation led to the union of the several brigade hospitals of a division, forming thus a division hospital. The division hospital was sometimes a mere aggregation of a regimental or brigade hospital ; but in its highest development, in connection with large armies in which troops were maneuvered by divisions, it formed a single unit having the same relation to the division that the regimental hospital had to the regiment. Very soon after the mobilization of troops was begun in 1861 it was found that the system of post and regimental hospitals was inadequate to provide for all the sick. Difficulty was especially experienced when a regiment changed station. It became necessary, therefore, to organize near the bases of opera- tions independent hospitals to receive and care for the sick necessarily left behind when troops moved, as well as those for whom regimental hospitals were inadequate, and the wounded after battles. Such establishments, known as general hospitals, being of a more or less permanent character, it was possible to provide more conveniences and comforts for the care of the sick and wounded than could be furnished in the field, and hence it became the custom to send the more serious cases, especially those requiring protracted treatment, to a general hospital. When, in the course of events, the general hospitals near the several bases of operations became encumbered with sick and wounded, others were established throughout the North, and the hospitals near the bases of operations were evacuated upon the more distant establishments, from time to time, to make room for the continual stream of diseased and disabled which constantly flowed from the scene of active operations. At the beginning of the War of the Rebellion this country knew nothing practically of large military hospitals. It was, therefore, not surprising that existing buildings were used. Hotels, churches, seminaries, dwellings, ware- houses, and factory buildings were used at the various places in the North and Middle West as extemporized hospitals. Frequently, when the ground in the vicinity of a building taken for hos- pital purposes was of a suitable character, the demand for increased accommoda- tion was supplied by hospital tents pitched so as to form a series of elongated pavilions, which in some instances were replaced later by long wooden pavilions. a Abstracted from Medical and Surgical History of the War of the Rebellion . 19 Illustrations used in this connection are slightly reduced from the originals, consequently scales on the reproductions do not apply. INTRODUCTION. 19 The prototype of the pavilion hospitals of the Civil War was erected in West Virginia. This was before the need of specially constructed hospitals in the large cities had received a practical recognition, and was due to the movements of large bodies of troops in West Virginia as well as the absence of adaptable buildings. This was a series of ridge ventilated wooden sheds, 130 by 25 by 14 feet to the eaves, each divided by transversal partitions into four wards of 20 beds each. The wards were roughly constructed, were well adapted for use in warm weather, but, because of the lack of shutters on the ridge ven- tilators, permitted the cold winds and snow to penetrate in the winter to an extent unbearable to the patients. The inauguration of the peninsular campaign in 1S62 filled the hospitals of Washington with sick men of the moving army. It occasioned also the vaca- I 4 tion of a number of barracks buildings near Washington and Baltimore, which were acquired by the Medical Department, and though intended to be used for makeshift hospitals, many retained the status of general hospitals to the end of the war. To adapt this type of dormitories to hospital purposes, they were generally repaired; additional windows were inserted; and ridges were laid open for ventilation in summer and louvered exits were provided for winter use. The lower rooms of two-storied barracks were connected with the ridge by ventilat- ing shafts. The greatest defect in the barrack buildings was their arrangement or relative position on the camp ground, which was seldom the most appropriate 20 MILITARY HOSPITALS IK THE UNITED STATES. for the aggregation of hospital pavilions. They were either so detached as to greatly augment the difficulties of administration, or so massed around a cential point as to materially interfere with ventilation. The difficulties encountered in the use of illy adapted buildings for hospitals led the United States Sanitary Commission, early in the winter of 1861, to urge upon the Government the importance of building hospitals on the pavilion principle. The first of the hospitals constructed in accordance with this sugges- tion were the Judiciary Square and Mount Pleasant hospitals, Washington, D. C . The most grievous fault in the plan of these hospitals lay in the common atmosphere which the single roof and the screen partitions gave to all the rooms occupied by the sick, including even those assigned for the purpose of isolation. Although nominally built upon the pavilion principle, they were wanting in the very point which was the leading idea of the system. A central corridor with a double row of attached pavilions, five on each side, does not appear to have met with favor, after recognized failure of attempts of this kind on the Mount Pleasant type. The improvements which were made in each succeeding hospital erected during the Civil War had reference to the character of the construction of the wards, their lighting and ventilation, the attachment of their bathrooms and toilets, and their arrangement as a whole, including their connection one with another and with the administration and executive departments of the hospital. Structural refinements replaced the former coarse joining and rough fin- ishing. The pavilions were gradually reduced in length from those of 24S feet with transversal partitions, giving four wards, to a clear ward length of 150 feet in each building. The width and height of the wards became increased to 24 or 25 feet and 12 or 14 feet, respectively. The open ridge, which admitted driving rains and snows, received protection, and other means of ventilation connected with the heating of the wards were introduced. Lastly, faults of aggregation were recognized and avoided. INTRODUCTION. 21 Fig. 6. — Sedgwick Hospital, Greenville, La 22 MILITARY HOSPITALS IN' THE UNITED STATES. The experience of the war was decidedly in favor of the pavilion system, each pavilion constituting a single ward isolated from adjacent buildings by somewhat more than its own width and connected by a covered walk with the other buildings of the hospital. In an aggregation this separation was effected without removing any of the wards to an inconvenient distance from the admin- SECTION Fig. 7. — Mower Hospital, Chestnut Hill, Pa. istration and executive buildings, by radiating them around some central point in a form determined by the configuration of the ground available for building. The force of medical officers indicated a decided preference for a pavilion length affording space for not more than 50 beds. The experience of the British in Crimea with similar pavilions was in favor of a ward containing from 26 to INTRODUCTION. 23 Fig. 8. — Salterlee Hospital, West Philadelphia, Pa. 24 MILITARY HOSPITALS IN THE UNITED STATES. 30 patients as giving better ventilation and greater comfort and economy of labor than one of larger capacity. From the foregoing progressive stages through which general hospital con- struction passed during the War of the Rebellion, it would seem that the United States Army slowly and independently arrived at conclusions similar to those drawn by the British and French. Billings, in his report on barracks and hos- pitals, states, in referring to the pavilion type of hospital recommended by the British, “The experience gained during the late war * * * contributed greatly to the recognition of its value in this country.” 9 AMERICAN MILITARY HOSPITALS IN THE INTERIM BETWEEN THE CIVIL AND WORLD WARS. Of the large especially constructed Civil War hospitals none has survived the ravages of time. Of the many post hospitals of that period — some of which were used as general hospitals — many remain, in name at least, for by altera- tion or new construction their original appearance is no longer recognizable. This alteration in the post hospitals was largely due to the publication of Billings’ “Report on Barracks and Hospitals,” 9 which forms a classic treat- ment of military hospitals in general. During the Spanish-American War nothing in the way of general hospital construction was accomplished which would add to the developed plan of the Civil War. Of the general hospitals established, the majority were extempor- ized by the use of tents, vacant barracks or other existing buildings — hotels or school buildings — post hospitals, etc. Where increased capacity was requisite, when existing buildings were used, tent wards were erected. 20 Several semipermanent general hospitals were constructed shortly after this period, three arrangements of the pavilion wards being used. 21 One con- sisted in locating the wards on the outer side of a covered way, shaped like an inverted V; in the establishment of them on two sides of a central square; and in arranging them in two parallel lines on each side of a covered passageway. The 1,000-bed hospital at Fort Monroe was built in the form of an inverted V, similar to the plans of the Lincoln and McClellan Hospitals of the Civil "War, and the hospitals used by the French at Metz in 1870-71. The administrative portion of the hospital was located between two covered corridors ; the entrance standing obliquely away from the latter in such a manner as to receive the full benefit of wind and sun without interference from each other. The chief disadvantages of this hospital were difficulty of administration and a too great size of the individual ward. The general hospital at Savannah, also having a capacity of 1,000 beds, was well planned and arranged for purposes of administration; the beds being closely placed at right angles to a long central corridor. The long axes of the pavilions, however, extended north and south — an undesirable arrangement in hospital buildings in such a southern latitude. The buildings were also too compactly placed, seriously interfering with each other in respect to air currents. The general hospital at. San Francisco had 10 general wards, each with an inside length of 153 feet and, including lavatory and administrative rooms of 180 feet. The width of the ward was 25 feet; the space between wards was 35 feet. These buildings were located in parallel lines on each side of a central square in which was placed the operating rooms and mess halls. The square INTRODUCTION. 25 was partially closed in at one end by the administrative building and was bor- dered by a covered passageway connecting all the wards, the block plan resem- bling very closely that of the Lariboisiere except that the latter had three- storied wards. This adaptation of the pavilion ward has proven, in its grouping of buildings, to be very convenient and easily administered; and, as will be seen later, materially influenced the block plans for the hospitals constructed at the large camps during the World War. HOSPITAL SITUATION AT THE TIME OF OUR ENTRANCE INTO THE WORLD WAR. In April, 1917, the number of beds in hospitals of the Army was 9,530, distributed among 131 post hospitals, 4 general hospitals, and 5 base hospitals. 22 The usual type of our post hospital differed materially from the military hospitals in use in foreign countries. 23 In our service, the small number of troops located at- any one place made our Army hospital buildings of corre- spondingly small size. Considerations of economy also forced the building of post hospitals of such a compact nature that they naturally and unavoidably presented many defects incident to all activities being present ’within the same structure. Among these faults may be mentioned the crowding together and close connection of the adminstrative portion, wards, kitchen, lavatories, etc., which should be separated one from another. Exceptionally, there were large post hospitals, to which, by special and successive appropriations, additions were made until the faults mentioned above were partially eliminated. The character of the construction of the general hospitals was very similar to that of the post hospitals, the difference being mainly in size, in the aggrega- tion of buildings, and in the more elaborate installation of surgical and medical appliances for the recognized specialties in general hospitals. Though desig- nated general hospitals, but two served for general cases — the Letterman General Hospital at San Francisco, Calif., and the Walter Reed General Hospital, Takoma Park, District of Columbia. The general hospital, Fort Bayard, N. Mex., was used solely for the treatment of pulmonary tuberculosis, 24 and the Army and Navy General Hospital, Hot Springs, Ark., cared for those cases for which the hot springs of Arkansas had a high reputation for benefiting. 25 The post and general hospitals were, usually, of permanent brick and stone construction. Some were of wood, some partly of stone, or brick and wood; a few were built of concrete. They contained central heating plants — hot-water systems usually — had range cooking facilities, and were rarely more than two-storied. The size of their wards varied, containing from 6 to 36 beds, dependent upon the size of the hospital. As a rule, the permanent hospitals were well constructed, durable, well lighted, and had ample porches. During the concentration of troops along the Mexican border in 1916, semipermanent hospitals were erected at various places for their care and treatment. 26 The two existing base hospitals at Fort Sam Houston, Tex., and at Fort Bliss, Tex., of about 200 beds each, were enlarged by the addition of pavilion wards, and increased to the capacity of 750 and 900 beds, respectively. 26 MILITARY HOSPITALS IN THE UNITED STATES. REFERENCES. (1) Eleventh Iliad. (2) Withington, E. T.: Medical History from the Earliest Times. The Scientific Press, (Ltd.). London, 1894, 69-70. (3) Garrison, F. H.: Notes on the History of Military Medicine. The Military Surgeon, Wash- ington, D. C., 1921, 1, No. 1, 22. (4) Withington: Op. cit., 117. (5) Garrison, F. H.: An Introduction to the History of Medicine. W. B. Saunders & Co. Philadelphia., 1913, 120. (6) Withington: Op. cit., 224. (7) Heizman, C. L.: Military Sanitation in the Sixteenth, Seventeenth, and Eighteenth Cen- turies. Journal of the Military Service Institution of the United States, Governors Island, N. Y., 1893, xiv, No. 64, 711. (8) Garrison, F. H. : An Introduction to the History of Medicine, 332. (9) Circular No. 4, War Department, Surgeon General’s Office, Washington, Dec. 5, 1870. A Report on Barracks and Hospitals. (10) Wylie, W. G.: Hospitals: History of Their Origin. New York Academy of Medicine Trans- actions, 1874-1876, 264. (11) Wylie: Op. cit., 266. (12) Wylie: Op. cit., 272. (13) Brown, H. E.: Medical Department of the United States Army, 1775-1873. Washington. D. C., Surgeon General’s Office, 1873, 52-53. (14) Brown: Op. cit., 89-90-91. (15) Report: Hospitals of the British Army in Crimea and Scutari. Eyre and Spottiswoode, London, 1855. (16) Wylie: Op. cit., 278. (17) Report of the Proceedings of the Sanitary Commission Dispatched to the Seat of War in the East. Harrison & Sons, London, 1855-1856. (18) Burdette, H. C.: Hospitals and Asylums of the World. J. and S. Churchill, London, Yol. IX, 34. (19) Medical and Surgical History of the War of the Rebellion, Part III. Medical volume, Chap. XII. (20) Annual Report of the Surgeon General, U. S. Army, 1898, 128-131. (21) Munson, E. L.: Military Hygiene. Wm. Wood & C'o., New York, 1901, 439—442. (22) Hospitalization Program for the LTnited States. On file, Record Room, S. G. O., Corre- spondence File, 632.1. (23) Munson: Op. cit., 434-436. (24) A. R. 1445, 1913. (25) A. R. 1441-42, 1913. (26) Annual Report of the Surgeon General, U. S. Army. 1917, 142. SECTION I. PROCUREMENT. CHAPTER I. EVOLUTION OF HOSPITAL PROCUREMENT METHODS. PRE-WAR PROCUREMENT. The Surgeon General personally authorized all hospital projects and approved all preliminary or sketch plans, 1 often as the result of conferences in which other officers of his staff joined. Three or four clerks, draftsmen, were employed in sketching preliminary plans for new hospital buildings. These preliminary plans, with supporting data, were furnished the Quarter- master General, to be used by him as a basis for the completed plans prepared in his office. 2 Frequently necessary changes were made in the preliminary plans by the Quartermaster General, in which event they were returned to the Surgeon General for his approval. Specifications were likewise prepared by collaborating with the Quartermaster General’s Office. Complete prints and specifications were finally approved by the Surgeon General and returned to the Quartermaster General, together with a request for construction. 3 Funds for the construction of hospitals were secured from Congress 4 as an appropriation specifically termed — Construction and repair of hospitals: For construction and repair of hospitals at military posts already established and occupied, including extra duty pay of enlisted men employed on the same, and including also all expenditures for construction and repairs at the Army and Navy Hospital at Hot Springs, Arkansas, and for construction and repair of general hospitals and expenses incident thereto, and for activities to meet the requirements of increased garrisons. Difficulty had been experienced in securing the complete construction of Army hospitals with money thus appropriated. This was due to the fact that several other appropriations, in addition to that for construction and repair of hospitals, were required to install electric fixtures, sewerage, cooking ranges, and, in large hospitals, the additional construction of barracks, quarters , roads, walks, etc. Even though ample funds were provided for the erection of build- ings, occupancy could not be effected unless funds existed in at least three other appropriations to cover expenditures for electric fixtures, sewers, etc. The average yearly appropriation under "Construction and repair of hospitals,” for the 10 years prior to the war, was $400,000, of which, as a rule, 55 per cent was used for repair and 45 per cent for new construction. 5 Funds for the construction of hospital stewards’ quarters were secured under separate, appropriate headings. 6 27 28 MILITARY HOSPITALS IN THE UNITED STATES. WARTIME ORGANIZATION FOR HOSPITAL PROCUREMENT. The preliminary study of the hospital problem, as applied to our Army after the declaration of war, was made the duty of an officer of the Medical Corps, especially detailed to the Office of the Surgeon General for that purpose because of his broad experience with the larger type of military hospitals. Early in July, 1917, a hospital division was created in the Surgeon General’s Office, under the officer mentioned, which was charged with the responsibility of producing hospital space in the United States for the cantonments of the National Army and encampments of the National Guard, and general and special hospitals for the care and treatment of sick and wounded from overseas, as well as those from numerous camps, requiring special or prolonged treatment. 7 There were 32 mobilization camps each of which required a large hospital. 8 Inasmuch as the first divisions of the new National Army were scheduled for mobilization in the early fall of 1917, it was essential to proceed rapidly with the development of preparations for the establishment of hospitals at the various camps of these divisions. At the same time plans had to be formulated for the provision of hospitals for the sick and wounded from overseas. That these latter hospitals would be numerous became early apparent from the experiences of the British and French. It was finally decided that provision would have to be made for 5 per cent casualties and 2 per cent sickness, the percentage referring to the total number of troops overseas and indicating the number estimated to require treatment and care on their return to the United States. This would make a total of beds equal to 7 per cent of the expeditionary troops. It was assumed that a turnover could be made, on the average, every six months, and a 31 per cent basis was adopted as a required number of beds for returning sick and wounded. 8 As the United States had been divided into 16 draft districts, the policy was adopted of providing in each draft district the number of hospitals and beds to be proportionate to the number of men inducted from each district. For obtaining these hospital facilities various methods were used. The Council of National Defense classified the hospitals of the United States as to size, convenience to railroad, equipment, facilities for expansion, and arrangements for handling special work. Tuberculosis sanitaria and dispensaries were inventoried and a survey was made as to hospitals for con- valescents. Offers of private houses and other larger buildings, tendered to the Surgeon General for use as military hospitals, were classified and tabulated for the Surgeon General’s use . 10 After due consideration, it was decided that the use of civil hospitals for the care and treatment of troops was not feasible because of the uncertainty of the supply of beds, the impracticability of taking over entirely civil hospitals in sufficient number without creating hardship on the civil population, and the difficulty in operating a military and civil organization in the same institution. The Surgeon General concluded that a program must be developed for obtaining a sufficient number of hospitals absolutely under military control, and pro- ceeded to develop that program. At the beginning of the fiscal year 1917-18, the plans prepared for the hospitals for the National Army and the National Guard divisions were being turned over to the Quartermaster Department for execution. Due to the PROCUREMENT. 29 antiquated printing apparatus in the construction branch of the Surgeon General’s Office, there was some delay incident to the printing of large numbers of plans requisite for erection purposes in the field, and it was necessary to run the printing machine 21 hours per day for weeks and demand overtime labor, on the part of the civilian employees concerned, with no increase of pay possible. Therefore a modern, motor-driven press and a motor-driven gas-heater drier were installed. The majority of the printing firms were well behind on work orders and in consequence could not be depended upon. In the preparation of these plans, medical officers, representing the various specialities, such as surgery, medicine, laboratory, were consulted, and, in so far as time, nec- essary construction, standardization, and funds permitted, plans were pre- pared to embody the essential features desired. These features were included with other usual hospital features and activities, and a general plan was evolved for the typical 1 ,000-bed hospital. A 500-bed hospital was planned by a similar process. In order to standardize equipment, materials, personnel, construction, and administrative requirements, it was thought best to accomplish this, and the 1,000-bed and the 500-bed hospital types were considered as more nearly approximating the majority of the proposed perfected features. The 500-bed hospital differed from the 1,000-bed hospital not only in number of wards, which were of the same type, but in the size of the administration building, receiving building, general mess hall, kitchen, and other service buildings. 11 During the execution of this planning work, considerable expansion occurred in the section of the Office of the Surgeon General charged with it. At the begin- ning five civilian employees were engaged in the work, under the supervision of one officer, who had other activities as well, and the section functioned directly under the officer in charge of the Hospital Division. It was necessary at this period to increase the drafting force. This was rendered difficult because the Civil Service Commission was unable to supply draftsmen, and the law did not permit the Medical Department to employ draftsmen except at a very low wage. To overcome this impediment, in a measure, architects, versed in hospital design and construction, or in military procedure, were commissioned in the Sanitary Corps, for supervisory duties. 12 By considerable effort and after extended delays, the drafting and designing force was organized and the hospital plans were studied and revised as occasions demanded. The difficulty incident to securing complete construction of Army hos- pitals from congressional appropriations, as they were made previous to the war, was overcome by adding the following phrase for incorporation into the enactment: * * * and for temporary hospitals in standing camps and cantonments. For the altera- tion of permanent buildings at posts, for use as hospitals, construction and repair of temporary hospital buildings at posts for use as hospitals, construction and repair of temporary hospital buildings at permanent posts, construction and repair of temporary general hospitals, rental or purchase of grounds and rental and alteration of buildings for use for hospital purposes in the District of Columbia and elsewhere, for use during the existing emergency, including necessary temporary quarters for hospital personnel, outbuildings, heating and laundry apparatus, plumb- ing, water and sewers, and electric work, cooking apparatus, and roads and walks for the same . 13 In the latter part of the year 1917, the necessity for closer cooperation between the Surgeon General’s Office and the Construction Division, War Department, became apparent to both bureaus, and as a result a hospital 30 MILITARY HOSPITALS LST THE UNITED STATES. section was organized in the latter. At this time about 250 hospital construc- tion projects were in the Construction Division, and the number was rapidly increasing. The creation of a hospital section in the Construction Division 14 proved to be an excellent innovation, most advantageous to all concerned, and eventually it grew to a considerable size. Upon the organization of the Hospital Division of the Surgeon General’s Office one of its sections was designated the procurement section. 15 Prior to that time the branch in charge of construction had not been concerned with the leasing or investigation of properties suitable for hospital purposes. Sub- sequently, however, all activities relating to the acquisition of places for hos- pital uses were initiated and followed up by the procurement section, necessitat- ing- the assignment of additional medical officers and architects to it from time to time. Its functions 16 were to determine requirements for hospital space; to secure adequate congressional appropriations; to locate and procure hospital space by lease; to make preliminary plans; to make request for new construction; to pass upon the requests for hospital space from War Depart- ment representatives in the field; to authorize allotments from the appropria- tions made by Congress for the construction and repair of hospitals and quarters of hospital stewards. In June, 1918, the planning subsection was physically placed in the Con- struction Division of the War Department. 17 This was done to obtain better liaison with the engineering and building activities and to economize in time. An officer from the Office of the Surgeon General was assigned to duty as liaison officer and to follow up projects which had been initiated. 18 After the necessity for hospital construction was determined in the Office of the Surgeon General, and the plans therefor completed in the Construction Division, in collaboration with the construction branch of the Surgeon Gen- eral’s Office, estimates for necessary funds, with a request that their expenditure be authorized, were made and sent to the War Industries Board, 19 through the Purchase, Storage, and Traffic Division, General Staff, for clearance. 20 After clearance by the War Industries Board, they were returned through the Purchase, Storage, and Traffic Division to the Operations Division, General Staff, for the approval of the Secretary of War, 20 after which they were re- turned to the Construction Division, whence they were sent to the field for execution. PROCUREMENT OF EXISTING BUILDINGS FOR HOSPITAL PURPOSES. The spirit of patriotic service which swept the country prompted many persons to offer their properties to the War Department for hospital purposes. These offers included buildings of every conceivable kind, such as lofts, depart- ment stores, sanatoria, private establishments, hospitals, and private homes. 21 Upon investigation, it was found that many of these could be utilized with advantage and could be obtained and converted into hospitals much more expeditiously than barrack hospitals could be constructed, and at less cost. Therefore, dependence was placed in the greatest degree upon these sources of supply, though many of the buildings offered required extensive remodeling and additional construction. PROCUREMENT. 31 When it was desired to lease a building, the Surgeon General requested the Quartermaster General to lease a specific property. Authorization was obtained from the Secretary of War, after which the approved lease was transmitted, by the Quartermaster General, to a local quartermaster, for accomplishment. 22 In August, 1918, this time-consuming routine was changed by the organization of a real-estate unit in the General Staff. 20 From that time on requests emanating from the Office of the Surgeon General, for the leasing of property, were forwarded directly to the General Staff, which, within its divisions, conducted investigations, authorized expenditures, and executed leases. When it was desired to establish a hospital in a building which required leasing and then had to be altered, after the lease had been accomplished, the routine was proceeded with as though new construction were being provided. As a rule, from two to six months were consumed in the establishment of large hospitals, representing the time between that when a request for a lease was forwarded from the Surgeon General’s Office, and the completion of any alteration work and the opening of the hospital for the reception of the sick. This necessitated the initiation of projects at a date from two to six months prior to anticipated needs. It was highly desirable that the method be simplified to save time, for during 1918 there was a progressively rapid increase in troop movement overseas. The increase in the active operations at the front portended an influx of sick and wounded into the hospitals of the United States; and to hasten the acquisition of a greater amount of general hospital space, the following plan was instituted: 21 Two groups of officers were formed, each consisting of a representative of the real-estate section of the Purchase, Storage, and Traffic Division of the General Staff, the Construction Division, and the Office of the Surgeon General. The duties of these groups were to investigate properties in the large cities; one for the eastern section of the country and one for the western. Upon the recommendation of the Surgeon General, the Secretary of War, on September 21, 1918, authorized the groups to close leases where rentals would not exceed $250 per bed per annum; and to authorize necessary funds for alteration purposes, provided each project would be cleared by the regional adviser of the War Industries Board and, further, that the three members of the group of officers were unanimous in their opinions. 21 When the described condition could not be effected the project required separate action in the War Department. Under the changed routine, hospital procurement progressed rapidly. Upon the execution of a lease and after the expenditure of funds for alterations had been authorized, the War Department was at once notified. To take up the work on projects where these groups stopped, other groups, consisting of an officer versed in Medical Department requirements, from the procurement section of the Surgeon General’s Office, together with assistants from the hospital section of the Construction Division, War Department, went to the site and, collaborating with the local quartermaster, completed the plans. 23 Definite knowledge was at hand as to when the conversion might be expected to be completed which permitted the advanced assemblage of per- 32 MILITARY HOSPITALS IN THE UNITED STATES. sonnel for the organization of the hospital and utilization of the hospital for patients at a much earlier date. It was found that work progressed smoothly and rapidly; uncertainty was largely eliminated; and arrangements, covering many details, could be completed locally without undue loss of time. REFERENCES. (1) A. R. 1465, 1913. (2) A. R. 1000, 1913. (3) A. R. 1468, 1913. (4) Bull. No. 30, W. D., May 22, 1917. (5) Table compiled from Annual Reports, Quartermaster General, 1907 to 1916. On tile, Record Room, Surgeon General’s Office, Correspondence File 632.1 (General). (6) Bull. No. 30, W. D., May 22, 1917. (7) Annual Report of the Surgeon General, U. S. Army, 1918, 304. (8) Ibid., 305. (9) Ibid., 306. (10) Report of the Chairman of the Committee on Medicine and Sanitation of the Advisory Com- mission of the Council of National Defense, Washington, April 1, 1918, 23. (11) Annual Report of the Surgeon General, U. S. Army, 1918, 317. (12) Ibid., 318. (13) Bull. No. 43, W. D., July 22, 1918. (14) Annual Report of the Surgeon General, U. S. Army, 1918, 319. (15) Ibid., 308. (16) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. II, 1141. (17) Annual Report of the Surgeon General, U. S. Army, 1918, 319; and 1919, Yol. II, 1142. (18) Annual Report of the Surgeon General, U. S. Army, 1919, Yol. II, 1142. (19) Second Annual Report of the Council of National Defense, for the Fiscal Year Ended June 30, 1918, 117. (20) G. 0. No. 80, W. D., Aug. 26, 1918. (21) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. II, 1144. (22) A. R. 1046, 1913. (23) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. II, 1145. CHAPTER II. GENERAL FACTORS UNDERLYING THE HOSPITALIZATION SCHEME. HOSPITAL PROVISION AT EXISTING ARMY POSTS AND TRAINING CAMPS. During the first few months after the war had been declared, Regular Army troops were being mobilized and trained at permanent military posts in numbers far in excess of those for which original hospital accommodations had been provided. At many posts, camps had been instituted in which there were being trained men who were afterwards to become officers of the new Army. The pi'ovision of additional hospital space for the sick of these troops was effected by the construction of temporary wards, mess halls, barracks, nurses’ quarters, or combinations of these or other hospital buildings adjoining the existing post hospitals at the various places. Plans were prepared and the con- struction of the buildings requested mostly in the month of May, 1917. 1 Rigid physical examination of the entrants to these camps excluded prac- tically all possible chronic ailments, and hospital provisions were made for only prospective acute illnesses. HOSPITAL PROCUREMENT AT CANTONMENTS AND CAMPS. Following the procurement of hospital space at the early training camps, the next necessity in point of time was the provision of hospitals for the sick of the drafted troops and the National Guard at the 32 cantonments and camps. As in the training camps, the character of the sick anticipated was the acute, and it was expected that an abnormal number of beds would he needed for con- tagious diseases and for cases under observation. In the completed plans (proposed along lines radically different from the usual Army type) it was supposed that ample provision had been made in these temporarily constructed buildings for laboratories, infectious diseases, wards for the insane, eye, ear, nose and throat patients, general medical and surgical patients, staff and nurses’ quarters, and administration. That the plans were faulty in minor respects was due to the necessity for haste and will not seem remarkable when one considers the length of time it requires to develop plans for much smaller hospitals in civil life. PROVISION OF HOSPITALS AT PORTS OF EMBARKATION. At these ports large camps were established for the temporary quartering of troops awaiting transportation abroad . 2 Here, the most rigid physical examinations were given troops and the provision of beds in hospitals had to he not only of sufficient number for the sick, but for communicable disease contacts and for soldiers under observation as well. As in large mobilization camps, the location of these embarkation camps determined that of the hospital. There was little or no information to serve as a guide to the amount of hospital space required in these camps. Moreover 45269°— 23 3 33 34 MILITARY HOSPITALS IN THE UNITED STATES. such information would have been of slight value as the size of the camps was frequently changed— usually increased — and hospital construction was forced to keep apace. As an instance to show the impossibility of foretelling the ulti- mate requirements of an embarkation hospital, the camp hospital, Newport News, Va., was originally built with a capacity of 250 beds. 3 Before the war had closed the capacity of this hospital had been increased to over 2,000 beds and the emergency capacity was even greater. 4 It should be stated, however, that a portion of this space was used for debarking sick. PROVISION OF DEBARKATION HOSPITALS. The general scheme for caring for the sick and wounded of the United States Army abroad provided for the return to the United States of those requiring prolonged hospital treatment. This necessitated the provision, at the ports, of hospitals for their reception. 2 The character of sick anticipated was the nonacute. The location of the hospitals for the reception of these returned sick and wounded was fixed, in general, by the location of the port. Specifically, the actual location was fixed by the larger, local considerations of avadabilitv and suitability of space, local transportation, connection with railroad systems of the United States, and connection with the actual point of debarkation. No one site was ideal in all of the above considerations. The good and bad features of available sites or properties had to be considered and the one pos- sessing the best combination selected. The absence of outside recreation space and the presence of extraneous noises and disturbances were disregarded. While these things were undesirable, the contemplated stay of sick in these hospitals obviated the necessity of going to an undue extent in avoiding them. Prompt reception, on short notice, and the possibility of rapid evacuation were features of first and most important consideration. The requisite space in these hospitals was the subject of considerable thought, being variously estimated. All estimates were subject to adverse criticism as they contained uncertain factors in their very foundations. Ac- cording to the view of one observer an estimate could be criticized for being too high; from another viewpoint another observer would feel that the est im ate was too conservative. The number of expeditionary troops was known and the monthly increments to that number were known. The battle casualties of past wars were considered and applied as far as it was possible to do so to the existing one. The incidence of injury and disease from normal causes could be foretold with a reasonable degree of accuracy. The plan to keep in France all sick and injured, returnable to duty within a period of sLx months, was known. It was not known until quite late, however, what the rate of return of sick and wounded from France would be. Based upon known factors estimates were made and revised as necessary, showing the number of sick and wounded that might be expected in the United States. These estimates were used in the Office of the Surgeon General as a basis for planning the capacity of the debarkation hospitals for both ports. 3 In applying them it was assumed that the average stay of the sick, returned from overseas, would not be for a longer period than 10 days in the port hospitals. PROCUREMENT. 35 PROVISION OF GENERAL HOSPITALS. Many unusual cases of illness or injury, for which facilities and personnel could not be provided in camp or post hospitals, necessitated the provision of general hospital care. These hospitals had to be made general in the sense in which the term is used in civil communities, equipped for the care and treatment of all varieties of injury and disease. The larger purpose of the general hospitals was, however, for the care and treatment of patients from abroad. 3 The number of patients from the expedi- tionary forces precluded the possibility of retaining them at debarkation ports longer than a reasonably sufficient time for their clearance from the debarkation hospitals, and accommodations for them had to be provided elsewhere through- out the country. The question of the number of returned patients to provide for was prob- lematical. Some of the general hospitals were solely for the tuberculous, others for mental cases, yet both these kinds of hospitals were potentially general hospitals, in the accepted sense, and were operated and controlled as such. Any necessary surgical or medical requirement could be met at any of the general hospitals with one exception — General Hospital No. 7, Baltimore. To secure this general hospital space by the use of military posts seemed appropriate, and, to a certain extent, this was so directed by the War Depart- ment. 6 The lease of civilian properties, hospitals, hotels, colleges, loft buildings, and the like was contemplated. This means was used to a great extent. 6 The provision of general hospitals by new construction was the most expensive, but could not he ent irely avoided, particularly where general hospit als for the tuberculous were concerned. It was always difficult to lease desirable property for use in the treatment of tuberculous patients. The medical profession recognized certain areas as being more efficacious than others in the treatment of tuberculosis and to lind suitable properties in these recognized localities for leasing purposes was extremely difficult. In accordance with prevalent opinion, the most popular sections for the treatment of the tuberculous were the mountains of New York and of North Carolina and the high and dry sections of central Colorado, New Mexico, and Arizona. It was in these locali- ties that practically all of our general hospitals for the treatment of tuberculosis were placed. 7 Population centers were chosen for the location of general hospitals, other than those especially planned for the tuberculous and neuropsychiatric, the majority of them being naturally located in the East, a few scattered throughout the West in military posts. Large civilian properties, convertible into 1,000- bed hospitals, did not exist in the West. THE INFLUENCE OF THE PERCENTAGE OF AMBULATORY SICK ON HOSPITAL PLANS. The expected percentage of ambulatory sick had a large influence in the planning of hospitals. Mess halls of the hospitals of the camps, as originally constructed, provided a seating capacity of 60 per cent. Later, it was found that this estimate had been too conservative and that the number habitually able to go to the mess halls varied from 60 to 75 per cent. 3G MILITARY HOSPITALS IN THE UNITED STATES. Fig. 9. — Goncral hospitals superimposed, upon Bureau of Census population map of 1910. PROCUREMENT. 37 The use of the two-storied ward barrack — a compromise between a ward and a barrack — early in 1918, was an example of how both exterior and interior arrangements were influenced by the quantity of ambulatory sick. In preparing the hospitals designed for the overseas sick and wounded, after their return to the United States, arrangements were made for 80 per cent ambulatory patients. Acute diseases were not anticipated, but a high percentage of ambulatory injured was expected. 8 The number of patients able to walk proved to be larger than originally estimated, varying from 90 to 95 per cent. 9 This discrepancy was attributed to the fact that, after the armistice, there was no military necessity for the retention abroad of the moderately sick and slightly wounded until cured, and these were returned to the United States from hospitals in France as patients whose convalescence, in many instances, had been completed. 10 HOSPITAL PROVISIONS FOR THE NEUROPSYCHIATRIC AND THE COMMUNICABLE DISEASES. During peace times, the incidence of mental diseases among troops had been about three per thousand per annum. 11 This figure was used, in a measure, as a basis for the provision of beds for mental cases in all of the hospitals. For each 1,000-bed hospital in the camps, two special wards, of 20 beds capacity each, were provided for the observation and treatment of mental cases. In the 500-bed hospitals only one ward, of 20 beds, was constructed. 12 In the groups of general hospitals, special hospitals were provided for the neuropsychiatric. Three were established for the insane and one for the psychoneurotic. 13 As a rule, 15 per cent of the space in hospitals, for the treatment of mental diseases, was especially prepared for the adequate care of the violently insane. 14 Approximately 8 per cent of the total hospital space in camps was de- signed for the isolation of cases of communicable diseases. 15 This space was readily augmented by the use of cubicles in the ordinary wards. DEFERENCES. (1) Annual Report of the Surgeon General, U. S. Army, 1917, 320. (2) Annual Report of the Surgeon General, U. S. Army, 1918, 305. (3) Letter from the surgeon, Port of Embarkation, Newport News, Va., to commanding general, Port of Embarkation, Newport News, Va., dated Dec. 10, 1917. Subject: Embarkation hospital. On file, Record Room, Adjutant General’s Office, Correspondence File, 632-1 (Newport News, Va.) N. (4) Letter from commanding general, Port of Embarkation, Newport News, Va., to chief, Em- barkation Service, Washington, D. C.; dated July 8, 1918. Subject: Provision for housing enlisted personnel, Medical Department. On file, Record Room, S. G. O., Correspondence File, 632 (Newport News, Va.) N. (5) Memo, from the Surgeon General to the Chief of Staff, dated Nov. 2, 1918. Subject: De- barkation hospitals. On file, Record Room, S. G. O., Correspondence File, 721.6 (Sick and Wounded Overseas). (6) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. II, 1148. (7) Ibid., 1167. (8) Third indorsement from the Surgeon General of the Army to Bureau of Medicine and Surgery of the Navy, dated Dec. 7, 1917. Subject: Transportation of sick and wounded from over- seas. On file. Record Room, S. G. O., Correspondence File, 721.6 (Sick and Wounded Overseas). 38 MILITARY HOSPITALS IN THE UNITED STATES. (9) Ambulatory sick, percentage of returned from overseas: Based on “Weekly reports of sick and wounded from overseas.” On file, Record Room, S. G. O., Correspondence File, 721.6 (Sick and Wounded Overseas). (10) Cablegram No. 2176 from Harris to Pershing, dated Nov. 12, 1918, subparagraph A. On file, Record Room, S. G. O., Cablegram File. (11) Annual Report of the Surgeon General, U. S. Army, 1917, 79. (12) Semiannual Report, Division of Neurology and Psychiatry, from Maj. Pearce Bailey to the Surgeon General, dated Jan. 2, 1918. On file, Record Room, S. G. 0., Weekly Report File (Neurology and Psychiatry). (13) Memo, for the Surgeon General from Col. C. R. Damall, M. C., dated Nov. 13, 1918. Subject: Care of insane, epileptics, and war neuroses. On file, Record Room, S. G. 0., Correspond- ence File 701 (Care of Insane). (14) Memo, from Maj. Pearce Bailey to Hospital Division. Surgeon General’s Office, dated June 13, 1918. Subject: Alterations in psychiatric ward. On file, Record Room, S. G. 0., Correspondence File, .024-10 (Neurology and Psychiatry). (15) Letter from the Surgeon General to the Quartermaster General, dated May 26, 1917. Subject: Estimates for base hospitals for cantonments. On file. Record Room, S. G. O., Corre- spondence File, 176796-R. (Old Files). CHAPTER III. CLASSIFICATION OF HOSPITALS CONSTRUCTED. The following group of tables divides the new construction of war hospitals into six main classes : Additions to post hospitals which were enlarged but which never became general hospitals; hospital buildings constructed at the National Army contonments; hospital buildings constructed at the National Guard camps; hospital buildings of the cantonment type constructed at places other than at National Army and National Guard camps; buildings constructed at the general hospitals for the treatment of tuberculosis; and semipermanent hospital buildings. 39 40 MILITARY HOSPITALS IN THE UNITED STATES. Table 1 . — Schedule shovjing nev ; comtruc- Post Hospital at — Fort Adams. | Fort Banks. 1 i i 1 Fort Barran- cas. Fort Caswell. | Fort Casey. Fort Clark. 1 Columbus, N. Mex. j Fort Constitu- tion. Fort Crockett. Fort Dade. to O O Q ^ c3 Of* o3 O Fort DuPont. | Fort Ethan Allen. Fort Flagler. I Fort Hamil- ton. | Fort Hancock. Fort Howard. I Jackson Bar- racks. t-s O p o © 1 Fort Me- Dowell. § 1 1 1 1 1 2 1 1 i 1 1 1 2 1 1 1 1 3 2 1 2 1 4 6 1 5 2 1 1 2 1 1 1 1 1 3 1 1 4 1 1 1 1 1 1 1 1 6 1 1 1 2 1 j . I 24 84 37 11 28 6 52 14 1,870 300 48 48 288 32 504 252 112 27 50 364 204 20 24 200 19 4, 618 1 1 1 3 2 4 1 1 55 5 3 2 9 1 7 9 4 1 1 7 3 1 1 1 1 2 1 1 139 BED CAPACITY. Post Hospital at — Patients. Officers. Nurses. Detach- ment. Fort Adams 2S 42 27 Fort Barrancas 34 Fort Caswell 62 11 68 32 2S Columbus, N. Mex 198 Fort Constitution 2S Fort Crockett 6$ Fort Dade 16 Camp Douglas SS 28 FortDuPont Fort Ethan Allen 34 Fort Flagler 32 Fort Hamilton 12S Fort Hancock 34 Fort Howard 24 Jackson Barracks 76 24 Fort Jay 136 511 24 52 312 154 a Data compiled from plans for temporary construction at post hospitals. Plans on file, Hospital Division, Surgeon General’s Office. PROCUREMENT, 41 tion ( temporary ) erected at post hospitals a Post Hospital at— Letter prefix. Description. Capacity. Fort Moultrie. | t-4 o >, o j Fort Niagara. Fort Rose- crans. Fort Schuyler. Fort Screven. g 3 o m o N Fort Stevens. 3 m •“ o Ph Fort Terry. Fort Thomas. Fort Totten. 1 V anco u ver Barracks. 1 Watertown Arsenal. Fort Worden. | Fort 11. G. Wright. D-S.. 24 1 E.... 42 1 E-4. . Nurses’ quarters and mess 37 E-6. . Female servants’ quarters 11 1 E-7. - Nurses’ quarters and mess 14 1 E-8- . 6 E-9. . 26 1 E-12 . 14 H-l. . Garage./. 1 H 3.. 1 1-2... 1-3... 1 1-4... 1-7... General mess and kitchen 1-9... Detachment mess 1 4 3 2 4 4 8 Ii-1 . . 34 1 K-8.. 60 K-17. 16 1 Iv-18. 24 1 3 K-20. do 32 K-23. 32 3 L-l. . 72 1 1 1 3 M.... 28 M-l . . Isolation / 1 28 M-2- . 27 1 N.... 50 N-2-. 52 1 1 N-3. . do 68 1 N-4. . 20 N-6. . 24 1 N-9. . 200 1 0.... 0-3.. 1 P.... Mortuary T R-3. . 19 BED CAPACITY. Post Hospital at — Patients. Officers. Nurses. Detach- ment. Fort McDowell 170 Fort Michie 16 Fort Monroe 68 14 52 Fort Moultrie 34 Fort Myer 136 42 Fort Niagara 31S Fort Rosecrans 68 14 200 Fort Schuvler 24 Fort Screven 28 Fort Slocum 60 F ort Stevens 164 Fort St. Philip 28 Fort Terry Fort Thomas 136 Fort Totten Vancouver Barracks 356 AVatertown Arsenal 32 F ort AV orden 96 Fort H. G. AV right 3,500 24 175 656 42 MILITARY HOSPITALS IN THE UNITED STATES, Table 2. — Schedule of hospital buildings erected at National Number of beds. Num- ber of build- ings. Base Hospital at- Camp Custer. Camp Dev- ens. Camp Dix. Camp Dodge. Camp Grant. Camp Gor- don. Camp Jack- son. Camp Lee. Camp Lewis. Camp Heade. Camp Pike. Camp Sher- man. 13 1 1 1 1 1 1 1 1 1 1 | 2 1 1 495 15 1 1 1 1 1 1 1 1 i 1 1 1 330 15 1 1 1 1 1 1 1 1 i l 1 1 1 60 15 1 1 1 1 1 1 1 1 i 1 1 i ! 630 15 1 1 1 1 1 1 1 1 i 1 1 i ; 370 10 1 1 1 1 1 1 1 1 1 1 60 10 1 1 1 1 1 1 1 1 1 1 1,456 56 4 4 4 4 4 4 4 4 4 4 4 42 3 1 1 1 255 5 2 2 1 104 4 1 1 1 1 15 1 1 1 i i 1 1 i 1 1 1 1 13 1 1 1 1 1 1 1 1 1 1 15 1 1 1 i i 1 1 1 1 1 1 1 3 1 1 1 15 1 1 1 i i 1 1 i 1 1 1 1 15 1 1 1 1 1 1 1 1 1 i 1 1 15 1 1 i i 1 1 1 i 1 1 1 1 15 1 1 i i i 1 1 i i i 1 1 15 1 1 i 1 i 1 1 i 1 1 1 1 j 15 1 1 1 1 i 1 1 i 1 i 1 1 7,480 220 16 16 16 8 16 4 16 16 16 16 16 16 11,392 178 10 12 12 12 12 12 12 12 12 12 12 12 420 7 4 3 576 18 9 2 1,220 10 10 9,360 130 8 8 8 12 8 14 8 8 8 8 8 8 1,204 43 3 3 3 2 3 2 3 3 3 3 3 3 5, 100 102 7 7 7 7 7 7 7 5 6 7 7 7 600 3 1 2 60 4 4 4 3 4 4 4 4 4 4 4 4 1 1 15 1 1 1 1 1 1 1 1 1 1 1 1 15 1 1 1 1 1 i 1 1 1 1 1 i 15 1 1 1 1 1 i 1 1 1 1 1 1 15 1 1 1 1 1 i 1 1 1 1 1 1 323 17 1 2 1 1 1 1 1 1 1 1 1 1 41,477 1, 14S RATED CAPACITY. Base Hospital at — Patients. Officers. Nurses. Detach- ment. 2, 184 26 215 350 550 350 350 750 350 350 250 300 2,043 26 S5 2 , 264 26 189 2, 012 26 26 203 317 1S9 3' 244 2,020 2,024 2, OSS 26 26 189 26 274 2', 024 26 189 a Data compiled from plans for base hospitals for National Army camps. Plans on file, Hospital Division, Surgeon General’s Office. PROCUREMENT. 43 Army camps ( base hospitals). All temporary construction. a Base Hospital at — Normal capacity. Camp Taylor. Camp Travis. Camp Upton. Letter prefix. Description. Pa- tients. Offi- cers. Nurses. De- tach- ment. 1 1 1 B Administration building B-l do 1 1 1 C 1-story officers’ ward 33 1 1 1 I) 1-story officers' quarters 22 1 1 1 D— 4 Commissioned officers’ quarters 4 1 1 1 E Nurses’ quarters, 1-story 42 E-4 do 37 E-8 Nurses' infirmary 6 4 4 4 E-9 Nurses' quarters^ 1-story 26 E-12 Nurses' quarters and mess 14 E-20 Nurses’ quarters, 2-story 51 i E-22 26 1 1 1 F 1 1 1 F-l 1 1 1 G G -4 Operating addition 1 1 1 H 1 1 1 H Shop 1 1 1 H 1 1 1 I 1 1 1 1-2 (1-8). J 1 1 1 16 16 16 K-l 34 12 12 12 64 K-8 do 60 K-20 32 K-34 122 8 8 8 L-l 72 3 3 3 M 28 7 7 7 N.... 50 N-9 200 4 4 5 0 0-8 do i 1 1 P 1 1 1 P 1 1 1 P 1 1 1 Q-5 1 1 2 R-2 19 RATED CAPACITY. Base Hospital at — Patients. Officers. Nurses. Detach- ment. Camp Meade 2,428 2,024 2,024 2,024 2,024 2,043 26 229 350 Camp Pike 26 1S9 350 Camp Sherman 26 211 350 Camp Taylor 26 146 350 Camp Travis. . 26 146 350 Camn Unton . . 26 146 350 32, 470 390 2,917 5, 700 44 MILITARY HOSPITALS IN THE UNITED STATES, Table 3. — Schedule of hospital buildings erected at the National Number of beds. Num- ber of build- ings. Base Hospital at — Camp Beau- regard. Camp Bowie. Camp Cody. Camp Doni- phan. Camp Fre- mont. Camp Greene. Camp Han- cock . Camp Kear- ny. Camp Logan. Camp Mac- Arthur. Camp Mc- Clellan. Camp Sevier. 16 1 1 1 1 1 1 1 1 1 1 1 1 528 16 1 1 1 1 1 1 1 1 1 1 1 1 352 16 1 1 1 1 1 1 1 1 1 1 1 1 54 16 1 1 1 1 1 1 1 1 1 1 1 1 072 16 1 1 1 1 1 1 1 1 1 1 1 1 555 15 1 1 1 1 1 1 1 1 1 1 1 96 16 1 1 1 1 1 1 1 1 1 1 1 1 910 35 4 3 2 2 2 3 2 1 2 3 2 28 2 1 1 26 1 1 16 1 1 1 1 1 1 1 1 1 1 i 1 2 1 1 12 ] 1 1 1 1 1 1 i 1 16 i 1 1 1 1 1 1 1 1 1 i i 4 1 1 1 16 1 1 1 1 1 1 1 1 1 1 i 1 16 i 1 1 1 1 1 1 1 1 1 l i 16 i 1 1 1 1 1 1 1 1 1 i i 16 1 1 1 1 1 1 1 1 1 1 i 1 16 1 1 1 1 1 1 1 1 1 1 l i 16 i 1 1 1 1 1 1 1 1 1 i i 6, 324 186 8 8 4 10 8 16 12 8 8 16 32 8 7, 552 118 8 6 6 6 6 6 9 9 6 3 8 9 2, 196 18 14 4 6, 336 88 4 8 8 6 4 8 6 4 4 8 4 1, 148 41 3 3 2 3 3 3 3 3 i 3 3 2 3,100 62 3 5 2 5 3 5 5 5 2 5 5 2 1,200 6 3 3 64 4 4 4 4 3 5 5 3 3 5 4 4 2 1 1 16 1 1 1 i 1 1 1 1 1 i 1 i 16 i 1 1 i 1 i 1 1 1 i 1 1 16 1 1 1 1 1 1 1 1 1 l 1 i 16 1 1 1 1 1 1 1 1 1 i 1 1 304 16 1 1 1 i 1 1 1 1 1 l 1 1 31, 391 960 RATED CAPACITY. Base Hospital at — Patients. Officers. Nurses. Detach- ment. Camp Beauregard 1,208 1,368 26 1S9 150 Camp Bowie 26 163 250 Camp Cody 1/204 26 137 100 Camp Doniphan 1,292 1,0S0 26 85 250 Camp Fremont 26 100 150 Camp Greene 1,640 26 137 250 3; 260 1,272 26 203 850 Camp Kearny 26 137 250 Camp Logan 1,024 26 111 100 a Data compiled from plans for temporary construction at National Guard camps. Plans on file Hospital Division. Surgeon General’s Office. PROCUREMENT. 45 Guard camps ( base hospitals). All temporary construction fl Base Hospital at— Camp Shelby. Camp Sheri- dan. Camp Wads- worth. Camp Wheel- er. Letter prefix. Description. Pa- tients. Offi- cers. Nurses. Detach- ment. 1 1 1 1 B-l Administration building 1 1 1 1 C 1-story officers’ ward 33 1 1 1 1 D 1-story officers' quarters 22 1 1 1 1 D-4 Commissioned officers' quarters 4 1 1 1 1 E Nurses' quarters, 1-story 42 1 1 1 1 E-4 do 37 1 1 1 1 E-S Nurses’ infirmary 6 2 2 4 1 E-9 Nurses’ quarters, 1-story 26 E-20 Nurses’ quarters, 2-story 14 E-22 Nurses’ quarters and mess 26 1 1 1 1 F Laboratory, head surgery and X ray F-l Head surgery ”. 1 1 1 F-6 do. 1 1 1 1 G Operating building 1 G-4 Operating addition 1 1 1 1 H Garage. .T. 1 1 1 1 H Shop. 1 1 1 1 H Exchange 1 1 1 1 I Patients' mess 1 1 1 1 1-2 (1-S). Detachment mess 1 1 1 1 J Receiving building 12 12 16 8 IC-3 1-story ward 34 11 6 11 8 K-5 64 K-34 2-story wing ward 122 6 6 8 4 L-2 Double ward and lavatory, 1-story 72 3 3 1 M Isolation ward, 1-story. 28 3 5 2 N Detachment barracks, 1-story 50 N-9 do 200 4 4 5 3 0 Storehouse 0-8 do 1 1 1 1 P Chapel 1 1 1 1 P Guardhouse 1 1 1 1 P 1 1 1 1 Q-5 1 1 1 1 R-2 19 Normal capacity. RATED CAPACITY. Base Hospital at — Patients. Officers. Nurses. Detach- ment. 1,448 26 137 250 1,736 26 163 250 L732 26 151 700 1,652 26 137 150 1, 360 26 137 250 i;960 1,152 26 189 250 26 H 100 24,388 416 2,287 4,300 46 MILITARY HOSPITALS IN THE UNITED STATES, Table 4. — Schedule of new hospital construction of the temporary type Hospital. Number of beds. Num- ber of build- ings. General Hospital No. 3. Edgewood Arsenal. Camp Hospital, Camp Eustis. General Hospital No. 41. General Hospital No. 25. Camp Hospital, Camp A. A. Humphries. Camp Hospital, Camp Jos. E. Johnston. General Hospital No. 9. Letterman General Hospital. General Hospital No. 2. | General Hospital No. 6. Base Hospital, Camp Merritt. Norfolk Quartermas- ter Terminal. General Hospital No. 14. General Hospital No. 5. General Hospital No. 24. General Hospital, Camp Perry. Raritau River, N. .1. "a ■ ~ >. I General Hospital No. 7. 3 . o o o ~ as tc 9 p ~ o r Z V5 3 1 1 1 4 1 1 1 1 1 1 1 1 3 1 1 2 1 330 9 1 1 2 1 1 1 1 1 12 1 1 110 5 2 1 68 2 1 1 24 6 1 1 2 1 1 40 1 1 21 1 1 162 3 1 1 1 96 4 1 1 51 1 1 24 1 1 50 1 1 378 9 1 1 1 1 1 1 1 185 5 1 1 1 1 1 304 4 1 1 1 1 14 1 60 10 1 1 1 1 1 1 1 1 1 468 18 3 2 4 4 4 1 72 2 40 1 102 2 2 26 1 1 100 2 2 8 1 1 1 1 1 1 1 2 1 1 2 1 1 i 1 2 1 1 i 1 2 1 1 2 1 1 7 1 1 1 1 1 1 1 1 1 1 8 1 1 1 1 1 1 1 1 1 1 5 1 1 1 1 2 1 1 1 1 2 1 1 1 1 i 1 1 .... i 1 4 1 1 1 1 3 1 1 7 1 i 1 1 1 i 2 1 1 1 1 4 1 3 3 1 1 1 2 1 1 1 1 6 1 1 1 1 1 3 1 1 1 1 1 2 1 1 1 1 1 1 1 10 2 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 a Data compiled from plans for temporary construction of hospitals. Plans on file, Hospital Division. Surgeon General’s Office. PROCUREMENT. 47 done at points other than the National Army and National Guard camps. a Hospitals. Letter prefix. Description. Capacity. Base Hospital. Fort Sill. Base Hospital, Camp Stuart. Walter Reed General Hospital. General Hospital No. 1. fl .2 M b-4 © © e © § & JS © cl B Administration 1 B-l do B-4 do i B-6 do 1 B-7 Administration additions 1 B-101 . . . 2-story, administration and receiving C Officers’ ward, mess, and kitchen. . / 33 C-102 do 12 1 1 D Officers’ quarters 22 D-3 Officers’ quarters, mess, and kitchen 34 D-4 Commissioned officers’ quarters 4 D-5 2-story officers’ quarters^ 40 D-6 Officers’ quarters 21 D-7 54 2 D-S Officers’ quarters . 24 D-10 2-story officers’ quarters 51 D-102 Officers’ quarters 24 D-103 do...! 1 1 E Nurses’ quarters, mess, and kitchen 42 E-4 do..; 37 E-5 2-storv nurses’ quarters, mess, and kitchen 76 1 E-7 Nurses’ quarters, mess, and kitchen 14 1 E-8 Nurses’ infirmary 6 E-9 Nurses’ quarters 26 2 E-10 do 36 1 E-15 40 E-20 Nurses’ quarters t 51 E-104 . . . do. . ; 26 E-105. . . 2-story nurses’ quarters 50 1 F Laboratory, head surgery and X ray F-l Head surgery ^ F-4 Laboratory .". F-5 Clinic building F-6 Head surgery ; F-ll 1 F-13 Chemical and bacteriological laboratory 1 F-20 1 F-l 01 . 1 F-102 . . . Head surgery../. // .* 1 G Operating. G-4 G-101 . . . Emergency and operating 1 1 H . Garage...." t 1 H . Shop^ 1 H . H-l... H-l. H-l. H-2. 1 H-6 H-ll " ' ‘ H-101 I 1 1-1... 1 1-2... 1-4. 1-5... 1-6. . 1-7... 1-9 1-13 1 1-14 1-17... 1-18 1 1 1-23 1 1-24. .. 1-38 . 1-103 1-104 1 J... J-2. . J-3 J-G.... 1 J-S do../ 48 MILITARY HOSPITALS IN' THE UNITED STATES. Table 4. — Schedule of new hospital construction of the temporary type Hospital. Number of beds. Num- ber of build- ings. General Hospital No. 3. Edgewood Arsenal. Camp Hospital, Camp Eustis. General Hospital No. 41. General Hospital No. 25. Camp Hospital, Camp A. A. Humphries. Camp Hospital, Camp Jos. E. Johnston. General Hospital No. 9. Letterman General Hospital. I General Hospital No. 2. General Hospital No. 6. I Base Hospital, Camp Merritt. | Norfolk Quartermas- ter Terminal. 1 General Hospital No. 14. 1 General Hospital No. 5. I General Hospital No. 24. || — 5" oQ © o Raritan River, N. J. 1 Base Hospital, Fort Riley. Gouorul Hospital No. 7. S- © o ~Z ~§ o ~~ © X 782 23 9 4 7,208 212 17 22 1 16 12 4 14 20 1 2 13 6 17 2 10 6 208 97 17 20 3 4 12 18 14 660 11 4 4 128 4 1 1 1 2, 048 64 29 25 9 1 32 1 1 132 4 4 2,944 46 3 17 l’ 053 13 6 .... 216 3 1,368 19 2 2 2 6 4 ’756 27 1 2 1 1 2 1 2 3 2 6 112 4 1 1 1 1 56 2 1 1 600 12 1 4 1 6 11 6 1 4 ;;;; .... 120 1 26 1 1 400 2 2 37 4 4 1 2 3 2 1 3 1 4 3 1 6 2 1 2 .... i 2 2 5 1 1 1 1 1 4 1 J 1 1 10 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3 1 1 1 24 2 1 152 8 1 1 2 1 9 19 1 1 3 1 1 1 1 2 2 8 2 2 1 1 5 2 2 1 1 28,331 889 RATED CAPACITY. Hospital. Patients. Officers. Nurses. Detach- ment. 1,727 109 76 364 24 26 1,040 28 84 300 General Hospital No* 41, Fox Hills, N. Y 2 , 150 4S 134 General Hospital No. 25, Fort Benjamin Harrison ’206 37 50 Camp Hospital, Camp A. A. Humphreys 1,897 49 147 112 92 So 200 320 442 42 2,241 374 104 252 85 50 2,344 62 7S 152 300 50 1,596 76 PROCUREMENT, 49 done at points other than the National Army and National Guard camps — Continued. Hospitals. Letter prefix. Description. Capacity. Base Hospital, Fort srn. Base Hospital, Camp Stuart. Walter Reed General Hospital. General Hospital No. 1. Patients. Officers. Nurses. Detachment. 10 K 34 4 19 14 18 K-l do 34 3 1 K-5 2-story ward barracks 64 1 2 K-8 2-story ward and barracks GO 1 IC-1 9.... Prison isolation 32 K-20 l-story ward 32 K-23 Sick prisoners 32 IC-101. . . 1-story ward 33 7 12 2 K-102... 2-story ward barracks 64 7 2-story ward 81 3 L Double ward and lavatory 72 3 L-l do 72 4 2 M 28 M-l do 28 M-101... 28 N Detachment barracks 50 N-2 do 50 1 N-7 2-story double barracks 120 N-8 Barracks and lavatory 26 N-9 2-story detachment barracks 200 1 3 0 1 0-1 1 0-2 3 0-4 2 0-6 1 0-7 0-101... P P 1 P P-1 do P-2 Chapel P-2 Q-2 Laundry Q-3 Laundry, disinfecting and linen Q-4 1 R-l 12 1 R-2 19 R-3 19 S Physiotherapy building 1 S-101— . Ido Li 4 U-101 . . . do t V 1 V-101 . . . do U-V RATED CAPACITY. Hospital. Patients. Officers. Nurses. Detach- ment. 503 42 200 102 64 26 237 32 1,642 22 37 68 1,238 124 352 14 2,057 70 88 2,140 22 114 120 804 24,640 646 1,749 1,296 45269 °— 23 4 50 MILITARY HOSPITALS IN THE UNITED STATES. Table 5. — Schedules of new construction (temporary, except General Hospitals Nos. 20 and 21), tuber- culosis hospitals A Number of beds. Number of buildings. Hospital. Letter prefix. Description. Capacity. General Hospital, ! Fort Bayard. General Hospital No. 21. l General Hospital No. 17. General Hospital No. 16. General Hospital No. 19. c3 a VI §S a © O 1 General Hospital No. 18. 1 General Hospital No. 20. .2 © © 71 © or, £ © © 1 1 B-102 2-story administration 138 3 1 1 1 C-3 Officers’ ward 46 88 4 2 2 C-6 22 192 6 4 2 0103 32 34 1 1 D 34 48 l 9 7 1 4 D-4 4 24 1 1 D-8 24 48 1 1 D-104... 48 37 1 1 E-4 37 77 7 7 E-6 11 12 2 1 l E-8 6 104 4 2 1 1 E-9 26 26 1 1 E-22 26 96 2 2 E-106 48 1 1 F 1 1 F-ll Small laboratory and operating 1 1 F-33 1 1 F-103 2-story laboratory and receiving 1 1 G 14 2 1 1 G-102 Operating and nurses’ infirmary 1 1 H 3 1 1 1 H-l Exchange 2 1 1 H-l 1 1 H-9 do 1 1 H-102 do 1 1 H-102. . . Recreation .... 1 1 H-l 03 Exchange 1 1 H-104. . . 1 1 I 4 1 1 1 1 1-2 1 1 1-4 do 1 1 1-6 do 1 1 1-9 do 2 1 1 1-11 General mess i 1 1-12 do 1 1 1 1-106 do 2 1 1 1-107 Detachment mess 1 1 1-108.... do 2 1 1 1-109.... do 1 1 1-113.... Alteration to kitchen 1-110 1 1 1-114.... Alteration to mess 1-106 2 1 1 1-2 Receiving building 68 2 2 K-1 1-story ward 34 408 12 2 10 K— 4 34 128 2 2 K-5 2-story ward barracks 64 720 20 14 K-7 Open-air tuberculosis ward 36 210 4 2 1 1 K-8 2-story ward barracks 60 462 14 2 9 3 K-12 Infirmary, tuberculosis ward 33 245 7 6 1 K-13 do. 35 1,232 44 10 31 K-14 Open-air tuberculosis ward 2S 168 6 6 K-15 .... .do 2S 23 1 1 IC-50 Infirmary ward for detachment 23 120 2 1 1 IC-103-1. Infirmary ward, 2-story 60 232 2 i 1 K-103-2. do. .1 116 232 2 i 1 IC-103-3 . do 116 336 12 12 K-104... Open-air tuberculosis ward, 2-story 28 26 1 1 IC-106 26 256 8 8 K-107 Open-air tuberculosis ward, 2-story 32 828 9 8 1 K-108... Semi-infirmary tuberculosis ward 92 23 1 1 Iv-109... Infirmary ward for detachment 23 74 1 1 K-110-. . Infirmary, tuberculosis for nurses 74 26 1 1 K-11S... Surgical ward 26 28 1 1 M-l Isolation 28 56 2 1 1 M-102 28 884 17 6 3 8 N-2 Detachment barracks 52 500 5 5 N-101 Detachment barracks, 2-story 100 6 i 1 2 2 O Storehouse 2 1 1 0-4 4 4 O-102... do 1 1 P Chapel 3 1 1 1 P Guardhouse 1 1 P Mortuary 1 1 P-1 do 1 1 P-3 2 1 1 P-102... Chapel 1 1 P-102... Guardhouse 2 1 1 Q-i Laundry a Data compiled from plans for general hospitals. Hans on file, Hospital Division, Surgeon General's Office. PROCUREMENT. 51 Table 5. — Schedules of new construction (temporary , except General Hospitals , Nos. 20 and 21), tuber- culosis hospitals. Number of beds. Number of buildings. Hospital. Letter prefix. Description. Capacity. General Hospital, Fort Bayard. \ General Hospital No. 21. General Hospital No. 17. General Hospital No. 16. General Hospital No. 19. General Hospital No. 8. General Hospital No. IS. General Hosjatal No. 20. j Patients. Officers. 3 & Detachment. 1 1 1 1 2 1 1 293 1 Q-102... Q-103... 1 41 1 R-102... U 41 1 2 1 U-101 . . . V-101 . . . u-v.... School 1 8,294 RATED CAPACITY. Hospital. Patients. Officers. Nurses. Detach- ment. 628 28 129 312 1,940 48 103 500 168 280 26 156 1,600 62 58 416 1, 212 16 43 60 502 7 6,390 154 366 1,384 52 MILITARY HOSPITALS IN THE UNITED STATES. Table 6. — Schedule of hospital buildings, semipermanent ( except General Hospital No. 28), of later design than buildings at hospitals of National Army and National Guard camps. a Number of beds. Number of buildings. Hospital. Letter prefix. Description. Capacity. Camp Hospital, Camp Bragg. Camp Hospital, Camp Knox. Base Hospital, Camp Mills. General Hospi- tal No. 28. 5 © V) © to Z | 2 1 1 B-9 Administration and receiving 1 1 B-ll 1 1 B-13 do 164 2 2 C-10 Officers ’ wing ward 82 4 1 1 D-4 Commissioned officers’ quarters 4 51 1 1 D-10 Officers’ quarters 51 81 3 1 1 1 D-ll Officers’ quarters and mess 27 255 5 1 3 1 E-20 Nurses’ quarters, 2-story 49 2 1 1 E-21 Nurses’ quarters and infirmary 49 52 2 1 1 E-22 Nurses’ quarters and mess .... 26 1 1 F-21 Large laboratory and mortuary 1 1 F-37 Laboratory and mortuary 1 i G-8 Surgical wong 2 1 1 G-12 Large operating wing 1 1 G-103 Surgery and laboratory building 1 1 H-8 Exchange 2 1 i H-12 Garage 1 i H-13 Shop 1 1 H-14 Exchange 1 1 H-18 Garage and shop 1 1 H-20 .... Exchange 1 1 1-28 Generalmess and kitchen 4 1 2 1 1-34 i 1 1-39 Large kitchen building 3 1 2 1-42 Double cafeteria mess wing 1 1 1-53 Nurses’ mess and kitchen 68 2 2 K-l 1-story ward 34 4, 758 39 16 1 22 K-34 2-story wing ward 122 92 1 1 K-47 General isolation wing ward 92 612 6 6 K-56 2-story wing ward, divided 102 432 6 6 K-117... 2-story pavilion ward 72 72 1 1 L-2 Double'ward and lavatory 72 218 2 2 M-3 2-story isolation wing war’d. 124 354 3 1 2 M-4 do 11S 57 1 1 M-104... 2-story isolation ward 690 3 3 N-9 Detachment barracks, 1-story *>00 100 i 1 N-10 2-story detachment barracks and mess I 100 400 2 2 N-12 2-stor v detachment barracks . _ _ 200 10 6 3 1 O Storehouse 1 1 0-12.... Food-nrenaration buildine 1 1 0-14 Storehouse and linen sendee 2 1 1 P-3 Guardhouse 1 1 P-4 Chapel 1 i P-6 do 1 i P-7 Guardhouse 116 1 i R-4 Psychiatric wing ward 116 1 1 S-l Physiotherapy building 1 i U-l Curative shop, 2-stor v 1 1 V-l 1 1 u-v Curative shop and school 8,565 132 RATED CAPACITY. Hospital. Patients. Officers. Nurses. Detach- ment. Camp Hospital, Camp Bragg 4S9 31 51 400 Camp Hospital, Camp Knox 2,186 78 228 700 990 27 General Hospital No. 28, Fort Sheridan 3,308 6,973 136 356 1, 100 a Data compiled from plans for temporarv hospital construction. Plans on file Hospital Division, Surgeon General’s Office. The available bed capacity and the number of beds occupied in the larger hospitals — general, base, port, and department base hospitals — controlled by the Surgeon General’s Office directly, or used by it for the treatment of overseas sick, were charted from weekly or daily reports. This information was of incalculable value to the Surgeon General’s Office in showing at all tunes the status of these hospitals. These data have been consolidated by months on the following chart covering the period January, 1918, to September, 1919. PROCUREMENT. 53 CHART op NORMAL BED CAPACITIES «n LARGER HOSPITALS IN THE UNITED STATES Fig. 10. 54 MILITARY HOSPITALS IN THE UNITED STATES. In Figure 11 the activity of the general hospitals is shown in a manner similar to the chart in Figure 10. However, hut one type of hospital has been charted and space, both available and occupied, has been shown in Figure 11. The activity of the base hospitals — National Army and National Guard camps — is shown in Figure 12, which was prepared in a manner identical to that for the general hospitals. GENERAL HOSPITALS Fig. 11. The rapid rise in number of both patients and beds in October, 1918, was inci- dent to the epidemic of influenza. The approximate maximum constructed capacity of these hospitals was fifty-five thousand beds, and this capacity was first available in July, 1918. 1 All the bed capacity shown as being higher than this figure was extemporized in corridors or on porches, or in the barrack build- ings of the camps proper. FUNDS APPROPRIATED FOR HOSPITAL CONSTRUCTION. Funds were made available by Congress from time to time for the procure- ment of hospitals and were provided in the appropriation for construction and repair of hospitals. From May, 1917, to July, 1919, the following sums were appropriated : 2 May 12, 1017 June 15, 1917 October G, 1917. . . March 28, 1918.... July 8, 1918 July 9, 1918 November 4, 1918 July 11, 1919 . $750, 000. 00 . 2,115,267.00 .35. 000, 000. 00 .19, 654, 300. 00 .13, 936, 015. 00 .SO, 000, 000. 00 .86, 469, 930. 00 .«5, 000. 000. 00 242, 865, 512. 00 The above amounts represent appropriations and not expenditures. How- ever, it may be stated that during the active part of the war period the expendi- tures were practically the same as the appropriations, with the exception of the fiscal year ending June 30, 1919, during which not over half the sum appro- priated for that period was expended for hospital construction. 3 a In this amount, $350,003 appropriated to purchase land at Walter Reed General Hospital is not included. PROCUREMENT. 55 1918 JAN. FEB. MAR APR MAY JUN JUL. AUG. SEPT OGT NOV. DEC 1919 JAN, FEB. MAR. APR MAY JUN. JUL AUG. B5000 130000 125000 120000 /> 115000 K 110000 1 100000 i 1 i 95000 \ 90000 r i 85000 f 80000 i S 1 1 75000 I \\ 70000 1 1 65000 \ \ NIDI DAT ES BED£ 60000 J \ N 55000 /' / \ V 50000 1 1 \ \ 45000 s' f s 400CO y / 35000 4 y >* 30000 / 1 25000 NDIC ATE S P ATI ENTS A \ 20000 15000 1 — 'v — > V- 10000 i 5000 11 1000 j BASE HOSPITALS Fig. 12. 56 MILITARY HOSPITALS 1 1ST THE UNITED STATES. CLASSIFICATION OF CONSTRUCTION PROJECTS. The major hospital construction projects may be briefly divided, into three classes representing buildings erected, and beds provided in both entirely new construction and in altered buildings, as follows: Hospitals. Buildings. Beds. Entirely new construction 62 3,597 88,460 29,383 6,056 Converted Army posts and leased buildings 39 659 Post hospital enlargements 48 365 149 4,621 123,899 REFERENCES. (1) Report of the Chief of Construction Division, W. D., 1919, 192. (2) Ibid., 61. (3) Taken from Treasury ledger accounts. On file, Funding Division, Office of Chief of Finance, War Department. SECTION II. CONSTRUCTION AND IMPROVEMENT. CHAPTER IV. CONSTRUCTION PLANS FOR TEMPORARY HOSPITALS. BLOCK PLANS. Figure 13 (p. 58) shows various groupings of hospital buildings. The key inserted in this figure explains symbolically and by letters the use for which the building was designed. Block plan (A) is that of the Letterman General Hospit al as that hospital was at the beginning of our participation in the war. 1 That this plan influenced the design of the early hospitals, built at the National Army and National Guard camps, is demonstrated when comparison is made between (A) and (B). Block plan (B) was used for the 32 hospitals of the National Army and National Guard camps, and for several other hospitals of approxi- mately the same size (1,000 beds) built soon afterward. 2 The block plan next evolved (C) was for the hospital at Camp Abraham Eustis, Va. 3 This hos- pital was designed when the scarcity of materials was beginning to be acutely felt. The street construction was minimized by using only one street with a side arm and a loop; all kitchens, utility, and supply buildings were placed on the street; and storehouses (0) were built parallel to the street, one being placed well forward on a main corridor to enhance its accessibility. Another point of difference between (C) and (B) was the location of the isolation and psychiatric wards (M-l) and (R-3) on the main corridors in the hospitals constructed on plan (C). The block plan next developed was for a smaller hospital where more fire-resisting materials were to be used. The Camp Bragg hospital, in North Carolina, was of this type (D). 4 In so far as the layout only is concerned, (D) differed from (C) mainly in the corridor connection. In the type of hospital represented by (D), the connecting corridors passed through the center of the ward building on both floors and were constructed to permit isolation from the adjacent buildings. Opening the corridor doors and closing the ward doors freed the passage from end to end. This block plan did not permit of great extension because of the eccentric location of the general mess hall and kitchen. Block plan (E) was that for the hospital at Camp Mills, Long Island. 5 Upon the promulgation of the approved military program to place 3,360,000 men in France by June 30, 1919, and meanwhile maintain an average of 1,400,000 men in the camps of the United States, 6 it was necessary to take careful stock of the available doctors, nurses, other hospital attendants, materials, and labor. This affected the problem of the care of the sick, whether in camp hospitals or general hospitals, and, very materially, requests for new hospital construction, which, from that time on, had to be so planned that the 57 58 MILITARY HOSPITALS IN THE UNITED STATES. maximum number of patients could be cared for by the minimum number of personnel. It resulted in the construction, at large hospitals, of large wards; in the general use of two-story buildings, more fire-resisting materials, consoli- dated kitchens and mess halls, the use of cafeteria systems and smaller mess halls. These changes in hospital construction influenced both interior arrange- ments and the block plan, but were effected only at Camp Knox. Ivy.. Camp CONSTRUCTION AND IMPROVEMENT. 59 Jackson, S. C., and Camp Mills, Long Island, which, were designed to he made the largest camps . 7 In a measure, also, the plan for the hospital at Camp Bragg, N. C., was influenced . 8 Here, however, the hospital was smaller and the large ward was less adaptable to a small hospital. The plans of the hos- pitals of these two classes of camps were prepared, at about the same time, in the fall of 191S. INDIVIDUAL BUILDINGS. The more commonly used hospital buildings have been divided into classes according to the purposes for which they were utilized. The following classification indicates the purposes of the more important buildings: Class I. For general administration and the operation of the hospital: 1. Administration building. 2. Receiving building. 3. Hospital exchange. 4. Guardhouse. 5. Chapel. Class II. For general care and treatment: 1. Ward buildings. (а) General wards — Common wards. Officers’ wards. Nurses’ wards. (б) Tuberculosis wards — Infirmary. Semi-infirmary. Ambulatory. (c) Psychiatric ward. ( d ) Isolation ward. (e) Ward barrack. (/) Prison ward. Class III. For special care and treatment: 1. Surgical buildings. 2. Head surgical buildings. 3. Laboratory buildings. 4. Physical reconstruction buildings — (a) Curative shops. (&) School buildings. (c) Physiotherapy buildings. Class IV. For food, housing, and supplies: 1. Kitchen and mess buildings for patients. 2. Kitchen and mess buildings for personnel. 3. Quarters for all personnel. 4. Storehouses. Class V. For utilities and physical operation : 1. Power house. 2. Shops. 3. Laundry. 4. Garage. 5. Fire station. 60 MILITARY HOSPITALS IN THE UNITED STATES. CLASS I. GENERAL ADMINISTRATIVE AND OPERATIVE BUILDINGS. For the reception and discharge of patients and the general administration of the hospital, certain offices were required. A condensed list of the elements involved follows : Receiving buildings . — The first type (plan J in Figure 14) was built for the National Army and National Guard hospitals. 9 It was necessary, later, both to enlarge and to redesign the administration and receiving buildings at all camps and cantonments in the United States, because of general additions to the hospitals. 9 In the receiving building greater floor area was provided, together with more adequate isolation space for observation and examination. A combined receiving and administration building is shown in Figure 17 (B-9) 10 (p. 63). This building had the advantage of being larger and of possess- ing separate facilities for the admission of the contagious or those suspected of having communicable diseases. It permitted the discharge of general adminis- trative duties, as well as the reception of the sick, and afforded opportunity for close contact between the hospital management and the troops in camp. It placed the dispensary where it was in easy contact with the hospital and where it was most accessible to the camp. The receiving building was the accepted point of contact with the members of the command to whom it was familiar. The dispensary, in the same building, was convenient for prescription work arising out of this contact. The entrance and hall farthest to the right on plan (B-9) was designed for the admission of suspects, and provision was made to keep these suspects separated from all other patients during examination and observation. 10 Through the central entrance, and the space to the rear of it, the ordinary cases were admitted, and to the left were provisions for the routine discharge of patients. For the reception of large numbers, another type of building, J-3 in Figure 14, was designed, and was erected at General Hospital No. 41, Fox Hills. Staten Island, N. Y., 11 which was planned for a debarkation hospital. Another type of combined receiving and administrative building (B-13) is illustrated in Figure IS (p. 64). Reception and discharge: Receiving room. Clerks. Undressing room. Linen room. Observation rooms. Small laboratory. Patients’ effects storage. Disinfector rooms. Clothing issue room. Dressing room. Discharging room. General administration: Commanding officer. Adjutant. Waiting room. Clerks. Registrar. Post office. Information and telephone. Chaplain. Visitors’ room. Toilet. CONSTRUCTION' AND IMPROVEMENT, 61 62 MILITARY HOSPITALS IN THE UNITED STATES, Fig. 15. — Administration building, base hospital. Fig. 16. — Receiving building, base hospital. CONSTRUCTION AND IMPROVEMENT, 63 Fig. 17. 64 MILITARY HOSPITALS IN THE UNITED STATES. CLASS II. GENERAL CARE AND TREATMENT BUILDINGS. This class included the various ward units. By ward units is meant the sum total of the facilities in one ward building used in the care of the sick, including the ward room, where the beds were located, and the auxiliary rooms for utilities, office, linen, and serving. The letters for the plans or buddings represent the symbols used by the Sur- geon General’s Office, 12 designating roughly the purpose of the budding: A, block plans; B, administration buddings; C, officers’ wards; D, officers’ quar- ters; E, nurses’ quarters and wards; F, laboratory, X ray, head surgery, etc.; G, general surgical buildings; H, hospital exchange, garage, shops, etc.; I, all kitchen and mess buildings; J and Iv, receiving buddings; L, wards (common and tuberculosis) ; M, isolation wards, and X, psychiatric wards. Xumerals following these letters indicate subsequent variations and new designs; 13 numerals above 100 further indicating a tile construction. As an example: B represents the earliest frame administration budding; M-3, the third variation or newer design of frame isolation ward; and F-102, the second variation or newer design of a tile laboratory. In ward designing, four classes of patients were provided for: 12 General, tuberculous, contagious, and mental. For the general cases, two variations from general designs were made: One to provide for officer patients and the other, a minor modification of the general ward unit, for prisoner patients. 14 Although several types and variations of general ward units were con- structed during the war period, by far the largest number of sick were treated in but two types of wards: 15 The one-story single ward (K-l) and its derivative, the double ward (L-l) and its final form (K-20) ; and the two-story ward bar- racks (K-5). The other general ward units differed from these types in minor details with two exceptions: The ward building known as (K-105) 16 , a two-story CONSTRUCTION’ AND IMPROVEMENT. 65 adaptation of the one-story single ward (K-l) ; and a special and distinctly different type of building (K-58) 17 . The following tabulation shows the total bed capacity of the different types of wards constructed throughout the country: 15 Building plan. Description. Number of buildings. Number of beds. Percentage of all bed construc- tion. K-l 1-story ward 491 16, 694 6,408 14 L-l Double ward and lavatory 89 5 K-20 1-story ward 97 3, 104 2i Total 677 26, 206 21i 2-story ward barrack 395 25,280 21 K-l 05 2-story ward 13 1,053 1 Total 408 26, 333 22 K-34 2-story wing ward 57 8,174 7 K-58 and K-l 17 2-story pavilion ward 6 432 i Other types 36, 249 32 20, 218 17 Grand total 117,612 100 The K-l type of the one-story ward was designed in the early summer of 1917, and was built at all the National Army and National Guard camps. 18 The plan K-l, and its final form Iv-20, were also used in the construction of most of Fig. 19. the other camp hospitals and the general hospitals previous to the fall of 1918. lj The K-20 type of one-story ward 19 was a revised form of K-l and included in its design various changes made in plan K-l, from time to time, as experi- 45209° — 23 5 66 MILITARY HOSPITALS IN THE UNITED STATES. ence dictated and as conditions demanded. The double ward L-l was evolved by combining, for purposes of economy, the toilet facilities of two K— 1 wards. 20 This type was discontinued after the completion of the hospitals at National Army and National Guard camps in the early fall of 1917. 13 These constituted the one-story pavilion types of wards. The first of the two-story type wards, known as a K-5 ward-barrack, was designed in the early part of December, 1917, and was erected at many of the hospitals 21 to provide for a very considerable increase in the capacity of the hospitals at the camps which became necessary at that time. The two-storv type was selected in order to concentrate the required number of beds in as small an area as possible, thus obtaining economy in first cost and facilitating -f-' 57' aVaW'ddii =/ | sL Eb s' D AV w cqoo fA .Al WA R.0 U.D Q10.CLD cofwtcTiNCi up[lHlllll!l!l;!'iu ^ CORRJOOR. GLAZLD P 0 H_C M covuto POR.CM CLtA^yro^v MtiGMxr: t^-o Two \/TO RY ■ WARD B A PJ>AC L •K- LATER. PLAN/> r CENTER. AECTI ON •Tv P I CA L C BJXCS J" E.CT I ON •Two yTORY- WARD K 1 - 5 • FlR/T ./TORY- Z^i/TORYAIWILARJDMnTING OFFICL/LRV. KITCMLN 6 1 QUILT RTk. Fig. 20. administration. Then, too, in many of the hospitals already built the area available for expansion, immediately adjoining the hospital, was limited. When making the increase in bed capacity it was necessary also to increase the housing capacity for the correspondingly augmented enlisted personnel. In order to secure further economy in cost and more rapid erection of the build- ings, it was decided to make but one design which could serve both purposes and to use this type of building in sufficient numbers to provide increased bed capacity and, at the same time, increased housing for personnel. This building had decided advantages in its flexibility, since it could be used either as a ward for the ambulatory patients or as a barrack. The two-story ward building of the K-105 type was designed to meet the special conditions which arose at United States Army General Hospital No. 2, CONSTRUCTION AND IMPROVEMENT. 67 Fort McHenry, Md., 22 where, during its erection, a large number of the K-5 buildings were being constructed. It was found that the existing one-story wards were not sufficient in capacity to provide the number of beds desired at that place, so it was determined to substitute, for some of the K-5 buildings, a number of two-story buildings suitable for acute cases. This K-105 building fol- lowed the general design of the one-story ward building K-l ; but the second story was arranged for convalescents; and the diet kitchen, the ward office, and one quiet room were omitted. 16 During July, 1918, it became necessary to design several large camp hos- pitals of about 2,500 beds each, and to make an extensive enlargement of one of the existing camp hospitals where the available space was limited. 23 It was W D □ □ o D o tfo d ol o tTb d do flUo '□•Q DODO DO'O-O □'□"DO O'D'DO dd'oo dd D-D a-0 M 0-0 D-D D-a D-a 1 j3 a □ a on □ □ d_d □ □ a j a a a □ ot □ a a K. ,3 A Lavatory. 34/hotuer — 3.J Water cloyet. -saWa-rh /mK ubth Dramboartl, nce-dino LightjaWall light". i=£adiatorj- AM/CLLLANIOU/- 1QUIP/ALNT 4o/htlv«A 4l Coun+tr. ■4lCabm«,f -43 Bench. 44LocKtry 43.rume Hooo 4tPlale Cac.* 47/peoal /hade Bo* 4&rreib«.rg Ventilator £12.1 Ceiling -./URGICAL-4" LABORATORY . PAVILION • r °*-300 BLD • HO/PITAL Fig. 33. same manner. 55 The construction of new buildings for physical reconstruction was not authorized by the Secretary of War except in some of the early general hospitals. 60 Figure 34 (S) (p. 82) shows an early plan for a physiotherapy build- ing. CLASS IV. FOR FOOD, HOUSING, SUPPLIES. Cooking and messing facilities . — The vital character of the cooking and messing facilities was appreciated from the beginning. The development of the designs for buildings for these purposes was, therefore, given the closest attention. The patients’ mess in the early design included rooms for the storage, preparation, cooking, and serving of the food for patients only, there being decentralized kitchens and messes for officer patients, as well as for medical officers, nurses, and the detachment, Medical Department. 61 In the later designs, and especially in smaller hospitals, the food was cooked for nearly the entire hospital in the general kitchen building. There were, however, separate mess halls for the groups for which cooking was separately done formerly. The elements concerned in the preparation and serving of food, were: In the kitchen, storage, preparation of the food for cooking, and cooking; in the mess, direct service in the mess hall and food service to wards, and the scullery. There were really three marked developmental designs for the general mess hall and kitchen. The first is represented by the plan designated by the letter I— 1, the second, a transitional stage, by two plans, I— 1 1 for a relatively small, 62 and 1-12 for a relatively large hospital; 63 and the third, or latest type, 45269°— 23 6 1 54 -V 82 MILITARY HOSPITALS IK THE UKITED STATES. ® PHYSICAL THERAPY BUILDING Fig. 34. CONSTRUCTION AND IMPROVEMENT. 83 by 1-34 for a 500-bed hospital 64 and 1-39, 1-42 or 1-43, and 0-12 for the three buildings, kitchen, mess and preparation building, respectively, for a hospital of 2,000 beds. 65 The numbers of all three types constructed were as follows: 66 Type. Plan. Number built. Early type I 49 Transitional type: I-11-. . 4 Large size 1-12 5 Latest type: T-34 4 Large size 1-39 (kitchen) 1 Do 1 Do 2 Do 1 Figure 35 shows the early type, I, constructed as a part of all of the large camp hospitals built during the first summer of the war, including all National Guard and National Army hospitals, as well as many others. 67 When the capacity of the hospital became overtaxed, the refrigeration space, which was found to be inadequate, was generally increased. 68 A third long table was added through the length of the mess hall; and often the food cart room was used for storage and office space, the food carts being kept in the corridors when not in use. Cement floors a was laid in many kitchens to replace one of wood. 69 With these exceptions, however, this building and its equipment withstood usage remarkably well. In construction there was little difference in these early kitchens from any of the other hospital buildings. The materials used were the same as those used in the wards; the length of the bay, the porches, the ridge ventilator, the sash size, all were built from the same detail sheet as that sent out for the wards. The plan shows the arrangement of the elements and their equipment. Ambulatory patients, figured at about 60 per cent of the total patients, were provided for in the mess hall by the system of serving them then in vogue in Army hospitals, called “set up service,” i. e., dishes and food were placed upon the tables in preparation for the arrival of the patients; the patients arrived at a given hour, ate, and left the mess hall. Tables were then cleared by attendants and clean dishes placed for the next meal, or for the next sitting of the same meal, if, as was more frequently the case, there were more ambu- latory patients than seats in the mess hall. Food for bed patients, figured at 40 per cent, was cooked in the main kitchen and in the diet kitchen, under the supervision of the dietitian. Food was then placed in the food carts which were rolled to the several ward diet kitchens, whence it was served under the direction of the ward nurse. In January, 191S, the first variation from the plan I was made, taking ad- vantage of the experience gained from the many camp and cantonment hospitals that had by that time been in operation for several months. 70 In a few steps there was developed the transitional type of general mess, represented by the plans (I— 1 1 and 1-12), for a small and a large hospital, respectively. 71 The restriction to the 24-foot width was discontinued. 15 This was the inevitable a Cement floors had been intended primarily, but through some error wood floors were originally laid in most camp hospitals. 84 MILITAKY HOSPITALS IN THE UNITED STATES, MEJU’&KITCHEN - 0 - Fig. 35, CONSTRUCTION AND IMPROVEMENT. 85 Fig. 36.— Interior of a base hospital general kitchen. Fig. 37. — Corridor adjacent to patients’ mess, showing equipment for transporting prepared food to wards. 86 MILITARY HOSPITALS IN THE UNITED STATES. result of the decision to give up the E-shaped plan in favor of the rectangular building, which was more adaptable to an uneven terrain, and more economically constructed. 13 A comparision of the perimeters and areas of plans I, I— 11, and 1-12 (Figs. 35, 38, and 39) is as follows: Building. Total ex- terior wall of mess and kit- chen. Area of mess and kitchen. Floor area per foot of outside wall. I 1, 190 430 12,500 6,840 16,400 Square feet. 10 1-11 1-12 790 21 The 1-1 1 building was planned for the use of both patients and attendants, and it had a cafeteria arrangement. The set-up manner of feeding, an old cus- tom in the Army, had become an unwieldy method of feeding a really large num- ber of men. The cafeteria system was made effective to overcome the necessity of greatly increasing the seating capacity of the mess halls, or the alternative of having successive sittings for the same meal. • When intelligently operated, it Fig. 38. had the following advantages: Hot food, faster service, less waste, operable with fewer mess hall attendants, greater flexibility — adaptability to sudden increase or decrease in the number to be fed — greater construction economy, economy in dishes, etc. The large general mess and kitchen of the transitional type (1-12), capable of feeding 2,000 men, shows a rectangular kitchen 36 feet wide, directly attached to a mess hall, six 12-foot bays wide, divided into two cafeteria units. The kit- chen in construction was similar to I— 11. The mess hall was a larger building consisting of a central nave of a 24-foot span with two 12-foot bays on either side. Close window spacing and a monitor provided sufficient light for this wider building. There was no ceiling over the main kitchen, scullery, and grocery storeroom. The 1-12 plan should be compared with I. It was designed to meet similar requirements. Each of the two large elements, the kitchen and the mess, be- CONSTRUCTION AND IMPROVEMENT. came simple rectangles. The kitchen was designed to keep orderlies, mess hall attendants, and food carts out of the cooking and preparation rooms, all serving being done over a counter. Access from the mess service corridor to all of the various rooms was obtainable without passing through the kitchen proper. A continuous service platform, in the rear of the kitchen, gave access to all of the rooms. This platform was left uncovered to afford the maximum of daylight throughout the kitchen. Directly abutting the kitchen building Avere the two cafeteria service rooms, each seiwing a unit similar to that of I— 1 1 . Fig. 39. During the summer of 1918, plans for the third and latest type of kitchen and mess were developed. 73 The smaller of the two representative buildings of this latest type, 1-34 (Fig. 40), Avas designed for use either as the general mess and kitchen for a 500-bed hospital or as a mess and kitchen for the medical detachment of a very large hospital. 73 It Avas really a sequel to 1-11 with a double mess hall to make it more flexible in its usage. Because of the fire risk and the vital character of this service, buildings of this type Avere made of metal lath and stucco instead of the Avood siding previously used; otherwise, the con- struction Avas similar. The Avashing room directly adjoined the cafeteria coun- 88 MILITARY HOSPITALS IN THE UNITED STATES. ters, thus eliminating the transportation of clean dishes, which had been found quite a burden in buildings I— 1 1 and 1-12. A monitor roof, over the serving and dish washing rooms, provided an extra amount of light and ventilation for that busy portion of the mess hall. All other sections of the building were pro- vided with metal ridge ventilators. The elements covered in the planning of the food preparing and mess buildings were storing, preparing, cooking, serving, eating, and dish wash- ing. It was necessary to depart from the ideal, direct contact arrangement of these elements in the feeding of large numbers of men in the military hos- pitals. 74 Variations and departures have been shown in the different build- ings already referred to. In the feeding of a still larger number, what were planned for and secured were: A kitchen separate from, though closely con- nected with, its storage and preparation facilities, and a dining room with its service and dish-washing arrangements in the portion proximal to the kitchen. This typical large general mess and kitchen consisted of three build- ings: Preparation building (0-12), kitchen (1-39), and double mess hall (1-43) shown in Figure 41. This group was planned to take care of the patients and the Medical Department detachment for a hospital of 2.000 beds. CONSTRUCTION AND IMPROVEMENT. 89 ■MEJy (g) <5 KITCHEN-©' Fig. 41. 90 MILITARY HOSPITALS IN THE UNITED STATES. The buildings were of metal lath and plaster on wood-frame construction with a plaster-board lining, the joints plaster filled. The commissary stores building (0-12) was a simple building, 32 feet wide, with a cellar in which were a 5-ton refrigerating plant and storage rooms. The first floor was used for vegetable storage, a dairy, vegetable and meat refrigeration, and meat and vegetable prep- aration. An inclosed corridor connected it with the cooking building. The 1-39 kitchen contained the cooking facilities for all regular and special diets. It was but slightly modified in construction from its predecessor, 1-12, by the division of its width, 36 feet, into unequal bays, the center bay being 20 feet across in order that there might be a wide aisle for the cooking equipment. The kettles and ranges were located in a double, back-to-back line running lengthwise with the building, the ranges facing the foot cart corridor. It will be noticed that it was possible by this arrangement for the cooks’ tables, opposite the ranges, to operate as a serving counter at meal times. The 1-43 mess hall was five 12-foot bays wide, the center bay running the length as a monitor. It contained two cafeteria units with the dish-washing room adjoining the serving counters. This type of mess hall caused both patients from the wards and food from the kitchen to enter at the head of the mess hall. It effected a considerable saving of aisle travel and, while it entailed a crossing of the food line through the in- coming patient line, this intermittent occurrence was not found to affect seri- ously the messing operation. 13 Near, and in constant communication with, the kitchen was the reserve counter of the cafeteria serving room. It provided a working counter for any final preparation, make-up, or dishing out. It also pro- vided counter and shelf area on which reserve supplies of food and dishes could be stocked from the outside and kept there. In front of the reserve counter, and at a distance no greater than that required by two men working opposite one another at the two counters, was the serving counter. In all standard designs for serving counters an effort was made to use 30 feet as a minimum length and 35 whenever possible. In the middle of the length was placed the steam table with food containers varying in number, depending upon the number to be fed and the distance from the kitchen. These containers were adequately high to obviate excessive stooping of those constantly working over them. Just in front of the row of containers and on a level with the main serving counter was a display shelf on which the food servers placed the plates of hot food as rapidly as they could and from which the patient could help himself as he passed by. A tray slide, slightly lower than the serving counter and display shelf, ran the length; and just near enough to make passing possible was a rail of sufficient height to make it uninviting and undesirable as a seat. In the operation and the detailed arrangement of the cafeteria, there was considerable variation due to the different needs of the hospitals and to the diverse ideas of the mess officer. Very broadly speaking, however, it was similar to the usual public cafeteria. In the planning of a cafeteria mess hall three closely related factors were considered: 13 The rate of serving, the average length of time a patient devoted to eating his meal, and the required seating capacity of the tables. It was found that the serving of 20 men per minute was entirely practicable; a man would seldom stay more than 10, never more than 15 minutes at mess; and, by a computation from these two facts, that from 300 to 325 seats were suffi- cient to keep a single serving coimter unit in smooth, continuous operation. 13 CONSTRUCTION AND IMPROVEMENT. 91 To permit the simplification of the service, a great deal of the equipment was later made interchangeable. 13 In the later designs for cafeterias in leased buildings, the containers that fitted into the steam tables were all of a uniform size, 15 by 12 inches by 11 inches deep. It was found that four of these con tainers held sufficient dinner (the largest meal) for 160 men. 13 The containers were partitioned and designated for use as follows: 13 Container No. 1, undi- 92 MILITARY HOSPITALS IN THE UNITED STATES. vided, for soup; container No. 2, undivided, for potatoes; container No. 3, divided in center, one-half for meat and one-half for gravy; container No. 4, divided at third point, two-tliirds for second vegetable, one-third for dessert. The same containers were used in the ward service food carts, and the same ward service food carts were used in the main mess hall in serving patients who were not quite active enough to serve themselves at a cafeteria. The food cart held the four containers set side to side and into an insulated box, making: the dimensions of the cart 2 by 6 feet by 3 feet high. A shelf, underneath the main box, was so placed to hold extra containers. Dish trucks, the necessity for which was minimized by having the cafeteria patients carry their own dishes to the dish-washing room, were built on a framework identical with that of the food carts. Thus the food distribution equipment was made simple, flexible, and interchangeable. Simplification was also accomplished in the cooking and the cafeteria serving. Based on experience in temporary hospitals, the fixed equipment of the main kitchen, diet kitchen, and cafeteria was standardized, and a schedule of standard equipment was prepared by the Surgeon General’s Office and the Construction Division. 75 This schedule had about 60 items of equipment and gave the steam, water, and electric connections required, the floor space occupied, and the number and size of each item appropriate for hospital messes ranging in capacity from 25 to 5,000. The problem of installing mess halls and kitchens in the leased buildings which were altered for hospital use was a very indefinite and variable one. Usually the feeding system was the fundamental f actor of the entire assignment of space. 75 Sometimes there already existed an adequate kitchen and mess hall, as in the cases of some of the institutions and hotels that were leased. At other times, there would be a fair-sized kitchen that needed only some additional equip- ment. Then again, there were absolutely no facilities in a building, and the possibilities of each floor, from the basement to the roof , demanded consideration. 76 Housing . — In our hospitals three classes of duty personnel were provided for: Officers, nurses, and enlisted men of the Medical Department. 77 However, before the war was over a half dozen other classes, male and female, had been added to the operating personnel of the larger hospitals. In the beginning this housing included some recreational facilities. 78 Soon the American Red Cross took over the housing of the recreational facilities for the nurses,' 9 and the Young Men’s Christian Association, Knights of Columbus, Jewish Welfare Board, and others, provided facilities for recreation for the enlisted per- sonnel. 80 The officers’ quarters were frame buildings, like others in the hos- pital, provided with a kitchen and mess hall and one room for each officer. sl Each hospital had in addition a small staff officers’ building of four rooms for the commanding officer and his staff. 82 The nurses’ quarters were similar to those for the officers, containing a kitchen and mess hall; but part of the nurses only were provided for in separate rooms and the remainder had dormitory space. 83 The dormitory was unpopular and in later construction a room was provided for each nurse. 84 The enlisted men of the Medical Department were provided for in simple barracks parallel to each other, each building having two or three small rooms for noncommissioned officers. 78 The kitchen and mess hall occupied usually a separate building in the middle of the group. 82 Where the hospital was small, a separate kitchen and mess building was not built. CONSTRUCTION AND IMPROVEMENT. 93 Fig. 43.— Officers’ quarters. Fig. 44.— Officers' diningroom. 94 MILITARY HOSPITALS IN THE UNITED STATES. Fig. 45. — Nurses’ quarters. Fig. 46. — Living room, nurses’ quarters. Fig. 47. — Fnlisted men’s quarters. CONSTRUCTION AND IMPROVEMENT. 95 Fig. 48. — Enlisted men’s mess hall Fig. 49. — Typical Red Cross recreation house for nurses. 96 military hospitals in THE united states, Fig. 50— Typical Red Cross convalescent house Fig. 51. — Typical Young Men’s Christian Association hut. CONSTRUCTION' AND IMPROVEMENT. 97 Fig. 52.— Interior of Young Men's Christian Association hut. 45269°— 23 7 Fig. 53.— Typical medical supply buildings. 98 military hospitals in the united states. Supply buildings . — The supply buildings were simple storehouses with a few separate rooms . 85 They contained appropriate shelving for the orderly handling of small articles, and counters and loading platforms required for reception and issue work for the hospital, or for both the hospital and the camp if necessary. CLASS Y. FOR UTILITIES AND PHYSICAL OPERATION. The following additional buildings were mainly used for utilities and the operation of the hospitals : 77 Power house, shop, laundry, garage, fire house and DISINrtCTING BUILDING LAUNDRY Q) Fig. 54 Fig. 55. dry cleaning (rarely). Laundries were planned for the hospitals of National Army cantonments and National Guard camps . 77 The buildings were con- structed, but were not equipped ; 86 so the hospital laundry was done either by CONSTRUCTION AND IMPROVEMENT. 99 civilian laundries or by that operated by the quartermaster of the camp. 87 At Debarkation Hospital No. 2 , Fox Hills, Staten Island, N. Y., a modification of the original laundry plan was used for the construction of a laundry; 88 and later, after this hospital had been built, a still further modified plan was used for laundries constructed at some of the tuberculosis hospitals and at a few large general hospitals which were isolated. 89 These utility buildings were Fig. 56 —Garage and cars at a base hospital not closely connected with the care of the sick and in none of them were there such distinct changes in plans as occurred in the wards, the mess buildings, and the surgical pavilion, where the mushroom growth of military activity led from one readjustment to another. The early type garage constructed was changed to a wider, more economical type of greater capacity. 90 REFERENCES. (1) Block plan A. On file, Hospital Division, S. G. 0. (2) Block plan B. On file, Hospital Division, S. G. O. (3) Block plan C. On file, Hospital Division, S. G. 0. (4) Block plan D. On file, Hospital Division, S. G. O. (5) Block plan E. On file, Hospital Division, S. G. 0. (6) Letter from the Acting Surgeon General to the Chief of Staff, September 16, 1918. Subject: Hospital program. On file, Record Room, S. G. 0., Correspondence File 632 (General). (7) Construction plans, Camp Knox, Ky., Camp Jackson, S. C., and Camp Mills, Long Island. On file, Hospital Division. S. G. 0. (8) Letter from the Surgeon General to the Construction Division, War Department, September 5, 1918. Subject: Hospital construction, Camp Bragg, N. C. On file, Hospital Division, S. G. 0. (Camp Bragg, N. C.) (9) Plans of receiving buildings. On file, Hospital Division, S. G. O. (10) Plan B-9. On file, Hospital Division, S. G. O. (11) Plan J-3. On file, Hospital Division, S. G. 0. (12) Original plan for hospital construction. On file, Hospital Division, S. G. O. (13) Statement from Maj. Floyd Kramer, M. C., April 12, 1922. to the Surgeon General. Subject: Hospital construction. On file. Record Room, S. G. 0., Correspondence File 632-1. (14) Plan K-25. On file, Hospital Division, S. G. 0. (15) Based on construction reports. On file, Hospital Division, S. G. O. (under camp). (16) Plan K-105. On file, Hospital Division, S. G. 0. (17) Plan K-58. On file, Hospital Division, S. G. 0. (18) Letter from the Surgeon General to the Quartermaster General, July 5, 1917. Subject: Cantonment hospitals. On file, Record Room. S. G. O., Correspondence File 176796 (Old Files)' . 100 MILITARY HOSPITALS IN THE UNITED STATES. (19) Plan K-20. On file, Hospital Division, S. G. 0. (20) Plan L-l. On file, Hospital Division, S. G. 0. (21) Letter from the Surgeon General to the Quartermaster General, December 26, 1917. Subject: Hospital increase at National Army and National Guard base hospitals. On file, Record Room, S. G. O., Correspondence File 632-11 (General). (22) Construction plans, Fort McHenry, Md. On file, Hospital Division, S. G. 0. (23) Camp hospitals of about 2,500 beds each, designed. Plans on file, Hospital Division, S. G. 0. (24) Memo, from Lieut. Col. Floyd Kramer, M. C., to Brig. Gen. Robert E. Noble, M. D., August 26, 1918. Subject: Hospital construction. On file, Record Room, S. G. 0., Correspondence File 632 (General). (25) Plans M and M-l. On file, Hospital Division, S. G. O. (26) Plans M-3. On file, Hospital Division, S. G. 0. (27) PlanM-6. On file, Hospital Division, S. G. 0. (28) Plan R-2. On file, Hospital Division, S. G. 0. (29) Plan R-4. On file, Hospital Division, S. G. 0. (30) Based on plans of various wards. On file, Hospital Division, S. G. 0 (31) Report of the Chief of Construction Division, W. D.. 1919, 59. (321 Letter from the Committee on Army Hospital Plans to the Assistant Secretary of War. No- vember 24, 1918. Subject: Report of study of plans for Army Hospitals. On file, Record Room, S. G. 0., Correspondence File 600.13 (Plans and Specifications). (33) Letter from Chief of Construction Division, W. D.. to the Surgeon General, October 23, 1918. Subject: Length of hospital buildings. On file, Record Room, S. G. 0., Correspondence File 632 (General). (34) Letter from the officer in charge, cantonment construction, to the Surgeon General, Decem- ber 13, 1917. Subject: Glass for sash. On file, Hospital Division, S. G. O. (35) Shown on detail plans of buildings. On file, Hospital Division, S. G. 0. (36) Second Annual Report of the Council of National Defense for the Fiscal Year Ended June 30, 1918. Government Printing Office, Washington. Page 171. (37) Letter from the War Industries Board, Council of National Defense, to the Secretary of War. April 8, 1918. Subject: Proposed building of new hospitals by the War Department. On file, Record Room, S. G. 0., Correspondence File 632 (General). (38) Medical and Surgical History of the War of the Rebellion, pari third, medical volume. Gov- ernment Printing Office, Washington. Pages 934, 945, and 952. (39) Plans Iv-34 and Iv-58. On file, Hospital Division, S. G. 0. (40) Memo, from Maj. C. W. Richardson, M. C., to Lieut. Col. E. P. Wolfe, M. C’., December 17, 1917. Subject: Sterilizers. On file, Record Room, S. G. 0., Correspondence File 414.4 (Sterilizers). (41) Plan K-l. On file, Hospital Division, S. G. 0. (42) Plan K-34. On file, Hospital Division, S. G. 0. (43) Report on Study of Mess Conditions in Base Hospitals, by Capt. E. L. Scott, S. C., April 29, 1918. On file, Record Room, S. G. 0., 720.1 (Food). (44) Shown on first plans of wards of base hospitals. On file, Hospital Division, S. G. 0. (45) Letter from the Surgeon General to the Quartermaster General. January 9, 191S. Subject: Slop sinks. On file, Record Room, S. G. 0., 652 (General). (46) Shown on plans K-34, K-58, K-l 17. On file, Hospital Division, S. G. 0. (47) Letter from Chief of the Construction Division to the Surgeon General. March IS, 191S. Subject: Construction of laboratory additions at National Army base hospitals. On file, Record Room, S. G. 0., 632-1 (General). (48) Plans K-J-fi, K-LG. On file, Hospital Division, S. G. O. (49) Shown on block plan of General Hospital No. 8, Otisville, N. Y. On file. Hospital Division, S. G. 0. (50) Shown on plans of General Hospital No. 21, Denver, Colo. On file, Hospital Division. S. G. 0. (51) Plan K-107. On file, Hospital Division, S. G. 0. (52) Plan K-108. On file. Hospital Division, S. G. 0. (53) Plan F. On file, Hospital Division, S. G. 0. (54) Plan F-6. On file, Hospital Division, S. G. 0. (55) Plan F-l. On file, Hospital Division, S. G. O. (56) Plan G-12. On file, Hospital Division, S. G. 0. CONSTRUCTION AND IMPROVEMENT. 101 (57) Plan G-103. On file, Hospital Division, S. G. O. (58) Letter from the Surgeon General to the Construction Division, November 22, 1918. Subject: Buildings for physical reconstruction. On file, Record Room, S. G. 0., 652 (General Hos- pitals) K. (59) Letter from the Surgeon General to the Construction Division, December 21, 1918. Subject: Allotment of funds for alterations for physical reconstruction buildings. On file, Record Room, S. G. 0., 632 (General). (60) Letter from the Surgeon General to the Construction Division, November 22, 1918. Subject: Buildings for physical reconstruction. Indorsements thereon. On file, Hall of Records, Fort Myer, Va. (Cr. 652-B.). (61) Plan I. On file, Hospital Division, S. G. O. (62) Plan 1-11. On file, Hospital Division, S. G. 0. (63) Plan 1-12. On file, Hospital Division, S. G. O. (64) Plan 1-34. On file, Hospital Division, S. G. 0. (65) Plans 1-39, 1^12, 1-43, 0-12. On file, Hospital Division, S. G. 0. (66) Based on reports of authorization and construction from various hospitals. On file, Hospital Division, S. G. 0. (67) Construction reports (name of camp). On file, Hospital Division, S. G. O. (68) Letter from the Chief of Construction Division to the Surgeon General, September 6, 1918. Subject: Allotment for refrigeration at base hospitals. On file, Hospital Division, S. G. 0. (National Army General File, Misc.). (69) Letter from the Surgeon General to the Quartermaster General, October 11, 1917. Subject: Concrete or composition floors for hospital kitchens. On file. Record Room, S. G. O., 633.3. (70) Weekly report of construction branch, S. G. 0., for week ending January 11, 1918. On file, Record Room, S. G. 0.. Weekly Report File (Hospitals). (71) Plans I— 11, 1-12. On file, Hospital Division, S. G. 0. (72) Weekly report of construction branch, S. G. O., for week ending May 16, 1918. On file, Record Room, S. G. 0., Weekly Report File (Hospitals). (73) Plan 1-34. On file, Hospital Division, S. G. 0. (74) “Report on Mess Administration,” by Maj. R. G. Hoskins, S. C., October 22, 1918. On file, Record Room, S. G. 0. Food and Nutrition File (Hospital Needs). (75) Schedule of ldtchen equipment. On file, Hospital Division, S. G. 0. (Kitchen Equipment). (76) Shown in floor plans of all buildings leased and used as hospitals. On file, Hospital Division, S. G. 0. (77) Letter from the Surgeon General to the Quartermaster General, May 26, 1917. Subject: Esti- mate for base hospitals for cantonments. On file. Record Room, S. G. 0., 176796 (Old Files). (78) Shown on plans for hospital barracks and quarters. On file, Hospital Division, S. G. 0. (79) Letter from the Surgeon General to Director General, Military Relief, American National Red Cross, March 22, 1918. Subject: Construction of recreation rooms for nurses’ home at military hospitals. On file, Record Room, S. G. 0., 632 (General). Letter from the Surgeon General to chairman. Operations Branch, General Staff, March 20, 1918. Subject: Rest rooms in camps, for Army nurses. On file, Record Room, S. G. 0., 632 (General). (80) G. 0. No. 57, W. D., May 9, 1917; G. 0. No. 82, W. D., July 5, 1917; G. 0. No. 2, W. D., January 7, 1918; G. 0. No. 46, W. D., May 9, 1918; Bull. No. 55, W. D., October 7, 1918. (81) Plans for officers’ quarters at hospitals. On file, Hospital Division, S. G. O. (82) Block plans of hospitals. On file, Hospital Division, S. G. 0. (83) Plans of nurses’ quarters. On file, Hospital Division, S. G. 0. (84) Plans of nurses’ quarters in late construction. On file, Hospital Division, S. G. O. (85) Plans of supply buildings at hospitals. On file, Hospital Division, S. G. 0. (86) Letter from the Acting Quartermaster General to the Chief of Staff. February 28, 1918. Subject: Laundries. On file, Record Room, S. G. 0., 633 (General). (87) Second indorsement from the Surgeon General to The Adjutant General. March 7, 1918. Subject: Laundries. On file, Record Room, S. G. O.. 633 (General). (88) Plan of laundry at Debarkation Hospital No. 2, Fox Hills, N. Y. On file, Hospital Division, S. G. 0. (89) Plan Q-4. On file, Hospital Division, S. G. O. (90) Plan of garage at hospitals. On file, Hospital Division, S. G. O. CHAPTER Y. HOSPITALS PROVIDED. HOSPITALS AT NATIONAL ARMY CANTONMENTS. It was contemplated as early as May, 1917, that there would be 32 camps at which the war army would be mobilized. 1 Sixteen of these camps were later located in the North and 16 in the South. Generally speaking, those in the South were for National Guard troops, and those in the North were for the National Army. Since there were no modern hospitals of temporary construction, of a size comparable with the ones required for the camps, whose plans could be followed, the provision of hospital facilities for the camps presented a problem of considerable magnitude. The Letterman General Hospital at San Francisco was the nearest approach to the type desired, and the degree of influence it exercised has already been mentioned. As all the hospitals for the moblization camps were to be alike, one plan was designed to serve for all the 32 camps; consequently, it was necessitated that the common plan be adequate and free from serious error lest a mistake be multiplied 32 times. DELAYED CONSTRUCTION. The preliminary plans which were prepared in the Surgeon General's Office showed the arrangement in each of the hospital buildings and their inter- relation as a group. The plans for the hospitals of the National Army camps were forwarded to the Quartermaster General’s Office and construction was requested on the following dates: On June 12, 1917, for Camps Devens, Dix, Jackson, and Lewis; 2 on June 13, 1917, for Camp Sherman; 3 on June 18, 1917, for Camps Upton, Custer, Lee, Meade, and Taylor; 4 on June 23, 1917, for Camp Grant; 1 on July 5, 1917, for Camps Dodge and Gordon; 6 and on July 9, 1917, for Camps Pike and Travis. 7 On June 22, 1917, the Quartermaster General acknowledged by letter to the Surgeon General the receipt of the plans for the first 10 camps which had been sent, and stated that the available funds for the construction of build- ings at the cantonments were not sufficient to cover the cost of the erection of hospitals. 8 Acting promptly on this information, the Surgeon General submitted an estimate to cover the deficiency, and on June 25, 1917, forwarded the letter of the Quartermaster General to the Chief of Staff by an indorse- ment in which he stated that the deficiency estimate had been made and he requested that the Quartermaster General be authorized, in the emergency, to proceed with construction of the National Army hospitals. 9 In passing through The Adjutant General’s Office an indorsement was added to the letter in which The Adjutant General requested the Quartermaster General 102 CONSTRUCTION AND IMPROVEMENT. 103 to delay action for a reasonable length of time to determine if possible what the will of Congress might be. 10 To this recpiest of The Adjutant General the Quartermaster General replied on July 16, 1917, stating that the time had come when a start must be made in the construction of the hospital part of the cantonments if the whole was to be completed together. 11 On the following day The Adjutant General forwarded to the Quartermaster General the instructions and authority of the Secretary of War to proceed with the construction of hospital facilities for 3 per cent of the commands, 12 and on July 24 and 26 the necessary plans and instructions were sent to the field by the Cantonment Division of the Quartermaster General’s Office. Under this authority of the Secretary of War the construction of the hospitals at the following National Army cantonments was begun: For hospitals of 1,000 beds each at Camps Devens, Dix, Jackson, Lewis, Sherman, Upton, Custer, Lee, Meade, Taylor, Grant, and Travis; and for 500-bed hospitals at Camps Dodge, Gordon, and Pike. The strengths of troops at the National Army camps, with the dates when the first sick were admitted to hospitals, 13 were as follows: Camps. First pa- tient re- ceived in Average number of troops in camps. canton- ment hospital. September, 1917. October, 1917. Upton Sept. 1.. Sept. 5.. Sept. 5.. Sept. 10. Sept. 13. Sept. 15. Sept. 21. Sept. 23. Sept. 27. Sept. 28. 10,000 8,500 22,000 29.000 19.000 28.000 37,500 23.000 32.000 27.000 31.000 Custer. Devens Lewis 19,000 Taylor 14^ 500 Sherman 13 ! 000 Travis 13 000 Lee 12 , 500 Pike 23 , 000 6, 000 24' 000 Meade 17; 500 17,500 Gordon 17, 000 13,500 Grant Oct. 14.. 28, 500 16,000 23.000 25.000 Jackson Oct. 22. . 13,000 Dodge Oet. 28.. 16,000 Dix Oct. 29.. 9; 000 ADDITIONS AND IMPROVEMENTS. The base hospitals, as orginally constructed at the National Army camps, were of pavilion type and all buildings were one-story, nearly all being con- nected by corridor without steps. Subsequently, 32 wards (all but the isola- tion and psychiatric wards) were connected by corridor with the administra- tion, receiving and forwarding, laboratory and X-ray, eye, ear, nose and throat, operating, mess and kitchen, and exchange buildings. 14 The whole group covered a rectangular area of approximately 1,200 by 1,400 feet, fronting on a long side. 14 The wards were placed parallel to each other in four rows of eight wards each, running from front to rear. Between the inner two rows, and from front to rear, were the laboratory and X-ray building, the operating pavilion, the exchange, mess hall and kitchen, in the order given. In front of the center was the administration building and to its right the receiving anti forwarding buddings. The nurses’ quarters were on one front corner, the officers’ ward on the other; the isolation and psychiatric wards on one rear 104 MILITARY HOSPITALS IN THE UNITED STATES. corner, and the quarters for the enlisted personnel on the other. To the rear of the latter two were the utilities and the storage buildings. The officers’ quarters were in front, but across the street and facing the hospital. All buildings were of frame; but all had modern equipment and fixtures, plumb- ing and sewerage, steam heating, cooking, and sterilizing. There were originally about 60 or 70 buildings in each National Army base hospital group. Subsequent conditions necessitated augmenting this number to 80 or 90 and in some instances even to 100. 15 ■ f 1 1 | R ? M M i m 1 1 30 M EZ 30 IP 30 ZO □ POWERHOUSE □ FIRE ENCINE I . . I H "1 r N N N 12 N N Ki KijZZZZJ K k ^MOM Ki f Ki Ki t- L KAI unoi. mncf !Ki ZII§Ki ^Ki fflKi w^rnm gg ki ki □ D iiz Lk Li K ELY B ADMINISTRATION C OFFICERS WARD D officers quarters EL NURSES QUARTERS F LABORATORY G 5URGICAL tt POST EXCHANGE.. SHOPS & GARAGE I MESS fir KITCHEN J RECEIVING BUILDING K.GL WARDS M ISOLATION WARD N BA CRACKS O STORE HOUSES P GUARD HOUSE, C MAP EL X !JodAvo_M 52 196 18 373 167 ”1 : :°S CIO •U85[oqoH , 1 1 ^efwv-wf =rs s a s s a s & s s s s a s a a -g B^oooododcccooccoccdcccdcc:- ■ssigg : £ . IlliliilIKIP lilHIflilll s¥s¥ =kss cccccccccceccc ^ZZZZZZZZZZZZZ i, Long li 40, St. ORGANIZATION, ADMINISTRATION, AND CONTROL. 177 CO 00 r X CO D00«ONI^CD03i0 05‘CONClCI---i00>’l 1 00C'1 , «'' HO 1C O C IS « C T •1' CO h c 0(0 O ICOOCIO (NO! (MIC05- : go go I C1CCNN- 00 03 t'- »0 O " Cl X Cj : -t* © c :ccc : — < 0 CN 3 CN CO 3 2 ? co © c i O oo 55 ^ ClrHl^Cd “ T I 1 T ■* C X — TI t> H »£ & > r O -r. o o o z: Gffloo C.&P.C Eggs c3 c3 c3 c3 IjOOO c3 c3 £0 . o -^aZ ■S^ggS^S S> ~i* S'cco l.2^£fe2S fiflfifeOOO . c. c. a c. c. c. e. g E a g E E g c3 c3 c3 C3 c3 c 2 c3 OOOOOOQ JZ2Q © - /V© -g? ! !0 life ai!i^ffli s fiiii W ® 3> cl c o w £ £ o 1|fo| g §£ -j .2 .at ® j'o-sco g a § Ss - = © cfl t£i O . 2 ’S’tf 2 a'-g-sTS? 5^1—3 : 3 « « H OJ o£P3 2 ■^guj C3 S 8 ® '^Jh & 2^2 5 •22 P P ■*^9 o -h w - ^ - ^ cow chinco § c’3’--' odd £ s z fe-azz^ ©C2 ^ G ^ — — — .a ^ £ s. §355 ? '3^,5 »■£■& £ tS o g _ o o o a '. 5^1552 PW c3 fc-f“c 3 c 3 c 3 *-* H b a r b b t. p^o ©4J_2©0© 8 2 — — - " © v" © © © © OWOOO 178 MILITARY HOSPITALS IN THE UNITED STATES. Figure 74 shows not only the distribution to June 30, 1919, but that up to November 11, 1919 — one year after the armistice. It exhibits, in a way impossible by any other method, the relative part played by the various hospitals in the care of these cases numerically. 11 It must be remembered, however, that not all cases admitted to a hospital completed their convalescence there. REFERENCES. (1) Memo, from the Surgeon General to the Chief of Staff, April 2, 1918. Subject: Hospitaliza- tion in the United States. On file, Record Room, S. G. O., 632 (General). (2) Cablegram No. 1908 from General Pershing, November 19, 1918. Subject: Estimate of average number of sick and wounded evacuations to be made to United States. On file Record Room, S. G. 0. (Cablegram File.) (3) Table showing number of patients arriving from overseas. On file, Record Room, S. G. 0., 721.6-2 (Sick and Wounded Reports). (4) Letter from The Adjutant General to the Surgeon General, Nov. 26, 1918. Subject: Return of wounded. On file, Record Room, S. G. 0., 323.9 (Ports of Debarkation). (5) Annual Report of the Surgeon General, U, S. Army, 1919, Vol. II, 1164-1167. (6) Memo, from Lieut. Col. Edgar King, M. C., to the Surgeon General, April 15, 1918. Subject: Evacuation of patients. On file, Record Room, S. G. 0., 721.6 (Sick and Wounded, A. E. F.) Y. (7) Letter from the Surgeon General to The Adjutant General, November 21, 1918. Subject: Transfer of patients. On file, Record Room, S. G. 0., 721.6 (Patients from Overseas). (8) Shown on strength cards. On file, Statistical Division, S. G. 0. (9) Letter from the Surgeon General to The Adjutant General, November 21, 1918. Subject: Transfer of overseas patients to base hospitals. On file, Record Room, S. G. 0., 721.6 (Sick and Wounded, Overseas). (10) Letter from the Surgeon General to surgeon, port of embarkation, Newport News, Va., Feb- ruary 24, 1919. Subject: Assignment of overseas cases to interior hospitals. On file, Record Room, S. G. 0., 721.6-2 (Sick and Wounded Reports). (11) Annual Report of the Surgeon General, U. S. Army, 1919, Yol. II, 1159. 112) Based on compilation of weekly reports of patients returning from overseas. On file, Hospital Division, S. G. 0. (13) Memo, from Lieut. Col. Floyd Kramer, M. C., to the Surgeon General, May 24, 1919. Sub- ject: Conclusions arrived at in reference to hospitalization. On file, Record Room, S. G. 0., 632 (General). (14) Chart showing distribution of overseas sick to November 11, 1918. On file, Hospital Division, S. G. 0. ORGANIZATION, administration, and control. 179 Fig. CHAPTER XII. TRANSPORTATION OF SICK AND WOUNDED. HOSPITAL TRAINS. Shortly after the United States declared war it was recognized that it would lie necessary for the Medical Department to provide some means of evacuating and distributing the sick and wounded from the ports to hospitals in the in- terior. There was only one hospital train in the possession of the Medical Fig. 75 — Hospital Train Xo. 1. Department at this time. 1 This train consisted of ten cars, comprising one kitchen and personnel car, three 16-section patient cars, one operating car, one storage and baggage car, three bed cars, and one officers' car. These cars were all of wooden construction, except the kitchen car and the officers’ car, which had steel underframes. They were remodeled from old Pullman cars, August, 1916, by the Pullman Co., for service on the Mexican border, and were leased by the Government on a per diem basis, with the understanding that they could be purchased. 1 The train had a capacity of 225 patients and accommodations for 31 personnel. 1 In October, 1917, the Surgeon General requested an appro- 1S0 organization, administration, and control. 181 priation sufficient to construct three additional trains of six cars each. 1 On Feb- ruary 13, 1918, authority was obtained for the purchase of these additional 18 cars, and in June, 1918, the cars had been purchased, remodeled, and placed in service. 1 Three bed cars were taken from Train No. 1, thus reducing it to a 7-car train; and one bed car was added to each new train. Fig. 76.— A I6-section patient-car, Train No. 1. There were now 4 trains of 7 cars each, with a capacity of 141 patients and 31 personnel for each train. Pending the arrival of overseas patients at the ports, these trains were distributed as follows: 1 Train No. 1 to Port of Em- barkation, Hoboken, N. J. ; Train No. 2 to the Medical Officers’ Training Camp, 182 MILITARY HOSPITALS 1ST THE UNITED STATES. Fort Oglethorpe, Ga., for instruction purposes until October, 1918, when it was sent to the Port of Embarkation, Hoboken, N. J. ; Train Xo. 3 to Fort Riley, Ivans., for instruction purposes at the Medical Officers’ Training Camp, at that place, and then to the Port of Embarkation at Hoboken, N. J. Fig. 77. — Car for sick officers, Train No. 1 . It was estimated in October, 1918, that the three hospital trains at Hoboken, with a patient carrying capacity of 423, could make a minimum of three round trips per month each from the port to interior points, 2 averaging a distance of 1,000 miles. ORGANIZATION, ADMINISTRATION, AND CONTROL. 183 It was apparent that, even if increased in carrying capacity by the addi- tion of three Pullman cars to each, these trains would be totally inadequate to distribute large numbers of sick and wounded. The most crying need was for cars with kitchen facilities, and after a careful study of the situation a request was made in October, 191S, for authority to purchase 20 cars and to have them remodeled into unit cars. 3 This authority was granted on October 25, 1918, 4 and the necessary arrangements were immediately insti- tuted with the Pullman Car Co. It was found that, owing to the increased cost of material and labor, the original estimate of $25,000 each for these cars no longer obtained, and that the cars would cost $27,000 each, 5 including remodeling. Nor could the Pull- man Co. promise delivery of them under three or four months. It was dis- covered though that 20 steel underframe Pullman parlor cars were available and could be remodeled and be made ready for service within a very short time. 6 The offer of these cars was accepted and the order given the Pullman Co. to remodel them and the cars were all completed and in service on January 31, 1919. 2 The remodeling of the cars, including removal of the interior fittings and the installation of Glennan adjustable bunks, large kitchens, refrigerators, axle devices and lighting systems, the cost of each added to the original cost, was $326,000 for the 20 cars. 7 Ten were sent to the Port of Embarkation at Hoboken and 10 to Newport News, Ya. In using these cars the plan adopted was to attach one of them to six or seven standard Pullman or tourists cars, 8 thus forming a hospital train of seven or eight cars. The patients from the entire train were subsisted from the kitchen in the unit car, and were cared for by the medical personnel assigned to that car. The plan was found to be very satisfactory in that it was practi- cable to furnish hot meals for 250 patients from each unit car. 8 There was room for sufficient personnel to care for all their needs and it was unnecessary to pay return mileage on the Pullman cars used as they were simply dropped at their destination 8 and the unit car alone returned to the port. This made possible a considerable saving over the use of a hospital train, in which case mileage had to be paid for the entire train. The arrangement for the evacuation of the large number of patients from the ports and while awaiting the delivery of the unit cars, made it imperative that some cars be obtained for immediate use. Authority was therefore obtained to lease from the Railroad Administration 20 cars at $15 per diem. 9 In the latter part of November, 1918, 2 kitchen-tourist cars, 2 hotel cars with kitchens, and 6 private cars with kitchens were leased 10 and were sent to the Port of Embarkation at Hoboken. At the same time 7 kitchen-tourist cars, 1 hotel car with kitchen, and 2 private cars with kitchens were leased 10 and sent to the Port of Embarkation at Newport News. These leased cars were used in the same manner it had been planned to use the unit cars. The tourist kitchen and hotel cars were the usual tourist and standard sleeping cars, with added facilities for cooking at one end. Each had a feeding capacity of 250 patients. 10 The private cars, on the other hand, varied in interior design and had a considerably less feeding capacity. They were the best obtainable for the time being, however, and provided a reasonably satisfactory substitute. It was intended that these leased cars would be used only until delivery was made of the unit cars; but when the unit cars were obtained, it 184 MILITARY HOSPITALS IN THE UNITED STATES. was found that the influx of patients was so great that it was necessary to retain the cars in service for a considerably longer period — until June, 1919 — when they were returned to the Railroad Administration. 11 The use of the unit cars in conjunction with ordinary Pullmans demonstrated their efficiency Fig. 78. — Hospital unit car fitted with Glennan adjustable bunks, showing manner of adjustment. in hospital train service. They were decidedly economical to operate and maintain and the initial cost per patient carried, or per car, or per train unit, was considerably less than would have been the case had complete hospital trains been provided. ORGANIZATION, ADMINISTRATION, AND CONTROL, 185 Fig. 79.— Hospital unit car interior. 186 MILITARY HOSPITALS IN THE UNITED STATES. Fig. SO. — Hospital unit ear in use. ORGANIZATION, ADMINISTRATION, AND CONTROL. HOSPITAL SHIPS. 187 At a very early stage of the war the problem of how best to return the sick and wounded to America arose. The Army had no hospital ships and the plan considered was the use of the Navy ship Solace, with its carrying capacity of returning 200 casualties a month; and the use later of two other Navy hospital ships, the Mercy and Comfort, with a carrying capacity of 300 each a month. 12 The estimate of a minimum of 5,000 returnable casualties per month showed these resources to be utterly inadequate, even had these three vessels not been required for their original and legitimate purpose of caring for the Navy sick. Out of this suggestion developed the arrangement by which the Navy transports would, on the westward passage, serve to the limit of capacity for the return of Army sick and wounded, and a schedule of each ship’s carrying capacity was prepared and promulgated for the guidance of all concerned. 13 The schedule given below shows the classified sick-carrying capacity of the great majority of transports in service on December 1, 1918. The figures fluctuated more or less with alterations in internal structural details, made for better ventilation or other sanitary considerations. In every case the number of different types that could be treated with gratifying results depended absolutely upon the type and general structure of the ship, which, in the main, was fixed and not susceptible to modification. 14 Table 11. — Revised table for rated capacity for troops invalided home September 5, 1918; on prin- cipal naval transports . 14 al bed- den in bunks. Able t o walk, re- quiring surgical dressings; in troop standees. Mental cases. Tubercu- losis in isolation or on open decks. Able to walk, re- quiring no attention in rooms for officers. Convales- cent, re- quiring no special at- tention; in troop standees. 24 100 10 30 145 2, 5S0 38 130 20 60 230 3; 000 59 140 12 25 215 3,600 40 110 5 25 100 1,660 42 100 5 20 80 1,100 12 150 20 50 i;ooo 40 200 6 30 150 3,350 60 500 s 50 500 4,600 40 400 45 38 116 2,200 20 550 3 40 38 200 5 25 100 2,200 50 350 8 16 64 1,164 38 110 5 25 140 2,250 24 300 2 30 80 1,500 40 200 16 20 150 2,600 100 1,000 360 55 400 1,000 20 100 10 44 1,000 45 300 5 30 100 1.800 40 100 5 25 105 1,750 20 100 10 40 1,200 38 300 22 40 175 2,850 50 150 25 30 100 2; 250 16 100 5 10 90 2,000 30 100 5 10 100 2, 000 44 110 20 25 120 2,300 33 300 5 25 170 2,850 40 130 25 25 140 1,800 44 510 45 90 120 1,700 40 500 25 190 2,000 25 100 15 50 1,000 38 200 10 45 100 2,000 38 120 5 25 130 2, ISO 40 300 10 25-150 57 1,400 55 110 5 25 200 4,400 35 150 5 16 150 3,000 50 1,000 10 40 155 USOO 50 500 25 90 2,000 30 200 5 25 100 1,300 45 130 5 25 105 1,850 40 100 b 200 3 20 60 10 42 103 100 1,150 a 650 1,500 20 100 5 27 500 5 30 76 1, 100 Name of ship. Aeolus. Agamemnon America Antigone Calamares De Kalb Finland George Washington Great Northern Hancock Harrisburg Henderson Huron Konigen der Nederlanden. Kroonland Leviathan Lenape Louisville Madawaska Mallory Manchuria Martha Washington Matsonia Maui Mercury Mongolia Mount Vernon Northern Pacific Orizaba Pastores Plattsburg Pocahontas Powhatan President Grant Princess Matoika Rijndam... Siboney Sierra Susquehanna Tenadores Von Steuben Wilhelmina Zelandia a Hammock. f> Cot. 188 MILITARY HOSPITALS IN THE UNITED STATES. Upon the signing of the armistice and with the initial movement of the return of our troops from abroad, steps were taken to utilize German ships 15 which had been unable to go to sea owing to the preponderance of allied naval power, and were still in German harbors. One of the first of this class was the Imperator, which was rapidly converted for transport purposes and, like the rest, was manned by a Navy crew. Other vessels of this type were the Graf Waldersee, Cap Finisterre, Kaiserine Augusta Victoria, Mobile, Patricia, Philip- pines, Pretoria, Prince Frederick Wilhelm, and Zeppelin. The various types or classes utilized in the transporting of sick and wounded from abroad may be classified as follows: 16 (1) Navy transports, (2) cruisers and battleships, (3) merchant vessels of German register assigned to the service of the United States by the provisions of the armistice, (4) cargo vessels belong- ing to the United States Army Quartermaster Department, having complete Navy standard equipment for the Medical Department and manned and navi- gated by Navy hospital ships. AMBULANCES. The onus of transferring the majority of the patients from camps to their base hospitals was a duty of the motorized ambulance companies of the camp. The average distance of the base hospitals from the population centers of camps was approximately one mile and a quarter. 17 To economize on time, efforts were made to transfer most patients on a prearranged schedule, that is, shortly after sick call. Emergency cases were provided for, however, and in this class was included the transfer of all patients suffering from, or suspected of having, a communicable disease. REFERENCES. (1) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. II, 1154. (2) Ibid. 1155. (3) Letter from the Acting Surgeon General to the Quartermaster General, October 17, 1918. Subject: Hospital cars. Onfile, Record Room, S. G. 0., 531.4-1 (Hospital Trains and Cars). (4) Memorandum from Director of Finance to Director of Purchase and Storage, October 25, 1918. Subject: Hospital cars. Onfile, Record Room, S. G. 0., 531.4-1 (Hospital Trainsand Cars). (5) Letter from the Pullman Co., manufacturing department, office of the sales manager, Chicago, to the Surgeon General, December 3, 1918. Subject: Unit cars. On file, Historical Division, S. G. 0. (6) Letter from Mr. Edward Hanson to the Surgeon General, November 29, 1918. Subject: Construction of new hospital car. On file, Record Room, S. G. O., 531.4-1 (Hospital Trains and Cars). (7) Letter from U. S. Railroad Administration to the Surgeon General, June 9, 1919. Subject: Statement of Pullman Car Co. On file, Record Room, S. G. 0., 158 (Pullman Co., Chicago). (8) Report Relative to Food Problems on Hospital Trains, by Maj. Don Joseph, M. C., July 10, 1919. On file, Record Room, S. G. 0. (Food and Nutrition Files.) (9) Letter from the Surgeon General to the Chief of Staff, Purchase, Storage and Traffic Division, November 20, 1918. Subject: Leasing of cars for movement of sick. On file, Record Room, S. G. 0., 322.2-4 (Hospital Cars). (10) Letter from the Pullman Co. , to the Surgeon General. November 29,1918. Subject: Leasing of Cars On file, Record Room, S. G. 0., 322.2-4 (Hospital Cars). (11) Letter from the Surgeon General to the Chief of Transportation Service, W. D.. June 23, 1918. Subject: Leased cars. On file, Record Room, S. G. 0., 531.4 (Port of Embarka- tion, Hoboken, N. J.), N. (12) Annual Report of the Surgeon General, U. S. Navy, 1918, 69. (13) Annual Report of the Surgeon General, U. S. Navy, 1919, 48. (14) Ibid., 50. (15) Ibid., 53. (16) Annual Report of the Surgeon General, U. S. Navy, 1920, 19. (17) Plans, National Armv cantonments and National Guard camps. Construction Division, W. D., 1918. CHAPTER XIII. DEMOBILIZATION. Immediately subsequent to the signing of the armistice, it was possible to consider a readjustment of the hospital program. Two principal factors influenced this readjustment — the number of sick and wounded in France, for which hospital beds in the United States would have to be reserved; and the rate of demobilization of the troops in the United States. Both factors were further influenced by subsidiary conditions; that is, the rate of return of patients from abroad and the changing number of available beds in the hospitals of the United States. The rapid demobilization of reserve troops in the United States released thousands of beds in the cantonment hospitals and made it possible to designate hospitals, at the camps to be abandoned, for overseas patients. This per- mitted the first step in retrenchment — the practical abandonment of all pro- curement projects not yet begun or completed. 1 All hospitals not designated for overseas patients were reduced in capacity and personnel at intervals during the demobilization period, as circumstances warranted. 1 After the first few months of 1919, during which the greater number of sick and wounded from France was returned home, 2 and the pressure became less acute, the policy was adopted of abandoning as rapidly as possible all leased properties, and concentrating activities, so far as possible, in Government- owned property. By the end of May, 1919, most hospitals on leased properties had been discontinued. 3 About the 1st of May the sending of overseas patients to the base hospitals at the camps was stopped. 1 This was done to permit the limitation of the activities of these hospitals to camp necessities, which was made possible by the fact that there was no longer a necessity for the conservation of space in general hospitals. Later, in June, the overseas sick at base hospitals in camps, requiring prolonged treatment, were transferred to general hospitals; so that by the end of June, the hospitals at camps were caring for practically only the sick of the camp commands. There had been a coincident gradual reduction in the number of general hospitals. On May 24, 1919, the following hospitals were selected as being those possessing the greatest probable degree of permanence: 1 Hospital. Location. Date abandoned. Army and Navy General Hospital Hot Springs, Ark Oct. 15,1919 Letterman General Hospital. T San Francisco, Calif General Hospital No. 6." General Hospital No. 11 Oteen. N. C General Hospital No. 26 General Hospital No 31 189 190 MILITARY HOSPITALS IN THE UNITED STATES. Those which follow were selected as the next most permanent hospitals which would operate for a sufficient time after July 1, 1919, to care for the greater number of chronic cases remaining in hospitals : 1 Hospital. Location. I Date abandoned. General Hospital General Hospital No. 2. General Hospital No. 3. General Hospital No. 8. General Hospital No. 20 General Hospital No. 28 General Hospital No. 30 General Hospital No. 41 General Hospital No. 42 General Hospital No. 43 Base Hospital Fort Bayard, N. Mex Fort McHenry, Baltimore, Md Colonia, N. J.' Otisville, N. Y Whipple Barracks, Ariz Fort Sheridan, 111 Plattsburg, N. Y Fox Hills, Staten Island, N. Y Spartanburg, S. C Hampton, Va Fort Riley, Kans Oct. 15,1919 Do. Nov. 15,1919 Sept. 30,1919 Oct. 10,1919 While circumstances developed from time to time necessitating changes in the decisions in reference to the hospitals, as has been indicated by showing in the above tables the dates when the hospitals were abandoned prior to the end of 1919, in the main the plan was adhered to. The most important considerations which influenced the abandonment or retention of hospitals were adequate care, economy of personnel, location in reference to population, and cost of maintenance. In cooperation with the United States Public Health Service, which was charged with the care and treatment of discharged soldiers and sailors who became beneficiaries of the War Risk Insurance Bureau, 4 the War Department had turned over to the Public Health Service, by July 30, 1919, the following hospitals intact: 5 Hospital. Bed capacity. Hospital. Bed capacity. Base Hospital, Camp Beauregard, La Base Hospital, Camp Cody, Deming, N. Mex. . . Base Hospital, Camp Freemont, S. C Base Hospital, Camp Hancock, Ga Base Hospital, Camp Joseph E. Johnston, Fla. . Base Hospital, Camp Logan, Tex Base Hospital, Camp Sevier, S. C 2,144 1, 2S9 1, 156 1,604 SI 6 1, 156 1,396 7.50 General Hospital No. 13, Dansville, N. Y General Hospital No. 15, Corpus Christi, Tex. . . General Hospital N o. 24, Parkview, Pa General Hospital No. 34, East Norfolk, Mass General Hospital No. 40, St. Louis, Mo N onvegian Deaconesses Hospital, Brooklyn, N. Y. Total 2SS 262 700 350 531 250 13,222 A priority schedule for abandoning some hospitals and reducing beds in others was tentatively prepared on August 18, 1919, when there were 33,414 beds available in general hospitals. 6 At that time it was planned to hold permanently 3,750 beds in general hospitals as follows: Hospital. War capacity. Reduction. Designated permanent capacity. 2,000 .500 1.500 2,200 1,500 700 266 16 250 General Hospital No. 19, Oteen. N". C t . . . T 1,300 800 500 1,603 803 800 7.369 3, 619 3.750 This reduction was gradually effected until by October 30, 1920, the number of available beds had been reduced to 3,750.' 191 REFERENCES. (1) Annual Report of the Surgeon General, IT. S. Army, 1919, Vol. II, 1159. (2) Annual Report of the Surgeon General, U. S. Navy, 1919, 48. (3) Annual Report of the Surgeon General, XI. S. Army, 1920, 259. (4) Bull. No. 9, W. D., March 3, 1919. (5) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. II, 1160. (6) Tentative priority schedule for abandonment and reduction in general hospitals. On file, Record Room, S. G. 0., 323.72-3. (7) Bed Report, October 29, 1920. On file, Record Room. S. G. O., 705.1 (Admission to Hospital), General. SECTION IV. TYPES OF HOSPITALS. CHAPTER XIV. BASE HOSPITALS AT CANTONMENTS AND CAMPS. BASE HOSPITAL, CAMP GRANT, ILL.a PHYSICAL CHARACTERISTICS. Geographic location. — The hospital was located in the northeast corner of the military reservation of Camp Grant, Winnebago County, 111., on the banks of Rock River, about 3 miles from the center of the city of Rockford. Terrain. — The country surrounding the site of the hospital is gently rolling along the Rock River, into which it drains. Soil. — The soil is a sandy loam containing deposits of gravel. Because of the character of the soil there was, in the immediate vicinity of the hospital, very little high-flying dust in dry weather; and what little there Avas was largely eliminated by means of grass grown on the neighboring unoccupied land. The soil became very muddy after rains, but the subsequent provision of cinder and board walks prevented the carrying of mud into the hospital corridors and Avards by the personnel, patients, and visitors. Roads. — The roads for transportation Avere three in number: One running northwest and southeast (the Kishwaukee Road) ; one running north and south; and one encircling the hospital. The Kishwaukee Road, extending to Rock- ford, was a well-built concrete road (about 20 feet AA r ide) ; the road running north and south Avas of macadam; and that encircling the hospital Avas of cinders. Climate. — Extremes of heat and cold Avere experienced. The mean tem- perature during the summer Avas 80° F.; hi Arbiter, 15°. During the summer, however, there Avas usually a pleasant breeze from the southeast bloAving up the river. Sanitary status. — The sanitary status of the neighborhood of the hospital Avas good. The Rock River, floAving along the western boundary of the hospital, is a very beautiful, rapidly running stream, shallow and not navigable, varying in breadth and containing wooded islands. Into this stream the entire sewage of the camp emptied. STAGE OF DEVELOPMENT. Organization. — The organization of the hospital may be divided into tAVO periods, the first being that in Avhich temporary quarters Avere occupied for hospital purposes; and the second, from the time when the base hospital officially assumed control of the buildings designed for its permanent occupancy. The a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Grant, 111.,” by Lieut. Col. H. C. Aiichie, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, AVashington, D. C. — Ed. 13 45269 °— 23 - 193 194 MILITARY HOSPITALS 1ST THE UNITED STATES. organization was gradual and part of its history is intimately associated with the period prior to the time when the hospital was officially designated a base hospital, and before the mobilization of the divisional troops had occurred. The events of that early period will be given to complete the historical descrip- tion of the hospital and to show the metamorphosis of the camp into the base hospital. During the earliest construction period information was received at the camp that troops would be assigned to that place commencing about September 1, 1917. The contractors promised the camp surgeon that the base hospital would be in readiness for occupancy on August 26, 1917 ; but as the plans for it were not received from the War Department until about the middle of August, and in view of the fact that special building materials were required, none of which was yet on hand, a further delay was necessarily caused. At this time there was a small number of troops in camp who had been provided as guards during the construction period. These troops required hospital facilities of some sort, and early in August the building contractors were requested by the camp surgeon to build an infirmary (regimental) building as soon as possible. To equip this building a 24-bed camp hospital was requi- sitioned by the camp surgeon, and on August 12, 1917, a small hospital of 24 beds was opened in Zone I of the camp. Nine patients were admitted at that time and were carried as “sick in quarters.” There were no cooks for this newly organized hospital and in order to hurriedly provide this necessary per- sonnel two promising enlisted men of the Medical Department detachment were assigned to one of the guard companies for one week to receive training in cooking. The personnel of the Medical Department at that time included, in addi- tion to the camp surgeon, two medical officers and five enlisted men. When it became obvious to the camp surgeon, about the middle of August, that the base hospital would not be in readiness at the time mobilization was scheduled, a complete field hospital, with the exception of transportation, was requisitioned. This equipment was promptly received and, when put into use, augmented the bed capacity of the hospital to 240. An adjacent regimental infirmary, together with six recently finished barrack buildings, were tem- porarily taken over for use as hospital buildings. One of the two infirmary buildings was used as headquarters of the hospital, and contained, in addition, the medical supply room, dental office, and the genitourinary wards. The other infirmary building was used as a kitchen and contained, in addition, the officers' ward and operating room, surgical wards, and space for the special medical examiners who had been detailed to duty at the cam]) in connection with physical examination of the registrants of the draft. Twenty-one additional Medical Department enlisted men were assigned to duty at the camp before the draft registrants had arrived. A course of instruction, which comprised nursing and operating-room technique, was begun in the hospital for them. For the operating room technique, mock operations were conducted. By the end of August, 1917, there were 19 officers on duty at the camp hospital, in which there were 27 patients. The chief of the medical service, together with nine of his assistants, had reported in compliance with M ar Department orders. TYPES OF HOSPITALS — BASE HOSPITAL. 195 No heat had as yet been installed in any of the buildings being used for hospital purposes, and, as at that time the weather was cold and wet, a request was forwarded to the War Department for authority to purchase 40 oil stoves. This was disapproved. The first troops of the division arrived in camp September 5, and from then on the number of patients in hospital rapidly increased. The necessity for heat was demonstrated to the division commander, who immediately authorized the purchase of the required number of oil stoves. All officers and enlisted men of the Medical Department, assigned to duty at Camp Grant during this period, were attached to the hospital for rations and quarters. This practice continued until October 14, 1917. It was quite difficult to satisfactorily care for them at first, principally because of the lack of cooks in the hospital detachment. This was gradually remedied, however, by assigning to the kitchen men who were seemingly most suitable and who were coached by qualified men from the camp school for bakers and cooks. The construction work on the new base hospital was being rapidly pushed, and by October 14, 1917, it was ready for occupancy, with the exception of the section for head surgery in the administration building, the receiving ward, and the officers’ quarters. The camp hospital was discontinued on October 14, 1917. The patients which it contained, still requiring treatment, were moved to the new base hospital. The equipment for a 500-bed base hospital had, in the meantime, been received and had been properly distributed in the new hospital. The equipment which had been used in the camp hospital, being no longer required, was turned in to the camp medical supply depot. Hospital provision for civilian employees engaged on the construction work of the camp buildings was made by the contractors. At first these contractors claimed that the Army should give care and treatment to all sick and injured civilian employees. The camp surgeon, however, informed them that this was not authorized, but that the injured employees’ compensation act of September 7, 1916, required the contractors to provide hospital and medical attention for all personnel employed by them who became injured in their service. After several weeks the contractors accepted this view and completed one of the regimental infirmary buildings in which a hospital for emergency treatment was started. Cases requiring more than emergency treatment were sent to the Rockford City Hospital. CONSTRUCTION FEATURES. There was considerable delay in commencing the construction of the hos- pital because of the delayed receipt of the plans for it from the War Depart- ment and because of the slow delivery of building materials. The materials used in the construction of the hospital were different in many respects from those required for the buildings in the main part of the cantonment; and, as the constructing quartermaster was not in the possession of information re- garding where these materials had been ordered by the Cantonment Division of the War Department, it was impossible to trace them. Actual construction, therefore, was not started until the latter part of August, 1917. Once begun, however, no time was wasted; and, within a period of a little more than a month, it might be said that the hospital, as it had been originally planned, was prac- 196 MILITARY HOSPITALS IN THE UNITED STATES. tically complete. The wards, with a capacity of 1,250, were ready for occu- pancy by the middle of October. Experience in the use of the various buildings of the hospital demonstrated that the more closely the use of them was restricted to that purpose for which they were provided, the more excellent was their design. There were many features, however, in connection with the different buildings, which this ex- perience showed should have been provided in some instances, and in instances where some features were provided these were used for other purposes. Administration building . — In the administration building it was found that there was great need for toilet facilities for the various classes of personnel engaged in the performance of duty therein. These included officers, nurses, female employees, and enlisted men. There was, likewise, a constant demand for a utility room. In the sergeant major’s office there was an inadequacy of space; so, one half of the contiguous porch was inclosed and made into a part of the room. The information bureau had a totally inadequate space allotted for the volume of business it carried on. The room intended for the registrar was never used as such, but was converted into an office for the chief nurse. Receiving building . — The receiving building was not satisfactory; there was a considerable wastage of space; and it was impracticable to admit patients in the manner prescribed by the Surgeon General’s Office; that is, to give each patient a bath, check his clothing, furnish him with hospital clothing and send him to a specified ward. There was but one bathroom in the receiving building; consequently, the contagious patients could not lie mixed with other patients; moreover, the distance was too great from the major portion of the wards, and the corridors were too cold during the winter to risk sending patients through them immediately after the patients had been given a hot bath. The use of the observation rooms was found to be impracticable because of their inadequate capacity, and the lack of any provision for diets. As the south wing of the receiving building was used as the receiving office and the office of the detach- ment of patients, the available room in which to store patients’ effect? was sufficient for only 940 patients. The original arrangement for storing the effects of patients comprised a series of pigeonholes, 18 inches square. In these small spaces all the clothing had to be practically stuffed. This arrange- ment was changed by hospital labor so as to provide holes 18 by 18 by 9 inches, six in a vertical row along the upper half of the racks, the lower half being so arranged that the patients’ overcoats, raincoats, blouses, and breeches could be suspended on clothes hangers. All underwear was laundered, and the outer clothing was pressed by a steam presser located in the clothing room. The officer of the day occupied the room constructed for him, and an adjacent room was used by the medical and surgical officers of the day. The noncommissioned officer in charge of male nurses occupied one room. A lavatory was divided into two rooms, making a unit lavatory. A small room adjacent to the receiving office was made into the receiving officer’s office, by constructing a door between the two rooms. Officers' ward . — The officers’ ward was well constructed; but the capacity originally provided was found to be too small, and an additional wing was added in the spring of 1918. Officers suffering from contagious diseases were cared for in the isolation ward at this hospital. This would have been obviated had TYPES OF HOSPITALS BASE HOSPITAL. 197 the additional wing been separated from the main portion of the officers’ ward, and been provided a diet kitchen, which would have permitted it being operated as a contagious ward. The lack of an electric bell system was seriously felt, and one was provided by the personnel of the hospital. Inconvenience was likewise experienced because of the lack of clothes closets in the separate rooms of the ward. Head house. — In the head house the dental department was very satis- factory. In the eye wing, and ear, nose and throat wing, a considerable amount of space was unused. Experience demonstrated that these activities could have been operated in a considerably more restricted building. X-ray laboratory . — In the X-ray laboratory there was never sufficient space to carry on the necessary work, and the inadequacy became more apparent as a large number of plates and films accumulated for storage. The need of a toilet was repeatedly demonstrated, not only for the use of personnel, but for use by patients, particularly those who had been given bismuth meals. The laboratory . — The laboratory as originally constructed was entirely too small, but in the spring of 1918 a satisfactory addition was made to it. No adequate storeroom having been provided, the short corridor running southeast was closed at the east end and this space was made into a very satisfactory storeroom. The animal house was located in the small space surrounded by the laboratory building and three corridors, was provided with a concrete floor, floor drains, and hot and cold water, and was heated by steam heat. The area surrounding the animal house was used as a yard for the animals. Since no chemical work was done at the hospital the hood and chemical laboratory were used as a place for the preparation of media. To facilitate the filtering of the media two small pipes were installed, fitted with funnels, and connected with the high pressure steam line. The arrangement operated most satis- factorily. To provide a water still of adequate capacity, an unserviceable hot water tank from a battery of sterilizers was connected with the high-pressure steam line and the cold water pipe. This improvised still had a capacity of 50 gallons a day. The gas plant, which was a part of the laboratory equipment, could never be made to operate, and proved to be a fiasco. Surgical pavilion. — Except for an inadequacy of space the operating pavilion was satisfactory. To overcome the deficiency an addition was con- structed, by the personnel of the hospital, north of the operating room and east of the corridor. This additional building was divided into three rooms — an office for the chief of the surgical service, an examining room with which it connected, and a room which was provided with a concrete floor and made into a gauze-reclaiming laundry. Immediately east of this division a pit was dug, lined with concrete and covered. An emergency boiler was placed there and connected with the high-pressure steam line. It so happened, however, that it was never necessary to use this emergency boiler. Post exchange. — Structurally, the exchange met all the requirements of the hospital, and no necessity arose which required any alterations in it. There were some objections connected with it, however, which were principally due to its location. Because it had been centrally placed it was practically impos- sible to prevent patients from buying any and all forms of foodstuffs, regardless of the diets prescribed for them. It was practically impossible, also, to keep the adjacent corridors clean. These objectionable features would have been 198 MILITARY HOSPITALS IN THE UNITED STATES. obviated had the exchange been located in a less accessible portion of the hospital group. Mess and kitchen. — The capacity of the general mess proved to be always ample. There were some faulty features in the original construction, which, profiting by experience, could be readily eliminated. The original tables were poorly constructed in that their tops were made of 3-inch tongue-and- groove boards, securely nailed down. These boards shrank, leaving fairly wide cracks in which foodstuffs collected, making it pratically impossible to keep them clean, and it was necessary to cover them with oilcloth. The ceil- ings were too low for the size of the building; consequently, the rooms were dark; and because of the absence of sunlight, the floors dried very slowly after being mopped. This difficulty was increased when the two additional wings were constructed. Ventilation of this room was found to be difficult also. The main diet kitchen was very satisfactory, but it was improved by installing in it a large electric range. The equipment of the main kitchen was adequate and well selected. A charcoal oven for pies Avas purchased and installed, but unfortunately was not a success. A toilet and root cellar were installed in the spring of 1918, and these proved highly satisfactory. The potato parer, meat chopper, and bread cutter were very satisfactory as labor and time saving devices. The ice boxes and refrigerating plant were ample and satisfactory in every respect. The storeroom Avas insufficient at first, but Avith the construc- tion of the new wing this shortage Avas eliminated. There was no original provision for the storage of bread, and a large bread cabinet was built by the personnel of the hospital in the room opposite the ice boxes. The rumvay northwest of the ice boxes, intended for the passage of food carts, was unused and proved to be Avaste space. It Avas found more satisfactory to have the food carts pass down the corridors and be served at the two large kitchen doors. To provide an office for the mess officer so that he could be constantly at the mess, and have sufficient space for his clerks and records, a room about 12 by 15 feet Avas built in the north corner of the kitchen, for Avhieh purpose a portion of the storeroom Avas taken. The space betAA r een the center and southwest wings was covered over and inclosed with Avire screening. This was provided with a concrete floor in Avhieh there Avas a floor drain, and the space Avas used as a central garbage station. Approximately 40 garbage cans Avere assembled there, according to the class of garbage designated for them. One man was kept on duty to care for this station, at Avhieh garbage from all Avards of the main part of the hospital, as Avell as from the general mess, Avas collected. Men from the Avards brought the garbage, after each meal, in closed commodes. Entrance to the garbage station for these men Avas from the outside. Guardhouse. — The guardhouse proved to have no value as such to the hospital, as all prisoners were taken care of by other organizations in camp. Single wards. — The linen closet of the single ward being entirely too small for a place in which the head nurse could have an office, it Avas never used for that purpose. In the recovery room there was rarely necessity for the use of more than one bed. The diet kitchen was satisfactory except that no shelving Avas provided; and, as it was not possible to obtain this until after January, 1919, a kitchen cabinet for each ward was provided, in lieu of shelving. These cabinets Avere built to order in Rockford, 111., to provide storage facilities for the standard ward kitchen equipment. This equip- TYPES OF HOSPITALS BASE HOSPITAL. 199 ment was sent to the factory with instructions to build a cabinet adequate to contain it, and, in addition, 18 loaves of bread. These cabinets proved to be better than shelving and were provided at about an equivalent expense. Their cost was $19 each. In the ward utility room no shelving was originally provided and there was insufficient shelving constructed in the linen closet. As no provision had been made in the ward surgeon’s room for papers, a set of pigeonholes was built by the Lane High School of Chicago for each ward. There were 60 pigeonholes in a set, each hole measuring 4 by 4 by 8 inches, which gave adequate space for each chart separately, and all the necessary blank forms. The toilets of the wards were satisfactory and met all require- ments. The wards proper provided ample space for 34 patients, and the veran- das, inclosed with movable screens, were large enough to accommodate all of the beds when necessary. When additional fire doors were built in each ward, an elevated runway had to be constructed from the floor of the ward up to the door, and then down to the floor of the veranda, because the return steam line passed along the floor. It was considered cheaper to build this runway than to change the return pipe line. This created a somewhat unsightly appearance in the ward and made it difficult to place the beds uniformly. Lighting, heat- ing, and ventilation of the wards were very satisfactory. The wall electric sockets were used but very little. Double wards . — The double wards were very satisfactory for all types of diseases, except contagious diseases, and were satisfactory with the latter class of cases when there was a sufficient number of them to fill both wards. These wards had a common toilet in which there was ample opportunity for the intermingling of patients from both wards, and it was necessary to quarantine both wards when a case of contagious disease developed in either. The one corridor connecting the two wards was used as a recreation room. This was very satisfactory as smoking was prohibited in the wards proper. No floor boards were constructed for the shower baths and the patients complained of having to stand on the cold concrete when taking their baths. Isolation wards . — The isolation wards proved very satisfactory for mis- cellaneous types of contagion. The greatest drawback was in taking care of patients in the provided rooms when there were different types of infection, as there was but one toilet in that portion of the building. The isolation wards were used for mixed cases when there were but few cases suffering from infec- tious diseases. The wards of the main part of the hospital were used when groups of the same contagious disease were sufficiently large to warrant it. Psychopathic ward . — The psychopathic ward was adequate to care for all nervous and mental diseases developing at this camp. This was made possible of accomplishment by causing a very rapid turnover of patients and not allow- ing persons to remain therein when they were not strictly hospital cases. The building was very satisfactory except that it was felt the windows should have been covered by iron bars on the outside, and heavy wire netting screens on the inside. This was done in only a portion of the building. No heavy wire screening was provided to cover the radiators to prevent insane patients from burning themselves, and steam supply pipes and return lines were within rooms rather than being above and beneath, respectively. Ward barracks . — The two-story ward barracks did not prove very satis- factory. As constructed, they provided four wards with separate linen closets, 200 MILITARY HOSPITALS 1 1ST THE UNITED STATES. toilets, ward surgeon’s room, and ward master’s room. They were distant from the main mess, connected by open corridors, and had no diet kitchen. They were not satisfactorily adaptable for bed patients, and to use them for convalescents created a waste of one-third their space. Wards of 200 beds. — At the signing of the armistice there were under con- struction five wards of 200-bed capacity each. These were located in the most convenient places, four of them being connected with the main part of the hospital by closed corridors. The wards, upstairs and down, were complete and separate. There were ample quiet rooms, toilet facilities, diet kitchen, and administrative offices. Wards of 100 capacity each would have been of great value to this hospital during the influenza epidemic and when large num- bers of overseas patients were received. Officers ’ quarters. — There was always a shortage of quarters for officers at this hospital. It was frequently necessary to place two junior officers in a room intended for one, and even this expedient left the quarters inadequate. They were, however, very well built and were quite comfortable. The recrea- tion room of the officers’ quarters was satisfactory as such, but general assem- blies were held in the chapel, where more space was available. The dining room, kitchen, and storeroom proved to be very satisfactory. The quarters provided for attendants in the west end of the south wing were never used for that purpose. Nurses’ quarters. — The first quarters constructed for the nurses were inad- equate both in the number of rooms and in the size of the recreation room. The individual rooms were also too small and all were quite dark. The second set was an improvement on the first and the dining room was of sufficient capacity to care for the nurses from both sets of quarters. Rooms of this newer set were larger, the building was constructed in a better manner and the halls were much lighter. The third set of quarters was a decided improve- ment over the second type. There were four buildings in this set, and they were used as quarters for the student nurses. They provided 104 rooms, all of which were used for the students. The fourth set of quarters was the best constructed at Camp Grant. The rooms were very large and light, the buildings, two in number, were well ventilated and lighted. They were two story buildings with plaster sidings. In one of them there was pro- vided a large dining room and well-equipped kitchen, which proved ample for all of the nurses. The dining room, formerly used for the nurses, was then made into a very attractive recreation room. The quarters provided for the help, in the latest set, were found to be inadequate. Two cooks and 16 maids were required to carry on the work of the nurses ’ quarters and mess. Because of the fact that this fourth set of quarters was not connected with the hot water system of the main portion of the hospital, a separate hot water heater was installed in one of the buildings. No shelving was provided in the original set of nurses’ quarters. Tables with a drawer were furnished each room in the second set. Nothing was provided for the third set and an open wardrobe and built-in table were provided for the fourth set. None of these was quite satisfactory to the nurses, and a dresser with mirror was purchased for each room. In addition, a wall writing desk was built at the hospital shop for the rooms in the student nurses’ quarters. Colored nurses’ quarters. — A separate building was built for the colored nurses who were on duty at this hospital. These quarters had a dining room. TYPES OF HOSPITALS — BASE HOSPITAL. 201 kitchen, and storeroom combined. They were excellent quarters and met all requirements. Detachment quarters . — These buildings were constructed for barracks for the detachment, Medical Department. They had a capacity of 62 men for each dormitory, in which, in addition, there were four separate rooms for noncommissioned officers. A solarium was provided in the east end of each. These quarters were very comfortable, well lighted, heated and ventilated. No provision having been made for storing the enlisted men’s clothing within the dormitories, a wall locker for each enlisted man was built by funds obtained from the post exchange. The total cost of these lockers was $1,140. They provided space for hanging the clothing, and there was a locked compartment at the top of each. A hasp and staple were placed on each locker and the soldier to whom it was assigned was provided a separate lock. The quarters of the enlisted men were primarily inadequate, and two additional sets of quarters were constructed in the spring of 191S. The outdoor toilets met all requirements. Additional quarters were authorized and construction was started on them in October, 1918. These buildings were of a more substantial type than those originally constructed and were of the same quality as the fourth set of nurses’ quarters previously mentioned. Construction was stopped on these buildings when they were about 60 per cent completed. The detachment mess . — The detachment mess was sufficient in size at first. In the spring of 1918, to accommodate the increased numbers, a short corridor was built connecting it with an adjacent building and both buildings were con- verted into a dining room. The kitchen was also enlarged and with these pro- visions it was possible to feed the entire detachment at one sitting. Prior to that time the surplus men were fed in the main hospital mess. A large detachment kitchen was constructed hi September, 1918, and it provided excellent kitchen and storage facilities. The equipment for this kitchen was of the cafeteria type. The ice boxes were very large but proved to be poorly constructed and they required an unusually large amount of ice. The cafeteria plan of feeding the men was very satisfactory and was quite economical in the saving of labor. The completion of this new detachment mess was very much delayed because of the difficulty in procuring the new kind of kitchen equipment and it was not opened until about February, 1919. Following the reduction in the number of enlisted men on duty in the hospital this large detachment mess was closed in May, 1919, and its cafeteria equipment was removed and installed in the general hospital mess. The enlisted men and the ambulatory patients were subsisted by this cafeteria. Large black enamel waiters were purchased, by the post exchange of the hospital, in sufficient numbers to provide one for each person. There was difficulty at first in getting the ambulatory patients to use the cafeteria mess. A table was provided for those who were crippled, but great difficulty was encountered in restricting the use of it to the authorized. It was found that a great many patients secured canes and crutches to take with them to the mess, wholly as an excuse to sit at the table for the crippled and thus obviate the necessity of waiting upon themselves. In order to break up this objectionable custom, it was necessary to provide every table patient with a card from his ward surgeon. The cafeteria system proved excellent, generally, principally because of con- venience of service and the saving of time. There was no evidence, however, that there was any great saving of food. 202 MILITARY HOSPITALS IN THE UNITED STATES. Garage . — This building was adequate for three ambulances only. It was well built, but had no floor drains to carry off wash water. There were no lockers for the storage of fatigue clothes of those on duty in the garage build- ing, nor were there shelves for the necessary garage tools. Utility shop . — This building was provided as a carpenter, plumbing, and steam fitters’ shop and was of adequate capacity, but, as other like build- ings, contained no shelving. An electrically driven saw with much detachable apparatus was purchased by the post exchange of the hospital, with which to construct lockers for the men of the detachment. This apparatus proved of the greatest value in maintaining the essential repairs in and about the hos- pital. Work done in this shop was performed almost exclusively by a force of men belonging to the Medical Department detachment of the hospital, thus making it almost independent of the utilities department. Laundry . — This building was constructed and was provided with a drying room, 22 tubs, collar racks, and a steam disinfector. Other laundry equipment Fig. 81— Laundry, Base Hospital, Camp Grant, 111. was not provided. The post exchange, however, purchased a complete set of laundry equipment and installed it in this building. It was necessary also to construct floor drains, as these were not originally provided. It happened that there was a laundryman in the Medical Department detachment to whom was given charge of the purchase and installation of the machinery. He afterwards trained the laundry force, which comprised 19 men. This force cared for all of the clothing of the detachment at a flat rate of $1.50 a month, and this included the cleaning and pressing of uniforms and overcoats. The men of the laundry detachment were given extra-duty pay at the rate of one-third of their salaries. The quality of the work they did was excellent and there were practically no complaints from the men. The laundry was able to reimburse the post exchange for the initial cost and declared dividends to the extent of approximately $5,000. The laundry also washed the face masks that were used in the hospital and frequently did emergency laundry work for the hos- pital, for which no charge was made. TYPES OF HOSPITALS BASE HOSPITAL. 203 Mortuary. — This building proved very satisfactory so long as the number of deaths did not exceed four per diem. Because of the proximity of the hospital to Rockford, 111., no embalming was ever done at the hospital. When autopsies were performed, the lack of running water over the post-mortem table was felt. Chapel. — Except when deaths occurred in the detachment, the chapel was not used for funeral purposes; but the building proved very satisfactory and was used daily as a meeting place for officers, for courses of instruction. It was also used once a week for general meetings of the medical officers of the hospital and camp. Power house. — The heating of the hospital was at all times adequate, and those troubles which occurred in the fall of 1917 and during the following winter were due to inefficient management. With the original construction there were a low-pressure system of steam heating, operated at approximately 10 pounds, and a high-pressure steam system for the steam tables, dish wash- ers, and other kitchen equipment, as well as for the operating room and the laundry. The high-pressure system was kept at about 60 pounds. During the summer of 1918, a return system of condensed water was installed, and the pressure of the heating system was then maintained at about 30 pounds, reduction valves being installed at the entrance to every building. The hot water for the main portion of the hospital (as originally constructed) was heated in the power house and pumped to various parts of the hospital. For the first 12 months this was never very satisfactory; the water was never very hot and frequently it was cold. The hot water for the two-story ward bar- racks, the Red Cross Convalescent House, the three sets of nurses’ quarters, and the colored nurses’ quarters was heated by steam coils in the separate buildings. Prior to the summer of 1918, when there was no return system, the water of condensation was exhausted into the sewer. The steam coils which were used for heating the water proved to be very satisfactory, as the water was always as hot as could be desired. Supply warehouse. — These buildings were well bunt, but proved to be insufficient in number when the hospital was operating at its maximum capac- ity. During the greater part of the time additional buildings of the hospital group were used for needed storage space. No shelving at all was provided these warehouses when they were constructed. It was therefore necessary to use scrap lumber and prepare temporary shelves upon which to place small articles until the necessary authority could be obtained from the War Depart- ment to provide suitable shelving. The Red Cross Convalescent House. — The Red Cross Convalescent House was built and equipped by the American Red Cross. Heat, light, and water were furnished by the Government. This building proved to be very satisfac- tory as such, and met all reasonable requirements. Corridors. — The corridors of the main portion of the hospital were all inclosed. Originally their floors were very rough and were made of short boards. As they were weak and constantly broke through, authority was obtained, in January, 1918, to lay a second flooring. This second flooring was placed on the original one, with its boards in the same longitudinal direction; consequently it did not strengthen it. Thereafter, it was not uncommon to 204 MILITARY HOSPITALS IN THE UNITED STATES. see large holes throughout the corridors where the boards had broken through. The corridors connecting the two-story ward barracks and isolation wards were of the umbrella type' and afforded no protection from the extreme cold in this section of the country. Large lire doors were constructed in the spring of 1918, to allow the crossing of motor-driven fire apparatus. In order to provide this passage, the level of the corridor floor was lowered to the ground. This necessitated the construction of two inclines, frequently as steep as 15 degrees. Because of this incline it was impossible to use hot water in the food carts of the wards, and in addition it was difficult to transport liquid foods in the carts. Wood strips, 3 feet long and 1 inch wide, were placed on these inclines half way across the corridor, to enable crutch patients to go up and down them. In spite of this provision, however, five patients slipped and fell on the inclines, causing a refracturing of arms or legs. There were several places where the lowering of the corridor floor was made to a level below that of the ground, giving rise during rainy weather to collections of pools of water. Lighting and ventilation . — The lighting and ventilation of the hospital were very satisfactory. The ventilators for all of the buildings originally constructed consisted of a parallel set of openings, 12 inches wide, passing down the center of each building. These could be closed by drop doors hinged in the attic. A spring was attached to the doors to keep them open, and cast-iron catches were pro- vided to fasten them when pulled down. These ventilators proved very unsat- isfactory, as the planks warped and the catches could not work. The later type of ventilator, which was a large door situated at intervals and opened by a rope, was much more satisfactory. The roof ventilators in the original con- struction were objectionable because they permitted the entrance of rain and snow and became such a serious, problem that it was necessary to cover them with burlap, in the winter of 1918. With the ventilators on the buildings subsequently constructed, there was never any trouble. Fire-alarm, system . — An aero fire-alarm system was installed in the spring of 1919, connecting all buildings used by the patients. This system proved to be very delicate and there were many false fire alarms. PERSONNEL. COMMISSIONED PERSONNEL. Because of the shortage of medical officers of the Regular Army, only one Regular Medical Corps officer was assigned to this hospital during the period of the war, with the exception of four newly appointed first lieutenants in the latter part of the existence of the hospital. Every caliber of officer was rep- resented among the medical officers assigned. With the exception of a very few, none of them had had any prior military experience. During the fall of 1917 there was quite a large number of medical officers, who were totally unqualified to perform any duty whatsoever, assigned to duty. Some of these could not be absorbed and it was necessary to discharge them from the military service. The rank held by a medical officer when he reported for service proved to be no guide to his professional attainments. Military rank was therefore not kept in the foreground at the hospital, and officers were assigned to fill TYPES OF HOSPITALS BASE HOSPITAL. 205 positions in accordance with their ability and not necessarily because of their seniority in rank. Drill and setting up exercises for officers were begun in September, 1917, and continued until the spring of 1919. In view of the fact that the age of officers at the hospital ranged from approximately 25 to 65 years, it was nec- essary to divide them into two or more companies. This was accomplished by placing the majors and officers of over 45 years of age in one company, and all others in one or more other companies, contingent upon the number of officers to be assigned. The older men were given drill and setting up exercises in moderation. The other companies were given one hour’s drill, later includ- ing the foot drill of the soldier, tent drills, ambulance drill, and the litter drill. Parades and reviews were given from time to time at which were present the entire personnel, including the band. Great interest was evidenced by all in drills and other functions. The officers were required to turn out for retreat daily when in camp, but any officer could be excused from drill upon his request. There was a roll call at drill and retreat and if any officer absented himself therefrom without excuse lie was required to make a formal explanation on a blank form provided for that purpose. This form was filed with the officer’s efficiency report. Each officer at the hospital had an efficiency record. This was made, by the chief of his service, on a form submitted weekly, and covered attention to duty, discipline and control of men, professional zeal, diagnostic ability, ab- sences from formations, and anything else of a special nature. The conduct of the officers and their esprit de corps were generally excel- lent. They took great interest in the organization and cooperated fully in the discharge of their duties, to the best of their ability. The dental officers assigned to the hospital had their offices and quarters there. They were directly under the camp dental surgeon, however, and no active part in their control was assumed by the commanding officer of the hospital. The number assigned was adequate and their work very satisfactory. The officers of the Sanitary Corps filled such positions as adjutant, mess officers, registrar, exchange officer, detachment commander, and recreation officer. These officers proved well qualified and of great help to the hospital. The following procedure was adopted to properly familiarize new officers with their duties in connection with the hospital and the service in general: The adjutant gave each newly arriving officer a blank preference card to com- plete. This card contained the officer’s name, rank, organization, age, name, and address of nearest relative, military service, professional training, and an expression of his desire for assignment to duty, first, second, and third choice. The officer was then presented to the commanding officer, who designated his assignment, following which the assistant commanding officer, assigned the new officer to quarters, arranged for his baggage, instructed him in the method of saluting, informed him as to meal hours, drill hours, classes, and other standing camp and hospital orders. He was then shown his pigeon holes where his orders and mail could be found and was instructed in the proper use of the officers’ register. The preference card was given to the sergeant major, who added the officer’s name to the roster and prepared special orders assigning the officer to duty. The assignment orders were distributed as follows: Officer’s pigeonhole, drill director, chief of laboratory (for vaccina- 206 MILITARY HOSPITALS IN THE TOUTED STATES. tions), chief of medical service (for physical examination), mess officer, chief of the service to which the officer had been assigned, and a copy for file in the officer’s file envelope. When officers were relieved from duty at the hospital a special order was issued, copies being distributed as described in the preceding paragraph, and, in addition, to the property officer. The officer to be relieved was given a hospital check sheet, and was required to call at the following offices to receive therefrom clearance signatures before he was permitted to leave the hospital: Mess officer, laundry, exchange, property officer, and chief of sendee. ENLISTED MEN. There was a general shortage of enlisted men on duty at the hospital until the spring of 1918. One noncommissioned officer and 4 recruits were assigned to duty in June, 1917, and 25 additional men in August following. The latter group included a sergeant, first class, for whom a special request had been made as lie was especially qualified to handle sick and wounded records. Sixty recruits were assigned by orders issued at division headquarters, 86th Division, about September 5, 1917. These men formed part of a group of 100 who had been transferred from Fort McDowell, Calif. About September 10, 1917, the first men of the draft were assigned. These men were generally of a very poor quality; five were discharged for physical disabilities and of the remainder only two ever rose to the grade of a noncommissioned officer. In an effort to properly classify the enlisted men assigned, the following plan was adopted at the beginning of the hospital: Every enlisted man assigned was personally interviewed by the commanding officer, special attention being paid to the following points, and the information obtained in relation to them made of record: Education, grade; occupation in civil life; military experience; position desired in the hospital; age; a general estimate of physical condition on the basis of 10 representing perfect; general rating on a basis of 10; and tentative assignment. (This tentative assignment was the first assignment the soldier received in the hospital and was decided upon after obtaining the information called for by the preceding headings.) It required approximately one month to obtain this desired information, but it proved of the greatest value. As an example of the accuracy and value of such an interview, every soldier who was interviewed and given a rating of eight and one-half or more, ultimately became a noncommissioned officer; and there was not an example where the soldier who received seven or less became a noncommissioned officer. This list of ratings was of more value to the hospital than the soldier s official qualification card, and was frequently referred to when it was desired to select men for special positions. The general shortage of enlisted men was especially felt in the general hospital mess, as it appeared almost impossible to obtain cooks. This shortage of cooks made it necessary to call upon the school of bakers and cooks for assist- ance. The school assumed practical charge of the mess until the latter part of January, 1918. Transfers from the organization proved a serious handicap to the hospital. For each officer and enlisted man in the camp there was a qualification card. These cards were classified at camp headquarters. Fre- quently these headquarters would receive an order to transfer a definite number of men of specific qualifications. The qualification cards would be referred to TYPES OF HOSPITALS BASE HOSPITAL. 207 and men possessing the desired qualifications would be taken, regardless of the position they were holding at the time. Frequently men had become efficient in some specialty other than that given on their qualification cards, and would be removed from the detachment for the original qualifications. Thus, on one occasion, orders were received from camp headquarters transferring the mess officer to a grave digging regiment, the mess sergeant and three of the seven cooks to southern camps as automobile experts. The hospital mess was at that time about to become independent and efforts were made to retain the men, but ineffectually. There were but five enlisted men assigned to the hospital who were a part of the Regular Army. One master hospital sergeant reported for duty in July, 1917, and proved of great value in assisting with the organization. He was commis- sioned and sent overseas early in 1918. One other enlisted man of the Regular Army happened to have a qualification in photography only and was of no value in any other capacity. One was transferred to the camp surgeon’s office, and the other two remained with this organization but a short while. In other words, the base hospital at Camp Grant was practically organized without enlisted men from the Regular Army and was run for approximately nine- tenths of its duration without any enlisted men therefrom. As trained non- commissioned officers were unobtainable, primarily, the most promising material was selected and each department of the hospital given a desk in the office of the co mm anding officer wherein all work was carried on in its infancy under his supervision. By the time these offices had expanded to that extent requiring more personnel, some one of the men had been instructed, to whom charge of the office work was given, and the offices were established in their proper places. About 50 per cent of the men assigned to the detachment were personally selected and transferred individually from camp organizations. Every effort was made to make their duty at the hospital as pleasant as possible, perhaps a little more so than with other organizations, with the result that there were a great many individual applications for transfer. Close attention was paid to the mess of the enlisted men, lockers were built in their quarters, a recreation room was provided and equipped for them, and dances, parties, athletics, and many other forms of amusement were provided. This all not only resulted in contentment but made it possible to select some of the best material in camp. Fortunately, both the commanding general of the camp and the division surgeon assumed the view that first-class work in the hospital could not be accomplished without there being well qualified men with which to do it. Because of delays incident to the required repair work of the hospital, it was decided to acquire, for the detachment, men qualified as plumbers, steam fitters, electricians, and carpenters. It was possible to accomplish this and the hospital performed practically all of the repair work with its own organ- ization. The men so selected were assigned to duty with the quartermaster of the hospital and worked under his supervision. The standard maintained for the enlisted men of the hospital was that unless they were physically qualified to perform the duties of a soldier of the line they were not physically qualified for duty with the organization of the hospital. This resulted in there being very few substandard men in the detach- 208 MILITARY HOSPITALS IN THE UNITED STATES. ment. In the spring of 1918 the Surgeon General requested a report showing the number of men physically qualified for overseas duty. Had the men reported as being qualified been transferred, it would have resulted in seriously handicapping the hospital. Three hospitals were organized at Camp Grant for overseas duty. Of these, one was a base hospital and two were evacuation hospitals. A nucleus of men was transferred from the detachment of the hospital to each of the over- seas hospitals, forming a very substantial foundation on which each of the new hospitals could build. The men were selected according to their classification and when grouped were able to carry on all of the administrative work for a small hospital. All enlisted men transferred to Camp Grant for duty with the overseas hospital were assigned to duty in the base hospital for instruction. Base Hospital 58 and Evacuation Hospitals 20 and 37 were trained in this way. Two hundred raw recruits from the South were all the men that Evacuation Hospital 20 had to start out with, but at the time this organization left camp its personnel gave the appearance of being of the best. In building up the organization of the hospital the plan followed was to train each man to fill a specific position rather than have him attain a slight degree of familiarity with all branches of the hospital as a basis for promotion. Promotions were made by grade and no men from the hospital were allowed to skip a grade. Promotions were made on the first day of each month. The officer in charge of each department was directed to submit his recommendations for promotion after having consulted with his senior noncommissioned officer to obtain from him information for or against the proposed promotion. These promotion lists were consolidated and forwarded to the detachment commander for his recommendation. If vacancies existed they were filled by such men who had been properly recommended, after they had been given a perfunctory examination by the commanding officer of the hospital. The following plan was utilized in the assignment of men to duty: The entire detachment was divided into 12 sections, each being in charge of a non- commissioned officer; and as many noncommissioned of Heel's were assigned to assist the noncommissioned officer in charge as were found to be necessary. The detachment commander ultimately had general supervision over all the sections. However, as it was very difficult to get a satisfactory detachment commander during the first 14 months of the hospital's existence, orders were issued to the effect that no man would be transferred from one section to an- other without the approval of the commanding officer of the hospital, except in the case of transfers from the casual section which was used as a general replacement section. This provision was found necessary, also, because many of the new noncommissioned officers were not sufficiently trained in their positions and would, at times, make transfers that proved to be not to the best interests of the service of the hospital. The following sections were established in October, 1917, and were continued throughout the existence of the hospital: Clerical and administrative; male nurse; mess; transportation: Quartermaster: police; laboratory; operating; X-ray; exchange; casual; and miscellaneous. 0 a In reality this miscellaneous section was not a section in the true sense of the word, since it had no noncommis- sioned officer in charge of the men assigned, and the work performed by the men belonging to this section, generally speaking, pertained to some other of the sections. The stenographers and orderlies assigned to the officers of the various chiefs of service belonged to this miscellaneous section. TYPES OF HOSPITALS BASE HOSPITAL. 209 The sick officers proved to be hard to satisfy, and it was difficult to retain enlisted men in this part of the mess. Authority was requested to give enlisted men on duty in the officers’ ward mess additional pay. This request was ap- proved. The additional pay made it possible to retain enlisted men of this mess section in a satisfactory state of mind. The nurses’ mess was operated under the supervision of the mess officer in the beginning, and there were civilian cooks and waiters. The nurses com- plained of the poor quality of food, and difficulty was experienced in trying to keep the mess from getting in debt. In an effort to better the conditions, the chief nurse ultimately took over the operation of the nurses’ mess and ap- pointed one of the nurses to have active charge. One enlisted man for each 50 nurses was assigned from the detachment of the main mess. This plan worked very satisfactorily and remained in operation thereafter. A separate mess was started in one of the isolation wards and was operated for the three isolation wards. At first this was thought to be very satisfactory and was so reported upon by several inspectors. As time went on, however, and all phases of the situation received consideration, there seemed to be no par- ticular reason for operating this mess, which required additional personnel and proved very expensive. It was discontinued, therefore, and food was served by means of food carts, as was done to all of the other wards, and this arrange- ment was found to be very satisfactory. The separate mess had been considered with a view of keeping the patients and personnel of the isolation ward apart from the remainder of the personnel of the hospital. It was impossible, however, to keep the nurses, enlisted men, and officers separate and it was necessary for these persons to retain their quarters with the remaining portion of the per- sonnel. In this connection, it may be of interest to know that there was not a case of exanthematous disease which developed in any officer, nurse, or en- listed man at the hospital who was associated with the care of that particular disease. There were approximately 10 dietitians who had been assigned to the hospital. Each worked in quite a different manner. The first dietitian did practically all of the special cooking, personnally, being assisted by two kitchen police. Later she was relieved by two other dietitians, both of whom assumed a supervisory capacity, performing less actual work personally; and from that time on the major portion of the actual special cooking was done by the enlisted men, under the supervision of a dietitian. ARMY NURSE CORPS. The first female nurse reported for duty October 10, 1917. Prior to that time nursing had been carried on exclusively by enlisted men. Thereafter, female nurses were rapidly assigned, and during the existence of the base hospital there were in all 815 nurses on duty at one time or another. This number included both graduate and student nurses. During the first six months of the life of the hospital, the type of graduate female nurse assigned was not of high professional quality, except those graduate nurses who already belonged to the Regular Army. The new nurses came from small hospitals, and small towns, and were advanced in years. As time pro- 45269 0 — 23 14 210 MILITARY HOSPITALS IN THE UNITED STATES. gressed a much superior type of nurse came into the service, and for the first eight months of 1918 the nurses assigned to this hospital proved to be of the highest type obtainable; they were well trained, energetic, enthusiastic, and physically qualified to perform their duties. The nurses, generally speaking, desired overseas service and several hundred were given their preliminary training and sent abroad. By the fall of 1918 it was evident that the supply of graduate nurses was approaching exhaustion in the United States, and the type of nurses then being assigned was more nearly similar to those who entered the service during the early period of the war. It was customary, from the beginning, to place the nurses in an officer's status at Camp Grant, and, because of this, it was difficult at times to prohibit social relationship between the nurses and enlisted men. An order was issued prohibiting this, and every nurse was furnished a copy of the order when she was assigned to duty at the hospital. Any infringement upon this order resulted in disciplinary measures being taken; and if the nurse did not respond to an ordinary reprimand, her discharge from the service was recommended. The question of recreation for the nurses was considered at a very early period. It was a difficult problem at the beginning because of the absence of a satisfactory place in the hospital for suitable entertainments. The city of Rockford could not be depended upon for the recreation for these young women, as any such recreational activities could not have adequate supervision. The medical officers’ wives were ineffectually called upon to assist, it being explained to them that this was something they could do toward helping win the war. The nurses themselves gave every evidence of being unable to entertain each other. Teas, card parties, picnics, and other forms of entertainments, where only ladies were present, were tried, but generally speaking such entertainments were not successful. When the Red Cross Convalescent House was built in the spring of 1918, it was possible to have dances, and this form of recreation proved to be practically the only form of amusement that a majority of the nurses cared for. Student nurses . — Student nurses were assigned to this hospital in groups, commencing in August, 1918, and in all approximately 150 were assigned for training. These girls were younger than the graduate nurses and were full of enthusiasm. The problem of absorbing them in a large hospital in a military camp where there were 50,000 men was considered with grave apprehension. It was concluded that one of the very best things to do was to teach these girls the meaning of military orders, to promote the honor system of regulations among them, and to make them feel that they were an important part of the hospital organization. With all this in view, they were organized into three provisional companies which were made into a battalion. They were given setting up exercises and the foot drill of the soldier. This drill was given by the commanding officer principally, and his close association with the student nurses made it possible for him to learn the individual characteristics of the young ladies and to so outline regulations, governing their military life at the hospital, as to make them meet the best interests of the students as well as the hospital. Student nurses were selected to act as co mmi ssioned and noncom- missioned officers for each provisional company; and the organization as a whole was given squad, company, and battalion drill. They were given the various TYPES OF HOSPITALS BASE HOSPITAL. 211 calisthenic exercises, signal drill; were taken on moderate marches; and were given may other types of instructions of the soldier. The student nurses were drilled daily, except on Saturday and Sunday, regardless of weather conditions, until the spring of 1919, when the wards of the hospital became filled with overseas patients, and nursing requirements in- creased to such an extent that it was necessary to retain some of the students in the wards at all times. The student nurses were furnished a winter uniform as follows: An olive drab shirt, olive drab breeches, puttee leggings, an olive drab overcoat, a khaki skirt, an overseas cap, a woolen helmet, woolen gloves, marching shoes, and overshoes. The Army uniform was used as far as possible; the gloves and over- shoes were furnished by the Red Cross; the marching shoes by the Salvation Army. The student nurses took a great deal of interest in the drill, which con- siderably improved their carriage and facilitated disciplinary control. Special insignia was devised and furnished to designate the different “officers” of the organization. The student nurses' battalion was required to turn out as a formation at retreat daily, except Saturday and Sunday. The recreation for the student nurses was not much of a problem. They possessed a great deal of talent among them, and this was utilized in such a way as to entertain not only the students themselves but others of the hospital. They were, generally speaking, girls of a superior type and made all of the en- tertainment in which they participated very successful. The Red Cross Con- valescent House was turned over to them on the first and third Fridays of each month and in it they gave such entertainments as their recreation committee had planned. Refreshments and music were furnished by the commanding officer, upon their request. The student nurse, like the graduate nurse, was placed on the status of an officer. PATIENTS. During the existence of this base hospital 35,899 patients were admitted for treatment and 38,757 out-patients were examined and treated. Two large epidemics were experienced. The first, commencing on Decem- ber 26, 1917, followed the arrival of about 500 recruits from Columbus Barracks and Jefferson Barracks. These recruits had every form of contagious disease commonly seen in this section of the country. The epidemic continued until late in the spring of 1918. Measles appeared first, and, fortunately for the hospital, the apex of the occurrence of this disease had passed when the scarlet fever outbreak reached its height. There was hut little meningitis. The second epidemic started the latter part of September, 1918, and ended in the following November. This was the influenza epidemic, in which it would seem that the pneumococcus played a more important role than the bacillus of influenza. The largest number of medical cases was under treatment during the month of October, 1918, being of the so-called influenza type. The largest number of surgical patients was handled in March, 1919, representing practically all overseas wounded. The largest number of genitourinary cases was treated in July, 1918, just prior to the departure of the 86th Division. This number 212 military hospitals in the united states. of genitourinary cases in camp was greatly augmented by the transfer of this class of patients from other camps, especially Camp Custer, Mich. The number of eye, ear, nose and throat patients was greatly increased upon the arrival of overseas patients in December, 1918, and the greatest number of such cases was handled during that month. This class of patients continued high throughout the spring of 1919. The number of mastoid operations in- creased following the influenza epidemic. The largest number of contagious cases developed during February, 1918, being incident to the first epidemic mentioned above. The largest number of nervous and mental cases was on record in July, 1918, which was due not only to the hospital cases, but to the fact that many cases were referred for observation from the camp during this month. The largest number of days lost per patient was in June, 1919, due to the high percentage of overseas convalescents in hospital at that time. A classified report was maintained, showing, numerically, the various classes of patients, and the days lost by them. This classified report was of great value in bringing forcibly to the attention of chiefs of service and ward surgeons the importance of discharging patients from hospital just as soon as possible. Each month this report would be considered at an officers’ meeting, when the services of the hospital would be compared one with another and from month to month. Quite a degree of competition between the services was thus brought about. The establishment of the genitourinary infirmary at Camp Grant was of the greatest value to the hospital; it relieved the hospital of an immense amount of work and prevented the hospitalization of thousands of patients who did not require confinement to hospital. Approximately 2,000 patients passed through the genitourinary infirmary. These patients were on a special-duty status and were kept in quarantine. Such cases were transferred to hospital as needed treatment therein, and the remainder were cared for at the infirmary. The genitourinary services of the hospital and the infirmary were closely associated. This was made possible by assigning the assistant of the genitourinary service of the hospital as officer in charge of the infirmary. GENERAL ADMINISTRATION. PROPERTY. Generally speaking, requisitions were handled very expeditiously and property received without very great delay. There were, of necessity, various grades of property. This was especially true of such articles as linen sheets and towels, of which there were all sizes and qualities received. The white enamel tables were insufficient in number and were very fragile. These tables were made of cast iron and the attachments for the legs were easily broken and could not be repaired. The wooden bedside tables did not prove satisfactory: they were 6 inches too low and provided but one shelf, they were easily overturned, and the varnish soon came off their tops, making them very unsightly. The lack of a suitable ward cart was very greatly felt, and every conceivable means, such as litters, wheel litters, wheel chairs, food carts, and baggage trucks, was utilized to convey supplies to wards. In January, 1918, an interior storage battery truck, with trailer complete, was furnished this hospital by the American Red Cross. As the hospital was TYPES OF HOSPITALS — BASE HOSPITAL. 213 built without steps this truck could reach any building used by patients. Its capacity was a ton and it could carry any load that could be upheld by the corridors. It was used to collect soiled and to distribute clean linen; to bring supplies from the medical supply depot and other places. In fact, it was used almost continuously throughout the day for hauling supplies of all kinds from one part of the hospital to another. In this service it proved to be of the greatest help. It was run by storage batteries, for which a charging apparatus was furnished. This charging apparatus had an automatic cut-off and every other night the truck was attached to the charging dynamo. When the batteries were fully charged the dynamo was automatically cut off. This truck was operated for more than 18 months without necessitating any ex- penditures for repairs. The hospital was embarrassed at times because of lack of funds to purchase articles needed immediately, such as rubber stamps, special office equipment, and emergency reports. QUARTERMASTER DEPARTMENT OF THE HOSPITAL. The first attempt at an organization of the quartermaster department of this hospital was made the latter part of September, 1917, when a portion of the permanent base hospital was taken over. At this time there was no allotment of Quartermaster Corps personnel, nor was there any evidence that such a corps allotment would be made. A rough draft of the requirements of the hospital was made and available personnel, possessing qualifications for that department, were transferred to the Medical Department and the organization of the Quartermaster detachment was then effected with Medical Department personnel. At that time all utilities were handled by the camp quartermaster; and as the personnel was limited and supplies were difficult to secure, a separate and distinct utilities department was organized in the quartermaster department of the base hospital. The medical supplies were being handled by the camp medical supply officer, who also served as property officer for the base hospital, though he was not directly under the supervision of its commanding officer. Considerable difficulty was experienced in deter- mining the line to be drawn between such duties as should be performed by the camp medical supply officer and those by the quartermaster of the hospital. The work of actually equipping the wards was of necessity handled by the quartermaster, as he had the only available personnel, transporation, and organ- ization with which to carry on this work. The question of accounting for Government property, under such a system, caused many delays and difficulties, and in most cases only the finest efforts at cooperation prevented serious delay in the functioning of the supply department. THE SECURING AND ISSUING OF PROPERTY. For several months after the organization of the hospital, property was issued to the various wards and departments upon memorandum receipt, signed by the ward surgeon or head of the department in question. This system was abandoned at an early date because of the constant change of personnel and because of the inability of the new officers to adequately supervise the care of property and to account for it. After many experiments it was 214 MILITARY HOSPITALS IN THE UNITED STATES. found that the following system possessed the greatest degree of merit and the least objections: The hospital was divided into sections, each having a property officer. This officer was, generally speaking, a junior and one whose qualifica- tions and temperament made him valuable for this type of work. On or before Wednesday of each week each ward or department submitted to the property officer of their section a requisition covering a week’s supplies, both expendable and nonexpendable. These requisitions were examined and approved by the property officer of the section and were turned in by him to the office of the supply officer by Wednesday night. In the office of the supply officer the requisitions were examined and after being approved, for issue, one copy was forwarded to the warehouse, where the storekeeper placed the articles requisitioned by each ward or its department in a separate container. The property requisitioned was ready for use on Thursday morning. Mean- while, the accounts section had placed all nonexpendable articles upon a ship- ping ticket and this shipping ticket had been turned over to the storekeeper for him to obtain the signature of receipt. When the ward master called for his supplies on Thursday he certified upon the issue ticket that he had received the nonexpendable articles listed thereon, and certified upon one copy of the requisition that he had received the expendable articles listed thereon. On Friday afternoon all issue tickets for the week were signed for by the property officer of each section. One copy of the shipping ticket was then filed in the numerical file of issue tickets; and the other copy, retained in the office of the supply officer, was filed in the folder of the particular ward to which the prop- erty was issued. This file was arranged so that a separate portion was reserved for each unit property officer, as well as a separate section for the issue tickets of each ward. Each unit property officer was provided a desk and file and was required to open and properly maintain loan record cards for each ward or building within his section. On Monday of each week these loan record cards were indexed by the loan adjusting clerk, to insure the proper posting of and keeping accounts up to date. Tuesday of each week was set apart for the turning in of unserviceable and surplus property, and receiving reports were properly accomplished on that day. All unserviceable property turned in was accom- panied by a statement, made by the unit property officer, that the property was rendered unserviceable by fair wear and tear. In cases where such a certificate could not be furnished, the unit property office was required to submit a statement showing how the property became unserviceable. Once each month unserviceable property was placed upon an inspection and inventory report and turned in to the salvage department. Medical property officers were required to check the property of their wards prior to the last day of the month and to submit a shortage and excess report upon a form devised by the supply officer. On this form, shortage and excess of property found in each ward or building were noted, and under the column for remarks a statement was made to show how such shortage or excess occurred. The loan-adjusting clerk then made a physical replace- ment of wards, as far as possible, by giving the excess of one ward or building to other wards or buildings wherein there were shortages. The net surplus remaining in any ward or building was then charged to the net shortage placed upon survey. In this way every effort was made to have each ward, on the TYPES OF HOSPITALS BASE HOSPITAL. 215 5th of the month, correct in its property accounts. Each ward was stand- ardized with basic articles and each ward was allowed such additional articles as were necessary for the proper functioning of that ward in accordance with its type. Every effort was made to discourage the transfer of property by wards, and when a patient was transferred from ward to ward the physical replacement of property was required. Emergency requisitions were allowed and were expedited, since during the major portion of the week there was no issue of general articles or supplies. After the above-described system had been working for a short time few emergency requisitions were necessary. Property was drawn from the camp supply officer in two ways: Upon monthly requisitions covering the general articles of issue, the need of which could reasonably be anticipated; and upon emergency requisitions requiring either open-market purchases or further requisitions upon the zone supply officer. Considerable difficulty was experienced in securing the expedition of open-market purchases where these purchases were made by the camp supply officer. Trying as was the difficulty of securing prompt purchase by the camp supply officer, equally trying was the difficulty of securing pay- ment of bills incurred, the payment for which was to be made by the Surgeon General’s Office. Considerable difficulty was experienced in the proper accounting for supplies purchased under allotment to the commanding officer of the hospital, due to the fact that the hospital did not maintain stock record cards, but merely loan record cards. This matter was properly adjusted finally by obtaining special authority to open emergency stock record cards for the purpose of dropping expendable articles purchased. All property issued to the base hospital by the camp supply officer was issued upon loan and, under regulations, was taken up on loan record cards. As the property accounts of a large Army hospital involved approximately 3,000 nonexpendable items and as the account was necessarily a very active one, the record card was found extremely difficult in use for property account- ing, and it was also found that within a short time it was necessary to make over great portions of the loan cards to accommodate additional entries. Also, after the account had run a few months it was necessary even to use the adding machine in order to determine accurately the amount of property on hand. TRANSPORTATION . Prior to the establishment of the Motor Transport Corps but little diffi- culty was experienced in the proper handling and upkeep of the motor transportation of the base hospital. Upon the establishment of the Motor Transport Corps the quartermaster of the base hospital was given a definite allotment of motor transport personnel, and thereafter no difficulty was experienced in making this department properly function in accordance with the needs of the hospital. Subsequent orders pooling the transportation, except ambulances, under the Motor Transport Corps officer, and the taking over by that officer of all duties relative to repair and upkeep of motor trans- portation, interfered with the transportation service of the hospital. It was difficult to make the transportation requirements of this large hospital fit in with the arranged transportation scheme of the camp. 216 MILITARY HOSPITALS IN THE UNITED STATES. Animal transportation in the base hospital was secured in adequate amounts and little difficulty was experienced in the proper care and use of such transportation. DISPOSAL OF WASTES. Perhaps no single duty of the Quartermaster Department presented so much difficulty as the proper observance of sanitary regulations and the disposal of wastes. After trying for several months the system of having garbage cans at the end of each ward, the plan was abandoned as an impossi- bility, and a central garbage receiving station was built in the vicinity of the hospital general mess. The station was screened and its doors, opening upon the loading platform, were provided with springs. Within the station the galvanized-iron cans were placed in rows, each row of a sufficient number to receive definite classes of garbage or waste. A competent noncommissioned officer was in charge of the station to supervise its operation. Each ward or building was provided with the proper number of closed commode pails, suitably labeled, showing the type of waste or garbage to be placed in each pail. Each ward or department was required to convey its pails of garbage to the garbage-disposal station between the hours of 8 and 9 each morning, and 6 and 7 each evening. At the disposal station the garbage was inspected and placed in the proper can. The disposal cans were called for each morning between 9 and 12 and hauled to the camp garbage-disposal plant. This system operated successfully in almost every particular. GROUNDS AND GARDENS. Through the use of hospital and exchange funds, together with funds received from the lied Cross and other welfare organizations, seeds, plants, and farming machinery were purchased, and the entire hospital grounds seeded in grass and laid out in appropriate flower beds. It was found that, by first seeding the new ground with oats, followed by blue grass and clover, excellent grass could be secured the first year. Well-seeded lawns not only enhanced the beauty of the hospital and added to the contentment and satisfaction of the patients and personnel, but had a decided advantage in that they prevented the raising of dust. The use of hospital funds permitted the operation of a hospital garden upon a neighboring 10-acre plot. This garden provided a large percentage of the fresh vegetables used in the mess and netted a clear profit in hospital funds through the saving of approximately $4,000. DISINFECTING PLANT. The operation of this plant had two purposes: The disinfecting of cloth- ing of patients admitted to the hospital, of the bedding used by patients suffering from contagious diseases; and the disinfection of clothing and equippage of the personnel of the camp suspected as contacts in contagious disease. This plant operated for 22 months with practically no shutdown, either day or night, and only two one-thousandths of 1 per cent of the cloth- ing and equipage handled was destroyed or rendered unserviceable. TYPES OF HOSPITALS — BASE HOSPITAL. 217 LAUNDRY. From the start difficulty was experienced in securing adequate service for handling the linen of the hospital, and this difficulty existed until the establishment of the camp laundry. The service rendered by the camp laundry in handling the linen of the hospital was satisfactory, except for the fact that it required considerable work in maintaining an adequate check of the hospital linen. This difficulty was finally overcome by placing at the camp laundry a noncommissioned officer of the hospital detachment who personally superintended the receiving and disposition of hospital laundry, and by the establishment of a separate section of the camp laundry for handling the hospital linen. UTILITIES. In 1918 the utilities of the camp were consolidated under the camp utilities department, and it was then clearly demonstrated that the hospital could not properly function by adhering to the general camp scheme for handling the utilities of the hospital. Due to the disinclination of the camp utilities officer to establish the zone system and place men of the utilities department on special duty at the base hospital, the general condition of the hospital buildings, equipment, and steam and plumbing lines became so bad that it was essential to make use of Medical Department men to look after needed repairs. The subsequent assignment of a new utilities officer at the camp enabled the quar- termaster of the hospital to so arrange a scheme whereby the noncommissioned officers of his own department were placed in general charge of their respective sections, and the enlisted men or civilian employees from the camp utilities department were assigned to the quartermaster at the base hospital. In this way a subutilities department was organized for the hospital and all calls for repairs of an emergency character were telephoned to the utilities desk in the quartermaster’s office, while the less urgent repairs and construction were requested by letter. Service orders were prepared and frequently reports, together with copies of service orders, showing labor and material expended, were forwarded to the camp utilities officer. With this arrangement the utilities service operated very satisfactorily with a minimum of delay and inconvenience to all concerned. GAUZE RECLAMATION. During the year 1917 information was received that there was a shortage of absorbent cotton and gauze, indicating the necessity for economy on the part of hospitals in the United States, so that overseas hospitals might be adequately supplied with these articles. A substitute for cotton was furnished, known as “ cellu-cotton.” This was tested out in every department of the hospital and was found of practical use in all departments except the laboratory and dental, eye, ear, nose, and throat sections. The fiber was so short that the material could not be made into satisfactory swabs or plugs. A gauze substi- tute was furnished, known as “ re-knit” gauze. This was a cotton material made in different widths and lengths with a texture similar to stockinet. Its absorptive quality was about equal to that of gauze, and because of its coarsely woven character, it was possible to wash it many times. 218 MILITARY HOSPITALS IN THE UNITED STATES. An addition was constructed adjacent to the operating room where gal- vanized-iron cans were installed. Hot and cold water and suitable drains were provided. Covered pails were furnished each ward where gauze was used, and instructions were issued that the soiled gauze be immediately collected after removal from patients, placed within the pails, and covered with a solution of 1 per cent cresol. An attendant from the gauze-reclaiming laundry, as the addition to the operating room was called, collected the soiled gauze daily, soaked it 12 hours in one of the galvanized-iron cans, and then sterilized it by boiling. The gauze was then washed in an electric washing machine, with soap, soda, and bleach, rinsed in cold water, run through the wringer, and then dried. By experience it was found that it was better to place the gauze on white enamel tables or on clotheslines for drying. After drying, it was packed in suitable packages, covered with muslin, and sterilized by fractional sterilization. Bandages were also cleaned in a similar Avay. The result of this reclamation process reduced gauze consumption from 700 yards per day to an average of less than 10 yards of new gauze per month. The consumption of absorbent cotton was reduced to 5 pounds per month, and the issue of new bandages to about five dozen per month. The gauze reclamation required labor and close supervision, but this was offset by the saving of material resulting from its use. The handling of these materials was under the supervision of the chief of surgical service. The build- ing was constructed by soldier labor of the hospital on locally prepared designs, and it contained, in addition to an office, an examining room for the chief of the surgical service, reclaiming laundries, and an emergency sterilizer for the operating room. It was built for approximately S365. It was possible to keep the gauze white, but great care was needed in bleaching it, otherwise the fiber Avas destroyed by the use of too strong a bleaching solution. It was very difficult to accurately keep track of individual pieces of re-knit gauze, but such efforts were made and it was possible to reclaim this re-knit gauze as frequently as 100 times. With the continuance of the reclaiming the various fabrics became roughened, Avith the result that more or less lint appeared on the surface. The gauze also became hardened Avith use, with consequent reduction of its absorptive qualities. To offset the possible dangers incident to the re-use of pus-soaked gauze laboratory checks were frequently made and a great deal of attention was paid to it by the chief of the surgical service. MILITARY SECTION. In the early days of the existence of the hospital, when the only quarters available Avere barracks in the Infantry area of the camp, no attempt was made to accomplish anything other than the care of the sick. When, however, the permanent hospital buildings were ready for occupancy, and the hospital personnel increased in number, efforts Avere made to give the newly enlisted and neAvly commissioned personnel instruction in the Medical Department drill. The medical officers of the hospital, Avith the exception of a few whose duties required their presence elsewhere at the specified horn's, were required to report for drill one hour daily except Saturdays, Sundays, and holidays, TYPES OF HOSPITALS — BASE HOSPITAL. 219 and for retreat on the same days. In the beginning this drill consisted of foot drill, as outlined in the Drill Manual for Sanitary Troops, and was conducted by the commanding officer. The routine foot drill was varied from time to time by setting up exercises, litter drill, ambulance drill, visits to the camp trench areas, and short walks. Because of the fact that many of the medical officers were of mature years and unaccustomed to physical exercise a little time was required to accustom themselves to this drill. They soon began to enjoy it, however, and, with the exception of a very few, were of the opinion that the drill was not only beneficial as an exercise but a pleasant experience. As time progressed it was found that some of the older officers and a few with minor physical disabilities were unable to keep up with the drill as outlined, and the increasing number of medical officers also made it necessary to conduct the drill in several detachments. By this time officers had been assigned who had had previous experience in some military organizations, such as the National Guard, and a sufficient number of them were found qualified to conduct the drill, thereby relieving the commanding officer of this duty, except as to supervision. Three detachments were formed and were designated Companies A, B, and C. Each had a commanding officer and a first sergeant. Company A consisted of officers over 45 years of age and who had had sufficient instructions, either locally or elsewhere, to be qualified for more advanced instruction. Company C consisted of officers under 45 years of age but requiring elementary instruction in drill. This company was used as a casual company from which officers were placed in Company A after being instructed. Company B con- sisted of officers over 45 years of age or those holding the rank of major. This company was given light forms of exercise, consisting largely of early morning walks and light setting up exercises. The drill of the graduate nurses was conducted under some degree of difficulty, by reason of the fact that no hour could be arranged when all graduate nurses could be spared from their duties, and because there was a necessary, constant changing of personnel. With the arrival of the first detachment of student nurses drill was started immediately, under the personal direction of the commanding officer. This drill was given the student nurses merely because of its benefit to them for exercise outdoors. They became especially enthusiastic and in a remarkably short time became well qualified. They were organized into three companies, each company representing a group. Keen class rivalry developed, particularly after officers had been selected from them and these officers had become quali- fied to handle their companies independently. The great problem in connection with their drill was that of uniforms, and the manner in which this was solved has been mentioned in the section on student nurses. Drill for the detachment Medical Department was conducted under the supervision of the detachment commander, and in the beginning was very unsat- isfactory. Men on duty caring for the sick could not be spared, and as a result drill instruction was given only to a limited portion of the personnel. This was remedied by introducing a method whereby the entire personnel was divided into five groups, each of these groups being required to drill for two hours one day a week at 1 p. m., and then being allowed the remainder of the day off duty. In this manner it was possible to give drill instruction to all members of the personnel and at the same time to afford them some leisure hours. The result of this arrangement was very satisfactory. 220 MILITARY HOSPITALS IN' THE UNITED STATES. From time to time reviews were held on the base hospital parade grounds, and were participated in by all of the above-named groups. The base hospital reviews were unique in the color combinations furnished by the graduate nurses with their white uniforms and blue capes thrown back over their shoulders to expose the redlinings, and the blue uniforms with olive drab knitted sweaters worn by the student nurses. Parades were participated in by the detachment at various times, and upon one occasion each of the above-mentioned groups was represented in a public-health parade in the city of Rockford. Military funerals were held at the base hospital chapel for some of the patients and those of the personnel who died while on duty. WARD MANAGEMENT. Every effort was made to have ward service attractive for the men, for it was soon found that good men could not be kept in the wards if their services were not appreciated by giving them promotion and responsibilities. General Orders, No. 5, Base Hospital, Camp Grant, 111., dated November 12, 1917, specified the duties for the ward surgeon, the head nurse, and the ward master of each ward. This system was very satisfactory. In addition to having a ward master for night and day duty in each ward, a supervising ward master was appointed for each row of eight wards. The ward master was rated as nurse, while the supervising ward master was a nonco mm issioned officer. This supervising ward master was the property sergeant of his row. All super- vising ward masters were under the noncommissioned officer in charge of male nurses, who had a day and night assistant, each of whom assumed general charge under his supervision. The care of the ward property was most unsatisfactory in the early history of the hospital when the ward surgeon acted as the property officer for his ward. Several plans were tried and the most satisfactory evolved was to assign an officer as property officer for each row of wards and the supervising ward master as his property sergeant. Patients were not allowed to have their clothing in the wards. There were two exceptions to this rule: Officers were allowed their clothing if they de- sired to retain it, and patients in convalescent wards dressed in their uniform. Prior to January 1, 1919, there were very few convalescent patients, conse- quently, there were very few patients who had their uniforms. Upon the arrival of overseas patients who had been allowed to have their uniforms in other hospitals the enforcement of the order became difficult. However, it was done. The number of convalescents increased and they were given separate barracks. There were times when it was necessary to give ward patients passes, on account of exceptional conditions arising at home. It was interpreted that if a patient was in physical condition to leave the hospital and go on pass or furlough, he had sufficiently convalesced to warrant transfer to the convalescence service, at least for a short time. A soldier under these conditions was transferred to a convalescent ward and given a pass. In other words no condition arose that necessitated a patient having his clothing in any wards except convalescent wards. This plan not only greatly unproved the neatness of the ward, but it prevented patients being absent without leave. Prior to January 1, 1919, there were but three patients absent without leave from this hospital : One was insane and the other two were colored men who left the hospital during the night to TYPES OF HOSPITALS BASE HOSPITAL. 221 escape operation. Upon the arrival of overseas patients and the establishment of a large convalescent service, it was not uncommon to have patients absent without leave when they had their uniforms in their possession. This practice, however, did not grow to alarming proportions and all cases were tried by court-martial and given appropriate sentences. Patients’ outer clothing was steam pressed in the hospital laundry and patients in the convalescent service were allowed to have their clothes pressed as frequently as they desired. This privilege was not abused. Patients in convalescent wards were given pajamas, sheets, and, at first, hand and bath towels. Because of a great loss of them, the issue of towels to convalescent patients had to be discontinued. The problem connected with patients smoking in the wards was one of more or less annoyance from the very beginning of the hospital. It was deemed advisable to prohibit smoking in the wards for three different reasons: Fire hazard, ventilation, and police. Smoking was prohibited in the wards during their entire existence. This became much more difficult upon the arrival of the overseas patients, and through the interference on the part of civilians, and others in more or less authority. Smoking was permitted in the bathrooms, on the verandas, and outdoors, as well as in private rooms. When it became necessary for a bed patient to smoke, his bed was taken out on the porch. Smoking was also prohibited in the mess hall, kitchen, corridors, and main assembly room of the Red Cross convalescent house. DEATH AND SERIOUSLY ILL CARD INDEX. When a telegram was sent informing the nearest relative of a patient of the fact of that patient’s death, a card was made for the latter, giving the name, rank, organization, date of death, and name and address of the nearest relative. A file of these cards made possible a rapid and ready reference for all deaths. Another index was kept for the “dangerously ill” telegrams, the cards being filed alphabetically, according to the towns in which the designated relatives lived. Each of these cards showed not only the town and State, but the name, rank, and organization of the soldier, name and address of the person to whom the remains were to be shipped, and the date on which shipment was made in the event of the death of the patient. This latter index was not found abso- lutely essential except when the number of telegrams became too large to be borne in mind for several days. From time to time there would be two patients with the same name, but living in different towns. Also telegrams would be received from relatives referring to patients as “brother,” “son,” etc., which made it practically impossible to locate the right soldier without a great amount of searching of the files. When such telegrams were received in response to telegrams sent out, the index mentioned was of great value. FOLDERS FOR CLINICAL RECORDS. One of the minor problems arising, from time to time, and one of the most difficult to solve, was the keeping of clinical records in such condition as to be suitable for permanent records of the Medical Department. The Shannon file, as prescribed, for keeping these charts, proved unsatisfactory, and various methods were tried in an effort to keep the charts in proper condition. The 222 MILITARY HOSPITALS IN THE UNITED STATES. successful method finally attained is shown in Figure 82. The folders and metal clips were purchased by the American Red Cross upon request of the com- manding officer. Fig. 82. — Folders for clinical records, Base Hospital, Camp Grant. The greatest advantage of this method of keeping charts hi the wards was that the charts remained clean and of good appearance; and the size of the clasps was sufficient to permit secure grasping of a chart of a considerable degree TYPES OF HOSPITALS BASE HOSPITAL. 223 of thickness. These charts carried the ward number and the bed number, thus maki n g them easy of identification. They were either hung upon the wall, or filed in pigeonholes. The folders consisted merely of a back and front cover of semistiff bristol board, hinged with cloth, over which was placed a spring steel clasp. Each ward was supplied a set of folders and clips equal in number to the bed capacity of the ward. BLANK FORMS. For the purpose of facilitating the transaction of routine business within the hospital, approximately 50 blank forms were locally devised and reproduced by mimeograph. These were of greater or less importance and those only which proved most practical will be included in this history. All officers on duty at the hospital, except those excused because of duties elsewhere, were required to attend all military formations. Roll was called at these formations and officers absent without proper authority immediately received a memorandum in the form shown below. When returned to the com- manding officer by proper indorsement, this form was filed with the officer’s record, and if the explanation was not satisfactory further steps were taken in in the matter. [Form No. 13-BHCG.] ' Headquarters, Base Hospital, Camp Grant, Rockford , III., 1918. Memorandum: To It is requested that you report to these headquarters, by indorsement hereon, your absence from this date. (Signature.) 1st Ind.: The work of the mess officer was. considerably facilitated by furnishing him daily reports from the main office of the hospital as indicated in Form 12. This form was made daily from the morning report and was sent to the mess officer as early as practicable. It furnished the mess officer a guide for his daily preparation of meals as well as a check against the diet cards submitted by each ward. [Form No. 12-BHCG.] (To the mess officers, Base Hospital.) Daily Report of Rations at Base Hospital. Date Base Hospital enlisted personnel Q. M. C. attached for rations Total rations due Female nurses Enlisted sick in hospital Officers sick in hospital Sergeant Major, Base Hospital. 224 MILITARY HOSPITALS IN THE UNITED STATES. Form No. 16 was a daily report prepared by the officer of the day and pre- sented by him to the commanding officer on completion of a tour of duty. It was made in duplicate, one copy being retained in the administration files and one delivered to the new officer of the day, for any later necessary reference. It will be noted that space is provided for the signature of a “ medical officer of the day” and “surgical officer of the day. ” It was found necessary during the busy periods of the hospital’s existence to furnish some assistance to the officer of the day, in order that all parts of the hospital might have adequate attention at all times; accordingly, an officer was assigned from the medical service as medical officer of the day and one from the surgical service for similar duties. These officers were charged with the professional care of patients and with rendering necessary assistance to the officer of the day. Their tour of duty was from 7 p. m., at which time they reported to the officer of the day, until the ward surgeon came on duty at 8.30 a. m. In addition the surgical officer of the day was assigned to duty as emergency officer from 8.30 a. m. to 7 p. m. the day following his tour of duty. With this report was submitted daily a list of seriously ill patients, in du- plicate, one copy for the information bureau and one for the clerk in charge of “danger” telegrams. A list of patients whose status was that of “prisoners awaiting trial” was also furnished, with a report of the officer of the day, for the information of the commanding officer and summary court-martial. [Form No. 16-GHCG.] Base Hospital, Camp Grant, Rockford, III. DAILY REPORT OF OFFICER OF THE DAY. 191... (Date going off duty.) Inspection of hospital made at (state hour) Inspection of hospital mess made at (state meals) Inspection of detachment mess made at (state meals) Night guard reported at (inspected twice) Detention ward (verified by personal count twice during tour i : Prisoners — General No, Garrison No. Awaiting trial No, Patients No. Total in detention ward Duties of female nurses performed satisfactorily Duties of male nurses performed satisfactorily.. Patients in hospital — last report No. Patients admitted No. Patients discharged No. Patients remaining in hospital No. Civilians admitted : (1) In Government service No. (2) Not in Government service No. Civilians in hospital (give ward and name under ‘ Remarks”) No. Civilians treated (out-patient). Separate special written report in each case No. Seriously ill patients in hospital (give name and ward number under ' Remarks " . . bo. TYPES OF HOSPITALS BASE HOSPITAL. 225 Deaths: ( 1 ) (Name.) (Rank.) (Organization.) (2) Effects in ward promptly checked and turned over to adjutant? (3) Remains promptly removed to morgue? (4) Officer of the day present when death occurred'? Emergency work? Remarks N. C. 0. in charge of quarters N. C. 0. in charge receiving office Night guard (Medical officer of the day.) (Surgical officer of the day.) . (New officer of the day. ) ( Old officer of the day.) It was the practice at the hospital to permit relatives of patients seriously ill to remain for a limited period as guests in the rooms provided for that pur- pose in the convalescent house of the American Red Cross. Four days was established as the maximum period for such guests to remain and for the information of the commanding officer the report of guests was submitted daily in the following form : Daily Report of the Red Cross House, Base Hospital, Camp Grant, III. Guest. Name of relative. Date admitted. Remarks (N. C. 0 . in charge.) The following form was devised for the use of chiefs of service; and upon it a monthly efficiency report was submitted, covering each officer on duty at the hospital. Name 1918. Attention to duty Discipline and control of men Diagnosis ability Professional zeal Adaptability Recommendations , M. R. C., Chief of Service. FORMS USED FOR WARD REPORTS. In compliance with paragraphs 446 and 456, Manual for the Medical Department, 1916, the diagnosis of all patients admitted to hospital was fur- nished the registrar on the forms shown below. These were reproduced by printing because of the large quantity required. The ward surgeon submitted these reports in duplicate, one copy being sent to the registrar and the other delivered to the chief of the service concerned, thus affording a double check upon inexperienced medical officers. 45269°— 23 15 226 MILITARY HOSPITALS IN THE UNITED STATES. Diagnosis Card. Submitted to the S. & W. office within 24 hours after admission. Make diagnosis agree with that of ward surgeon on page 55F. State always whether it is your original, a change, or an addi- tional one. Indicate all operations and changes of status with dates. Diagnosis must comply with paragraphs 446, 445, and 456 MMD. Reg. No Date Name Rank Organization Line of duty (yes or no) Ward No Bed No , Ward Surgeon. One of the most important local forms was the ‘‘ Request for transfer.” This form was prepared and signed by the ward surgeon and sent to the chief of his service for approval. It was then sent to the chief of service destined to receive the patient, who designated the ward and gave approval for the transfer. The transfer having been accomplished, the request form was taken to the receiving office where it was recorded and signed, then to the information bureau where it was again recorded and signed. In this manner the wall ward-index in the receiving office was kept accurate and up to date, and the card file in the information bureau was adequately maintained. This pro- cedure was of the greatest value in providing an accurate record at all times of the exact location of the patients within the hospital. Request Transfer of — Name Rank Company Regiment Request No From ward bed to ward bed Diagnosis: Ward Surgeon. Approved : ............................. .... j Chief of Service. Approved : Chief of Service. (Receiving office.) Date , 191. . (Information bureau.) A request for consultation was made on the form shown, which was repro- duced in a size to be readily filed with the chart. This request was initiated by the ward surgeon, approved by the chief of service, and sent to the chief of the service where the consultation was obtained. The consultant recorded his opinion and recommendations and signed the request for the chief of his service. The transfer request shown above was never approved unless con- sultation had been secured. By this means many unnecessary transfers were avoided and assurance was obtained that transfer when made was being made to the proper ward. TYPES OF HOSPITALS — BASE HOSPITAL. 227 [Form No. 27a BHCG.] Request For Consultation. From ward surgeon, ward To chief of service. Subject: Request for consultation in the case of (Rank.) (Company.) (Organization.) Bed No of this ward. Questions - Ward Surgeon. Approved : Chief of Service. Date ,19.. Opinion of recommendations File with brief 130. Chief of Service. The report on contagious diseases was required daily by the camp surgeon. The form shown is self-explanatory. In practice the ward surgeons were required to submit this form with their diagnosis cards, thus affording the registrar a check both against this report and against the diagnosis. From wards where contagious diseases occurred only occasionally, this form was sent direct to the registrar. In the contagious-disease subsection of the service of internal medicine there was a noncommissioned officer in charge of records of contagious diseases. Each patient admitted with a contagious disease was identified by a 3 by 5 inch register card, on which appeared his name, rank, organization, initial diagnosis, date of admission, number of ward, white blood-cell count, and date of discharge. These cards were filed alpha- betically by name; and were modified as to change of diagnosis, additional diagnosis, transfer, and discharge, thus maintaining an up-to-date record of all current cases as well as a dead file exhibiting all contagious diseases treated at the hospital. The form was prepared by a ward surgeon of contagious- disease wards; and was delivered daily to the officer in charge of contagious diseases, together with diagnosis cards; and in the office of that officer these reports were consolidated, the index file was brought up to date, and the correct report was delivered to the registrar. 228 MILITARY HOSPITALS IN THE UNITED STATES. [Form No. 31 BHCG.] Report op Contagious Diseases. Instructions: This report is to be submitted to the registrar before noon daily for all contagious patients admitted to this ward the last 24 hours. Also for additional diagnosis if of a contagious nature. The case to be reported upon but once for any given disease. Front page of history (55a) furnishes all information except diagnosis. Report upon the following diseases: Pneumonia, influenza, measles, scarlet fever, mumps, meningitis, diphtheria, smallpox, chicken-pox, whooping cough, and typhoid fever. Ward No Name. Rani. Organization. Race. Barracks number. Diagnosis. 1 1 Upon the return of large numbers of officers from overseas, it was found that many of them were convalescent and then condition did not warrant handling them as ward patients. Therefore, quarters were provided these convalescent officers, at a considerable distance from the officers' - ward and the convalescents quartered therein; and they were placed upon a status equivalent to that of an officer on duty, with nothing to do, however, but to report daily for treatment or examination. For the information of the commanding officer, the name, rank, and organization of each officer was reported daily on the form shown below. Daily Report op Officers in Officers’ Ward Annex. 191 Instructions: This report will be prepared daily and sent to the adjutant for the information of the commanding officer before noon. Only officers actually occupying rooms in the officers’ ward annex will be included. (This will include those absent on leave less than 48 hours, but will not include those absent for a longer period.) Room number. Name. Rank. Organization. Remarks. (Rani, i TFartf Master. (Name.) TYPES OF HOSPITALS BASE HOSPITAL. 229 The large number of inexperienced medical officers on duty in the hospital soon resulted in a tendency for patients to remain in hospital longer than was necessary. In order to check this, all patients who had been in hospital for 30 days or more were reported to the commanding officer on the last day of each month, on the form shown. This method had a decided influence in pre- venting patients from becoming fixtures in hospitals. [Form No. 6 BHCG.] Monthly Ward Report. (To be rendered by each ward on the last day of the month, giving by name, rank, and organi- zation, every patient who has been in hospital 30 days or more. The date of admission to hospital as shown on the front sheet of the history, the diagnosis, degree of improvement and signature of the ward surgeon to be shown.) Name, rank, and organization. Date of admission. Diagnosis and improvement. Ward Surgeon. In the receiving office an envelope was used wherein to place a patient’s money, trinkets, and other valuables. A copy of the receipt furnished the patient was filed in the envelope. This receipt was a copy of the patient’s clothing card. The patient’s name, rank, organization, and serial number were noted on the envelope. The receiving officer, at designated times, took the envelope and clothing cards to the registrar where they were checked. Special drawers were constructed in the registrar’s office for the filing of these envelopes by register number. After the patient had received his valuables, his name, rank, etc., were erased and the envelope returned to the receiving officer, to be used again. This system worked very satisfactorily and required no revision. DEMOBILIZATION FORMS. With the beginning of demobilization it was found that many of the requirements could be met by the use of forms devised locally, particularly in the classification of applications for discharge and in the making of certain required certificates and affidavits. At the time of the signing of the armistice, there were on duty at this hospital 947 enlisted men of the Medical Department, of whom all but one were drafted men, members of the enlisted Medical Reserve on active duty, or those who had enlisted for the period of the emergency. In general, the point of view assumed by these enlisted men was that the tune of war ceased with the signing of the armistice. At this time the hospital had not fully recovered from the shock of the influenza epidemic, and the enlisted strength of the com- mand was none too great for the necessary work remaining to be done. De- mobilization instructions began to be received from the War Department, which, particularly Circular No. 77, War Department, 1918, with its various 230 MILITARY HOSPITALS IN THE UNITED STATES. amendments, offered a means of release from the military service to men who submitted claims properly substantiated. These claims immediately began to appear. The requirement was then announced by the commanding officer that two affidavits from responsible parties, uninterested, must accompany each claim. A conscientious effort was made to place the proper recom- mendations on each application, for the information of the commanding general. Approximately 200 applications being received and forwarded, it became evident that some means of classification would be necessary in order to secure justice to worthy applicants for discharge and at the same time to maintain a sufficient personnel for the effective operation of the hospital. A classification of the entire enlisted detachment was made, determining and recording the relative merits of every claim for discharge. A form was devised entitled “Personal preference card,” which was printed on blue stock. This card was filled out by the soldier and sworn to before a summary court officer. It was carefully explained to the men that their services were urgently needed and appeals were made to their patriotism and sense of duty to indicate as late a date for discharge as they possibly could. In a great majority of instances a fine spirit of cooperation was manifested. The blue cards, having been completed, were filed alphabetically by name. For each blue card a 3 by 5 inch index card was prepared, giving the soldier’s name, rank, duty, and date of discharge requested by him. These cards were filed by dates, beginning with the earliest date when discharge was desired. Proceeding through the entire detachment as rapidly as possible, each soldier was interviewed by a board of officers who made an effort to determine the merits of each claim. The following classification was then adopted : Immediate discharge; dates definitely specified; dependency claims, class B; dependency claims, class C; industrial claims, class A; indus- trial claims, class B; industrial claims, class C; educational clahns; and valid claims for discharge. PERSONAL PREFERENCE CARD. TYPES OF HOSPITALS — BASE HOSPITAL. 231 be 0 0 & 0 73 a b*"> £ & 73 ^0 J 3 § h-1 & o b- c3 w £ o o o >>£ w »W) •cS-g §°£ °as . ■£ © S I'S'S’E § +2 ® © G w <1 S3 I C3 o rd O >> a a § £ a -g C^~ a o o _CQ >r 3 *-M o3 £h 0 O * o HH ^ m O l-H .3 £ o b^< © O £ & O o b- c3 3 be a •p II be ■rH OJD ^ S C 'S r* rn C$ u> © b* c3 Ph O a a a 2 cc 232 MILITARY HOSPITALS IN THE UNITED STATES. DEATH RECORDS. The following five sample forms were devised for use in keeping the death records. Form No. 233 BHCG.] U. S. Army Base Hospital, Camp Grant, III. Case number (Deach check sheet, deaths in hospital only.) 1 . 2 . (Name.) (Rank.) (Diagnosis) was not due to the soldier’s own misconduct. 3. Seriously ill telegram sent? Yes? No? Copy attached? Yes? No? 4. Death telegram sent? Yes? No? Copy attached? Yes? No? 5. Were remains claimed? Yes? No? If ‘ ‘Yes,” by whom (Name.) 191.. (Date of death.) (Organization.) in line of duty (no, yes) death was or (Address.) If not, what disposition made 6. Was report sent to commanding officer? Yes? No? (Par. 162J as amended.) 7. Was report sent to camp quartermaster? Yes? No? 8. Death certificate to undertaker? Yes? No? (Copy attached? Yes? No?) 9. Was an autopsy held? Yes? No? (Copy attached? Yes? No?) 10. Collection of effects from — Adjutant. Ward. Clothing room. Discharge office. By whom receipted for 11. Report of inspection of remains by medical officer attached? 12. Report of undertaker attached? 13. Report of chaplain or religious services attached? 14. Was death due to natural causes? Yes? No? If not, is report of board of officers attached? Yes? No? 15. Case closed 191.. 16. No. of inclosures Sgn (Name.) TYPES OF HOSPITALS — BASE HOSPITAL. 233 [Form No. 10 BHCG.] Notification of Seriously III Patient in Hospital. (This form to be filled in and immediately sent to the adj utant as soon as a patient becomes seri- ously ill; that is, if the patient is more apt to die than to recover. The ward surgeon will be held responsible for this report between the hours of 8 a. m. and 4 p. m. and the officer of the day be- tween the hours of 4 p. m. and 8 a. m. Ward surgeons will notify the 0. D. of the seriously ill patients in their wards before going off duty.) Reg. No Hour m. Date 1918. (Surname.) (Christian name.) (Rank.) (Co.) (Organization.) Name of nearest relative Exact address Clinical diagnosis Name of messenger M. R. C. Received by the adjutant at Relative notified at By Remarks , Adjutant. Headquarters, U. S. Army Base Hospital, Camp Grant, Rockford, III From: The commanding officer, base hospital. To: The commanding officer. Subject: Report of death of enlisted man. 1. The death of . is reported. Cause of death 2. Death occurred at this hospital at His remains are with , undertakers, Rockford, Illinois. Your attention is invited to paragraph 83^ A. R., C. A. R. 77, 1918, and the 112th A. W. 3. The designated relative has been notified by wire, rquesting disposition of remains. 4. You are requested to have your summary court officer call on the summary court officer, base hospital, to collect and receipt for the effects of this soldier. 5. In compliance with orders of the commanding general, 86th Division, May 6, 1918, the following is offered for your information and guidance: “A presentable uniform will be provided in each case. It is not believed that this calls for a new uniform in each case. If the soldier's uniform is in pretty good condition, it should be used in lieu of a new uniform, being properly pressed, if necessary. If the man's uniform is not in good condition, a new one should be seemed, but by reason of the present large demand for uniforms, etc., care should be taken to conserve the supply in this manner as much as possible. 6. Instructions from the War Department, June 4, 1918, provide that — “The articles of uni- form to be furnished deceased soldiers under the provision of paragraph 37, A. R., as amended by telegram (722.2 Misc. Div.) Office of The Adjutant General, March 9, 1918, shall consist of the following: One cotton or woolen, 0. D.; one pair breeches, cotton or woolen, 0. D.; one pair drawers, cotton or woolen; one undershirt, cotton or woolen; one pair stockings, cotton or woolen; one collar, white.” 7. It is requested that this matter be expedited so that the remains may be shipped. Lieut. Colonel, Medical Corps, U. S. A. (2 copies to camp Q. M.) 234 MILITARY HOSPITALS IN THE UNITED STATES. [Form No. 11 BHCG.] Certificate of Undertaker for Deceased Soldiers. Date , 1918. This is to certify that (Name in full.) formerly a of (Rank.) (Organization.) has been properly embalmed at our undertaking establishment in Rockford, 111., that the vessels of the head were or were not (erase words not needed) properly injected, that the remains were properly clothed (complete suit of underwear, socks, blouse, breeches, O. D. shirt, leggings, shoes, collar ornaments) furnished by the soldier's commanding officer. The remains were shipped to (Street address.) (City.) (State.) Did relatives view remains? Name of relative Remarks made by relatives Date and hour of shipment via Railroad. Contract Undertakers for the Government. [Form No. l(i BHCG.] Record of Funeral Services. (Chaplain, Base Hospital.) Funeral services were held over the remains of the late at m. (Name.) (Rank.) (Organization.) (Time.) (Place.) The relations were (not) present. This soldier died of at m., (Time.) (Rank.) COLORED PATIENTS. Before any colored troops were assigned to Camp Grant, the commanding general assembled all unit commanders and instructed them to treat all soldiers alike irrespective of color. He stated that the colored men were drafted for the same purpose as the white men and officially no distinction was to be shown. All unit commanders assembled their commands in turn and imparted to them these instructions. In the hospital, colored patients were placed in the same wards with the whites; there was a common dining room; and they were freely allowed the use of the exchange. Not an instance of racial friction was reported as having occurred between patients in the hospital. During the spring of 1918, general instructions were received from the Surgeon General to classify the patients in hospitals in accordance with their race and to place the colored patients in separate wards. No friction had arisen and the hospital was comfortably filled with patients. A segregation would have necessitated twice the ward space being used. In view of the fact that no trouble had arisen and that there was inadequate space to prop- erly segregate the patients, the old plan was continued. TYPES OF HOSPITALS BASE HOSPITAL. 235 CORRELATION OF OFFICES AND RECORDS. Receiving office, discharge office (office of the registrar), ward, informa- tion bureau, clothing room: All patients were admitted through the receiving ward, and each was accompanied by a request from his organization surgeon for admission. This request had a tentative diagnosis, the name, rank, organ- ization, barrack number, and sometimes the serial number of the patient. All patients were brought to the hospital by ambulances, obtained either from the ambulance company or the hospital. RECEIVING OFFICE. Forms 55 a, 55/ (the transfer diagnosis) three copies of the patient’s clothing card, the receipt for a patient’s valuables, and one blotter sheet were prepared in this office. The ward to which the patient was to be assigned Fig. 83.— Receiving office, Base Hospital, Camp Grant. was designated. The patient was then conducted to his ward by the orderly, who took with him Forms 55 a and 55/ and one copy of the clothing card. This was the authority for the ward master to admit the patient. The clothing card showed all articles of uniform the patient then had in his possession. The patient retained the receipt for his valuables. The clothing cards, 55a, blotter sheet, and receipt for valuables were num- bered by means of a duplex numbering machine, and in advance. The blotter sheet provided space for 31 admissions. Thirty-one sets of clothing cards, histories, and receipts were numbered in advance and kept intact, being used consecutively. After midnight the noncommissioned officer in charge of the receiving office made five consolidated copies of the day’s admissions, one for each of the following offices: Registrar, information bureau, chief educational officer, head medico-social aide, and receiving office (retained copy). At 9 a. m. the following morning, the receiving officer took the money, valuables, and trinkets to the discharge officer (registrar), with 236 MILITARY HOSPITALS IN THE UNITED STATES. two copies of the clothing card. These cards listed the valuables, etc. The registrar checked the lists, and if they were found correct he receipted for them on one copy of the card. This card was held by the receiving officer as his receipt. The third copy of the clothing card was filed with the patient’s valuables in the registrar’s safe. WARD. The patient was received and his clothing was checked against the clothing card. The clothing was then returned to the patient’s clothing room with the property tag attached, a duplicate of which was retained by the patient. The clothing was accompanied by the property card, which was again checked by the noncommissioned officer in charge of the clothing room, the card then being returned to the ward by the messenger and attached to the patient’s history. The other Forms 55 were added to the patient’s history in the ward. Xo Forms 55 a were allowed in the wards, as a safeguard against patients being admitted directly to the ward. If a history was seen without Form 55 a there was an immediate investigation. The authority for discharging the patient was with the ward surgeon. When the lower half of Form 55 a was completed by the ward surgeon, it was then the duty of the ward master to get the patient out of the hospital. The signed history and property card were taken to the clothing room by the ward master and the clothing of the patient was obtained. The history was taken to the registrar. The ward master assembled his patients for discharge and took them to the registrar at 1 p. m. The patients were checked out by the histories. Their clothing and valuables were checked by the third copy of the clothing card on which the patient receipted for them to the registrar. After all patients were dis- charged, the registrar made five consolidated lists of discharges, one copy for each of the following offices: Information bureau, chief educational officer, head medico-social aide, receiving office, and the registrar’s office (retained copy). A wall board was kept in the receiving office. On this board there was a row of cards for each ward; and each row was provided a card for each bed in the ward. The list of discharges was used in withdrawing cards from this board, of patients discharged, and the blank spaces, therefore, indicated empty beds. REGISTRAR. The registrar received the blotter sheet daily from the receiving office at 9 a. m. This sheet gave the necessary data for starting Form 52 for each patient. The list of admissions from the receiving office was used as a check. The valuables and clothing cards were also received at 9 a. m., and filed by register number in a safe, especially built for this purpose. This safe was kept in a strong room. The patient’s register card was prepared from the blotter sheet and filed. All patients were discharged through the registrar’s office on Form 52, completed from the history and diagnosis cards. The consolidated list of discharges was furnished the information bureau. THE INFORMATION BUREAU. The admission sheets were received from the receiving office; and when possible, the noncommissioned officer in charge of the receiving office at night prepared a card index for each patient admitted, showing the name. rank. TYPES OF HOSPITALS BASE HOSPITAL. 237 organization, and ward to which assigned. If these cards were not prepared in the receiving office, they were prepared in the information bureau and filed alphabetically. The discharge office furnished a daily list showing all discharges. The cards were then withdrawn and placed in a dead file where they were held for 10 days and then destroyed. Patients were transferred from ward to ward only upon request of the ward surgeon and after approval of the chiefs of services concerned. When this transfer was completed, the ward master would take the request for transfer to the information bureau and the patient’s ward number was changed accordingly. The request for transfer was then returned to the ward and filed with the history. Two telephones were installed in the information bureau, one for incoming calls and one for outgoing calls. When calls were received the patient was located, his ward called, the necessary information obtained and given to the person calling, without it being made necessary to ring off. A great deal of emphasis was placed on each office explicitly carrying out these instructions. However, in spite of this, patients would occasionally get lost in the hospital. The plan was then adopted to re-check all patients in hospital semimonthly, so as to obtain their exact location. All forms of dis- position of patients were handled, as described, by discharge to duty. T his system was very satisfactory and enabled the receiving office, discharge office, information bureau, and all wards to keep informed as to the movement of patients. OFFICES OF THE MESS OFFICER, SERGEANT MAJOR, DETACHMENT COMMANDER, CHIEF NURSE, PERSONNEL OFFICER, COMMANDING OFFICER OF DETACH- MENT OF PATIENTS, RECEIVING OFFICER, AND REGISTRAR. This correlation is explained to show how the mess officer was kept informed, at all times, of data essential to checking his daily mess re- ceipts. The detachment office and personnel office would send daily a statement to the sergeant major exhibiting all changes in the enlisted per- sonnel — assignments, transfers, discharges, and sick. The chief nurse rendered a daily morning report to the sergeant major showing similar changes among the nurses or civilian personnel employed for the nurses. The personnel office reported to the sergeant major, likewise, changes for reconstruction aides, after the morning report from the chief educational officer had been received. The detachment of patients rendered a morning report for patients on furlough or on sick leave. The registrar furnished a list of discharges to the receiving office. This list was then classified according to officers, nurses, enlisted men, and civilians, added to the surgeon’s morning report and returned to the sergeant major. The sergeant major then made his report to the mess officer, showing the number of enlisted men, officers, nurses, and civilians employed in the hospital that day. The information also showed what civilian employees were entitled to rations and those civilians sick in hospital who were on either the enlisted or commissioned status. This enabled the mess officer to compute his income for that day. These details were necessarily accomplished by 9 a. m., and were checked by the commanding officer. 238 MILITARY HOSPITALS IN THE UNITED STATES. OFFICER OF THE DAY’S REPORT, SURGEON’S MORNING REPORT, BED REPORT, AND FIELD REPORT OF PATIENTS (FORM 83, M. D.) The old officer of the day reported at 9 a. m. daily, presenting in writing his report for the preceding 24 hours. On this report was shown the number of admissions, discharges, the number of civilians, byname, and the total number of patients in hospital. These figures were checked against the surgeon’s morning report, which was prepared under the sergeant major’s supervision, classified by organization. These two reports were checked against the bed report which showed the total number of patients in hospitals, by wards, prepared under the supervision of the receiving officer. The three reports were then checked against the patient’s field report (Form 83, M. D.), prepared by the registrar, and showing the total number of patients in hospital, by diseases. The four reports were checked by the commanding officer. A great deal of information was obtained by reading these reports and any errors in them were readily detected in the number and classification of patients. DEATH RECORDS. No patient was declared dead except by a medical officer. This officer then completed Form 55 a of the clinical history and prepared the death certificate in duplicate (one for fde). These records were immediately sent to the adjutant, who caused the death check to be started, giving this particular death the next serial number. The clinical chart was marked conspicuously in red pencil with this number, which was also placed on an adhesive strap fastened, under the supervision of the medical officer, around the deceased's left forearm, near the elbow joint. The strap showed, in addition to the num- ber, the patient’s name, rank, and organization. The remains were taken to the mortuary where the noncommissioned officer in charge entered in the mortuary book the information shown on the adhesive arm band. It was the duty of the adjutant to see that a ‘‘danger” telegram had pre- viously been sent and that the undertaker was immediately notified. A copy of the “danger” telegram was attached to the death check sheet. The fact of death was immediately reported to the deceased’s organization commander on a blank form used for that purpose. This form also included any necessary data for the organization commander. The following morning five complete and itemized lists of deaths were prepared, one copy each for the camp sur- geon, the attending surgeon in Rockford, the hospital chaplain, the chief of the laboratory, and one to be retained. The undertaker called for the remains, and reported to the adjutant, who gave him a copy of the death certificate. This certificate was the authority for the undertaker to receive the remains from the noncommissioned officer in charge of the mortuary. The undertaker receipted in the mortuary book for the remains, and that the remains were properly embalmed was certified to by the undertaker. When the remains were ready for shipment the undertaker notified the chaplain and the attend- ing surgeon in Rockford. The attending surgeon inspected the remains in accordance with regulations and submitted his written report of that fact. The chaplain held services, of which he submitted a written report. The chief TYPES OF HOSPITALS BASE HOSPITAL. 239 of the laboratory was informed in order that he might perform an autopsy, if advisable. All of the above-mentioned reports were returned to the adjutant and attached to the death check sheet, as was also the receipt for the patient’s valuables, in compliance with the one hundred and twelfth article of war. When shipping instructions were received from relatives, a copy was furnished headquarters, Camp Grant, where the necessary transportation was issued, as well as orders for an attendant when necessary. Copies of these proceedings were also attached to the death check sheet. When shipment had been made and all reports had been turned in, the entire proceedings were brought to the commanding officer for signature, after which they were filed with the patient’s chart. If an autopsy had been performed a report of this was also filed with the chart. By this means it was possible to double-check every action taken, and out of 1,304 deaths which occurred at this hospital but one serious error was made. This error was due to the fact that, during the influenza epidemic, among those who died were two enlsited men, one named Toney Mack and the other Mack Toney. Both bodies were shipped to the same address. The error was discovered, however, before the remains reached their destination and the shipment was stopped by telegram. The error was detected in the double-check system. DUTIES OF OFFICERS OF THE DAY AND ASSSISTANTS. Memorandum No. 35. Headquarters, Base Hospital, Camp Grant, Rockford, III., May 26, 1919. By direction of the commanding officer the tour of duty of the officer of the day is 24 hours, 9 a. m. to 9 a. m. He will report on duty and off duty to the commanding officer in person with a written report and his recommendations at 9 a. m. During his tour he will remain in touch with the telephone operator and the receiving office so that he can be located without delay. He will admit all patients to the hospital between the hours of 12 p. m. and 8.30 a. m. He will be responsible that patients are admitted to the proper wards, that their money, valuables, and trinkets are properly collected and receipted for and delivered to the registrar, and that patients receive the proper treatment after the ward surgeons are off duty. Civilians will not be admitted to this hospital without authority from the commanding officer except civilian employees of the Quartermaster Department who are suffering from injuries or extreme emergencies, and in either case the report of the officer of the day will give the details in full. A separate written report will be made for all civilians treated at this hospital who are not admitted, giving name, date, circumstances, diagnosis, and treatment. No charges will be entered against any patient, except the hospital charges under Army Regulations, and no one will receive payment from the patients for services of any character. The officer of the day will inspect the hospital once between 6 p. m. and midnight and once be- tween midnight and 6 a. m. At each inspection he will satisfy himself that the night guards are properly performing their duties, that all unauthorized lights are extinguished at 9 p. m. and that the hospital is quiet and orderly. He will visit all wards and satisfy himself that all patients are receiving the necessary treatment and that the ward attendants are properly performing their duties. At each inspection he will check the patients in the detention ward and verify the pres- ence by observation of every prisoner in the hospital. He will inspect at least two meals a day in all kitchens except nurses’ quarters and officers’ mess (officers on duty). Any medicine or property issue urgently required for the cure and treatment of the sick after the ward surgeons are off duty will be signed by the officer of the day, entering the word “emer- gency ” over his signature. 240 MILITARY HOSPITALS IIST THE UNITED STATES. The adjutant will be notified of all seriously ill patients that have not been previously reported, and all deaths, giving the name of patient, his organization, and name and address of his nearest relative in order that the required telegrams may be sent. The remains will be labeled by placing a strip of adhesive plaster 1 inch wide around the middle of the left forearm, giving the full name, rank, and organization, and promptly removed to the morgue and placed in the morgue refrigerator. The officer of the day or ward surgeon will see all patients before death if possible; otherwise, immediately after death. A report of death will not be accepted from nurses. Interchange of a part of a tour of duty between officers is prohibited, but officers may change entire tours by notifying the adjutant the day before the tour commences. At the termination of his tour, the officer of the day will enter on his report any untoward events which have happened, sign this report, along with signature of new officer of the day, and present it in the proper manner to the commanding officer. In addition to the officer of the day there will be a medical and surgical officer of the day detailed by the chief of their respective services. These officers will report to the officer of the day at 7 p. m. in the receiving ward, and the report of the officer of the day will give the names of these officers. The duties of these professional officers of the day will be to attend the sick in their respective services between the hours of 7 p. m. and 8.30 a. m. They will make at least two rounds during their tour of duty, visiting all wards in their service, give the necessary emer- gency treatment, and assure themselves that the attendants are awake and on duty, and that the patients are receiving the proper care. Any neglect in the care of patients or other factor worthy of note is to be reported to the officer of the day, who will incorporate it in his report. These officers will remain in touch with the receiving office at all times during their tour so they can be located without delay, and will sleep in the receiving ward. These officers will not remain in their permanent quarters while on duty. Any unnecessary delay in being able to locate any one of these three officers will be taken as a neglect of duty on the part of the officer in not keeping the receiving office properly informed. In case of fire or fire drill the officer of the day is directed to report at the scene of the fire and take charge of the Government property. He will order the necessary number of soldiers who may be standing around to guard the property. In case of fire drill he is to report to the fire marshal. All orders issued prior to this date that are contradictory to this order are hereby rescinded. By order of . FIRE PREVENTION AND FIRE DRILL ORDERS. General order No. 6. Headquarters, Base Hospital, Camp Grant, Rockford, III., May 26, l r >}8. For purposes of instruction, fire prevention, and fire fighting at the base hospital units, this unit is divided into eight zones, as follows: Zonel . — Including nurses' quarters, A, C, and D; officers' quarters, wards 11, 12, 13, 21, 22, 23, 24; commanding officers' quarters, administration building, laboratory, operating room, and receiving ward. Zone 2 . — Including officers’ ward, eye, ear, nose, and throat building, wards 31, 32, 33, 34, 41, 42, 43, 44, and Red Cross building. Zone 3 . — Including wards 15, 16, 17, 18, 25, 26, 27, 28, general mess hall, kitchen, and guardhouse. Zone 4 ■ — Including wards 35, 36, 37, 38, 45, 46, 47, and 48. Zone 5 . — Those buildings north of the first line of wards, including wards A. B. C, E. F, G, and H, psychopathic ward, morgue, chapel, power house, nurses' annex, nurses quarters B. E. and F, and base hospital barn. Zone 6 . — That part of the base hospital unit east of Kishvaukee Road, including the detach- ment mess and kitchen, barracks, and lavatories, medical supply depot warehouses, shops, laun- dry, and garage. Zone 7. — Including wards 51, 52, 53, and 54. Zone 8 . — Including wards 55, 56, 57, and 58. The zones will be designated by sounding fire call, followed by 1, 2, 3, 4, 5, 6, 7, or S blasts, indicating the proper zone. This to be repeated as long as necessary. TYPES OF HOSPITALS BASE HOSPITAL. 241 The noncommissioned officer in charge of the detachment will take charge of the hose cart located near the power house. The recruiting sergeant will take charge of the hose cart located south of ward 46. The senior noncommissioned officer in the sergeant major’s office will take charge of the hose cart immediately in front of the administration building. The detachment commander will detail 10 men to report to each of the above noncommis- sioned officers to handle the above hose carts. When fire is discovered it will be immediately reported to the telephone operator, who will report it to the central fire station, Camp Grant, 175; he will also notify the fire marshal of the base hospital, the officer of the day, the commanding officer, the adjutant, and the detachment office. One male nurse will remain in each ward, all others reporting to the fire marshal at the scene of the fire, bringing with him a pail of water. The operating room force will immediately repair to the operating room and prepare for an emergency. All available men from the dining room, kitchen police, all men of the outside police section, casual section, and of the quartermaster section, will report to the fire marshal at the scene of the fire. The officer of the day will report at the scene of the fire, obtain a detail from the men available, and guard all Gov- ernment property. The officer in charge of the laboratory will keep two litters in the laboratory and detail four litter bearers to report to the officer of the day at the scene of the fire to handle such cases as may be necessary. W T ard surgeons and the necessary administrative officers will report at their respective places of assignment and maintain order. Fire extinguishers and fire buckets are in the various buildings of tliis hospital and everyone is expected to use every possible means to extinguish a fire as soon as it is discovered: the use of fire buckets for any other purpose than fighting fire is prohibited, and the officers in charge of the various buildings where these are located will be held responsible that these buckets are kept filled with water and used only for the fighting of fire. When fire is discovered and the alarm given, the various details ■will procure their fire apparatus and report to the fire marshal at the scene of the fire. The various noncommissioned officers will familiarize themselves with the location of all of the fire plugs of the base hospital unit so that there will be no delay in finding these plugs. G. 0. No. 7, headquarters, Base Hospital, Camp Grant, 111., dated December 25, 1917, is rescinded. By order of . HOSPITAL DEPARTMENTS. MEDICAL SERVICE. During the first year in the history of the hospital, the great problem was the control and treatment of contagious diseases. Of these infectious diseases, measles was the most difficult to deal with, though streptococcus pneumonia complicated the measles in only a small proportion of cases. Mumps assumed considerable proportions because of the increase in the noneffective rate; but contagious diseases in general did not assume alarming figures in this camp during the first year. The medical service from the first was well organized, and it was changed in no essential afterwards. It was here that the mask and the cubicle system of curtaining the beds were first used; and it was also on the recommendation of the first chief of the medical service that patients were masked when sent from camp infirmaries to the hospital. This system of masking was extended, by instructions from the Surgeon General’s Office, to all hospitals in this country. Following in the wake of the outbreaks at Camp Devens, the Great Lakes, and other camps, Camp Grant was visited by the so-called Spanish influenza in an explosive manner Saturday, September 21, 1918. So sudden and appall- ing was this visitation that it required the greatest energy and cooperation of every officer, every man, and every nurse to meet the emergency. Up to that 45269°— 23 16 242 MILITARY HOSPITALS IN THE UNITED STATES. time the 12 ward barracks were occupied as quarters and storehouses, and 12 wards of the main part of the hospital were empty. It was obvious that the epi- demic was on hand and that great effort would have to be made to provide sufficient bed space. Therefore, all two-story ward barracks were vacated and every available officer, nurse, and enlisted man was called upon. On Sunday, September 22, 1918, the admissions to hospital numbered 194. The main portion of the hospital was made ready for occupancy, increasing the available beds to 1,318. The total number of patients in hospital was 836. On the following day the admissions to the hospital were 370, making a total of 1,159. Telegrams were then sent to all officers on leave to return without delay. Every effort was put forth to open all two-story ward barracks, and by night- fall six of these buildings were completely equipped for 480 patients. Property meetings were held among the various executive departments of the hospital, the camp medical supply officer and his assistants, as well as the local director of the American Red Cross. Immediate steps were taken to obtain more property. Tuesday, September 24, admissions were 494. SLx additional beds were added to every influenza ward and two convalescent barracks were completely equipped. On the following day the admissions were 711. Patients were placed in corridors 2, 3, and 4. A property meeting was held, and, because of the emergency, the camp medical supply officer sent his assistant to Chicago to expedite shipments of supplies. One thousand units of mess equipment were ordered by the mess officer, and the Red Cross placed an order in Chicago for 6,000 sheets and other supplies. On Thursday, September 26, there were 607 admissions, making a total in hospital of 2,598. Up to this time there had been three deaths from the disease. The detachment, Medical Department, moved out of its barracks into tents, and these barracks, the exchange, and the corridors were made into a 500-bed hospital. Evacuation Hospital No. 37 turned over its entire personnel to the hos- pital; the depot brigade furnished 250 men as laborers; beds were set up and bedding sacks stuffed with straw; and quartermaster property was used entirely to enlarge the hospital over 1,800 beds. Officers, nurses, and enlisted men were sick in the hospital. Four carloads of medical supplies were received by express, and about 30 motor vehicles were put into use handling the heavy supplies. The receiving office was overtaxed but found to be handling the patients very satisfactorily. The Red Cross took over the handling of the patients’ money. The depot brigade cared for patients also. Approxi- mately 300 patients were sick in the infirmaries. Tent floors, Sibley stoves, and electric lights were supplied the tents occupied by the enlisted men of the hospital detachment. The clothing room becoming overtaxed, the patients’ clothing was checked, bundled, and placed under the heads of the patients beds. The mules of the animal-drawn ambulances became exhausted, and Quar- termaster trucks and private motor vehicles were called into use. Seventy-five enlisted men from the depot brigade were attached to the base hospital, but many of these men were sick upon arrival. The registrar's office was moved to the ward room (officers’ ward), and the entire receiving ward was turned TYPES OF HOSPITALS BASE HOSPITAL. 243 over to the receiving officer. Patients who were discharged were sent with a request to their commanding officer that they be relieved from duty for one week; and, because of the weakened condition of the patients, they were not allowed to walk to their barracks. The number of nurses was inadequate, and the Red Cross transferred 25 from Chicago and surrounding points. On Friday, September 27, 1918, the admissions were 671; total patients in hospital 2,936; deaths, 3. Because of the cold nights and threatening weather, it was considered a risk to place patients on the various verandas without inclosures, so the constructing quartermaster was called upon for assistance. He furnished 50 carpenters, and the utilities department furnished a like number. With their cooperation, 39 verandas were inclosed with roofing paper and muslin, and 800 beds were placed on them and made ready for occupancy. The War Relief Committee was called upon to make sputum cups, thus relieving nurses of this work; and the school for bakers and cooks was requested to furnish 14 cooks. On Sunday, September 29, 1918, the admissions to the hospital numbered 788; the patients then in hospital numbered 3,346; deaths, 6. Nine barrack buildings of the sanitary train were turned over to the hospital for hospital purposes. Barracks 827-N was fully equipped for 126 patients, and all mumps cases were transferred thereto from the main part of the hospital. A kitchen was started in this building, and all mumps patients were subsisted there. The heavy equipment was placed in six other barrack buildings in preparation for further expansion. A check was made of the hospital, and all wards were furnished with additional hospital property, principally linen, as a working surplus. Two hundred and sixty additional enlisted men were attached to the hospital; the others from the depot brigade, as well as officers, nurses, and enlisted men, were showing marked fatigue at that time. There were 4 med- ical officers, 45 nurses, and 63 enlisted men of the base hospital detachment sick, principally with influenza. By extreme effort on the part of all concerned, and using all means to obtain property, the hospital was expanded from 610 occupied beds to a capac- ity of 4,102 beds within a period of six days. The American Red Cross opened an emergency canteen service in the Red Cross house from which to serve light lunches and hot coffee to officers, nurses, and enlisted men of the base hospital. On Monday, September 30, 1918, there were 6S3 admissions to the hospital; 490 patients discharged; and 8 deaths. The total number of patients in hos- pital was 3,546. During the day 160 beds were added to the various verandas of the influenza wards, thereby increasing the hospital bed capacity to 4,381, and two additional barracks of the sanitary train were fully equipped as wards, making three barracks in that area available for patients. Patients in hospital, plus personnel on duty (including those attached) , brought the total population of the base hospital up to approximately 11 per cent of the entire camp. The main kitchen served the major portion of these and during the day prepared 2,780 liquid diets and between 1,500 and 2,000 regular diets. As the number of persons becoming sick was increasing, all those on duty at the hospital were advised to take advantage of every oppor- 244 MILITARY HOSPITALS IN THE UNITED STATES. tunity, when off duty, to take light exercise in the open, or rest or relaxation. On this date there were 5 officers, 51 nurses, and about 100 enlisted men on sick report. In the event ward men were left on duty for more than 12 hours a day, they were instructed to call the detachment commander and inform him accordingly, as occasionally this detail was overlooked during the rapid expansion of the hospital. The nursing force of the wards was extremely inadequate. However, every nurse and available man was assigned. In order to help the situation, a service corps was organized and divided into eight sections; and a student nurse was placed in charge of each section, with 6 men as her assistants. The hospital was divided into eight areas, a service section being assigned to each area. The principal duties of these sections were to assist the ward per- sonnel by policing the ward and doing the heavy work. Their hours of duty were from 7.30 a. m. to 5.30 p. m. Tuesday, October 1 , 1918, 561 patients were admitted to the hospital; 496 were discharged, making a total in hospital of 3,601. There were 14 deaths. All deaths were due to pneumonia following influenza (clinical). The admis- sions to the hospital had diminished approximately 100 daily for the preceding three days. To keep relatives of patients ill in hospital informed as to the condition of the patients, “ danger” telegrams were sent out at regular intervals. On Wednesday, October 2, 1918, the admissions were 412, discharges 426, total number in hospital 3,587. There were 30 deaths that day, due to pneu- monia, all following clinical influenza. The number of admissions was smaller than during the previous day, but the patients admitted were more seriously ill, and a major number of litter cases was among them. The number of pneu- monia complications rapidly increased; nine wards were filled with this type of disease. Local undertakers were unable to cope with the situation, their capacity being estimated at 13 to 15 bodies a day. Inspection of their establishment revealed 25 untouched bodies at 5 p. m., while 47 remained in the mortuary at the base hospital. Their establishment was in confusion and was not being systematically managed; so two soldiers (embalm ers) were sent to their assist- ance to work under a sergeant of the base hospital detachment, an experienced embalmer. Five more soldiers and a clerk were asked for. Great confusion in the records of the information bureau resulted from many transfers of patients in and about the hospital without the information bureau being properly notified. A consultation was held and it was decided that, generally speaking, pneumonia patients would be as well cared for in influenza wards as they would be if transferred to pneumonia wards. One ambulance and three wheel litters and a motor truck, together with many men, had been in use an entire day in transferring pneumonia patients to pneumonia wards. On Thursday, October 3, 525 patients were admitted to the hospital; 4S2 were discharged; total remaining in hospital, 3,659. There were 42 deaths due to pneumonia following influenza. There was a slight increase in the number of cases admitted and a large increase in the death rate. Patients admitted to the hospital were more critically ill than before; there were more litter cases admitted; and more patients were developing pneumonia throughout the TYPES OF HOSPITALS BASE HOSPITAL. 245 hospital than had been the rule. Approximately 40 nurses arrived for the emergency, and telegraphic notice was received that a like number would arrive in the near future. The ladies of Chicago volunteered their services in large numbers. The services of these ladies were used for filling capsules, work at the information bureau, the preparation of paper cups, clerical work in the wards (transferring temperatures from memoranda to clinical records), and in the supervision of the Red Cross canteen. The number of visitors, relatives who had been summoned by “danger” or “death” telegrams, greatly increased. The ward personnel was instructed to show these visitors every consideration during their moments of deep dis- tress. Authority was received to employ civilian nurses, and, as they were sadly needed, a great many were employed. There were 438 telegrams sent out and received by the hospital on this day; and as the telephone lines were swamped a letter was written to the com- manding officer, Camp Grant, recommending additional lines. From 400 to 500 telegrams were sent and received daily. The establishment of an emer- gency telegraph office was recommended. All the undertakers of Rockford were called into a conference, at which each agreed to take his share of the base hospital work at 850, the contract price. There were at that time 49 bodies in the mortuary and about 30 in Rockford untouched. Each undertaker took his capacity, which was from 3 to 10 bodies, and after all had their establishments filled there were about, 30 bodies left in the hospital mortuary. It was obvious that something had to be done in the way of organization and increased capacity. The president of the Western Casket Co., of Chicago, was requested to come to Camp Grant for consultation and assistance. On Friday, October 4, the admissions to hospital numbered 437 ; discharges, 520; and deaths, 76 — all due to pneumonia. The total number of patients in hospital was now approximately 3,396. There was a decrease of approxi- mately 100 patients admitted to hospital, but the condition of those admitted was of a more serious nature. The exact hour of death, to the minute, had to be given on the clinical record, and ward surgeons were instructed to see that this information was placed on all clinical histories before they were sent to the office. The handling of the effects of the deceased grew into an enormous burden. To meet this emergency, an Infantry officer was attached to the base hospital on this date to handle all patients’ clothing, valuables, trinkets, etc. His office was established in the clothing room of the receiving ward, and to him company commanders had to report in order to obtain, and receipt for, the effects of the deceased. The procuring of transportation for remains developed into a large and important problem. A sergeant of the Quartermaster Corps was placed in charge of the transportation for remains as well as the clearing of the same from the hospital mortuary. His office was located in the administration building of the hospital, and all inquiries relative to the shipment or location of a body were referred to him. The president of the Western Casket Co. arrived, on this date, with a num- ber of embalmers. He consulted with the local undertakers, and by evening a 246 MILITARY HOSPITALS IN THE UNITED STATES. building had been secured which satisfactorily cared for the situation. Ar- rangements were made whereby local undertakers were to transport the bodies. Three trucks, without tops or sides, were furnished for this purpose, but these were rejected and Army trucks were used, with an officer of the Quartermaster Corps in charge. By midnight the mortuary was empty, although there had been 103 bodies during the day. On Saturday, October 5, 1918, there were 439 admissions, 328 discharges, and 102 deaths, all of the latter due to pneumonia, and the total number of patients in hospital was 3,579. The admission rate remained practically at this level for several days. The mortality rate having increased steadily from the first week of the epidemic, it was thought probable that the apex had not yet been reached. There was no known specific treatment for this disease and no known abso- lute prevention. Therefore, the following memorandum was issued: ‘‘The wearing of masks and gowns, frequent washing of the hands, and avoiding put- ting the hands in mouth or nose are very important. Persons must avoid crowding whether on duty or not, and all officers, nurses, and enlisted men shoidd use every effort to avoid this. Fatigue plays a very important part in rendering one susceptible to sickness and should be avoided as much as possible.” A sufficient number of nurses arrived under orders, together with an ade- quate number of enlisted men. There being a division of responsibility be- tween the service corps and the ward men, the wards were not sufficiently policed. The service corps was then abandoned. The embalming problem was solved through untiring effort. On Sunday, October 6, the admissions numbered 370; discharges, 430; deaths, 99 — all due to pneumonia. The total number of patients in hospital was 3,420. During the day the head house was equipped and opened as nurses’ quarters. The eye department was moved to the former electrother- apeutie room; the ear, nose, and throat department was moved into operating room No. 3; and the recruiting office was moved into the hallway of the dental department. There were now 370 nurses (including student nurses) and these were quartered in the Red Cross house and barracks 1029-N, as well as in the head house and in the regular nurses’ quarters. The death rate reached its highest point October 6, when 116 deaths were recorded. The city mortuary was overtaxed, leaving 20 bodies at the base hospital at 8 p. m. The number of visitors increased until thousands of persons called upon the information bureau daily for various kinds of information. During a day several thousand telephone calls were answered and sent and 768 telegrams received and sent out. The space was inadequate, and in order to meet the demand a hospital ward tent was erected, floored, and wired with drop lights. Three tele- phones were installed, desks conveniently arranged, seats provided for visitors, emergency beds placed for persons who might need them, cloak and coat hooks provided, and stoves installed. The new information bureau was conspicuously marked by signs, electric lights, and a Red Cross flag. An arc light was pro- vided and the parking area in the vicinity of the information bureau brilliantly illuminated. The tent communicated with the near-by corridor through which visitors were conducted to the various wards by Red Cross representatives, after TYPES OF HOSPITALS BASE HOSPITAL. 247 masks and gowns had been provided them. The index was transferred and only direct information to visitors was given, the clerical side of the information bureau being retained in its original place. On Monday, October 7, the admissions numbered 235; discharges, 301; deaths, 116; total patients in hospitals, approximately 3,238. The number of pneumonia cases increased until there were about 1,250 patients in the hospital suffering from this disease. Following a conference held among the medical men of the institution, it was decided to group pneumonia patients so that those acutely ill, coughing, and running high temperatures would be in one group, the convalescents in another group, and the intermediate cases in a third group. Transfers were made accordingly. The idea of the plan was to prevent reinfection of the convalescent patients. It was also decided that cubicle sheets extending to the foot of the bed both interfered with venti- lation and prevented the ward attendants from keeping a close watch on the patients; so, thereafter, cubicle sheets were so arranged as to extend from the wall to a point not beyond the patient’s waistline. There were several instances where mistakes were made in the addresses of the deceased. So far as known such errors were discovered before shipment of the remains. Case numbers were used on all records after death, including a numerical roster, alphabetical card index, death certificate, history, reports to the quartermaster and company commanders, the arm band, the check sheet, and telegrams. This proved of the greatest value. A list of the admis- sions was made, in triplicate, in the receiving office, one copy being sent to the chief of medical service, one to the camp surgeon, and one to the receiving office. The receiving office handled only the blotter sheet and the valuables of the patients. At the time Form 55 a was made, the register of patients’ card, No. 77, was made, with a carbon for the index and the discharge of the patient. The receiving office also prepared a discharge sheet in duplicate, one for the information bureau and one to be retained. On Tuesday, October 8, the admissions dropped to 195; 358 patients were discharged; and the total number in hospital was 2,957. There were 98 deaths, all due to pneumonia following influenza. The genera] improvement in the appearance of the hospital during the preceding 48 hours exhibited a better control and a nearer approach to the previous efficiency of the hospital organization. The extra beds were removed from the 30 rows of wards. There was every indication that the epidemic had reached its peak. On Wednesday, October 9, 133 patients were admitted, 268 were dis- charged, leaving a total in hospital of 2,782. There were 107 deaths, all due to pneumonia. As there were approximately 1,500 cases of pneumonia in the hospital, this death rate was not considered surprisingly high. During the early days of the epidemic, the increasing morbidity rate among the personnel was alarming. The civilian nurse personnel showed the highest percentage, and, of those sick, three died. There was great difficulty in getting these nurses to wear masks or gowns, or to carry out many other orders. The graduate nurses came next in number, on the sick list, and three of the Army nurses died. The detachment, Medical Department, had a very high sick rate. About 10 per cent were sick in hospital and the deaths were 12. The nurses, 248 MILITARY HOSPITALS 1ST THE UNITED STATES. Army School of Nursing, had the lowest sick rate, with but one death. This nurse was not in good health and appeared below normal on admission to the school. As the pupil nurses worked in the wards, on long hours, it was thought that the reasons for their low sick rate were strict adherence to carrying out orders pertaining to masks and gowns, their outdoor training before the epi- demic, and their physical condition in general. Eleven medical officers con- tracted influenza, but among them there were no deaths. Many of the emergency nurses did not render satisfactory service and caused considerable work and worry by expressing their desire to resign and go home. It was believed that the service would he better off without this class, and they were allowed to return, although some of them rendered less than one day’s service. The sick rate for the nurses continued high, and on October 8 there were 71 off duty out of 400, while of 1,600 enlisted men on duty there were but 57 excused because of sickness. To this date 4 nurses and 12 enlisted men died; there were no deaths among the medical officers. On Thursday, October 10, 1918. 1 18 patients were admitted to the hospital; 214 were discharged; and the total number in hospital was 2,579. There were 77 deaths, all due to pneumonia. There was a noticeable improvement in the general condition of the epidemic during the previous 24 hours — there were fewer deaths, fewer admissions, and the patients as a whole seemed in better condition. On Friday, October 1 1 , 86 patients were admitted; 175 were discharged. There were 37 deaths, all due to pneumonia. One thousand five hundred pneumonia patients still remained in hospital. Every effort was made to furnish as much fresh air to patients during the epidemic as possible, as rest in bed and fresh ah', with ample water to drink, were believed to be the most important forms of treatment known at that time. On Saturday, October 12, the admissions numbered 99, discharges 112, and deaths 54, all due to pneumonia. The total number of patients in hos- pital was 2,391. The small number of patients discharged was due to the fact that convalescents were being held longer in hospital. Up to this time it had been necessary to discharge patients, as soon as possible, to infirmaries, because of the pressing need of beds. On Sunday, October 13, 85 patientswere admitted; 128 were discharged; deaths from pneumonia numbered 36; and the total number of patients in hospital was 2,331. There were 1,504 cases of pneumonia, 24 less than on the preceding day. The general appearance of the patients in hospital was greatly improved and the number of convalescents seen in the wards rapidly increased. On Monday, October 14, 40 patients were admitted; 124 were discharged; and there were 29 deaths due to pneumonia. Tuesday, October 15, 65 patients were admitted, 123 were discharged, and 20 died from pneumonia. The patients in hospital numbered 24 39. The two-story ward barracks were now standardized at SO beds each, and all Quarter- master property was removed and replaced by Medical Department property. On Wednesday, October 16, 95 patients were admitted and E5 were dis- charged. There were 22 deaths, one of which was due to scarlet fever, the remainder to pneumonia. TYPES OF HOSPITALS BASE HOSPITAL. 249 On Thursday, October 17, there were 67 admissions and 146 discharges; 1 0 patients died from pneumonia. The total number of cases of influenza, pneumonia, and deaths reported daily is tabulated below: Table 12. — Influenza and pneumonia statistics, Base Hospital, Camp Grant. III. Date. New cases of influ- enza. New cases of pneu- monia. Deaths. Date. New cases of influ- enza. New cases of pneu- monia. Deaths. 1918. 1918. Sept. 21... 70 0 0 Oct. 16 19 25 10 Sept. 22... 177 0 0 Oct. 17 30 17 IS 293 0 0 Oct. IS 19 11 9 Sept. 24 488 0 1 Oct. 19 6 4 13 689 0 0 Oct. 20 19 8 9 864 6 0 Oct. 21 15 8 984 3 3 Oct. 22 9 Sept. 28 872 19 6 Oct. 23 14 3 3 Sept. 29 803 9 8 Oct. 24 1 1 2 Sept. 30... 616 6 14 Oct. 25 3 2 3 133 30 Oct. 26 10 0 1 Oct. 2 697 380 42 Oct. 27 8 1 1 Oct. 3 408 193 76 Oct. 2S 6 4 3 409 247 102 Oct. 29 3 0 1 318 276 99 Oct. 30 4 0 0 Oct. 6 21S 231 116 Oct. 31 3 0 1 186 201 98 Nov. 1 0 2 0 Oct. 8 171 160 107 Nov. 2 2 0 2 100 97 Nov. 3 1 3 1 86 S7 37 Oct. 11 96 54 Total 9,554 2,332 1,060 Oct. 12 120 33 36 Not reported a 1,185 34 32 25 29 Oct. 14 32 20 Total 10, 739 2, 332 1,030 Oct. 15 20 25 21 a Upon investigation by the epidemiologist it was found that approximately 1,185 cases were not reported by the medical officers. These were the mild cases which were taken care of in the various i nfir maries. Table 13. — Drugsusedin dispensary, Base Hospital, Camp Grant , III., during the influenza epidemic, 1918 . Magnesium sulphate — solution(3,600,000 Brown mixture (900,000 c. c.). gallons. . 250 c. c.) gallons . . 900 Liquor ammonium acetate (40,000 Liquid green soap (800,000 c. c.).do 200 c. c.) . -gallons. . 10 Alcohol (360.000 c. c.) . .do 90 Tincture digitalis (20,000 c. c.). .do 5 Whisky (108,000 c. c.) . . . do 27 Calomel tablets 20, 000 Chloroform cough mixture (800,000 c. c.) Aspirin tablets 92, 000 -gallons. . 200 Aspirin powder . .pounds. . 40 Liquor antiseptic, alkaline (600.000 Codeine tablets 3, 000 c. c.) -gallons. . 150 Morphine tablets 2, 400 Dobell's solution (400.000 c. c.)..do 100 Strvchnine tablets 25, 000 Liquor cresolis compound (160.000 Adrenalin tablets 5, 000 c. c.) -gallons. . 40 Atropine tablets ( hypodermic) 7, 500 Castor oil (80,000 c. c.) . .do 20 Quinine tablets 2, 000 Formaldehyde (80,000 c. c.)_. .. .do 20 Digifoline . ampules . . 250 Elixir iron, quinine, and strychnine (120.000 c. c.) . gallons . . 30 Table 14. — Figures and statistics from the influenza epidemic compiled by the Quartermaster Depart- ment, Base Hospital, Camp Grant, III. Carloads 17 Total weight of supplies handled pounds.. 750.000 Cubicle wire (about 50 miles). . .do 260. 000 Muslin yards. . 11. 000 Tar paper do 30. 000 Straw pounds. . 125. 000 Sheets 25, 000 Total blankets used 20, 000 Pillowcases 7, 600 Supplies transported i truck loads) 240 Supplies transported > wagonloads) 520 Electric wiring Over 1 mile Labor days, 1 man for 1 day 2, 675 Emergency tents with stoves and floors. 215 250 MILITARY HOSPITALS IN THE UNITED STATES. There were 81 officers on duty at the hospital when the epidemic com- menced. This number being very soon inadequate some medical officers were transferred from the camp, and request was made to the Surgeon General for additional officers. The number was rapidly increased to 130. Medical officers were relieved from all duties, such as detachment commanders, that could he performed by line officers, and line officers were assigned to the hospital hv the commanding officer of the camp. In order that the medical service could function properly with the rest of the hospital it was necessary to create an additional office. The officer in charge of this additional office was designated “chief of clinics.” Special orders were issued placing this officer in charge of all hospital services, and empowering him with the authority to issue orders in the name of the commanding officer of the hospital. The chief of clinics continually made rounds over the hospital, visiting every ward daily, examining such cases as he thought necessary, instructing the ward surgeons and taking general charge of the distribution and discharge of patients. His services were of the greatest value, not only in this capacity but as an adviser to the commanding officer. Much time was spent in preparing required reports. The services of five experienced officers of the medical service were required for from two to five hours each morning in preparing the reports for the camp epidemiologist, and then frequently the reports were only relatively correct. Other reports required by higher authorities demanded much time and necessitated the services of valuable medical officers. During this epidemic the medical service constituted almost the entire hospital, since only a few surgical and special wards remained beyond the juris- diction of the service. Yet, in spite of this enormous expansion within the short period of a week, there was system and order in the work of the medical officers. The chief of the medical service established a system of inspection and consultation that kept the service coordinated, and by means of a night force of medical officers on duty from 10 p. m. to 8 a. m. all medical officers had adequate rest and were at all times capable of performing efficient work. The post-epidemic period until January 1, 1919, was one of anticlimax, both because of a let down after the epidemic and because the signing of the armistice brought a lessening of enthusiasm in all branches of the service. Logically, there was no reason for the latter effect in the Medical Corps, but it existed nevertheless. It is to the credit of the hospital organization and its personnel that this state of mind did not result in any lowering of professional standards. The arrival of overseas convalescents brought a great variety of chronic cases, including some of the rarer diseases. During the first year of hospital activity there was a certain monotony in the type of disease cared for. During the second year, and especially after January, 1919, there was a greater number of chronic cases, the nephritic, cardiac, rheumatic, gastrointestinal, essential blood diseases, and diseases of ductless glands. Another circumstance which increased professional interest considerably was diagnostic work done in cooperation with the medical discharge board in the demobilization organiza- tion. Many obscure cases reached the hospital from this source. TYPES OP HOSPITALS BASE HOSPITAL. 251 SURGICAL SERVICE. When the hospital was opened there were no surgical patients; and under the direction of the commanding officer drills were held daily for the pur- pose of teaching operating-room technique. The first operation was a herniotomy. Following it, the number of opera- tive cases gradually increased, until at the end of the year 1917 the total sur- gical admissions had reached the not inconsiderable number of 631. The work of the surgical service was very much the same as that of any of the general hospitals of the larger cities of the country. Only 2 deaths in a series of 228 operations occurred, each the result of general peritonitis follow- ing acute appendicitis, the peritonitis existing at the time the patient was admitted to the hospital. Until the middle of December, 1917, the sterilizing of all surgical supplies for the operatingroom was done in an Arnold sterilizer; in spite of this fact, there was but one case of postoperative sepsis. This complication was very mild and occurred in a double hernia, the interesting feature being that both sides of the patient were done without any change in gloves or gowns, and the side operated upon first became infected, the opposite side healing by first intention. Subsequent to the middle of December, the sterilizing was done in a modern steam sterilizer of the Morris-Scanlan type. Prior to October 23, 1917, the operating was accomplished in the end room of one of the wards originally intended for either recovery of patients or as an isolation room. On October 23 the operating personnel and equipment were moved into the operating pavilion, which was devoted entirely to operating- room work. This pavilion had, with the exception of elaborate details of con- struction, all the advantages of a modern metropolitan hospital. Primarily, all the enlisted personnel on duty in this operating suite had absolutely no knowl- edge of any of the principles of asepsis or antisepsis, but very soon they reached a high state of efficiency. The surgical service at the end of its first year of existence had the equipment of a first-class surgical unit. In the operating pavilion there were two large oper- ating rooms which were connected by an anesthesia room and sterilizing room, containing ample sterilizers to easily meet the demand of 50 operations weekly. Adjoining the operating room was the office of the chief of surgical service, which was added in May, 1918, and a small laundry to reclaim soiled gauze and bandages. The latter proved of great economic value by reducing the use of surgical dressing materials to a remarkable minimum. A third operating room, used only for septic cases, with an adjoining dress- ing room for emergency cases, was opened in the building for head surgery. Surgical wards comprised, at the end of the first year of the hospital’s exist- ence, a receiving ward, which was opened in April, 1918. To this receiving ward were sent cases which did not go directly to the operating room. Here their histories were taken, physical examinations of them were made, and diagnoses of their conditions reached after careful consideration. There was installed in this ward a unit clinical laboratory in which the various blood and urine ex- aminations were made in shorter time than by the usual routine. Here also the laboratory work of the other surgical wards was done. By using this ward as a diagnosis and observation ward, better diagnostic conclusions could be reached, 252 MILITARY HOSPITALS IK THE UNITED STATES. and the danger of occasional contagious diseases being admitted to other wards was lessened. It was here that instructions to new officers were given in paper work, in the keeping of charts, and in the routine work of the ward. In addition to the receiving ward, the surgical department had two recovery wards for clean postoperative cases, one ward for pus cases and one for ortho- pedic patients, including those with fractures. About 150 officers were instructed in the surgical service and prepared for overseas work, many lectures and lantern slide demonstrations being given for this purpose. Officers of Base Hospital No. 58 and Evacuation Hospital No. 20, both organized at Camp Grant, were afforded opportunities to work in the wards and operating rooms, thus enabling their respective chiefs to observe the staffs concerned and to assign members of them in accordance with their quali- fications. In addition to the regular officer class for instruction, special surgical meetings were held three times weekly; and ward “walks” through different wards took place practically daily, to keep up the interest of the surgical staff. In so far as the surgical work at the base hospital is concerned, three epochs may be distinguished : The period of development from the beginning of the hos- pital to September, 1918. In September, 1918, the second period was ushered in by the influenza epidemic which demanded all hospital space and brought into the surgical service approximately 100 empyema cases. Fortunately, this period was of short duration and was followed by the period after the armistice, when the entrance of overseas cases into the surgical service of the hospital changed the character of the surgical work entirely. During the first period, the fitting of soldiers for duty, by operating on remediable defects, constituted the main activity of the service. Incidentally, appendicitis, accidents, and rarer surgical conditions, to be expected in a camp population of over 40,000, gave a variety to the work. In the second period, the work consisted principally of operative procedures on the empyemas occurring in the influenza epidemic. The statistics of the hospital show a mortality rate of all the empyema cases with all complications to be but 20 per cent. In the reconstruction period many cases of compound fractures following gunshot wounds, in all stages of repair and nearly all accompanied by osteomyelitis, kept the hospital surgeons and the departments of physiotherapy and reeducation busy. A number of aneurysms, skull defects, in juries to peripheral nerves, were of special interest. During this time, patients in the surgical department numbered as many as 1,400. SECTION OF ORTHOPEDIC SURGERY. This section was under the direct supervision of the chief of surgical service, and no sharp line of demarcation appeared between the orthopedic and surgical sections. The arrangement worked with complete satisfaction because of the willing cooperation of the various chiefs concerned. The orthopedic section was one of the innovations in the Medical Depart- ment, and by reason of its newness in the military hospital, the limits of its field of activity were not clearly defined; and there was at this hospital, as in many civil hospitals, some concern in the assignment of the cases to the various sections of surgery. Previous to the receipt of overseas wounded, the major portion of the orthopedic cases in hospital were fractures or joint injuries, the remainder TYPES OF HOSPITALS BASE HOSPITAL. 253 being back cases, arthritic conditions, and deformities admitted for study or corrective work. Other important work of this section was the examination of men to deter- mine their fitness for various arms of the service or for their retention in, or rejection from, the Army. As a matter of course, a large percentage of such examinations was made on subjects of real, imaginary, or pretended foot disa- bility. The handling of these foot cases for the best interests of the service presented quite a problem. During the earlier days of the orthopedic section, considerable time was given, by the out-patient service, to the correction of such deformities. With the growth of the camp, and increasing activities within the hospital, this work was taken up in the development battalion, and the orthopedic section acted only in an advisory capacity or as a board of review in these cases. Other important groups examined were those suffering from low-grade arthritis of long standing, traumatic or focal in origin, and subjects of old healed bone and joint injuries which, though not incapacitating them for relatively inactive civilian occupations, produced sufficient disability to neces- sitate rejection from the military service. Particularly was this the case with internal derangements of the knee, and the fact was strongly impressed upon the officers of this service that this type of injury merited much more considera- tion than had been given many men already treated by them. In the wards themselves the grouping of the bone and joint cases had very material advantages in the application of definite lines of treatment and in comparisons of end results obtained. The standard splints were used routinely and did not apparently lessen a man’s initiative. They left much opportunity for ingenuity in their application to individual cases and at the same time offered strong evidence of the fact that simple apparatus, properly applied, gives the desired result. Such standard splints simplified the kind of supplies very much and their use made the officers in training familiar with them before these officers were assigned to units for overseas service. With the admission of overseas cases in December, 1918, the service began to expand rapidly and take on a very different character. The signing of the armistice, and the demobilization following it, had greatly reduced the work of the orthopedic section; but after December 15, 1 9 1 S, the wards quickly filled with open and closed injuries of bone, nerves, and soft parts. Dressing cases, hitherto rather rare in the orthopedic section, became the rule and the character of work to be done changed completely. The resources of the department were taxed to the utmost and the officers within it at this time were called on for more activity than at any time in the existence of the hospital, save during the days of the influenza epidemic. Once again the orthopedic section and the general surgery section had no sharp line of demarcation, for the cases were border line in such a large proportion of instances that only by active coopera- tion could the best results be obtained. At this time the orthopedic section, besides caring for wards where patients, more definitiely orthopedic, were collected, acted in an advisory capacity on splinting and physiotherapy throughout the hospital. The addition, in January, 1919, of the department of physiotherapy, sup- plied the orthopedic service with a very necessary help in the way of massage 254 MILITARY HOSPITALS IN THE UNITED STATES. and supervised gymnastics. The contribution by this department to the results obtained was a very large one and demonstrated the need of permanent provision of this kind wherever bone and joint injuries were treated. LABORATORY SERVICE. The degree of development and progress attained by the laboratory sec- tion could be equaled only by the best civilian institutions in the larger cities. Many physicians entering the military service at this hospital were astonished to find such a well organized and well equipped laboratory in the posses- sion of facilities anticipating their demands to a marked degree in almost every phase of clinical medicine. In fact many men recently graduating from class A medical schools found the facilities for obtaining clinical laboratory data practically along the same lines and with the same degree of refinement as had been taught them while at school. Those who had been in general practice came to realize the importance of blood, urine, and other examinations in a way not before recognized; and discovered that clinical bacteriology, including pneumococcus-typing, claimed a position not to be disregarded in the intelligent care of medical and surgical patients. This much may be said regarding the relation of the laboratory to the ward surgeon, covering, in general, the examinat ions usually regarded as routine. The laboratory at this hospital did all this but its organization plans included a field of development almost equally important to the hospital and of paramount significance to its personnel, namely, constructive investigation. Unfortunately, its growth in this direction was cut short by the disorganization incident to demobilization of the Army. During the most trying period of the existence of the laboratory, when the hospital was suddenly crowded with sick of the influenza epidemic, and when demands for laboratory supplies and equipment exceeded by far any antici- pations, special provision was made locally, and so promptly were requests carried out that not once was the laboratory work delayed on account of want of equipment or supplies. X-RAY DEPARTMENT. The X-ray department was opened on October 31, 1917, when the space allotted to it consisted of but three rooms. The first room was used as an office and viewing room as well as for filing exposed plates. As the volume of work increased, the space allotted for the filing of plates became congested and it was found necessary to remove the old plates from the file. These were carefully placed in boxes and were moved out into the corridor; and the boxes were numbered and so placed that, when it was necessary to look at an old plate, it could be very easily found. The second room was used for radiographic and fluoroscopic purposes, a small room being walled off in which the transformer and unexposed plates were kept. The third room was used for a dark room and as a storeroom for chemicals and accessories. The transformer installed was the Universal type (Wantz model) manu- factured by the Victor Electric Corporation, and the accessories used were manufactured by the various X-ray firms of the country. Due to the unusu- ally heavy demands on the transformer and to minor errors in installation, TYPES OF HOSPITALS BASE HOSPITAL. 255 some difficulty was experienced in the early weeks of operation, but after the troubles were located and rectified no further difficulties were experienced and a greater volume of work was handled daily. Until the end of 1917 there was a chief of service, one officer as an assistant, and three Medical Department enlisted men, acting as technicians. This personnel handled the work satisfactorily during that period. Subsequent to the end of 1917 there was a steady increase in the number and variety of X-ray examinations, as a result of which the work grew to such an extent that it was found necessary to increase the personnel and make some additions to the equipment. The personnel was increased to two officer assistants and six enlisted men. The principal addition to the equipment was one United States Army table and one portable X-ray outfit complete, this being added about the middle of the year 1918. The apparatus and laboratory space permitted the accomplishment of any ordinary X-ray work, but was grossly insufficient for the volume of work de- manded during the year 1919. The X ray proved to be a very important factor during the last quarter of 1918, when the influenza epidemic was present, the major portion of the work consisting of X-raying pneumonia and empyema cases; also during the first quarter of 1919, when overseas patients in large numbers were X-rayed. The majority of these overseas patients were recovering from the effects of gunshot wounds and were for the most part such surgical cases as those with foreign bodies, fractures, and osteomyelitis; but there were some gassed cases and miscellaneous conditions which were included in the medical service. This great inrush of patients placed a heavy demand on the X-ray department, both for diagnostic purposes and as a means of obtaining a complete record of the man’s physical condition before his discharge from the Army. During this time from 60 to 80 patients were handled daily and a great many instructive and interesting cases were encountered. After Camp Grant was made a demobilization center, numerous patients were sent to the X-ray department for examination. A great many of these were men who had been overseas and had been seriously gassed. Each case was fluorscoped and if anything suspicious was found a set of stereoscopic plates was made. A report was sent to the medical examining board the same day; and in that way the men, in case their conditions did not warrant observation or treatment, were able to receive their discharges with the other members of their respective organizations. On account of the inconvenience of sending the men from the examining board to the hospital, and because the number of suspicious cases increased, a fluoroscopic machine was installed at the place where the men were examined. This took a great amount of work from the X-ray department, and only cases that needed plating were sent thereafter to the X-ray department. The addition of the portable apparatus to the X-ray equipment made possible radiographic work in the pneumonia and empyema wards. It proved to be an indispensable aid during the influenza epidemic. All acute chest conditions were X-rayed as a routine on their entrance to the hospital. The empyema cases had a plate and a film taken on the same exposure. The plate was kept on file in the main laboratory and the film was 256 MILITARY HOSPITALS IN THE UNITED STATES. sent to the ward with the roentgenologist’s report, both of which served as a means of reference until the case was dismissed from the hospital. The film was then returned to the main X-ray laboratory and was placed with the plate. A complete set of localization apparatus was added to the X-ray depart- ment; and during the rush of convalescent overseas cases some localization for foreign bodies was required; but the work was not done on an extensive scale. GENITOURINARY DEPARTMENT. Immediately upon the opening of the genitourinary service of the base hospital, a definite policy was established to minimize to the greatest possible extent the loss of effectives from venereal diseases. To accomplish tins it was necessary to organize and train a force of men to properly treat venereal dis- eases; and each enlisted man of the Medical Department, assigned to this service, was given individual instruction. A small unit laboratory was estab- lished and within a month after the opening of the base hospital the genito- urinary department was functioning in every way and running smooth^. The percentage of venereal diseases detected among the inducted men differed in no way from the average percentages detected at other camps; however, only active venereal diseases were admitted to this hospital for treat- ment. A working plan was established in connection with the organization of the camp, and all ambulatory venereal cases were treated as out-patients at the base hospital. By so doing it was possible to limit the service to two wards of the hospital and at the same time give the best possible treatment to all cases of the camp. Each venereal case was gone over thorougly and its pathological condition was located. No routine treatment was followed for cases affected with gonorrhea; each case was individualized and treated according to the patho- logical condition present. When urethritis existed there was no self-treatment by the soldier. Each venereal ulcer was thoroughly examined for spiroclueta pallida. Many times this required repeated examinations. Once the spiro- chseta pallida was demonstrated, intensive luetic treatment was started im- mediately. By following this plan of procedure not many cases of active secondary lues developed. The luetic treatment which was a dminis tered was in accordance with instructions issued by the Surgeon General. Venereal ulcers which were not luetic were handled in such a way that the stay in hospital of those having them was comparatively short and among them very few suppurating buboes developed. Cases of pyuria, hematuria, etc., were carefully studied to locate the true pathological condition. Most of these complications were found to have existed prior to enlistment and men suffering from them were discharged on surgeon’s certificate of disability. Those that were contracted after entrance into the service were given appropriate treatment. Very little operative work was done. Many soldiers were observed with varicocele. It was borne in mind that operative intervention in this condition was often followed by untoward results, and these cases were given palliative treatment, an effort being made whenever possible to have the men affected assigned to a duty compatible with the condition present. TYPES OF HOSPITALS BASE HOSPITAL. 257 During the spring of 1918 the camp received a large number of colored troops and among them there was a high rate of venereal disease. Because of this condition a camp venereal infirmary was established. The conditions which these colored recruits presented were such that they were not fit for military service, still it was felt nothing special could be gained by placing them in hospital. A thorough understanding between the officers at the base hospital and those on duty at the camp venereal infirmary made it possible for these two units to work hand in hand, and the same policy Avas pursued relative to minimizing the number of noneffectives by sending only those cases to hospital in which there Avas a definite indication for hospital treatment. No soldier Avas denied hospital treatment whenever such treatment Avas necessary. DEPARTMENT OF OPHTHALAIOLOGY. The work done in the department of ophthalmology consisted of the folloAA'- ing four distinct classes of activity: That hi the out-patient department, Avhere most of the work Avas done; the care of patients in the eye ward; consultations in other wards of the hospital; and the fitting and dispensing of eye glasses. The work of the out-patient department consisted of the treatment of the vari- ous eye diseases, refraction, numerous examinations for commissions, pro- motions, discharges on Surgeon’s Certificate of Disability and special examina- tions for the air service. The total number of new cases treated in the depart- ment av as 4, 0S3; return patients 6,583. The total number of refractions Avas 2,529. Only serious cases, accidents, etc., were sent to the eye ward. In a great many instances men Avere accepted for military service Avhen they had surprisingly low vision. Correction of the error in these cases was most neces- sary for their usefulness in the Army and after their return to civil life. A gratuitous issue of glasses Avas made to these men. They were inclined to take tAvo pairs of glasses, that furnished by the Army, and another, of better appear- ance, at their oaatl expense. When the glasses, gratuitously issued, were sent to the soldiers it was very difficult to secure a receipt for them, accordingly, the practice was adopted of obtaining their receipt at the time the glasses were fitted. Many pairs, having been receipted for, were never called for, and it Avas neces- sary to use the frames and lenses for other soldiers. Among the negro soldiers there were many absurd complaints, but in gen- eral their eyes were very good. Some cases of trachoma were seen, however, as Avell as some cases of true night-blindness. The influenza epidemic left but one medical officer in the eye department, the tAvo others being called upon to assist in the handling of the epidemic. A great deal of work Avas done in the eye department during the epidemic period, the influenza patients being affected usually Avith conjunctivitis. During the period in which overseas patients AA T ere being handled in large numbers at this hospital there were many cases of Avound of the eye and brain. In addition, many cases Avere referred to the department from the demobiliza- tion center of the camp for examination. 45269°— 23 17 258 MILITARY HOSPITALS IN THE UNITED STATES. OTOLARYNGOLOGY SECTION. The arrangement by which the work in the several specialties was taken care of in departments devoted to these specialties proved to be one of the great- est features in the organization of the base hospital. This provision made it possible to utilize the services of men whose years of work in each field pre- pared them for this task. The department of otolaryngology was an important part of the base hospital at Camp Grant, as has been evidenced by the number of cases cared for in the department. The work naturally fell into three divisions: That in the otolaryngological ward; consultation on cases confined to other wards in the hospital; and the out-patient department. All the cases which required surgical treatments were included in the otolaryngological ward. The cases on which operations had been done under local anesthesia, such as the various intranasal operations, were placed in the ward for at least the first night, in order to guard against risk from a possible bleeding. Consultation work on patients in other wards of the hospital included the examination and treatment of a great many patients, especially in the wards assigned to the care of acute infectious fevers. These cases included, for the most part, those suffering from otitis media, acute tonsillitis, particularly where the condition was compli- cated by peritonsillar abscess, of which there were a great many, and cases of acute infection of the nasal accessory sinuses. The work carried on in the out- patient department was especially important. As in most out-patient de- partments where otolaryngology has been represented, the number of patients applying for treatment was very great, the major portion of them requiring advice rather than special treatment. Every effort was made to discourage unnecessary revisits to this department. This was done by directing the pa- tient himself how to take care of such local treatment as could be readily done by the patient. Such cases were chiefly those who applied for treatment of nose anil throat conditions, where surgical measures were not called for. Cases suffering from chronic defects in hearing were carefully diagnosed; and all those, where local treatment could offer no hope for improvement, were advised to return for a course of treatments. This latter group included cases of otosclerosis, many cases of chronic middle ear catarrh, and those with nerve defects. By this policy, not only was unnecessary congestion in the out- patient department avoided, but soldiers were not kept unnecessarily from duty. An important part of the work which fell to this department was the exam- ining of cases found to have defective hearing after they had been sent to Camp Grant for discharge. It was important to differentiate the cases of deafness due to shell concussion from those of chronic deafness, the result especially of otosclerosis or nerve deafness. This differentiation required a careful analy- sis such as could be carried out only by making a functional examination of the hearing with tuning forks. Due to the large number of cases treated, efficiency in the work of the out- patient department was possible only through the intelligent assistance of the enlisted personnel, and that obtained from the nursing department. Where so many cases were passed upon, as was found to be necessary in this depart- ment each day, it meant that much of the work, particularly that dealing with the administrative part, the selection and preparation of instruments, etc., had to be entrusted largely to assistants other than medical officers. TYPES OF HOSPITALS BASE HOSPITAL. 259 NEUROPSYCHIATRIC SECTION. The function of the neuropsychiatric service in the hospital was chiefly the examination of recruits referred by the division psychiatrist, during the early days of the emergency, and the care of the psychoneurotic, and of the frankly psychotic, soldiers during the entire period. From the beginning, of course, it was understood that all the insane would be discharged from the Army as quickly as possible. In consequence, the psychopathic ward was based on retention rather than treatment. Quite fre- quently, however, it was found that patients had to be retained in the ward for a considerable length of time, due to various unforseen circumstances. The construction of the ward was found to be quite adequate and well arranged, but it hardly met the requirements for the insane, the psychoneurotic and the neurological cases and a guardhouse for the prisoners. It was very obvious that the insane, especially the disturbed type, should be isolated, preferably in single rooms with windows well secured and barred. It was rare that three or four patients of this class were in the ward at the same time, when four or five single rooms constructed in this manner would have been sufficient. The lack of trained attendants and nurses was one of the handicaps in the neuropsychiatric service. A large percentage of the enlisted personnel on duty therein had little or no training in the care of the insane. DENTAL DEPARTMENT. When the first dental officers arrived in camp, four of them were assigned to the base hospital. One of these happened to have with him a student case of dental instruments and a foot engine. There being at that time no Govern- ment dental equipment in camp, these four dental officers alternated in the use of this secondary outfit. For a dental chair they used a plain wooden kitchen chair with an improvised headrest made of a piece of board, and the cuspidor was a galvanized-iron bucket. Wfith this equipment they took care of such emergency cases as presented themselves. On the arrival of the portable dental outfit, the hospital dental infirmary was moved into the bacteriological laboratory. When the hospital took over its permanent building the dental infirmary was temporarily established in two rooms of the administrative building. One of these two rooms was used as the office of the camp dental surgeon, the other was used as a dental operating room. The personnel consisted of four dental officers and one assistant. The arrival of the base hospital dental equipment marked the next and final move of the dental infirmary. This was on December 29, 1917. The equipment, which consisted of three complete base outfits, each of which contained a Columbia dental chair, Ritter wall bracket, electric all-cord engine, and pressed steel aseptic dental cabinets, was finished in white enamel. Other articles of equipment, such as bedside tables, electric grills for the sterilization of small instruments, and electric fans, were issued from the supply room of the base hospital, by direction of the commanding officer. These three base equipments were installed in offices especially planned as to wiring, plumbing, and lighting; and gave the hospital a three-chair dental office, comparable to 260 MILITARY HOSPITALS IN THE UNITED STATES. the better-equipped offices found in civil life. In addition, and in connection with these offices, there was a well-equipped dental laboratory with electric air compressors, electric lathes, vulcanizers, etc. Later there was added an X-ray equipment in a separate room, with an adjoining dark room. This was found to he necessary because the main X-ray laboratory was so busy as to make it impracticable to do the necessary dental work. The surgical work included corrections of jaw fractures, partial jaw resec- tions, draining of antra, removal of oral growths of various kinds, apiectomies, and extractions. This work was done under conduction anesthesia, except in rare instances where a general anesthetic was indicated, when either nitrous oxide and oxygen, or ether was used. This particular branch of the dental service of the hospital handled also between 400 and 500 cases of so-called trench mouth, or Vincent’s angina (oral). PHYSICAL RECONSTRUCTION. Prior to January 1, 1919, there was no need of physical reconstruction at this hospital because the class of patients treated was principally of an acute type. Patients requiring prolonged convalescence were transferred to general hospitals. With the arrival of large numbers of overseas patients, however, it became essential to revise some of the policies of the hospital. Among the more important changes were those permitting patients more liberties, and the institution of means of procuring contentment, largely of a recreational nature. The first 1,000 overseas patients admitted to this hospital proved to be extremely difficult to handle. They were disorderly, undisciplined, defiant, and were not willing to abide by military law as had been the case with other patients. Many of them had not been paid for months. They were improperly uniformed and were self-ornamented by many types of improvised so-called war insignia. They had a very exalted opinion of themselves and openly stated that persons who had not gone overseas were not in their class. From a professional standpoint the overseas patients varied a great deal in grades of physical condition, representing those cured and ready for immediate discharge, and all grades up to and including bed-ridden patients of months’ duration. Among them were all classes of general medical and general surgical cases. It was obviously necessary to use military discipline cautiously. It was also necessary to expand the hospital and its facilities to care for the entirely new type of patients. This expansion was provided along two general lines: First, to care for the professional needs of the patient; and second, to provide for his contentment in so far as that was practicable. It was to meet this latter re- quirement that physical reconstruction was destined to exercise its most im- portant function, and it was about January 1, 1919, that instructions were received to organize this new service. There were no persons at Camp Grant in the possession of any experience in physical reconstruction. There were no funds available nor was there ex- istent space. Every effort ivas made to obtain officers and enlisted men at Camp Grant, but this was exceedingly difficult since nearly all pei-sons then in the service were highly interested in being discharged therefrom. However, TYPES OF HOSPITALS BASE HOSPITAL. 261 personnel was secured wherever possible, and officers and reconstruction aides were subsequently assigned by the War Department. Funds were allotted the latter part of January, 1919, but it was found difficult to utilize these funds because of either the complicated procedure in obtaining them, or misunder- standing on the part of local authorities. The entire hospital being occupied for purposes other than physical reconstruction, it was difficult to secure ade- quate space for this activity. This was overcome, however, by assigning one of the two-story ward barracks and securing the entire sanitary train area (which was adjacent to the base hospital) as a part of the hospital. It was not until the latter part of February that it was found possible to organize the re- construction department, but thereafter its growth was reasonably rapid. The occupational and educational work was originally outlined in two sections: The academic and the manual training; and ward work. The first or academic and manual training work was prescribed for those patients who were con- valescent and who wore their uniforms. This was necessary because the build- ings used for this purpose were outside the base hospital area, necessitating patients going a considerable distance in order to reach them. The ward work was carried on exclusively in the wards among those confined either to bed or to ward clothing. There was little difficulty in organizing the academic and manual training department excepting the procurement of supplies. Consider- able difficulty arose, however, following the development of ward reconstruction activities in the same place and at the same time that a great deal of surgery was being accomplished. The wards were filled with surgical patients, many of whom were more or less seriously ill. The confusion, necessary noise, and dirt incident to carrying on this work interfered with the care of the patients. Ward surgeons became apprehensive over infections, and the worry on the part of some of the patients. The nurses and ward men complained bitterly of the dirt and their inability to keep their wards in a presentable condition. Con- sequently, it became necessary to make a change as follows: The two-story ward barracks, nearest to the surgical ward, was set aside for electrotherapy and massage on its first floor. One half of the second floor was converted into a collective gymnasium, the other half being equipped for making such articles as basketry, bead work, and rugs, which hitherto had been carried on in the wards. This plan became so popular as to necessitate having more space, and in con- sequence one veranda was closed in, where clay modeling, poster painting, and other activities were carried on. This building was used principally by ambulatory ward patients of the bath-robe type, every effort being made to make their ward attractive. The patient was taken out of the hospital en- vironment in going to this ward and was given every opportunity for work and amusement at one and the same time. Smoking materials were furnished by the hospital exchange and welfare organizations, a victrola and piano player were provided, and the recreational committee furnished refreshments and entertainment from time to time. The corridor leading to this building was inclosed to protect the patients from undue exposure. The use of this two- story ward for reconstruction work for ambulatory patients eliminated a great deal of confusion and many objectionable features from the sick wards. How- ever, it was necessary to carry on some ward work for those patients who were not able to walk or propel themselves in invalid chairs. This necessitated con- 262 MILITARY HOSPITALS IN THE UNITED STATES. tinning reconstruction work among the bed patients, hut on a much smaller scale, and included not only those in general wards but in the psychopathic and tuberculosis wards as well. The occupational therapy for patients who were permitted to leave their wards consisted of the following activities: Woodworking, toy making, basketry, metal working, block printing, sketching, poster making, bookbinding, leather work, weaving, and plastic art. The work was continuous and the teaching staff comprised a group of efficient instructors in the arts mentioned. Occupational therapy for patients in the wards consisted of the following activities: Bead work, weaving, leather work, and macrame. The educational work was instituted to provide every possible course for which there was a need. Several members of the teaching staff gave their Pig. 84. — Ward class in physical reconstruction, Base Hospital, Camp Grant. entire time to helping the men to decide correctly as to what work was most worth while for them after reentering civil life. The classes met at 8.30. 9.30. 10.30 a.m., 1, 2, and 3 p. m., each day except Sunday. The usual period was 40 minutes with 15 minutes at the end for individual help. Some of the shop and study classes extended over a longer time. Ward classes were independ- ent of the general schedule. The course given covered commercial art, academic subjects, shop work (including electricity, elementary electrical engineering, automotive features, farm machinery), commercial subjects (in- cluding bookkeeping, accounting, auditing, commercial geography, shorthand, and typewriting), and agriculture. No man was retained for courses after he had become physically ready for discharge from the hospital, except after arrangements had been made on his own request. On discharge each student was given a certificate stating the number and kinds of credits that he had earned. A credit represented two TYPES OF HOSPITALS — BASE HOSPITAL. 263 weeks of satisfactory work in a course, and was of value in planning further educational work under the Federal Vocational Guidance Board. RECREATION. The policy of the commanding officer of the hospital was to further prop- erly conducted recreation in moderation. With this in view, practically every entertainment was outlined and approved by him before any steps were taken to put it into effect, and practically every entertainment was attended by him with a view to studying it for future use and for the purpose of seeing that all persons conducted themselves with decorum. From the very beginning no social relationship was permitted between the nurses and enlisted men, and entertainments were given for officers and nurses, the enlisted men and patients. The entertainments for ambulatory patients were of two kinds — those for patients able to dance; and those, including such games as cards and checkers, for patients with injured legs. Ward entertainments, such as victrola concerts, moving pictures, singing, musicales, and games, were given, but victrolas were not kept constantly in wards because of the noise and disturbance that continuous playing would create. The duration and type of ward entertainments were made to conform with the sickest patients in the ward. Dancing was the favorite form of enter- tainment for the nurses, and the first and third Tuesday evenings were set aside for graduate nurses, the second and fourth Friday evenings for student nurses. The first and third Thursday evenings were for the detachment, Medical Department, while on every Monday evening parties were given for convalescent patients. These entertainments were held in the Red Cross Convalescent House; the hospital band furnished the music: and the refresh- ments were provided from the general mess. The nurses were permitted to invite officers from the entire camp personnel. Young lady guests to the entertainments for the Medical Department detachment were obtained through the Patriotic League of Rockford or through the Young Women’s Christian Association. Besides the regular entertainments, special entertainments were given on all appropriate occasions such as Halloween, Thanksgiving, Christmas, and New Year’s Day. The entertainments for the Medical Department detachment were alter- nately dances and smokers. It was found that about one-third of the enlisted men attended the dances and practically all of them the smokers. The smokers were divided into two parts. The first part was a vaudeville perform- ance in the Red Cross Convalescent House; the second part was a supper, with music and monologues, in the general mess. It was noted that, though many arrangements were made and a certain amount of money expended, unless there was some person who was especially trained to conduct the parties they were frequently unsuccessful. In the spring of 1919, a country cottage was secured at the junction ot Rock and Kishwaukee Rivers, about three and one-half miles from the hospital, in a grove on a bluff overlooking the river. It was electric lighted and had a capacity of about 15 people. This capacity was augmented by means of tents, 264 MILITARY HOSPITALS IN THE UNITED STATES. which were floored and electric lighted, to accommodate 50 people. The cottage was used alternately by the officers and their families, the nurses, or by the enlisted men, one week being given to each. Large tables were built outdoors and a detail of enlisted men was assigned to do the major portion of the work. All persons, however, were required to assist in keeping the grounds clean and taking care of the quarters and tables. During the week one or more special entertainments were given and the entire personnel, or officers, nurses, or enlisted men, were invited to spend the evening. Such enter- tainments as corn roasts, barbecues, and cotillions were given. Ham- mocks, swings, boats, bathing suits, fishing apparatus, and many forms of games were provided for the amusement of the cottage occupants. Each nurse was given three days off duty, and each enlisted man was given 24 hours Fig. 85. — Cottage used by the hospital personnel for outing, Base Hospital, Camp Grant. off duty, to spend at the cottage. An officer was kept at the cottage at all times and when there were ladies present a chaperon was provided. THE HOSPITAL BAND. Although there were several military bands in the camp, it was difficult to obtain them for use at the hospital, and it was thought advisable to drill and train a band solely for the hospital. Authorization was requested to organize a 2S-pieee band on the basis of bands of this size for Infantry regiments. This was approved, and in the spring of 191S all the enlisted men who possessed any knowledge of music were requested to meet at the chapel with a view to organ- izing a military band. A complete set of instruments was purchased and the band leader of one of the Infantry regiments offered his services in training the new band. Daily rehearsals were held; and with the acquisition of several experienced musicians a creditable band was soon obtained, so that in about TYPES OP HOSPITALS BASE HOSPITAL. 265 three weeks after its organization it was playing at retreat and in six weeks accompanied the hospital nurses to Chicago and paraded them in a large Red Cross drive. The organization rapidly improved in efficiency and was fre- quently called upon to furnish music in the surrounding towns. An orchestra was organized from the band and furnished music for practically all of the entertainments given for the personnel and patients of the hospital. The band participated in every Liberty Loan drive and all other large patriotic drives that were made by the hospital organization. During the summer of 1918, chill of the personnel was held daily, the music for which was furnished by the hospital band. It proved a great stimulus to enthusiasm and made it possible to cor.duct drills daily without apparent fatigue to the enlisted men. Improvement in efficiency was continuous until the band came to be looked upon as one of the best at Camp Grant. It was not possible to have a commissioned officer as director, but the leader was promoted through con- secutive grades until he reached that of hospital sergeant. Noncommissioned officers were appointed in the band in conformity, as nearly as practicable, with Infantry organizations. This was necessary to hold the musicians, as the various musical organizations of the camp were continually trying to get the better musicians transferred away from the hospital band. The organization remained intact until the 7th of July, 1919, when it was discharged as a group. WELFARE ORGANIZATIONS. During the early period of the hospital’s existence everyone was too busy to give thought to any form of recreation, and it was not until about the time of the signing of the armistice that recreational problems could be considered. The welfare organizations, namely, the Red Cross, Young Men’s Christian Association, Knights of Columbus, and the Jewish Welfare Board, were repre- sented at this hospital from about the beginning. The War Camp Community Service entered into the activities during the fall of 1918, and the Salvation Army frequently offered its services, but there was no place that this organiza- tion could take without overlapping the activities of some other organization. In so far as the hospital was concerned, the Red Cross was by far the most active. They had no representative at the hospital until about February, 1918, but the field secretaries frequently visited the hospital and distributed such articles as sweaters, caps, chest protectors, and socks. They offered to do any- thing that the commanding officer would suggest for the improvement of the hospital, within their limitations. The Young Men’s Christian Association confined its activities during the years of 1917 and 1918, almost exclusively to visiting the wards and distributing stamps and stationery, while the Knights of Columbus activities were restricted to religious lines. About February, 1918, the Red Cross placed a representative at the hos- pital to work under the jurisdiction of the commanding officer, to provide means of writing letters for patients who were too sick or whose disabilities were such as to prevent writing. The hospital furnished this home service section of the Red Cross with a daily list of seriously sick patients in the hospital. A Red Cross representative visited each ward and wrote any letters that the patients desired to have written for them. These letters were all stamped with the Red Cross and censored by one of the officers of the hospital personnel. 266 MILITARY HOSPITALS IN THE UNITED STATES. After the signing of the armistice, and after the arrival of overseas patients in December, 1918, there was a real need for recreational work. The personnel became restless with the desire to return to their homes, and the patients from overseas were disorderly, undisciplined, and frequently defiant of military law. It was quite evident that a crisis was at hand unless the root of the evil could be detected and corrected. Under date of December 6, 1918, the Surgeon General promulgated a bulletin outlining the various recreational activities for hospitals. In this bulletin there was a statement to the effect that the Red Cross would furnish a recreational officer to take charge of its activities; that the recreational officer would work under the chief educational officer; and all welfare organizations would work under the Red Cross recreational officer. Because of the increase in the size of the Red Cross organization at this hospital it was necessary to move their office from the administration building to the Red Cross Convalescent House. This was done at the time the first recreational officer reported for dut v. Instead of placing this Red Cross recreational officer in entire control, a recrea- tional committee was organized with the chaplain as chairman, the Red Cross representative as first assistant , and the social director for nurses and the band director as other assistants. This committee was given a tentative outline to follow. The committee did not work harmoniously, as the conduct of the chap- lain in general was such that it was necessary to recommend his discharge from the Army. The Red Cross recreational officer was then placed in charge. Entertainments were given for the patients, officers, nurses, and enlisted men, but the hospital bore the expenses and planned practically all the details. The number of patients and personnel had considerably increased and the problem of their entertainment was growing more extensive and complex. The various welfare organizations were working in the hospital without very definite outline and their work was constantly overlapping. As it was obvious that a civilian could not carry on the recreational activities harmoniously with the requirements of the commanding officer and in such a way as not to interfere with the running of the hospital, the entire recreational activities were reor- ganized, an officer of the hospital was placed in charge, and each welfare organi- zation supplied a member to represent it on the recreational committee. Meet- ings were held once a week at which various recreational problems were dis- cussed. Certain phases of the work were assigned to definite organizations upon their approval, each organization being required to make a written weekly report covering its activities. These reports were consolidated and sent to the commanding officer of the hospital for his approval. Any new line of work required the commanding officer’s approval before it was placed in effect. It was never possible to make the welfare organizations correctly visualize the military view of recreational work. They assumed that the larger the num- ber of post cards, sheets of paper, and other supplies they gave away, the more important their work. They took the view that every man should have exactly what he wanted whenever he wanted it ; that a visitor should be allowed in wards at all times; that all military discipline was wrong if it interfered with the patients’ wishes; and that the treatment of patients should be secondary to the recreational work. They wished to place talking machines and other musical instruments in all wards of the hospital, and it Avas difficult to make them under- TYPES OF HOSPITALS — BASE HOSPITAL. 267 stand that the conduct of the wards must necessarily be based upon the sickest patients therein. To meet the needs of the patients, victrolas were obtained on movable stands and a victrola concert was given every evening for about 20 minutes, under the supervision of the head nurse of the ward. These concerts were especially planned and the victrolas were removed if any patient showed signs of being disturbed by the noise. Moving pictures were given in the ward in a similar way. The welfare organizations conducted the concerts and moving pictures. The Young Men’s Christian Association had two secretaries on duty at the hospital for practically the whole of its existence. These men caused no trouble whatever in the hospital and their efforts seemed to be directed largely to dis- tributing stationery and selling stamps. Although they assumed certain obligations on athletics for the detachment, little or nothing was ever accom- plished by them and practically all athletic work was carried on at the expense of the hospital exchange and under the supervision of the hospital athletic officer. The Young Men’s Christian Association representatives were always willing, but seemed to be greatly handicapped by the need of funds. The association had a hut located near the hospital but it was not made use of by the hospital personnel to any extent. The Knights of Columbus had a hut adjacent to the hospital, and its local organization accomplished much in the provision of entertainments for the patients during the year of 1919. Regularly they had moving pictures and parties, and their building was maintained as the soldiers’ club room. The Red Cross Convalescent House was at all times under the immediate jurisdiction of the commanding officer of the hospital. A noncommissioned officer was detailed in charge of it and the policing of it was done by the members of the hospital detachment. An information bureau was located within it and rooms were maintained for relatives of seriously sick, summoned by telegram or letter. A matron was maintained and within the building the Red Cross associate field director had his office. It was constantly required that this Red Cross building be kept clean and orderly and its conduct such that ladies could enter at all times. It was open to patients from 11a. m. to 9 p. m. (for bath- robe patients) and to 10.30 p. m. for convalescent patients. All patients were required to remove their hats on entering the building and to refrain from smoking in its main room, a smoking room being provided in one of the wings. This Red Cross building was the only building that was maintained for visitors, and it was felt perfectly safe at all times to send ladies to it. The American Library Association opened a library at the hospital in February, 1919. Subsequent to the arrival of the large number of overseas patients, their library was an attractive reading room and their representative visited the wards, furnishing books and other reading material to all persons desiring them. This association also assisted in the nurses’ training school and in the reconstruction work. THE HOSPITAL NEWSPAPER. Under special authority granted by the Surgeon General in 1918, a semi- monthly newspaper was started at this hospital, the first issue appearing April 1, 1919. The issues that were published from time to time were as follows: 268 MILITARY HOSPITALS IN THE UNITED STATES. April 1, 1919 (introductory number); April 15, 1919; May 1, 1919 (athletic number); May 15, 1919 (reconstruction number) ; June 1, 1919; June 15, 1919 (pictorial number); July 5, 1919 (band number); July 20, 1919; and August 1, 1919 (combined number — roster of personnel). The publication was christened The Silver Chev’ , this title being selected from a number of suggestions as being most typical of this hospital in view of the fact that at the time publication was begun there were no persons on duty at the hospital who had actually seen service overseas. At the time of the first appearance of the publication, overseas patients were beginning to arrive in large numbers and demobilization was constantly progressing. Due to these circumstances the most able enlisted men were fully employed on other duties and it was difficult to secure personnel to bring out the paper. This difficulty was accentuated by the fact that enlisted men anxious to be discharged feared that assignment to the paper would delay their discharge. Nevertheless, there was a creditable, progressive improvement in the hospital paper. A degree of difficulty was experienced locally in securing adequate attention to the acutal printing of the publication, and it was necessary to go to Chicago or Milwaukee to secure satisfactory service at reasonable cost. A firm in Milwaukee was ultimately secured to publish the paper and from then on no difficulty was experienced. Late in March, when plans for the publication were being formulated, certain of the enlisted men instituted an advertising campaign in Rockford, 111., with very gratifying results. Advertising matter was secured to the amount of approximately $300 per calendar month (for two issues), the advertising to continue during the contemplated existence of the paper, six months from April 1, 1919. This figure, with the sale of the paper at 10 cents per copy to the members of the personnel of the hospital and to the patients, as well as to subscribers in Rockford, constituted a profit-paying income. In securing the advertising matter, however, an error was committed on the part of the enlisted force assigned to that work, in unwittingly making the statement that the probable circulation of The Silver Chev’ would be 4,000 per issue. Furthermore, the advertising was obtained through verbal contract only. Alien, therefore, it became evident to the advertisers that the circulation was approximately 1,000 instead of the estimated 4,000, and that, owing to demobilization and the constantly decreasing number of patients, this circulation would decrease still further, it became impossible to retain the advertisers and some of the contracts were repudiated by the merchants who made the statement that they author- ized the appearance of their advertisements for but one month. Publication of the hospital paper was discontinued with a double number, representing the issues of July 20 and August 5, 1919, there being at that time a deficit of approximately $350. The Silver Chev ’ never emerged from the experimental stage, but during its brief existence it was of distinct value to the personnel. Its financial failure, attributable to demobilization and lack of adequate supervision in its earlier stages, was more than offset by its influence in enhancing the morale of the hospital during that critical period when every organization in the camp, except the base hospital, was deriving all the benefits of demobilization. TYPES OF HOSPITALS — BASE HOSPITAL. 269 Fig. 80. — Cover design for one of the issues of The Silver Chev’, Base Hospital, Camp Grant, 111. 270 MILITARY HOSPITALS IN THE UNITED STATES, The Wounded Man Speaks I left an ear in a dug-out, When a shell hit made us dance. And at Belleau Wood where the mixing was good I gave up a mitt for France. I ll step off a ship at Hoboken And I'll say: “Well, here I be. Straight from Belleau Wood, and its under- stood That nobody grieves for me/’ I lay on a cot a-smoking And thought I was getting well. But the moon was blight on the bomb plane's sight And the Gothas gave us hell. And no pussy footing sissy Shall grab at my one good hand. And make me feel drunk with the good old bunk. Just to make hlmselt sound grand. They certainly spoiled my beauty. And my leg is a twisted curve; They busted me up like a mangled pup. But— THEY DID NOT BUST MY NERVE! For I’m damned if I’ll be a hero. And I ain't a helpless slob. After what I’ve stood, what is left is good. And all I want is — A JOB. PATIENTS The next issue of the “ Chev * 99 will be devoted entirely to news and live stuff about PATIENTS. Get into the game and help us make it go. Now that the Easter season has passed and the trees and flowers are busy pushing forth their leaves and buds to the call of Mother Nature’s demand to bring happiness to mankind; let us stop and ask ourselves — “What am I doing to make this world a bet- ter place to live in, what part am I play- ing in the great game of RECONSTRUC- TION WORK at our Hospital, for those who have suffered for humanity. Just how much interest am I taking, and is it gen- uine and earnest, or merely passive?” Someone has said that true happiness is found only in making others happy. Try this yourself and prove that this is true, see whether you can make the other fellow smile, with a cheery salutation as you pass by his bedside, or see him hobble by on crutches. If you feel blue and discouraged and old man “Gloom” is hanging around pretty steadily, — look above you. and it’s a safe bet you'll find some one much worse off than yourself, and if you are sincere with yourself, you can discount about (Continued on page 19.) Fig. 87. — Specimen page of The Silver Chev TYPES OF HOSPITALS BASE HOSPITAL, 271 Statistical data. United States Army Base Hospital, Camp Grant, Rockford, III., from September, 1917, to July, 1919, inclusive. 11 SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate Number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for disability. Deserted. 1 Discharged, ex- | pirationofterm. Transferred to insane asylums. Transferred to | other hospitals. 1 Otherwise dis- posed of. By trans- fer. Other- wise. Hospital. | Quarters. Hospital. I Quarters. 1917. 9 38 165 0 912 Ill 2 8 3 88 1, 332 88 32 515 337 4 41 1 252 252 33 582 867 536 3 19 1 9 299 9, 393 299 64 801 7 1,171 617 3 66 28 457 11,503 1918. 457 113 1,414 15 1,999 732 11 73 46 300 837 21,046 837 91 l' 045 7 1,980 733 16 54 118 170 889 21, 626 689 68 1,023 5 1, 785 1,063 12 12 47 595 21,816 595 87 1,286 1, 973 1,096 24 16 802 21 ; 135 802 1 079 4 1,930 1,305 17 40 23 4 541 22, 474 541 21 '908 2 1,472 895 27 19 3 523 14, 852 523 33 1,312 1 1, 869 1,270 6 25 1 12 9 546 17, 538 546 41 1, 083 3 l' 673 1, 139 11 37 2 10 9 472 16', 079 472 344 7 6,' 602 2,845 43 30 10 4 3,670 32, 352 3, 670 226 3' 868 10 7, 774 5,239 1,024 13 18 8 1,472 65, 012 1,472 66 '902 3 2, 443 1,635 24 23 1 '760 30; 480 '760 68 2, 141 10 2,979 1, 888 28 9 15 1,032 23, 257 1919. 1,032 84 2,522 3, 643 2,443 18 6 20 1,141 32, 698 1, 141 87 2,044 4 3, 276 1,895 14 18 47 1, 2S7 34; 397 1 ' 287 105 1,' 808 9 3,209 1,990 9 8 141 39 1,022 33, 789 l' 022 7? 1, 686 2 2, 788 1,897 7 14 81 29 760 '760 46 1,695 13 2,514 1,706 4 54 33 32 685 24, 362 June 685 27 '373 5 Togo '473 2 144 54 27 390 15; 450 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1917. 1918. September 1 1 January 185 1S5 October 0 0 191 191 November 215 215 March .1 196 196 December 215 215 PERSONNEL ON DUTY. 6 Year and month. Officers. Enlisted men. Nurses. Civilian employ- ees.’ Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1917. September 244 October 43 2 2 47 249 40 November 63 2 2 67 273 50 1 December 76 1 1 78 277 1918. January 72 2 1 75 272 16 288 71 F ebruary 65 2 1 68 274 16 290 79 March..! 74 2 1 77 300 20 320 79 April 86 1 1 88 529 20 549 88 May 82 2 2 86 612 20 632 108 June 67 3 2 72 579 20 599 105 1 July 78 3 3 84 647 19 666 114 1 August 89 5 2 96 496 19 515 169 1 September 79 6 2 87 741 18 759 125 1 October 96 7 2 105 846 IS 864 211 2 November 101 7 113 830 18 848 250 December 82 8 3 93 803 18 821 132 1919. January 75 2 77 810 18 828 100 F ebruary 79 7 86 816 17 833 95 March 70 1 11 82 878 17 895 92 April 66 11 77 790 790 82 May 61 10 71 608 608 73 June 40 10 50 455 46 a From A. G. O. records. b Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office, (name of hospital). CHAPTER XV. THE GENERAL HOSPITAL (PERMANENT). WALTER REED GENERAL HOSPITAL, WASHINGTON, D. C.<* PRE-WAR PERIOD. Walter Reed General Hospital is a monument to the memory of Maj. Walter Reed, Medical Corps, United States Army, whose biography is so rich in records of research work of far-reaching consequences. It is also an unfinished monu- ment to the Medical Department, whose aim it is ultimately to make it not only an adequately-sized group of attractive buildings, permanently constructed and equipped for the definitive care of all classes of patients, but an educational center where will be located technical schools for the advancement of knowl- edge of the members of the different branches of the Medical Department. This effort to have established in the city of Washington a permanent general hos- pital, and in connection with it a training school, germinated during the early days of the Civil War. In the Annual Report of the Surgeon General of the Army, 1862, a recom- mendation was made to the Secretary of War that a permanent general hospital be established in Washington, and in connection therewith, the establishment of an "Army Medical School, in which medical cadets and others seeking ad- mission to the corps could receive such special instruction as would better fit them for commissions.” This recommendation came to naught. In 1S93, however, Surgeon General Sternberg succeeded in accomplishing the establish- ment of the Army Medical School in Washington; but it was not until 189S, as an incidence of the Spanish- American War, that the organization of a permanent general hospital in Washington was effected. General Orders, No. 140, War Department, September 8, 1898, designated the post hospital, Washington Barracks, D. C., a general hospital, and placed it under the exclusive control of the Surgeon General of the Army. While this was a step forward in securing a permanent Army general hospital in the city of Washington, a step which demonstrated the great advantage of such an institution, the building in itself was in no way adequate and it was necessary to add one-story ward buildings of a temporary character. These temporary buildings rapidly deteriorated and there was a ceaseless and untiring effort on the part of the Medical Department to secure a more permanent hos- pital of sufficient capacity to meet the requirements of the Army dming peace times, with reasonable possibilities for expansion dining war. Certain conditions arising in 1903 rendered the situation acute. In the Annual Report a The statements of fact appearing herein are based on the “History, Walter Reed General Hospital, ^ ashington, D. C.,” by Capt. H.C. Dean, M. A. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 273 of the Surgeon General, United States Army, for the fiscal year ending June 30, 1903, this statement appears: The work of construction at Washington Barracks, now well underway, will render the removal of the general hospital imperative in the near future. Plans for the War College and Engineer School contemplate a new building on the present site of the hospital. It has been proposed to move the present building and use it as a post hospital during the construction work, and for the purpose it is neither too large nor too good. It is inadequate in size for a general hospital, however, and, being largely built of timber it has shrunk and settled until is is no longer possible to maintain it in the perfect sanitary condition absolutely necessary where aseptic operations are to be performed. The building is about 10 years old and cost about $40,000. It is always crowded, so that nurses must be lodged outside, and there are no private rooms for officers or special cases. The location is not suitable, even if it were possible to retain the site, as the ground is low and the heat excessive in summer. The Company of Instruction of the Hospital Corps is quartered in temporary wooden pavilions in bad repair, which were built during the war with Spain and are now worthless for any purpose. I repeat most earnestly my previous recommendation that a general hospital of sufficient size and perfect in every respect be built in the District of Columbia for the following purposes: First. Treatment of cases needing the services of specialists, surgical or other observation, and treatment of officers incapacitated for service prior to their appearance before retiring or examining boards. Second. Training enlisted men of the Hospital Corps in nursing and military duties. Thud. Instruction at the Army Medical School in military surgery, hospital administration, Hospital Corps drill, and establishment of field hospitals. Fourth. To serve as a nucleus around which, in time of war, temporary wards may be erected without delay to any extent and at minimum expense. The recommendation of the Surgeon General was followed closely by official action looking to its realization. On October 12, 1903, The Adjutant General of the Army appointed a board of officers "To meet as soon as practi- cable for the purpose of ascertaining the most suitable location within the District of Columbia for the erection of a general hospital.” Subsequent to the receipt of the order the board met at different times and its individual members carefully scanned the District for land which might be available. In deciding upon the suitability of a site the board was governed by the use to which the hospital was to be put, and these uses dictated the following re- quirements: That the site be well drained, that it have water and gas supply, and an accessible sewer, if possible, and that it be situated on a good road, acces- sible to street cars and near a railroad so that sick might be transferred directly to the hospital without being carried to the city. This combination of require- ments limited the choice of locations, and from 32 available tracts the less desirable were gradually eliminated until the judgment of the board narrowed to the final selection of the "Cameron tract.” This tract had an elevated, sub- urban situation, near the northern boundary of the District, two street car connections with the city of Washington and direct communications with the cars running near the Army Medical School, and was less than a mile removed from a station of the metropolitan branch of the Baltimore & Ohio Railroad. The purchase of this site, as recommended by the board, was accomplished on May 20, 1905, the tract containing 43.27 acres at $2,311.07 per acre, the total cost being $100,000. Funds for the purchase were made available by act of Congress approved March 3, 1905, which appropriated $100,000 to be imm edi- 45269°— 23 IS 274 MILITARY HOSPITALS IN THE UNITED STATES. ately available, and provided that the “ total cost of said hospital, including site therefor, * * * shall not exceed the sum of $300,000.” The tract thus purchased was announced as a military reservation May 2, 1906, in War Department general orders of that date, the name of the hospital having been previously announced in General Orders No. 172, War Department, October 18, 1905. Under the urgency deficiency bill approved by the President February 27, 1906, there was made available the sum of $200,000 for the building of a general hospital. The main building, known as building No. 1, was completed December 4, 1908. It was of brick, its dimensions being 192 by 48 feet. Its total floor Fig. S8_ — Administration building, Walter Reed General Hospital. area was 27,648 square feet. The foundation was concrete and there were a basement, three floors, and an attic, with a tin roof. The building was heated by hot water, lighted by electricity, and provided with water and sewer connec- tions. It was intended primarily for administrative purposes principally, and its bed capacity was only 65. On the first floor space was provided for the following activities: The commanding officer, adjutant, clerks, first sergeant, reception hall, resident physician, eye, ear, and throat, officer of the day, library, reception room, laboratory, etc.; on the second floor were one large ward and several small ones, the prison ward, reception room, rooms for ward masters, toilets, etc. ; on the third floor were the operating suite, recovery rooms, dressing rooms, and several small wards. TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 275 The original construction cost of the main building was $197,860, but additional cost has been incurred by improvements and additions as follows: In 1909, $1,985; 1910, $705,000; and in 1912, $106,540. The cost of repairs made to March 1, 1918, a period covering practically the first 10 years of the life of the building, totaled $9,204.37. Building No. 2, a double set of hospital stewards’ quarters, was completed April 18, 1908. It was of brick, with a concrete foundation; and contained a basement, two floors, and an attic, with slate roof. I*'IG. 89. — Hospital stewards’ quarters, Walter Reed General Hospital. Building No. 3 was similar to No. 2 in construction and use to which it was put. Building No. 4 was a storehouse for quartermaster and commissary supplies. Building No. 5 was a stable; and No. 6 was a wagon shed and garage, with capacity for 12 animal-drawn vehicles in addition to three automobiles. Building No. 7, a barracks for the enlisted personnel, had a capacity of 200 men. This building was completed March 8, 1910. It was of brick with concrete foundation and a roof of slate. Its dimensions were 137 by 119 feet, with total floor area of 21,230 square feet. It was heated by steam and lighted by electricity. Water and sewer connections were provided. Building No. 8 was a captains’ set of quarters and was completed March 8, 1910. This building was likewise of brick with concrete foundation and slate roof. Its dimensions were 33 feet by 46 feet 5 inches, and its total floor area 3, 812 square feet; it was heated by steam, lighted by electricity, and was 276 MILITARY HOSPITALS IN THE UNITED STATES. provided with water and sewer connections. The original cost of this building was $12,757. Building No. 9 was completed March 8, 1910, and was similar to building No. 8. Building No. 11 was the mortuary. Building No. 12, the Army Nurse Corps home, with capacity of 20 nurses, was completed April 9, 1911. It was of brick with concrete foundation, and roof of slate; it was heated by hot water, lighted by electricity, and provided with water and sewer connection. The original construction cost of this build- ing was $24,998. Fig. 90. — Detachment barracks, Walter Reed General Hospital. Building No. 13, the isolation hospital, with a capacity of 12 beds, was completed on November 15, 1913. It was constructed of brick with concrete foundation and a roof of slate. The total cost of its original construction was $22,302.24. On April 6, 1904, ward A, the west addition to the main building (building No. 1) was completed. It was of brick construction to correspond with the main building, and had concrete foundation and a tin roof. The dimensions of this west wing were 43 by 54 feet, and the corridor connecting it with the main building was 17 feet by 34 feet 6 inches. The total floor area, including the corridor, was 2,3S0 square feet. This addition had a basement and one floor. In the basement there were a recreation room, toilet, closet, corridor, and TYPES OF HOSPITALS — GENERAL HOSPITAL (PERMANENT). 277 stair hall. On the first floor there was a ward, 51 by 24 by 13 feet. The cost of the construction of this wing was $23,158. A second addition to the main building was completed December 28, 1914. This addition, joined to the rear of the main building, was the kitchen and mess, and was constructed of material similar to that of the parent building. Its dimensions were 28 by 37 feet and 28 by 63 feet. There were three floors and a basement. The basement was used for the storage and preparation of food; the first floor contained the dining hall; and on the second and third floors the rooms were used as wards. The construction cost of the building was $43,258. Fig 91.— Officers’ quarters, Walter Reed General Hospital On May 8, 1915, ward B, the east addition to the main building was completed. It was similar in size and appearance to the west addition, and was used for wards. In the basement were the wards for the insane. On April 26, 1915, the addition to the nurses’ home (building No. 12), with a capacity of six beds, was completed. The original construction cost of this addition was $18,729. On May 1, 1909, when there were only the main building and the two double sets of hospital stewards’ quarters, the hospital opened for the reception of patients, in compliance with General Orders No. 702, War Department, April 14, 1909. The post return for May, 1909, shows that there were on duty at the opening, 5 officers, 62 enlisted men of the Hospital Corps and 3 civilian employees — a carpenter, an engineer, and a cook. There was also a matron. 278 MILITARY HOSPITALS 1ST THE UNITED STATES. Company C of the Hospital Corps, representing 1 officer and 82 enlisted men. was attached to the hospital for quarters and rations. That the hospital began to function promptly is indicated by the post return record of the patients remaining at Walter Reed on May 1, 1909, the end of the first month of activity. At that time 5 officers and 1 1 enlisted men, 2 retired enlisted men and 1 civilian were under treatment at the hospital. Members of the Army Nurse Corps were first assigned to the hospital in June, 1911, after completion of the nurses’ quarters. One chief nurse and three nurses joined for duty on June 21, 1911, and a fourth nurse joined on Fia 92. — Nurses’ quarters, Walter Reed General Hospital. June 24. Their assignment to the hospital facilitated the admission of female patients, who, prior to that date, had been dependent upon the matron for nurse’s care. The annual reports for the years preceding 1917 indicate steady progress in the work at Walter Reed General Hospital and marked improvement in the physical aspect of the buildings and grounds. The register shows that up to April 6, 1917, the day on which war was declared, 7,017 cases had been admitted to Walter Reed. The post return for April, 1917, gives the following personnel record for that month: On duty — 15 officers, 145 enlisted men of the Medical Depart- TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 279 ment and 13 enlisted men of the Quartermaster Corps; patients — 19 officers, 89 enlisted men, 3 retired officers and enlisted men and 10 members of the National Guard. The administrative system at that time was comparatively simple. There were one commanding officer, one chief of the medical service (who, in addition, performed the duties of the summary court officer), one chief of the surgical service, one chief of the eye, ear, nose and throat service (who also performed the duties of recruiting officer and acted as assistant professor of ophthalmology at the Army Medical School, Washington), one officer who performed the Fig. 93. — Isolation building, Walter Reed General Hospital. duties of post quartermaster, post ordnance officer, signal and medical property officer, and the commanding officer of the detachment, Medical Department and Quartermaster Corps, one officer who acted as adjutant, registrar, and mess officer, and one officer who performed the duties of pathologist and roent- genologist. One dental officer was on duty and gave dental service to the entire command. The additional officers on duty were assigned as assistants in the various departments and performed such additional duties as members of boards, post exchange officer, athletic officer, and librarian. 280 MILITARY HOSPITALS IN THE UNITED STATES. HISTORY SUBSEQUENT TO BEGINNING OF WORLD WAR. PHYSICAL CHARACTERISTICS. Geographic location — Walter Reed General Hospital is located at Takoma Park near the northern limit of the District of Columbia. It may be reached by street car in one hour’s time from the center of the city of Washington. A main highway, Sixteenth Street, likewise connects it with the center of the city, extending directly from the Executive Mansion, the White House, through an attractive part of Washington to the western entrance to the hospital grounds. Terrain . — The site of the hospital possesses a varied terrain. Portions of the grounds are gently rolling and admirably suited to building purposes; other portions are roughly hilly and not adaptable to the orderly arrangement of large numbers of temporary buildings in regular rows. The grades for the necessary roads are moderately easy. Serpentine cmwes of the main roads through the grounds, which are covered with a wide variety of well spaced Fig. 94 1 — Aeropbotograph, Walter Reed General Hospital. trees, furnish a vista both parklike and picturesque. The elevation of the site averages 300 feet. Soil . — The tract is situated where the Coastal Plain and the Piedmont Plateau meet. The resultant soil is diversified in character: it is gravelly and varies in color from grayish yellow to yellowish gray. The subsoil is composed of partially weathered Piedmont Rock and is reddish yellow to brownish. The physical characteristics of both soil and subsoil are such that moisture is moderately well conserved except during unusually dry periods. Climate . — The climate is moderate throughout the year. The winters are usually relatively short and “open ’: the summers are proportionately long. The prevailing winds (averaged for 20 years) are northwest for January, February, March and April; south for May, June, July, August and Septem- ber; and northwest for October, November and December. Roads . — Within the hospital grounds the roads are of well-kept concrete, bordered by side walks of similar material. TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 281 Hospital environment . — The sanitary status of the surroundings of the hospital area is that of a well-managed suburban residential section, and is entirely satisfactory. Asphalt streets, maintained by the city of Washington, extend to the entrance to the hospital grounds. 1 Voter supply . — Water is supplied by the city of Washington, its original source being the Potomac River about 22 miles up stream. It is treated in sand filtration beds before it enters the city system. Sewerage . — The sewage of the hospital is disposed of through an adequate sewerage system, which becomes a part of that of the city of Washington. Surface drainage is likewise disposed of through the city system. Garbage disposal . — Garbage is stored in covered receptacles and is removed daily, except Sunday, by contract. WAR-TIME PHYSICAL EXPANSION. The war emergency of 1917, necessarily assembling a number of troops in the vicinity of Washington, initiated the expansion of Walter Reed Hospital, which continued during the following three years. It will be recalled that, in his recommendation made in 1903, for the establishment of the hospital, the Surgeon General, United States Army, had contemplated such a war- time expansion in that provision of his report which urged that the hospital "serve as a nucleus around which, in time of war, temporary wards may be erected without delay to any extent and at minimum expense.” In addition to its functions as a general Army hospital and as the post hospital for Washington Barracks, Walter Reed General Hospital now served as a post hospital for the several camps in the vicinity of Washington. The construction of temporary buildings was commenced June 15, 1917. By the end of the year the hospital had a capacity of 950 beds, and the following buildings of the temporary groups had been completed : Nurses’ quarters: One-story frame construction, 24 by 497 feet (3 wings), used as quarters for the Army Nurse Corps (female), with accommodations for 50 nurses. Barracks: Two-story frame construction, 93 by 111 feet, used as quarters for enlisted men, with accommodations for 250 men. Mess hall: One-story frame construction, 25 by 157 feet, used for enlisted men's mess, with accommodations for 250 men at one sitting. Storehouse: One-story frame construction, 73 by 137 feet, used for storage of medical supplies. Guardhouse: One-story frame construction, 24 by 35 feet, used for confinement of prisoners. Capacity: Guards, 4; prisoners, 15. Linen building: One-story frame construction, 24 by 70 feet, used for storage of linens. Receiving ward: One-story frame construction, 82 by 93 feet, used for the receiving of patients, and storage of their personal effects, with accommodations for 8 patients, pending their assignment to other wards. Ten single wards: Wards E, F, G, II, I, L, M, N, Q, and R, of one-story frame construction, 24 by 157 feet, used for the accommodation of enlisted sick. Capacity of each ward, 45. Thirty additional patients could be accommodated on the porches of each ward. (These wards were later designated as 11, 12, 13, 14, 15, 2, 31, 32, 33, and 34, respectively.) Three double wards: A and B, C and D, J and K, of one-story frame construction, 24 by 314 feet, used for the accommodation of the enlisted sick. Capacity of each ward, 85 patients. (These wards were later designated as 1-2, 16-17, and 18-19.) All of the above enumerated temporary buildings, erected in 1917, as will appear from the individual descriptions, were of frame construction. They were built on concrete piers, had composition roofs and wooden floors, were lighted by electricity and were provided with water and sewer connections. 282 MILITABY HOSPITALS IN THE UNITED STATES. In May, 1917, there was commenced the construction of a central power plant from which all temporary buildings were to be heated. As this power- house was not completed until the following year, the heating arrangements of such temporary buildings as were used during 1917 were necessarily of a makeshift character. The necessity for obtaining additional land to afford ground space for the rapidly multiplying buildings became apparent and immediate. Three adjacent sections of land were accordingly purchased during 1918. On January 30, 1918, a deed recorded in liber No. 4057, folio 174, of the land records of the District of Columbia, conveyed 0.118 acre. Release and quitclaim deeds of the same property were executed on February 1, 1918, and April 18, 1918. On February 2, 1918, a deed recorded in liber No. 4057, folio 177, of the land records of the District of Columbia, conveyed 5.988 acres. Release and quit- claim deeds to this property were executed May 5, 191S. The land conveyed by the above-described deeds constituted two triangular sections. One sec- tion was bounded by Dogwood Street on the north and by Thirteenth Street on the west, while the hypothenuse of the triangle, to the southeast, lay along the northwestern boundary line of the original hospital reservation. The other section was bounded by Dahlia Street on the north and by Fourteenth Street on the west, while the hypothenuse of the triangle, to the southeast, coincided with the northwestern botmdary of the original hospital reservation. On March 25, 1918, a deed recorded in liber No. 4057, folio 173, of the land records of the District of Columbia, conveyed 19.76 acres. This addition extended the northern and southern boundary lines of the original reservation west of Sixteenth Street. The above enumerated purchases, consisting of 25.966 acres, added to the original purchase of 43.27 acres, brought the total area of the reservation up to 69.136 acres. TYPES OF HOSPITALS GENERAL HOSPITAL < PERMANENT ) . 283 At the end of the year 1918 the annual report for the hospital shows a capacity of 2,500 beds, and in the same report the record of the completion of temporary buildings, which includes the construction for the years 1917 and 1918, stands as follows: Nurses’ quarters: Three 1-story frame constructions, 24 by 497 feet, 0 24 by 217 feet, and 24 by 217 feet, used as quarters for the Army Nurse Corps (female), with accommodations for 150 nurses. (Known as nurses ’ homes, Nos. 2, 3, and 4, respectively.) Barracks: Two-story frame construction, 93 by 111 feet, used as quarters for detachment, Quartermaster Corps, and Motor Transport Corps, with accommodations for about, 250 men. Quartermaster mess hall: One-story frame construction, 25 by 157 feet, used for enlisted men ’s mess, with accommodations for 250 men at one sitting. Mess hall No. 2: One-story frame construction, 24 by 625 feet, used for enlisted patients’ mess, with accommodations for 700 men at one sitting. Medical Property storehouse: One-story frame construction, 24 by 261 feet/' used for the storage of medical supplies. Kitchen storehouse: One-story frame construction, 24 by 70 feet, used for the storing of canned goods and other staple supplies used by the mess department. Linen building: One-story frame construction, 24 by 70 feet, used for the storing of hospital linen. Baggage storehouse: One-story building, 24 by 36 feet, used for the storing of baggage. Frame construction. Quartermaster storehouse: One-story frame construction, 100 by 118 feet, used for the storing of quartermaster supplies. Guardhouse: One-storv frame construction, 24 by 35 feet 6 inches, used for the confinement of prisoners. Capacity: 4 guards, 15 prisoners. Receiving ward: One-story frame construction, 82 by 93 feet, used for the receiving of patients and storage of their personal effects, with accommodations for 8 patients pending their assignment to other wards. Also used as a post-office substation . Two 2-story isolation wards, 24 by 156 feet (designated as wards 23-24, and 27-28), of frame construction, each ward having accommodations for 72 patients. Two 1-story isolation wards, 24 by 151 feet (designated as wards 25 and 26), of frame con- struction; capacity, 36. Three double wards and lavatories, 24 by 314 feet (designated as wards 1-2, 16-17, and 18-19), of frame construction, 1-story plan. Twenty-six single-ward buildings: Wards 3 and 4 (orthopedic); ward 5 (used at present as a nurses’ home); ward 11 (orthopedic); wards 12, 13, 14, 15 (medical); wards 31, 32, 33 (orthopedic); wards 34, 35, and 36 (eye, ear, nose and throat); wards 41, 42, 43, 44, and 45 (psychopathic); wards 65 and 66 (orthopedic); wards 71, 72, 73, 74, and 75 (orthopedic). These ward buildings were 1-story frame construction and were used for the accommodation of enlisted sick. Capacity of each ward, 36. Dimensions of each ward, 24 by 157 feet. Thirteen double-ward buildings: Wards 51-52 (used as quarters for detachment, Medical Department); wards 53-54, 55-56, 57-58, 59-60 (orthopedic); wards 61-62 (occupied by the con- struction quartermaster and used as office buildings); wards 63-64 (genitourinary); wards 81-82, 83-84, 87-88, 89-90, 91-92 (orthopedic); wards 85-86 (occupied as quarters by detachment, Medical Department). These ward buildings were 2-story hollow-tile construction. Each double ward had accommodations for 72 patients and was occupied by enlisted sick. Dimensions of each ward, 24 by 157 feet. Officers’ pavilions 1 and 2: Two 1-story frame construction, 24 by 314 feet and 24 by 272 feet, used for the accommodation of officers’ sick. Capacity, 50 patients each. Red Cross building: Tile and frame, 82 by 120 feet. Post-exchange building and auditorium: One-story frame construction, 44 by 157 feet, used as a salesroom and auditorium by the post exchange. Bakery: One-story frame construction, 24 by 92 feet, used as post bakeshop. Wagon shed: One-story frame construction, 75 by 90 feet, used for the storing of wagons, and also occupied by the hospital fire department. a This building had 3 wings. 284 military hospitals in the united states. Bacteriological laboratory: One-story frame construction, 24 by 170 feet. Laboratory addi- tion, 40 by 81 feet 6 inches. Dental building: One-story tile construction, 24 by 350 feet, occupied by the dental, eye, ear, nose, and throat clinics. Oil shed: One-story frame construction, used for the storing of oils. One school building: Wards 93-94, 2-story hollow-tile construction, 24 by 157 feet, used as administrative and school building by the division of reconstruction. Wards 95, 96, 97, and 98: One-story hollow-tile construction, 24 by 157 feet, used as curative workshops by the division of reconstruction. The physiotherapy building: One-story hollow-tile construction, 24 by 410 feet, including rooms for the hydrotherapy department, electrotherapy department, massaging, and also a gym- nasium. (This building was not actually ready for occupancy until 1919.) A nim al house: One-story frame construction, 10 by 20 feet. Most of these buildings had concrete foundations (though a few were built on wooden posts), wooden floors, and composition roofs. The wagon shed, bakery, and animal house had concrete floors. All were lighted by elec- tricity and provided with water and sewer connections. Fig. 96. — A view of temporary buildings, Walter Reed General Hospital. In addition to the rapid temporary construction during the war period it was necessary to make certain permanent improvements in the hospital proper. The heaviest expense was incurred in the construction of a power house from which all the temporary buildings were heated. The power plant, although started in May, 1917, was not completed until the following year. The foundations are of concrete, the walls of brick, and the roof steel truss. It has two stacks of radial tile, 150 feet high. The dimensions of the plant are 140 by 40 feet with an L wing 40 by 30 feet. Other permanent buildings erected at this time include an incinerator, a morgue, and a garage addition. The incinerator was a Xye odorless crema- TYPES OP HOSPITALS GENERAL HOSPITAL ( PERMANENT ) . 285 Lory incinerator, consisting of a basement and one story, of brick construction with concrete foundation. Aside from actual building operations the permanent construction of this period included the installation of various systems and devices, which, with other costs, are enumerated below: Roads, concrete §38,097.48 Electric lighting system 794. 98 Aero alarm system 19, 640. 00 Water supply system (in reserve) 45, 886. 83 Water supply mains (to reserve) 27, 071. 96 Sewer system 35,681.26 Powerhouse, heating, original 293,000.00 Heating system (exterior to buildings) 59, 311. 40 Heating system (power house addition) 57, 331. 30 Heating system (north stack) 6, 250. 70 Total heating system, part 2 245, 408. 90 Total 828,474.81 The cost of the permanent buildings erected during the war period is itemized as follows: Powerhouse, building proper, original §36,000.00 Incinerator (old building) 8, 000. 00 Garage addition 24, 373. 00 Morgue 3, 346. 30 Alterations, attic of barracks 11, 830. 59 Service club (a gift paid for from National Catholic War Council Fund) 85, 000. 00 Total 168,549.89 In September, 1918, the Lane Convalescent Home was taken over as a convalescent home for enlisted sick. This home was located in Takoma Park, D. C., about one-half mile distant from the hospital, and had accom- modations for 10 convalescent enlisted men. In November, 1918, the Friendship Home, also known as the McLean Estede, was taken over as a convalescent home for sick officers. This home, which was offered to the Government by the owner, was located on Wisconsin Avenue NW., Washington, D. C., about 5 miles from the hospital. It had accommodations for 50 convalescent officers. ADMINISTRATIVE EXPANSION. After the declaration of war the personnel of the hospital rapidly increased until it was doubled and then redoubled. The picked men of the Regular Army of this time had furnished a small quota of sick, and Walter Reed Gen- eral Hospital had been an uncrowded, unhurried sanitarium for the care of this small number. Under the pressure of the war emergency it expanded in a little over a year’s time into an institution the inhabitants of which were sufficient to make a thriving little town, and possessing many more activities than such a town would have known. The forced growth required unremitting care and control and the widely varied elements gathered at Walter Reed General Hospital had to be bound together with a tight organization. In 286 MILITARY HOSPITALS IN THE UNITED STATES. perfecting such an organization a comprehensive set of regulations was evolved, in which was outlined the following administrative system: HOSPITAL ORGANIZATION THE COMMANDING OFFICER. Department of administration: 1. The executive officer — (а) Officer of the day. (б) Night administrative officer. 2. Correspondence and records — (a) Adjutant. (b) Personnel adjutant — (1) Insurance officer. (c) Supervisor of clinical records — (1) Registrar. (2) Curator, department of illustration. (3) Medical examining board for officers. (4) Disability board for enlisted men. (5) Demobilization board. 3. Inspection — (а) Hospital inspector (inspection of administration and service departments). (б) Sanitary inspector (inspection of grounds and buildings for sanitation and main- tenance). (c) Post surgeon (inspection of dairies, food supplies, etc.). (d) Adjutant (inspection of public funds). (e) Survey officer (inspection of unserviceable property). 4. Detachment administration — (a) Detachment commander, patients — (1) Receiving officer. (2) Disposition officer. ( b ) Detachment commander, Medical Department. (c) Detachment commander, Quartermaster Detachment. (d) Detachment commander of nurses. (e) Detachment commander of aides. 5. Police and fire protection — (a) Intelligence officer. (b) Prison officer. (c) Fire marshals. (d) Police officer. (e) Courts-martial. Department of service and supply: 1. Service of supply— (a) Supply officer. (b) Ordnance officer. (c) Finance officer. (d) Transportation officer. (e) Salvage officer. (/) Medical supply officer. 2. Constructing and utilities service — (a) Constructing quartermaster. ( b ) Utilities officer. 3. Mess service — (a) Mess officer. (b) Dietitians. 4. Motor transport service — (a) Motor transport officer. 5. Telphone and telegraph service — (a) Signal officer. TYPES OF HOSPITALS — GENERAL HOSPITAL (PERMANENT). 287 Department of service and supply — Continued. 6. Post exchange — • (a) Exchange officer. 7. Recruiting service — (a) Recruiting officer. 8. Morale, education and recreation service — (a) Chaplains. (b) Morale officer. (c) Education and recreation officer. ( d ) Service club hostess. (e) Librarian. Department of professional services: 1. Surgical service: Chief of service — (a) Administration officers — (1) Assistant to chief of service. (2) Chiefs of sections. (3) Ward surgeons. (4) Surgical emergency officers. ( b ) Professional sections — (1) General surgery. (2) Septic surgery. (3) Empyema. (4) Maxillofacial. (5) Neurosurgical. (6) Eye, ear, nose and throat. (7) Orthopedic. (8) Amputation. (9) Dermatology and syphilis. (10) Urology. (11) Obstetric and gynecologic. (c) Professional departments — (1) Dental. (2) X-ray. (3) Orthopedic appliance shop. (4) Anesthesia. 2. Medical service: Chief of service — (а) Assistant to the chief of service. (б) Chiefs of section — (1) General medicine section. (2) Neuropsychiatric section. (3) Contagious disease section. (c) Receiving officer. ( d ) Post surgeon. ( e ) Ward surgeons. (/) Medical emergency officer. Laboratory department — (а) Bacteriological section. (б) Chemical section. (c) Pathological section (mortuary). Reconstruction and education departments: 1. Ward handicrafts: For patients unable to leave their wards. 2. Curative shop work: For patients whose primary requirement is curative; occupational therapy. (a) Wood working. ( b ) Rug weaving. (c) Clay modeling. (■ d ) Gardening. ( e ) Typewriting. 288 MILITARY HOSPITALS 1 1ST THE UNITED STATES. Reconstruction and education departments — Continued. 3. Educational and vocational training — (a) Academic: English, reading, writing, arithmetic, etc. ( b ) Commercial: Shorthand, typewriting, bookkeeping, accounting, office appliances. (c) Trade and vocational training — (1) Auto mechanics. (2) Garden and greenhouse management. (3) Electrical wiring and dynamo tending. (4) Drafting. (5) Jewelry making and repairing. (6) Machine shop practice. (7) Motion picture operating. (8) Photography. (9) K,ug weaving and repairing. (10) Wireless telegraphy. (11) Oxyacetylene welding. (12) Vulcanizing and tire repairing. (13) General printing. (14) Linotype operating. (15) Wood shop practice. Physiotherapy department: 1. Measurement and record section. 2. Hydrotherapy. 3. Electrotherapy. 4. Massage. 5. Medical gymnastics. Nursing department: 1. Army Nurse Corps — principal chief nurse — (а) Assistant chief nurse (records and correspondence). (б) Day supervisor for graduate nurses. (c) Night supervisor for graduate nurses. 2. Army School of Nursing — (a) Superintendent — ■ (1) Theoretical instructor. (2) Practical instructor. (3) Circulating supervisors for student nurses. HOSPITAL DEPARTMENTS. The activities of the hospital were organized under a commanding officer and divided into six departments, namely, administration, service and supply, professional services, reconstruction and education, physiotherapy, and nursing. Department of Administration. In the department of administration there were five functional divisions: The executive officer; correspondence and records; inspection; detachment administration; police and fire protection. The executive officer was charged, under the direction of the commanding officer, with the coordination of all departments of the hospital. Under his supervision the duties of the officer of the day and the night administrative officer were performed. The officer of the day was detailed by the adjutant from the roster of the officers, below field rank, on duty at the hospital, and the detail took precedence over all other details. The tour of duty for this officer was for 24 hours, during which time he might not absent himself from the post. In the absence of the commanding officer and subordinate administrative officer, TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 289 the officer of the day acted, and he was further specifically charged with the duties of making an inspection tour of the main building and all wards of the hospital at least once during his tour of duty; inspecting the guard at least three times during his tour of duty; inspecting at least one meal at each mess conducted for patients, nurses, and enlisted personnel of the hospital; in case of fire, taking charge pending the arrival of the commanding officer or fire marshal, reporting in detail any fire occurring during his tour of duty and visit- ing the firehouse at least once during his tour to assure himself that the crew was on duty; acting for the commanding officer in carrying out hospital regu- lations regarding uniforms, passes for visitors, extinguishing lights, and in the maintenance of order and discipline; witnessing the preparation of the bodies of deceased patients and forwarding reports of deaths to the registrar’s office; opening all official telegrams received outside of regular office hours, and sending telegrams indicated by serious illness, deaths or other emergencies; conducting the guard detail, in which connection he was charged with the responsibility of safeguarding the prisoners. The night administrative officer was the night representative of the executive officer in the coordination of the hospital administration. He was called upon to render all possible assistance to the officer of the day in the maintenance of good order and military discipline, and particularly to maintain by frequent inspection and necessary action the police and fire prevention of the post. CORRESPONDENCE AND RECORDS. The adjutant had charge of all incoming and outgoing correspondence, orders, and circulars, and had general control of all hospital records. He verified and issued all orders and details, including administrative assignments, both roster and special of officers and civilian employees. He examined in person all incoming correspondence and referred to the proper officer, letters, orders, or circulars, for guidance or action, maintaining such record of disposi- tion of papers as would insure prompt and certain execution of public business. He caused replies, indorsements, and reports to be prepared for the signature of the commanding officer and replied, in the name of the commanding officer, to letters of inquiry concerning patients. In cases of critical illness or serious operative procedure, he was charged with the notification of relatives, and in case of death in the command, he was charged with the arrangement for the disposition of the remains and the effects of the deceased and the notification of all concerned. He insured the audit of all public funds and submitted a report of audit, together with a statement of all funds, as soon as possible after the end of each month, to the commanding officer. He also acted as historian of the post. The personnel adjutant maintained the official records of all commissioned officers either on duty or sick at the hospital. He prepared all pay cards, pay rolls, and reports of changes in the status of officers and enlisted men, and all papers, other than professional, relating to the discharge of enlisted personnel on a surgeon’s certificate of disability. He was further charged with the main- tenance of records of enlisted casual sick, records of the naturalization of aliens, with notarial duties, instruction in income-tax returns, and the supervision of 45269°— 23 19 290 MILITARY HOSPITALS IN THE UNITED STATES. the insurance officer in all matters relating to insurance, compensation, and allotments under the Bureau of War Risk Insurance. The insurance officer was responsible for the preparation of all applications, alterations, conversions, or discontinuances of insurance, and the presentation to the War Risk Bureau of all claims for insurance in cases of permanent total disability. The supervisor of clinical records was responsible for the permanent record of all patients admitted to the hospital and the preparation of data for the commanding officer relating to the clinical records or professional pronounce- ment for record and correspondence. He was charged specifically with the following duties: Requiring the proper clinical records to be submitted from the various professional services upon completion of cases whether by dis- charge, transfer, death, or other disposition; supervising the proper classifica- tion, indexing, filing, and preservation of clinical records; signing death certi- ficates; filing records of clinical importance in connection with discharge or other disposition of officers admitted to the hospital; furnishing the command- ing officer with a definite and authoritative statement concerning patients, when called upon to do so ; representing the commanding officer on the advisory board of the department of exhibits. The registrar maintained in an indexed and available form all medical and surgical records, prepared all reports and returns pertaining to the sick and wounded and kept an accurate index of diseases. The curator had charge of the department of illustration. The purpose of this department was to collect, index, preserve and exhibit prints, slides, sketches, specimens and models of scientific interest in connection with the work of the hospital. The department was composed of a pictorial sec- tion (oil, black and white, water color) ; a photographic section (color, portrait, specimens, prints, slides, enlargements and reductions, microphotography) ; and a modeling section (plaster, wax). The curator received requests for work from any department of the hospital and assigned the execution of the work to the proper artists. He bore the responsibility for the care, preservation, and proper arrangement of all exhibits. The policy of the department and all questions arising in connection with the character of work and a priority of consideration, were determined by an advisory board consisting of the chiefs of the medical and surgical services, the chief of laboratory service, and the supervisor of clinical records. The medical examining board for officers consisted of the chief of the surgical service, the chief of the medical service, the chief of the eye, ear. nose and throat department, and the supervisor of clinical records. The last named officer was the recorder of the board. The board acted on recommendations for retirement or other disposition of officers of the Regular Army; the disposition of temporary officers; the disposition of nurses; and the review of cases of appeal from action of the disability board. The disability board for enlisted men, the duties of which were those indicated by the name of the board, consisted of the supervisor of clinical records, the first assistant supervisor of clinical records, a representative of the surgical service, a representative of the medical service, a representative of the eye, ear, nose and throat department, and a representative of any speciality, upon call of the chairman. TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 291 The demobilization board, organized for the purpose of examining officers and enlisted men prior to demobilization, consisted of the supervisor of clinical records, the first assistant supervisor of clinical records, the second assistant supervisor of clinical records and a representative of the eye, ear, nose and throat department. INSPECTION DIVISION. The inspection division was organized as follows: Hospital inspector (inspection of administration and service departments) ; sanitary inspector (sanitary inspection of grounds and buildings) ; post surgeon (inspection of dairies, food, food supplies, etc.); adjutant (inspection of public funds); and survey officer (inspection of unserviceable property). The hospital inspector was required to make a progressive study of the administration and service of the departments of the hospital, with a view to increased efficiency. The sanitary inspector made periodical inspections of all buildings and grounds of the station for the adequate maintenance of sanitation, police, fire prevention, upkeep of building, and general discipline of enlisted personnel on duty. Seven noncommissioned officers were detailed to assist him in such inspection. The post surgeon furnished medical attendance to the personnel on duty. He held sick call and prescribed physical inspection for detachments of the enlisted men; he furnished medical attendance to nurses and aides. He was responsible for the furnishing of medical attendance to every man in confinement and acted as ward surgeon to detention wards. He was authorized to call upon the special professional services for special treatment, when necessary. He was responsible for the maintenance of prison wards in a proper sanitary condition. He was expected to make a careful survey of conditions affecting health of the command, instituting corrective measures whenever indicated, and at the end of every month to prepare the surgeon’s sanitary report; to keep informed concerning the source, prevention, and disposal of food supplies; and to see that food handlers were free from contagious or communicable diseases. The disinfection of buildings and property exposed to contagious diseases was in his charge. To the survey officer fell the duty of disposing of property which had been rendered unserviceable other than by fair wear and tear in the service, as indicated in paragraph 717, Army Regulations. DETACHMENT ADMINISTRATION. The division of detachment administration included five commanders, for the patients, Medical Department, Quartermaster Department, nurses, and aides. The commander of the detachment of patients performed all duties of his office as prescribed in Army Regulations, Manual for the Medical De- partment, general orders of the War Department, and the regulations of Walter Reed General Hospital. Under his direction the receiving officer and the dis- position officer performed their respective duties. The receiving officer was charged with the following duties and responsibilities: (1) To receive, examine, classify, and send to the proper wards all incoming patients, exercising due precaution in the prompt isolation of contagious or infectious diseases. (2) To keep informed at all times concerning the number of beds available in the various wards and to foresee and provide for expected arrivals. (3) To supervise the transportation of sick and wounded to and from the hospital 292 MILITARY HOSPITALS IN THE UNITED STATES. (4) To care for all incoming patients who required immediate or emergency treatment. (5) To receive, receipt for, and safeguard the valuables of incoming patients. (6) To provide transportation and to receive and receipt for the baggage of the patients. (7) To prepare all required forms, records, and notifications in connection with the admis- sion of patients. (8) To provide medical attendance, nursing, and ward service for patients in the receiving ward. In connection with the duty of safeguarding the valuables of incoming patients, when such patients were irresponsible, the receiving officer was required to cause the money or valuables of those patients to be collected in his presence and that of a competent witness. The disposition officer was held responsible for the conduct of the disposition office, the post office, the informa- tion desk, the patients’ baggage room, and the patients’ bank. He made all necessary arrangements for patients expecting to leave the hospital, providing special transportation for crippled or invalid patients. Information concerning railroad transportation was furnished as well as assistance in procuring it; the delivery of baggage and personal effects; and the furnishing of transportation to home or railroad station. Upon receipt of approved requests, the disposi- tion officer issued passes to patients for temporary absence from the hospital. In performing his routine duties in connection with the personal effects and baggage of patients, the disposition officer was required to keep four files: A live fde for the effects of patients in the hospital; a dead file for the effects of patients who had left the hospital and taken their belongings with them; a suspended file for the effects of patients who had left the hospital and had not taken their belongings with them; and a file of receipts for baggage held b}^ the supply officer. An elaborate filing system was required for the maintenance of the bureau of information, for all patients and personnel of the hospital. The detachment commander, detachment, Medical Department, assigned personnel to duty in the hospital and made prompt replacements for casualties. He provided for the instruction of enlisted personnel assigned to him and main- tained the discipline of the detachment. He kept a detachment punishment book; personally investigated accusations before preferring charges; and he furnished a record of company punishments or prior court-martials, with rec- ommendations, or a brief statement of his investigations in submitting charges. He performed such other special duties in connection with the personnel on duty at the hospital as were assigned to him, as well as all duties of a detach- ment commander. The detachment commander, quartermaster detachment, performed all duties of a detachment commander as prescribed in existent regu- lations and orders. The detachment commanders of nurses and aides were responsible for the discipline, performance of duty, and conduct while on duty, of nurses and aides assigned to their respective departments. POLICE AND FIRE PROTECTION. The police and lire protection division of the department of administration included an intelligence officer, a prison officer, fire marshals, a police officer, and courts-martial. The intelligence officer carried out the instructions of the military information division and such other instructions as he received from the commanding officer. The prison officer exercised immediate command of the guard detachment and assigned the guard detail by roster. He kept a TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 293 record of all prisoners and made the necessary reports of prisoners: he also kept a guard report. He was charged with direct responsibility for the security of the guardhouse and other places of confinement of prisoners, and with the cleanliness and sanitation of such places. The prison was designated and occupied as follows: The main guardhouse, for garrison prisoners other than patients; the detention ward, for patients under detention; and ward “A,” separate rooms for the confinement of prisoners sick with contagious diseases, and for other special purposes. No prisoner suffering with a contagious disease was confined with other prisoners who were not similarly affected. All pris- oners in confinement were equipped with proper clothing and bedding, and any prisoner claiming to need medical attention was given prompt medical examina- tion. The fire marshal was charged with the inspection of fire apparatus, and to him fell the duty of making recommendations for fire prevention and of initiating additional measures for this purpose. He insured the instruction and drill of the regular fire crew and of the officers and enlisted personnel on duty. Pending the arrival of the District of Columbia fire department, he was expected to take immediate charge of fire fighting. The following is a resume of the fire regulations of the hospital. In the fire protection branch of the hospital there were at least at all times a fire marshal, a first deputy fire marshal, a second deputy fire marshal, the officer of the day, and the fire chief (civilian). One of the officials, in addition to the officer of the day, was on duty at all times. The senior officer present assumed charge of fire fighting until the arrival of the commanding officer or fire department officials. In order to prevent fire, smoking was strictly prohibited in storerooms, garage, motor transport office, repair shops, stables, and workrooms of the reconstruction shops ; floor bright- eners and other highly inflammable materials were required to be kept in tightly corked original containers, and with the cloths used in applying them were stored in sealed lockers, not in wooden closets or storerooms. Smoking was prohibited in the post auditorium and Red Cross house during performances or assemblies, and the closing or blocking of exits from these buildings was pro- hibited. At the alarm of fire, the personnel other than those for whom special duties were provided in the regulations, proceeded ’with all possible speed to the scene of the fire and reported as follows : Administrative officers, and others not assigned to the professional services, to the executive officer or his deputy, for assignment to duty with sections of the fire-fighting department. Officers of the surgical service to the chief thereof or his deputy, for assignment to specific stations and duties. The function of the surgical service was the removal of patients from threatened buildings. The chiefs of litter squads, upon arrival at the scene of a fire, were required to report to the chief of the surgical service or his deputy. Officers of the medical service to the chief thereof, or his deputy, for assignment to specific stations and duties in connection with salvage operations. The chiefs of salvage details, upon arrival at the scene of a fire, were required to report to the chief of the medical service or his deputy. All ward medical officers, whose wards were in the district in which the fire developed, repaired to their respective wards to maintain order and prepare, if necessary, to remove their patients. Nurses repaired to their wards and, if danger threatened, prepared their patients to be moved. Noncommissioned officers in property and finance offices closed their offices and proceeded to the scene of the fire. Noncommissioned officers 294 MILITARY HOSPITALS IN THE UNITED STATES. and attendants on duty in receiving and disposition wards remained at their posts of duty. Cooks preparing meals remained at their posts, but dining-room attendants proceeded to the scene of fire. All enlisted men in barracks, not otherwise provided for, assembled upon the detachment parade grounds under the supervision of the senior noncommissioned officer present, who conducted them at double-time to the scene of the fire and reported to the fire marshal or the officer in charge. Patients in buildings, other than the one which was on fire, did not leave them unless the fire marshal deemed it necessary to have them moved to a place of safety. The officer of the day made a personal check of all motor and hand-drawn equipment reporting at the scene of the fire and noted the time of arrival of each vehicle. The fire chief, or the first officer arriving at the scene of the fire, notified the telephone operator if it was appar- ent that the services of the Washington City fire department would be required. The fire chief was charged with the instruction, discipline, performance of duty, and conduct while on duty, of all personnel permanently detailed or employed in the lire department. He was responsible for the maintenance in proper condition for instant use of all fire-fighting equipment in the post. lie was further charged with a daily inspection of the hospital, with the view to the elimination of fire risks, and he was placed under immediate direction of the fire marshal in all particulars. The fire marshal held frequent fire drills, subject to the approval of the commanding officer, and immediately following such drills all fire apparatus was inspected. The aero automatic fire-alarm system which was installed in practically all buildings could be set in operation in two ways: by breaking the glass rod in the signal box, and by means of sudden rise in temperature on the aero wires. Variations in temperature, not resulting from fire, caused frequent false alarms to come in over the automatic fire-alarm system, so that it became necessary to map out a procedure when this alarm sounded. All personnel heretofore specified were to proceed at once to the building from which the alarm ema- nated, and under no circumstance to leave the vicinity until the fire marshal or other competent officer made a thorough investigation of the cause of the alarm. If the alarm proved to be a false one, recall was sounded and personnel and equipment returned to their proper stations. In case of aero alarm, switch- board operators were not required to give notice of fire until notified by a respon- sible officer that a fire actually existed; nor did the sergeant of the guard have “fire call’’ and the siren sounded until after receipt of like information. The officer in charge of the utilities department was responsible for the proper manning of all equipment in the fire department. He was permitted to call upon the post supply officer and the motor transport officer for such number of men as he might need. The detachment commander, Quartermaster Department, detailed from his detachment properly trained day and night crews for handling hose and ladder trucks and 22 carts. The detachment commander, Medical Department, detailed day and night crews to handle other hose carts. He also formed and instructed in their duties one salvage section, one bucket section, one fire extinguisher section, and one ladder section. The hospital was furnished with a complete fire-fighting equipment and was provided with numerous fire telephones, marked at night with red lights and with signal boxes. TYPES OF HOSPITALS — GENERAL HOSPITAL (PERMANENT). 295 The following fire-fighting equipment was maintained: One La France auto combination pump, chemical and hose truck; one Ford motor chemical tank (33 gallons); one Ford motor combination chemical and hose wagon (33 gallons) ; one hand-drawn hook and ladder truck with a 55-foot extension ladder, two 24-inch plain ladders, and one 10-foot roof ladder; four hand-liose reel carts with 45 feet of 24-inch hose; three hand-drawn chemical carts (66 gallons); 15 hand-drawn chemical carts (33 gallons); 7 extension ladders, 40 and 50 foot lengths; 43 ladders, plain (30-foot lengths); 641 buckets, fire; 216 chemical fire extinguishers, 1 quart (Pyrene) ; 77 chemical fire extinguishers, 1 quart (Fight Fire) ; 144 axes (pick); 226 hand grenades; 45 fire hydrants; 1,750 feet of f-inch rubber hose for chemical tanks; 3,250 feet of 24-inch cotton hose. The automatic fire-alarm system was installed in the temporary wards and storehouses. It consisted of 126 circuits, 2 punch registers, and 10 aero gongs. In addition to the aero alarm system there was a local alarm system for the administration building only, with a signal alarm in the basement and on all floors. An electric siren and alarm was installed at the power house, but did not prove to be satisfactory. The police officer was charged with the general policing of the grounds of the post, and made a systematic inspection of each section of the post for this purpose. Courts-martial were conducted in accordance with the Manual for Courts-Martial, and all officers charged with the administration of justice or with the execution of military sentences were required to acquaint themselves with the provisions of this manual. Department of Service and Supply. The department of service and supply included eight divisions, identified as follows: Service of supply; constructing and utilities service; mess service; motor transport service; telegraph and telephone service; post exchange; morale; educational and recreation service. The division of service of supply included six officers, namely, supply, ordnance, finance, transportation, salvage, and medical supply. The supply officer was charged with the procurement and issue of all supplies for the post, and the proper accounting for the supplies received. In the absence of a commissioned subordinate, he administered the ordnance, the commissary, the transportation, salvage office, and the medical supply office. Tfie medical property officer was in charge of the supply, issue, repair, care, and disposal of all medical property. He was the equipment officer of the hospital and was expected not to wait for requests but to seek in every way possible to obtain and issue the . best equipment for the hospital. His responsibilities included receiving, accounting for, and transmitting to the United States Treasury all money collected for sale of medical supplies to civilians. The officer in charge of the dispensary transmitted to him all funds received for the sale of supplies to civilians, with the name of the purchaser, the date of sale, and the prescription number. A medical officer was designated as in charge of the pharmacy by the commanding officer. This officer supervised the work of the department and was responsible for its proper functioning. The functions of the pharmacy Avere as follows: Compounding prescriptions; issu- ing drugs upon prescription of the medical officer on duty; manufacturing 296 MILITARY HOSPITALS IN THE UNITED STATES. compounds for the wards of the hospital; and procuring, recording, storing, and issuing supplies in accordance with regulations. The constructing and utilities service was administered by two officers — the constructing quartermaster and the utilities officer. The constructing quartermaster was responsible for the construction work in accordance with the plans, specifications, and instructions received from the Chief of the Con- struction Division, War Department. The utilities officer was charged with the repair and maintenance of all military structures on the post and with the maintenance of all utilities connected therewith, except the handling of passengers and freight. Specifically, the utilities officer was responsible for buildings and grounds, roads, walks and fences, sewerage and drainage systems, plumbing, heating, electrical energy, refrigeration, water supply, and fire protection. The mess service was administered by a mess officer, assisted by the dieti- tians. The mess officer was in charge of all messes on the post and was responsible for the procurement of proper food supplies and their satisfactory preparation and service. He exercised immediate control of both civilian and enlisted personnel assigned to mess duty, required necessary medical and laboratory examination of all food handlers; supervised the assignment and performance of duty of dietitians and provided such special diets or articles as might be prescribed by the medical officers. The head dietitian cooperated with the mess officer, the professional services, and the chief nurse in the preparation of proper diets for patients in the hospital. She assigned her subordinates and was in direct charge of their discipline. The dietitian placed in charge of the mess was responsible for the dietary service of that mess. She was expected to acquaint herself, by consultation with the ward surgeon or head nurse, with the special needs of the individual patients, and strictly to follow instructions received from special services for special diets. A daily report was furnished by the head nurse of each ward to the principal chief nurse, giving constructive criticism upon meals served in her ward. Tins report was submitted to the mess officer through the head dietitian. The mess department conducted messes as follows: (1) An officers’ mess which provided for officers and civilians in the status of officers who were patients in the main administration building, and also for ambulant patients of these classes in other wards. (2) Patients’ general mess, which provided for all enlisted men and civilians upon such status. (3) Detachment mess, conducted by detachment commander. (4) Nurses’ mess, conducted by the stewardess assigned to this mess under the supervi sion of the chief nurse. (5) Mess for officers’ pavilion No. 1, which provided for patients in said pavilion and other neighboring officer wards. (6) Mess for the women’s ward. The motor transportation service provided four classes of service: Passen- ger, freight, ambulance, and fire-fighting equipment. The motor transport officer was charged with the procurement, maintenance, operation, and dis- position of all motor transportation of the post; he controlled military and civilian personnel assigned to his department ; and he required obedience to traffic laws, promptly investigating and reporting traffic accidents involving his equipment. TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 297 The signal officer maintained the telegraph and telephone service of the post. He employed and controlled the civilian personnel assigned to the service, and exercised immediate control of enlisted personnel detailed for this duty. The exchange officer conducted the post exchange, in compliance with Army Regulations. The exchange, in addition to the usual store service, included a barber shop and a lunch counter. It also provided funds for con- ducting a cafeteria service by the service club. The net profits of the cafeteria service, after all operating expenses had been paid, were assigned by the post exchange to the educational and recreational officer, to be used for recreational service for the enlisted personnel and patients of the hospital. The morale, education, and recreation service included chaplains, a morale officer, an education and recreation officer, a service club hostess, and a librarian- The chaplains performed the usual duties of their office. The morale officer, under the direction of the commanding officer, established a morale organization, charged with the general functions indicated in War Department instructions. The education officer was charged with the institution and operation of schools for the enlisted personnel of the post. The recreation officer had supervision of the entertainment of patients and hospital personnel and of the recreational work of the welfare organizations and other volunteer organizations permitted on the post. He provided generous and varied opportunity for athletics and recreation for convalescent patients and for personnel on duty. Under his direction a service club was operated by a hostess and a post library by an authorized appointee. Department of Professional Services. THE SURGICAL SERVICE. The surgical service was administered by a chief of service, an assistant to the chief of service, chiefs of sections, ward surgeons, and surgical emergency officers. The chief of the surgical service was charged with the responsibility for all matters relating to his service, including the character of professional service rendered and the care and treatment given to surgical patients, the prepara- tion, maintenance, and disposition of clinical records of surgical patients and the instruction of medical officers, nurses, and enlisted personnel assigned to this service. The assistant to the chief of the surgical service performed all the duties of an administrative officer to the service and such additional duties as might be assigned to him by his chief. The chiefs of section were responsible for the efficiency of professional services rendered; for the care and treatment of patients; for the maintenance of good order, military discipline, police, and sanitation; for the instruction of subordinate medical officers, nurses, and enlisted attendants; and for the preparation, preservation, and the proper disposition of records of patients in each section. Each chief surveyed all patients in his section at frequent and regular intervals, in company with the ward surgeon, and initiated measures for the disposition of patients at the proper time. In consultation with the ward surgeon, he caused to be prepared the disability reports for military patients who were recommended for disability discharge and insured that com- 298 MILITARY HOSPITALS TN THE UNITED STATES. plete clinical records were forwarded with these recommendations to the super- visor of clinical records, through the chief of service. He required that a care- ful clinical history of all patients be submitted to him by the ward surgeon at ins first consultation or within 24 hours thereafter; and that progress sheets and diagnoses be kept up to date. He held consultation with an officer rep- resenting the physiotherapy department for every patient in his section whose condition indicated such special treatment. He was responsible that any necessary dental examination, eye, ear, nose, and throat examination, and other indicated special examinations were accorded patients in his section. Pie maintained an office and forwarded routine papers at least twice daily. All requests for leaves or passes for officer patients, furloughs for enlisted patients, requests for transfer, or other disposition of patients were sent by the ward surgeon, with his recommendation, to the chief of section, who promptly for- warded the same, with recommendation, to the proper office. Furlough requests were forwarded direct to the commanding officer, detachment of patients. All other leave requests, transfer requests, etc., were sent to the chief of the surgical service. A chief of section was required to report to the office of the chief of service one-half hour prior to the beginning of the tour of duty of the senior surgical emergency officer and to inform the emergency officer concerning special treatment of serious surgical cases of his section. The chief of a section was further required to investigate complaints of patients and to make satis- factory disposition of such defects as far as possible. He controlled the transfer of patients within his section and made recommendation to the chief of service for transfers to other sections or services. He was responsible for measures of fire prevention in his section and assumed charge of the removal of patients and the salvage of public property in his section in case of fire. He submitted to the curator requests for work by the department of illustration. The surgical service included the following sections: General surgery, septic surgery, empyema, maxillofacial, neurosurgical, eye, ear, nose, and throat, orthopedic, amputation, dermatology and syphilis, urology, obstetrics, and gynecology. The general responsibility of a ward surgeon included the care and welfare of all patients in his wards; the treatment and diet of his patients; the disci- pline of the attendants and patients; the police of his wards and porches; the rendition of reports and returns; and the enforcement of hospital regulations in so far as they applied to his ward. He made at least one round of his wards in the morning and at least one in the afternoon. Ward morning reports were prepared by him to cover all cases admitted, disposed of, or transferred from and to the ward in the previous 24 hours ending at midnight. Daily diet requests and mess storeroom requests were signed by the ward surgeon and sent to the mess officer before 9.30 each morning. Diagnosis cards, received by the ward from the receiving officer, were completed by the ward surgeon and turned in to the sick and wounded office as soon as possible, preferably within 48 hours. Duty slips for all cases disposed of either as duty, discharged, transferred to other hospitals, sick leave or furlough, were completed by the ward surgeon and sent through the chief of the section, with complete clinical records, to the registrar, 24 hours previous to the patient's departure. A com- plete examination and clinical history were made in every case by the ward TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 299 surgeon as soon as practicable after the admission of a patient. Upon the dis- position of a case the clinical record was completed and signed by the ward surgeon and sent to the registrar. In case of death of a patient, the clinical records were completed (including a statement as to the cause of death, signed by the ward surgeon) and sent to the registrar without delay. Requests for consultation were prepared by the ward surgeon and were submitted to the chief of section. As soon as practicable after admission of a patient the ward surgeon called upon the dental surgery officer for a dental exami- nation, and the chief of the eye, ear, nose, and throat section for an eye, ear, nose, and throat examination. When a patient was to be trans- ferred from one ward to another, a transfer slip, signed by the ward surgeon and initialed by the disposing chief of section, was sent to the chief of section receiving the case, who indicated the ward to which the patient was to be sent. The transfer slip and clinical record were then sent with the patient to the ward indicated. The ward surgeon promptly sent the transfer slip to the registrar. Recommendations for transfer to other hospitals were prepared by the ward surgeon and sent to the chief of section for the consideration of the chief of service. When a patient was discharged for diasbility, the ward sur- geon arranged for a consultation with the chief of section and submitted the data for the preparation of a certificate of disability. Routine pass privileges were granted or refused by the ward surgeon. Special requests for leave of patients were submitted by the ward surgeon to the commanding officer, detachment of patients. For all contagious diseases, mumps excepted, the ward surgeon immediately made out a report card to the Health Department, District of Columbia. This card was sent, together with the diagnosis card, to the registrar; and when the patient had recovered from the disease, the ward surgeon sent a recovery card in the same manner. Every precaution was taken in contagious-disease wards to prevent spread of the contagion. The ward surgeon was responsible for the preparation of notifications of death or serious illness and their transmission to the proper officer. Upon the death of a patient he prepared the notification in quadruplicate and sent one copy to the adjutant, one to the detachment commander of patients, one to the super- visor of clinical records, and one to the officer in charge of the mortuary. Upon receipt of this notice the adjutant, or in his absence the officer of the day, noti- fied the nearest relative with utmost speed. All valuables were removed from the body under the direct supervision of the ward surgeon and were turned in to the adjutant. In case of serious or critical illness, or contemplated major operations, serious illness cards were sent by the ward surgeon to the adjutant. These slips included the names of such relatives as the patient wished to notify and stated whether the notification should be made by telegram or letter. The ward surgeon was further required to notify the chaplain of cases of death and serious illness. He also kept relatives of the patients in his particular ward informed of the clinical progress of the patient. The ward surgeon signed requisitions for medical supplies, sending them to the medical property officer direct. He was required to exercise special care in the matter of requi- sitioning narcotics, intoxicating liquors, or habit-forming drugs, and after their receipt he was required to keep them under lock and key. Finally, he was responsible for the protection of the property of the patients, for the mainte- nance of discipline, and for observing precautions against fire in the ward. 300 MILITARY HOSPITALS IN THE UNITED STATES. Two surgical emergency officers were detailed by roster from medical officers on duty in the surgical service. The senior member was an officer of field rank and his tour of duty was from 5 p. m. to 9 a. m. The tour of the junior member was from 9 a. m. to 9 p. m. The senior member saw all acute surgical cases and visited all patients who had been operated on the day of his tour, taking any action indicated. He acted as consultant and advisor to the junior member and, upon request, to the medical emergency officer. The junior officer functioned in the absence of surgical ward surgeons. He made a complete inspection of the entire surgical service between the hours of 9 p. m. and 12 midnight. In case of death he saw that the body was properly tagged and removed to the mortmuy. Professional departments which were subsidiary to the surgical service were the dental department, the X-ray department, the orthopedic appliance shop, and the department of anesthesia. The chief of the dental department was responsible for the dental service rendered at the hospital, for the supervision and instruction of all personnel assigned to his division, and for all the public property under his control. All military patients admitted to the hospital were examined by the dental survey officer, who furnished a report to the chief of his department. The chief of the dental department furnished imperative dental attention whenever indi cated and elective dental attention as far as possible. The chief of the X-ray department was responsible for the X-ray service rendered at the hospital, for the supervision and instruction of all personnel assigned to his division, and for all equipment and public property under his control. Before ordering an X-ray series, surgeons were required to ascertain whether a series had been taken within four weeks; and, if such a series were available and satisfactory, to refrain from ordering another series. In no instance was another series ordered within three weeks of a former exposure of a patient unless specifically authorized by the officer in charge of the X-ray department. The chief of the orthopedic appliance shop was responsible for the conduct of the shop, the supervision of the personnel assigned thereto, and the care of the equipment. The chief anesthetist supervised the administration of anesthetics, gave instruction in such administration, and took general charge of the operating rooms and personnel. THE MEDICAL SERVICE. The organization of the medical service closely followed that of the surgical service and included a chief of service, an assistant chief of service, chiefs of sections, ward surgeons, and a medical emergency officer. With the exception of the last-named officer these officers were charged with responsibilities corre- sponding to those already outlined for the surgical service. The medical emergency officer was appointed by the chief of service from among the avail- able officers of the medical service. His tour extended from 9 a. m. of the date designated to 9 a. m. of the succeeding day. During his tour he did not leave the reservation and was required to keep the switchboard operator advised of his whereabouts at all times. The medical emergency officer was charged with the care of all persons and patients in the detention wards. In the absence of TYPES OP HOSPITALS GENERAL HOSPITAL (PERMANENT). 301 ward surgeons he was in charge of all medical patients. When patients of the medical service developed surgical conditions he consulted with the surgical emergency officer, and he likewise stood ready to give advice concerning surgical patients who developed medical conditions. When any patient died in the medical and detention wards he examined the dead and ordered the remains to be removed to the mortuary. THE LABORATORY SERVICE. The chief of the laboratory department was responsible for the laboratory service rendered at the hospital, for the supervision and instruction of all personnel assigned to the laboratory, and for the care of all laboratory equip- ment. He maintained a bacteriology section, a chemical section, and a patho- logical section in his laboratory. He assigned responsibility for the care and conduct of the mortuary; and he was responsible for the proper performance of autopsies, when authorized by the commanding officer, and for the proper disposition of the bodies of all deceased patients received at the mortuary. Upon request of the mess officer or detachment commanders he examined food handlers to eliminate typhoid carriers, and upon request of chiefs of service he examined any patients or personnel to identify carriers of communicable disease. At regular intervals he examined food supplies. Upon requests of chiefs of service or detachment commanders he administered vaccine. He maintained a list, by groups, of volunteer donors for blood transfusions, and supplied a donor when requested by chiefs of service. The Department of Reconstruction and Education. The department of reconstruction and education included three divisions, namely, ward handicrafts, curative shop work, and educational and vocational training. The department was administered by an educational director. The Physiotherapy Department. The physiotherapy department was likewise administered by a director who was responsible for the conduct of his department, its personnel, and equipment. Physiotherapy was prescribed by chiefs of service or section, and frequent consultations were required between the medical officers pre- scribing the treatment and the officers who gave it. The Nursing Department. The nursing department of the hospital was administered by the principal chief nurse and the assistant principal chief nurse, the day supervisor of gradu- ate nurses, the night supervisor of graduate nurses, and the superintendent of the Army School of Nursing. The principal chief nurse was responsible for the efficiency of the nursing and for the conduct of the Army School of Nursing. She had charge of the instruction, assignment, discipline, performance of duty, and conduct while on duty of members of the Army Nurse Corps and Army School of Nursing, and the supervision of the female help employed for general kitchen and house- keeping purposes. She was responsible for the equipment and public property for the nurses’ quarters and for the sanitation of and measures for fire pre- 302 MILITARY HOSPITALS IN' THE UNITED STATES. vention in those quarters. She supervised the records of the Army dietitians and was responsible for the preparation and disposition of the records of her department. The assistant principal chief nurse was charged with the records and corre- spondence concerning the nurse corps on duty at the hospital and such other duties as might be assigned to her by the principal chief nurse. In the absence of the latter the assistant assumed complete charge. The day supervisor of graduate nurses made a daily inspection of all wards for the purpose of determining the character of the performance of duty by the nurses. She devoted special attention to the care and nursing afforded the seriously ill, the preparation and service of diets in wards, and the measures taken to protect and issue intoxicating liquors and habit-forming drugs. The night supervisor of graduate nurses made a nightly inspection of all wards corresponding to the daily inspection made by the day supervisor. The superintendent of the Army School of Nursing conducted the school for undergraduate nurses at the hospital. She was guided by instructions received from the commanding officer and from the principal chief nurse; and she supervised the work of the nurses in charge of instruction in theoretical nursing, practical nursing, and supervision of undergraduate nurses in the wards. PERSONNEL. STRENGTH OF COMMAND. The mean daily strength of personnel on duty at the hospital in the year 1917 was: Medical officers, 22.8; Medical Department and Quartermaster Corps, 223.1 ; Army Nurse Corps, 44.7. During the year 1918, the mean strength of the command was: Medical officers, 86.3; detachment, Medical Depart- ment, 889.1; detachment, Quartermaster Corps, 136.7; Army Nurse Corps, 147.8; reconstruction aides, 33.6; civilian employees, IS. 9. The post return for December 31, 1919, shows 451 officers present and absent; and a total strength of command of 3,188, the latter figure including a military total of 2,661, present and absent, and a civilian total of 527, present and absent. An analysis of the figures shows the strength of the detachment, Medical Department, as 648 men. At the beginning of 1919, 1,090 enlisted men of the Medical Department were on duty at the hospital. All but 70 of this number were emergency men who, during the year, were discharged and replaced by enlisted men of the Regular Army. In June, 1919, 166 nurses were on duty. During the year replacements and transfers were effected and at the end there remained 201 nurses on a duty status. ARMY SCHOOL OF NURSING. The first student nurses arrived at Walter Reed General Hospital August 5. 1918. In September, there were about 45, 9 of whom were of the training class of Yassar College. In November, 25 more students arrived. These young women had been helping, during the influenza epidemic, at Camp Humphreys, Va. To this group, 26 probationers were added, making a class of 51. At the beginning of January, 1919, there was a total enrollment of 66 student nurses in training. During February and March following, the students were accepted as regular members of the Army School of Nursing, upon completion of their four months of probationary training. In March and April, all student TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 303 nurses who had entered the Army for service during the emergency period were released from the rapidly closing camps. Students who desired to com- plete the three-year period of training were, in many instances, transferred to Walter Reed General Hospital. This policy of concentration continued un- interruptedly throughout the year 1919, toward the end of which the total enrollment was 112; and in this number were represented students from practically all the units of the Army School of Nursing, formerly connected with eastern military hospitals. The theoretical and practical work given the student nurses was in strict compliance with the standard curriculum for schools of nursing as authorized by the National League of Nursing Education, 1918. In Circular Letter No. 301, Surgeon General’s Office, 1919, authorization for allowance of from three to nine months was given for students with college credits or with credits from approved technical schools. By means of affiliation with civil hospitals, students were given adequate training in pediatrics, gynecology, obstetrics, psychiatry, and public health nursing. The time allowed for affiliation work was one year. The daily routine was eight hours of work in the wards, one hour of class work, and one hour of study. In addition to being placed in surgical and medi- cal wards, the students were also placed on duty in the general operating room, the eye clinic, the ear, nose, and throat clinic, the dental clinic, the various diet kitchens, and the surgical dressing room. Each student was given a service of eight weeks in each department. A course of occupational therapy was given to the student nurses in the occupational therapy department. This course included the teaching of all forms of invalid occupation. COURSE OF SURGERY - FOR MEDICAL OFFICERS. Due to the fact that demobilization had separated a great many competent surgeons from the service, and also to the fact that hospitals contained many cases requiring surgical intervention, it became necessary to train officers of the Regular Medical Corps in surgical technique, to enable them to cope with the situation confronting the Medical Department after the cessation of hos- tilities. Because of the unusual number and variety of surgical cases at Walter Reed General Hospital, a three months ’ course of surgical instruction for Regular Medical Officers was begun the latter part of June, 1919. The course comprised a series of lectures by the different section chiefs of the surgical service, the assignment of each officer to each section for one week’s practical instruction in the wards, his assignment as an assistant in operations performed on patients in the section to which he had been detailed, and his designation as principal operator in certain types of ordinary surgical operations (particu- larly herniotomies and appendectomies) . Patients. The work of the hospital during 1917, the first year of the war period more than doubled. There were 4,256 patients admitted during the year, an increase of 2,906 over the preceding year. A table prepared for the Walter Reed General Hospital Annual Report for 1917, to show the average number 304 MILITARY HOSPITALS IN THE UNITED STATES. of days in hospital for each patient, also indicates the range of cases and their distribution in the various services of the Army. This table follows : Table 15. — Average number of days lost in hospital, Walter Reed General Hospital , 191 7. REGULAR ARMY. Class of cases. Officers. Enlisted men. Medical 16.253 16. 295 22.282 30.004 26. 666 32.303 31 286 29.07S 23.821 19.983 NATIONAL ARMY. Venereal Mental Eye, ear, nose, and throat 11.233 20.000 3.500 1.750 5. 133 15. 193 20. 180 25.964 23.700 14.250 NATIONAL GUARD. Medical Surgical 21,273 11. 166 13.077 25. 470 24.649 32.400 Eye, ear, nose, and throat 13.500 18.666 CIVILIANS. Class of cases. Males. Females. 17.344 18.273 34.851 21.53 26.333 13.833 4.000 34.082 40.318 In the surgical clinic, 974 operations were performed during 1917. A condensed tabular statement furnishes an admirable projection of the surgical experience of the hospital during that year, when the massing of troops had concentrated the demands upon the surgeons but before the overseas cases, with their more complicated problems, had arrived. Table 16. — Surgical operations performed at Walter Reed General Hospital, 1917 . Officers, Regular j Army. Enlisted men, Reg- ulaCArmy. Officers, Organized Militia. Enlisted men, Or- ganized Militia. Officers, National Army. f-\ . c - o £ © C +* O 'fl Army Nurse Corps. 'c3 p © CD u> "© © . © © Civilians. JO t. 1 1 2 4 4 3 1 11 2 2 13 26 50 1 1 S3 i 1 21 23 106 1 6 i 8 l 7 s 16 11 44 2 11 6 2 76 159 159 235 2 1 3 3 6 2 s 4 4 12 2 20 4 26 1 1 2 28 60 207 1 25 5 28 i 327 2 4 51 57 3S4 Gynecological: 1 i 1 24 24 24 9 3 74 i 1 5 7 SI 2 6 1 2 11 2 2 13 4 27 2 5 i 1 40 i 3 10 14 54 Total 119 433 7 59 6 44 3 671 6 10 2S7 303 974 TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 305 During 1918, 13,752 patients were admitted to the hospital, an increase of 9,496 over the preceding year. The average number of days for each case was as follows: Table 17. — Admissions to Walter Reed General Hospital , 1918. Class of cases. Officers. Emitted Civilians. men. Male. Female. Medical 23. 631 25. 841 18. 972 18. 886 45. 804 48. 599 21. 073 22. 172 59. 307 44. 119 28. 000 13. 000 21. 000 57. .546 63. 829 31.333 19.880 26. 398 13. 782 14. 482 The surgical operations performed during 1918, are shown by the following table : Table 18. — Surgical operations performed at Walter Reed General Hospital, 1918. Officers, active. Enlisted men, active. Army Nurse Corps. Total. Retired officers. Retired enlisted men. All others. Total. Grand total. 1 1 2 2 8 47 55 12 12 67 36 251 1 288 16 16 304 11 32 48 53 103 440 6 549 1 42 43 592 5 20 1 26 2 2 28 23 28 1 1 29 15 148 163 6 6 169 99 890 4 993 2 23 25 1,018 Gynecological: 3 3 3 3 6 13 13 13 22 248 1 271 10 10 281 31 260 4 295 5 300 Minor, not included 13 325 2 340 6 6 346 Total 349 2,685 27 3.061 3 144 147 3,208 The following is a summary of patients admitted to and disposed of from January 1, 1919, to December 31, 1919, inclusive. Table 19 . — Admissions and dispositions, Walter Reed General Hospital , 1919. Officers and All enlisted others. Total. men. Remaining Dec. 31, 1918 Admitted from command, 1919. Admitted by transfer, 1919 Admitted otherwise, 1919 1, 766 47 1, 060 178 3, 077 69 3, 949 778 1,813 1,238 3, 146 4,727 Total Dispositions, 1919: Returned to duty Died Discharged for disability Deserted Transferred to insane asylums. Transferred to other hospitals. Otherwise disposed of Total Remaining Dec. 31, 1919 9, 852 4, 335 88 2, 127 65 27 953 650 8, 245 1,607 1,072 203 24 30 717 974 10, 924 4, 538 112 2,127 65 27 9S3 1,367 9, 219 1,705 45269°— 23 20 306 MILITARY HOSPITALS IN THE UNITED STATES. During the year 1919 over 1,200 cases of mental conditions were treated by the neuropsychiatric division. This statement does not accurately estimate the work of the section because there were many cases where the nervous con- dition was secondary, or the mental state, while abnormal, could not be classed as a definite psychosis and hence would not appear in these tables as such. PROFESSIONAL ACTIVITIES OF THE HOSPITAL DEPARTMENTS. SURGICAL SERVICE. The chief of the surgical service held a daily conference with all chiefs of sections, and a Saturday meeting at which all officers on duty in the surgical service attended. At the Saturday meeting, hospital orders, memoranda, and other pertinent matters, or irregularities of the service, were brought to the attention of the officers attending. A surgical conference of one hour’s dura- tion was held weekly for all officers of the surgical service, the various section chiefs, in turn, presenting interesting clinical cases from their respective services. The chief of the surgical service and his assistant dailj" inspected a group of surgical wards. During this inspection the chief of the service was consulted as to diagnosis and suitable treatment of unusual developments and compli- cations arising in cases of the service. At least twice weekly he surveyed every case of the surgical section. Requests for consultation between the sections for cases of the surgical service as well as those from other services for surgical conditions, were all referred through the chief of the surgical service to the special section con- cerned. Amputation section . — A large number of amputation cases during the early part of 1919 were received from overseas. At least 90 per cent of these cases required operative treatment of some character before they could be fitted with artificial limbs. Postoperative infection, low grade, was frequently encountered, but the percentage of cases requiting re-operation was very small. The shop for fitting artificial appliances fitted as many as 156 cases in one month. The work of this shop improved in grade and amount after the soldier labor was replaced by skilled leg fitters. Noninfected stumps were fitted routinely six weeks after operation; others three weeks after healing. Numer- ous makes and types of buckets for thigh and leg fitting were purchased and tried. Some could never be used owing to improper molding. The physio- therapy department assisted in the massage of stumps and the application of elastic bandages to improve circulation and age shrinkage, and to make stiff joints mobile, and gave instruction in the use of appliances. Patients, after being fitted, were assigned to working classes for one hour's instruction daily. They usually became proficient in the use of the appliance in from three to four weeks and were then ready for discharge. All were instructed in the care of the stump, adjustments being made in the appliance as shrinkage occurred ; and all were examined by the chief of section prior to discharge, for final instruction to determine the correctness of the fitting and the condition of the stump. All amputations, after fitting, were assigned to the occupational shop for instruc- tion in the use of the appliance. Fittings for hip disarticulation and certain other stumps, which could not be properly fitted from stock, were ordered from outside artificial limb makers. TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 307 Dental section . — The dental service was divided into five subsections: Dental hygiene; X-ray; operative; prosthetic and oral surgery; and one dental officer for the survey of patients. The completion of the new dental building in August, 1918, and its immediate occupancy facilitated the success- ful detachment of the dental department. The new building consisted of a large operating room, adequate for nine operators, an oral surgery department, including an operating room, and an extracting and record room, and quarters for the officer of the day and sergeant in charge, together with necessary storage space. A dental X-ray laboratory and developing room were provided and an officer was detailed to care for this work. From three dental surgeons in 1918, the personnel of the department increased to nine dental officers, one of whom was on duty to render emergency treatment at all hours of the day and night. In January, 1919, the prosthetic department was organized for the construction of splints for maxillofacial cases and prosthetic restoration of all kinds. Five female technicians were on duty in the hygienic department of the clinic. This permitted the dental officers to spend their entire time operating. Eye, ear, nose, and throat, section. — In April, 1917, the eye, ear, nose, and throat section had a personnel of two officers. This was gradually increased to seven officers by the end of 1918. A division of the department into the eye section and the ear, nose, and throat section was made in July, 1918, to promote a more efficient service. At that time the number of patients had increased from 15 to 170, and it could be seen that better results could be obtained from a more complete specialization. Originally the section operated in the main building of the hospital, but soon outgrew the space allotted and was assigned to two temporary wards. In August, 191S, a special building had been con- structed for the section, known as the eye, ear, nose, and throat building. Empyema section. — In March, 1919, Walter Reed General Hospital was designated as one of the concentration points for chronic empyema. Most cases were primarily chronic, relatively few being acute, and those few practically all from the influenza epidemic of 1918-19. It is noted that no case on which a primary operation was done during the calendar year 1919 became a chronic case. Maxillofacial section. — The first maxillofacial patients arrived at the hospital on January 15, 1919, at which time Walter Reed General Hospital was one of the three hospitals designated by the Surgeon General’s Office to receive this class of patients. They were scattered throughout the surgical wards at first, until a chief of section was detailed to care for them, in February, when they were all assembled in three wards. Prior to March very little surgical operative work was done. On February 21, in compliance with instructions received from the Surgeon General, a thorough system of recording these cases was begun. At the end of the year over 800 photographs, a large number of wax models, drawings, and descriptions were made, illustrating all cases of interest from a scientific point of view. In addition, the dental splints made overseas or in the United States were mounted, with a view to their scientific interest, as there is no type of jaw fracture which is not represented in the series. Diagrammatic sketches of operations performed were made in many instances to supplement photographs and models. Cases were photographed in four classes, bone graft, scar excision, superficial plastics, and deep plastics. 308 MILITARY HOSPITALS IN THE UNITED STATES. Coordination with the dental surgeon, necessary in the treatment of most of the cases, was early established. Neurosurgical section . — The majority of the cases of this service were the result of gunshot wounds incurred in action, while less than 5 per cent were the result of accident or disease. Peripheral nerve injuries constituted a large number of cases; 30 per cent were operated upon, 20 per cent of which showed the nerve to he divided. In suitable cases indicating the use of nerve grafts, two-stage or three-stage operations were done, the neuromata being approxi- mated by tension sutures until resection of the nerve ends and neurorrhaphy coidd be accomplished. Orthopedic section . — Prior to June 25, 1918, there had been no true sub- division of this section from the general surgical service, although in November. 1917, an officer was placed in charge of two wards in which there were some cases of an orthopedic nature, mainly foot, back, and joint injuries, from the surrounding camps. From June to December 31, 1918, the section materially increased in size, and on the latter date occupied 21 active wards. Toward the latter part of July, 1918, the first contingent of wounded from overseas was ad- mitted to the orthopedic section, and by the end of the year the admissions averaged 300 monthly. The majority of these cases were deformities re- sulting from gunshot wounds received in action overseas, plus a large number of orthopedic conditions unsuccessfully treated at other general hospitals. Roentgenological section . — A notable development of the hospital service during 1918 was in the X-ray department. In March, 1918, the new X-ray laboratory situated in the east wing of the third floor of the administration building was completed and ample facilities were then available for conducting every conceivable method of X-ray examination. The installation included the equipment for administering deep therapy. The commissioned personnel of this department was increased to five, and the enlisted personnel was increased proportionately. During December, 1918, three of the largest type of X-ray transformers were in daily use, and, in addition, six United States Army standard bedside X-ray units were in constant demand to execute numerous requests for exam- ination of patients too ill to be moved. An auxiliary X-ray laboratory was opened in Ward No. 61 to expedite the handling of overseas patients in the orthopedic department. A second auxiliary laboratory was opened in the dental infirmary. The influenza epidemic which became alarming the early part of October, 1918, was made a subject of extensive study by means of X-ray investigation. More than 3,000 X-ray films of the pulmonary complications were made with the bedside machine, and in no instance was the patient removed from the bed. The investigation of focal infection, which was begun in 1917, was contin- ued throughout the year 1918. In certain types of patients the examinations were done as a routine on the teeth, accessory sinuses, genitourinary tract, gall- bladder, and the gastrointestinal tract. All amputations and bone-injury cases from overseas were examined on admission. During 1919, the character of work done varied from month to month. The number of cases with purely battle casualties decreased and the number of more or less civil injuries and disease increased gradually. During the year TYPES OF HOSPITALS — GENERAL HOSPITAL (PERMANENT). 309 there was a considerable increase in the relative number of gastrointestinal examinations over 1918. No X-ray burns or other untoward effects were noted. A separate room for roentgenotherapy was maintained and proved of considerable value in certain selected cases. Septic surgery section . — The work of this service was concerned mostly with old war injuries from overseas and those unsuccessfully treated at other general hospitals, involving bones, and complicated by chronic suppurative osteomye- litis. In addition there were domestic and local septic cases, both bone and soft parts. The standardized Carrel-Dakin technique was closely followed in the treatment of these cases, and the results obtained fulfilled all expecta- tions. GENERAL MEDICAL SERVICE. The general medical service was divided into the medical service, the neuropsychiatric service, and the receiving ward. The medical service com- prised the officers’ section, including examinations, ward, contagious or in- fectious disease section, and the noninfectious disease section. There was a chief of medical service, one assistant chief, two chiefs of sections, and nine ward surgeons or assistant ward surgeons. The neuropsvchiatric section comprised one chief of section and five assistants. The medical service conducted the physical examination and furnished medical attendance for the Medical De- partment and civilian personnel at the hospital, a population in the neighbor- hood of 2,000. It also furnished a consultation service covering medical con- ditions in other services at the hospital. An officer of the medical service, at the receiving ward, admitted all patients to the hospital. The scheme for operating the neuropsychiatric service comprised the pro- fessional staff and four specialized corps: The female nurses; the enlisted men, Medical Department; social welfare workers; and reconstruction aides. The nurses looked after the medications and those physically ill; the corps men cared for the physical comfort and material welfare of the patients; the social workers acted as liaison officers, securing touch with the patient’s rela- tives, the study of former environments, and followed these features up so that the service would know how former patients progressed, and assisted in arrange- ments for the food; the reconstruction aides had charge of the vocational therapeutics, the principal aim being to keep the patients’ minds along normal channels, assisting them in utilizing their resources and outlining the business side of life. The work of these corps naturally overlapped or dovetailed in the great effort to restore the patient to mental health by all possible means. The professional staff was in charge of the patients and directed all matters profes- sional and otherwise having to do with their diagnoses, care, treatment, and environment. The service was also called upon to make careful examinations and render conclusions in cases of legal and moral responsibility. This brought the neuropsychiatric service in close touch with the Judge Advocate General’s Department. LABORATORY SERVICE. At the beginning of the war the general laboratory of the hospital occupied two small rooms on the first floor of the main or administration building. As the hospital, at that time, was located entirely in this building and had not 310 MILITARY HOSPITALS IK THE UNITED STATES. more than 200 beds, the laboratory facilities were adequate. No commissioned officers were in charge of the laboratory, the personnel consisting of one ser- geant and two privates, one of the latter being a chemist of considerable ability. In August, 1917, one captain was assigned to duty in the laboratory, and in September following, two lieutenants were added to the commissioned personnel. At this time the laboratory was not equipped for cultural bacteriology, tissue work, or complement fixation tests. Work of that character was sent to the well-equipped laboratory of the Army Medical School in Washington. Follow- ing the detail of commissioned officers to the laboratory, bacteriological appa- ratus was installed and the space allotted became overcrowded; and provisions for the care of a few animals had to be made beneath the tables in the laboratory. Plans were accordingly drawn up for what appeared then to be a spacious and commodious laboratory building. During the period 1917-18, the enlisted personnel was increased to six men. These men, together with three officers in the laboratory, made a very crowded place, but in spite of insufficient room and apparatus a great deal of routine and other work was accomplished, par- ticularly along the line of investigations in pneumonia, empyema, and menin- gitis. In March, 1918, the new laboratory, located just to the rear of the main building, although not entirely complete, was so far finished as to be in a usable condition, and the apparatus was removed from the main building to the special laboratory building. The personnel at this time was increased by the addition of two sergeants; and in April the enlisted personnel was much in- creased, the number varying from IS to 30. On moving into the new building, apparatus for the microscopic examina- tion of tissues was installed, and subsequent to that time the laboratory did its own diagnostic tissue work instead of sending it to the Army Medical School. In the latter part of June, 1918, the Wassermann reaction was undertaken, and in addition there was subsequently established a complement fixation for tuberculosis. One room was devoted to clinical work, and a considerable amount of modern apparatus for the examination of blood and other body fluids was installed. After the hospital had increased in size to nearly 2,000 beds, several expan- sions occurred in the laboratory service, and three ward laboratories were created. One of these, in ward 15, the admitting ward for the medical service, proved especially valuable; another in the genitourinary ward relieved the main laboratory of much routine work; and a third was established in the psychiatric ward. Female technicians were employed, one in April. 1918, one in the middle of August, and two in September following. They efficiently per- formed the work which otherwise would have required extra men. One was assigned to chemistry, one to serology, one to tissue work, and one to routine sputum and feces examinations. The work of the laboratory increased with such rapidity during 1918 that it outgrew its new quarters in a few months, and in October it became neces- sary to turn over to the laboratory service a second frame structure near by, which had previously been used as a hospital storehouse. This was connected by a corridor with the main laboratory building. Special attention was paid by the laboratory service to post-mortem examinations, and an effort was made to examine each case of death and to TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 311 make a survey of the clinical record as compared with post-mortem findings. Many of the specimens were sent to the Army Medical Museum. The autopsy reports were so made as to give a brief clinical record of the cases; and sufficient copies were made to file one in the record office, keep a serial file in the laboratory, and transmit a copy to the Army Medical Museum with material sent there. Because of the policy established by the Surgeon General’s Office of sending all known typhoid carriers to Walter Reed General Hospital, considerable work was done on this type of patient. Much work was done on the hemolytic streptococcus problem; and during the year 1919, 100 cultures of empyema, tonsils, throats, etc., were tested for sugar reaction. During the epidemic of influenza, 50 autopsies were performed and cultures made from various organs. A great deal of available pathological and bacteriological data was secured. With the establishment of a training school for nurses at the hospital, members of the laboratory staff gave instruction to student nurses in bacteriology, chemistry, etc. This work took the form of a course of lectures to the class as a whole, supplemented by laboratory exercises to the class in sections. RECONSTRUCTION. The first systematic trial of occupational therapy at Walter Reed General Hospital was initiated in February, 1918. Experiments were started in a workshop to determine the value of handicrafts in the cure of patients who needed definite functional treatment. To begin this experiment a single room was secured in what was originally the Lay homestead, dating from Civil War days, and tenanted by the post carpenter and his family. The work was necessarily limited to the simplest kind of carpentry, since the only tools avail- able were portions of a set which the post carpenter had discarded. After a preliminary trial it was found that such treatment of functional defects as had been planned was impossible without adequate equipment. The work which had been started proved of very definite value in keeping cheerful and contented and physically well the patients who were engaged in it. With this value in mind, the shop was continued for patients who cared to work in it. About the 1st of March, 1918, the Division of Physical Reconstruction of the Surgeon General’s Office instituted a survey of the various types of cases at Walter Reed General Hospital to lay the foundation for the establishment of a well-equipped shop and school. In April, 1918, an expenditure of $3,000 was authorized to equip the shops with the necessary tools, and expert educa- tional directors were assigned to the work. The fundamental aim of the work in the department of occupational therapy was curative. Specifically, its purpose was to help each patient to find him- self and function again as a whole man — physically, socially, educationally, and economically. It sought to restore him physically by helping to restore his body, so far as possible, to its normal condition; socially, by enabling him to feel that despite his physical handicap he might still be a self-reliant and self- respecting member of the community; educationally, by furnishing him with such training as would increase his personal efficiency; and economically, by providing him with a means of earning a comfortable livelihood so that with his return to civil life he might be an economic asset instead of a liability. The problem thus broadly outlined was a new one. Upon each instructor in the department there fell a share of the responsibility for working out a solution. 312 MILITARY HOSPITALS IN THE UNITED STATES. and this meant that he must get in closest personal touch with his patients. The activities of the organization of the department were therefore the out- growth of many conferences at which were discussed the observations of the various instructors, and their significance. At the close of the year 1918 the scope of the work included: Academic. English, French, Spanish. Arithmetic, geometry, algebra, trigonometry. Penmanship, left-hand writing. Civil Service preparation. Physics, chemistry. History. Commercial. Commercial arithmetic and English. Shorthand, stenotype. Filing and recording. Bookkeeping. Commercial law. Agricultural. Truck farming out of doors. Vegetable forcing under glass. Growing of flowers. Textbook studies. Printing. Hand composition. Linotype operation. Presswork. Mechanical and electrical. Automobile repairing. Oxyacetylene welding. Wiring for bells, lights, and motors. Telegraphy, radio operation. Motion-picture machine operation. Machine-shop practice. Electrical studies. Mechanical studies. Drafting. Shop drawings, details and assembly. Tracing and blue prints. Architectural drawings. Topographical drawings. Freehand sketching. Woodworking. General carpentry. Framing, cabinet work. Pattern making. Display painting. Lettering. Sign painting. Poster making. Arts and crafts. Wood carving. Jewelry making and repairing. Silver smithing. Watch and clock repairing. Engraving. Leather work. Shoe repairing. Physical education. Athletic sport. Calisthenics. Gymnastics. Rug weaving. Fundamentals of rug weaving. Rug repair. Loom work. Dyeing. The department of occupational therapy was divided into five sections: Administrative, psychological and statistical, general or academic, technical, and recreational. The administrative section was charged with the ordinary duties of a record and property office. A large staff of clerks was required because of the rapidity of the growth of the department, the large “ turnover" of pa- tients, and the compilation of reports and data for the Surgeon General's Office. The psychological and statistical section was primarily responsible for the psychological and educational surveys of individual patients. In this section an extensive study was made of the learning problems encountered under the curative workshop schedule, the adaptation of curative methods to particular patients and specific disabilities, the application of trade tests and vocational guidance, and the measuring of intelligence by approved methods. TYPES OF HOSPITALS — GENERAL HOSPITAL (PERMANENT). 313 The section was especially successful in measuring the increase and strength of the movement of ankylosed joints and stump limbs, such measurements serving the double purpose of furnishing an incentive and encouragement to the patient, and of informing the surgeon and physiotherapist as to the rate and locus of improvement. The academic section offered a curriculum which covered a fairly wide range of subjects, from the most elementary to those of high-school grade. This section succeeded in reaching large numbers of patients who had been denied the advantage of courses which required some academic background. The technical section worked out a broad program which offered valuable instruction to the men who were mechanically inclined. The automobile department early seized upon the idea of doing practical work repairing cars. This gave the men the opportunity to put into practice what they had learned in class discussions. The work in the machine shop was at first hampered by lack of facilities and rooms for the proper conduct of work, but with the con- struction of new shops, the purchase of machinery, and, with the settlement of the type of power, this work became a valuable part of the curative program. The drafting division aroused the interest of the men, and gratifying results were obtained along that line. The farm and the greenhouse proved profitable. The woodworking division in addition to making a good record as a curative agency did a good deal of post repair work and made possible many conven- iences in the new shops. The rug-weaving division always made an appeal to the patients, and it developed a number of new types of curative exercises. The men were interested also in the jewelry division and produced some par- ticularly fine work of this character. The modeling developed the artistic temperaments of some men and provided them with a pleasing occupation while in the hospital. The recreational section handled the formal exercises and play hours of the patients, and under skilled instructors offered the following work : (1) Daily lectures on personal and community hygiene. (2) ('lasses in general calisthenics, using largely natural movements (3) Special instruction for amputation cases and special classes for disabled groups. (4) Classes in athletic and folk dancing. (5) Instruction in boxing, fencing, wrestling, bag punching, swimming, jiu-jitsu, and target shooting. (6) Games — volley ball, handball, tennis, indoor baseball, basket shooting, and com- petitive group games. (7) Course in military drill and Army regulations for men returning to duty. On February 15, 1918, the first aides were employed by the hospital. They began by teaching some of the bed patients in the orthopedic wards to knit colored wool squares for blankets, and the men welcomed the opportunity to do something. Gradually the work spread through the different wards; and with the increase of facilities and enlargement of personnel, a variety of activi- ties broadened the occupational interests of the wards and results were both remedial and palliative. To train the aides adequately for their work, a school for reconstruction aides was started late in the fall of 1918, and continued until after the signing of the armistice. The course of training consisted of practical work with the patients under the supervision of experienced aides, and of lectures of both a general and a professional nature. 314 MILITARY HOSPITALS IN THE UNITED STATES. In the latter part of the summer of 1918, the department of occupational therapy instituted weekly meetings of the staff and patients, which were held in the Red Cross house or the post auditorium. The purpose of these meetings was to present to the patients the advantages of taking work with the depart- ment of occupational therapy, and attractive as well as instructive programs were offered. This particular department was a training and demonstration school for other hospitals and an experimental laboratory for trying out methods of teaching, outlines of subject matter, types of equipment, and the selection and training of personnel. To Walter Reed General Hospital belongs the dis- tinction of being the first American hospital to have a professional psychologist on its staff. The rapidity with which the personnel and work of the department of occupational therapy expanded is evidenced by the erection, during 1918, of five curative occupational buildings. The apparatus in use in the hydrotherapy, electrotherapy, gymnasium, and baking departments of the hospital during 1917-18 occupied four rooms. The activities of the department of occupational therapy continued throughout the year 1919, and in September the first classes of nonpatients (detachment, Medical Department, and detachment, Quartermaster Corps, and nurses) were organized. Approximately 6 educational and 13 vocational subjects were offered in these classes. The total attendance ranged from 160 to 170. In the department of physiotherapy about 265,000 treatments were given to approximately 3,000 patients during the year 1919. RECREATION. Recreation at the hospital was in general under the charge of the educational and recreation officer, who had under his immediate supervision the recreational work for patients provided by the Red Cross, and activities for the hospital staff and personnel provided from various sources. This included the recreational activities of the Young Men’s Christian Association, the Knights of Columbus, the Jewish Welfare Board, and the War Camp Community Service, while they functioned on the post. Practically all indoor recreation for patients was provided in the Red Cross Convalescent House and in Service Club No. 1; entertainments for officers, nurses, aides, and enlisted men were provided in the Service Club, gymna- sium , post auditorium, in the Young Men’s Christian Association, and Knights of Columbus buildings on Dogwood Street. From 3 p. m. to 10.30 p. m. on Monday, Tuesday, Thursday, and Friday of each week, and from 1 p. m. to 10.30 p. m. on Wednesday and Saturday, a program of recreation was arranged wherein all groups in the hospital — patients, officers, enlisted men, nurses, and aides — were offered the opportunity of some form of entertainment. Every night in the week moving pictures made up a portion of the program; other activities included dances, musicales, classes in dancing, community sings, lectures, addresses by men and women prominent in their special fields, sightseeing trips; and, in season, excursions to important places of interest like Mount Vernon and Great Falls; corn roasts, picnics, theater parties, with supper at the Red Cross canteen, athletic games by post TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 315 teams, free trips to the ball park of the American League, dramatics, masquer- ades, and the like. The nurses had a weekly program of activities in their recreation house; the aides provided for themselves a clubhouse near the post; and the service club and the recreation room of the enlisted men’s barracks offered additional places for unscheduled recreation. ATHLETICS. Opportunities were offered in the appropriate seasons for baseball, basket ball, tennis, handball, quoits, track sports, volley balk indoor baseball, and other gymnasium games, boxing, wrestling, bowling, and swimming. Two organized baseball teams from the Medical Department played regular sched- ules during the baseball season, both at the post and at neighboring posts, and Fig. 97. — Hospital sw immin g pool, Walter Reed General Hospital. several teams of patients were organized for special games. A basket-ball team was organized and played an unusual number of successful games. Tennis tournaments for patients, nurses, aides, officers, and detachment men were conducted. Three special days for meets were held, with events and prizes for detachment men and patients. A baseball and athletic field was made on a plot of ground opposite the reconstruction buildings. Bleachers were conveniently placed in the shade of tall trees. Two tennis courts were constructed for the nurses near their quar- ters, and two for general use were constructed, one outside of building 76, the other at Fourteenth and Dahlia Streets; and three other courts were built by the welfare organizations. These were freely available for the use of the patients and enlisted personnel. 316 MILITARY HOSPITALS IN THE UNITED STATES. Through the generosity of a former field director of the Red Cross at the hospital, a modern outdoor cement swimming pool, 33 by 85 feet, with dressing rooms, showers, etc., was built and presented to the hospital. Two bowling alleys were constructed in the recreation room of the enlisted men’s barracks. WELFARE ORGANIZATIONS. THE RED CROSS. The welfare organizations functioned under the direction of the co mm an ding officer and under the supervision of the Red Cross, as prescribed in regulations. The American Red Cross utilized its building for all of the activities authorized for this society by the Secretary of War; and carried out its program with a personnel staff of 93, consisting of the field director, assistant field director, three home service men, three entertainment men, one accountant, four ste- nographers, and 80 ward workers and house entertainers. Great effort was made to see that all the patients admitted to the hospital were given every possible attention and service within the jurisdiction of this organization. The home service department rendered a most valuable service. Their record shows that more than 7,556 file cases were taken care of, besides the hundreds of dollars worth of Liberty bonds and State bonuses secured and the thousands of miscellaneous matters taken up and straightened out for the men. The entertainment department entertained over 30,000 patients. Theater parties were conducted on three days a week for all able patients, and vaudeville acts were secured and brought out to the Red Cross house on Wednesday after- noons for the entertainment of those who were in wheel chairs, or who were too invalided to go out of the hospital. World-famous entertainers were brought to the Red Cross House from time to time. This building was open every day from 10.30 a. m. to 10 p. m. Two dances were given each week, and a regular moving- picture program operated weekly. Entertainments of every conceivable kind which would have a good effect on the morale of the men were secured and given in the wards and in the convalescent house. Yictrolas were placed in the wards where it was permissible, and were adequately supplied with records. Games of various kinds were provided for use in the wards and in the convales- cent house. Letter writing was stimulated to such an extent that S00.000 sheets of paper and 500,000 envelopes were given out to the men. Quantities of ap- proved supplies were distributed to the patients for their comfort and pleasure. A diet kitchen was established by the Red Cross in which were served extra supplies. YOUNG men’s CHRISTIAN ASSOCIATION. In 191S, the Young Men’s Christian Association began its activities at W alter Reed General Hospital in a room in the basement of the main building. When the Red Cross building was completed the Young Men's Christian Association was given the end of the main room of that building where they remained until the completion of the “Y” hut on Dogwood Street, just across from the hospital reservation. TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 317 On Christmas Eve, 1918, the “Y” hut on Dogwood Street was formally dedicated and the greatly enlarged activities of the Young Men’s Christian Asso- ciation were begun and continued until the end of the war period. The social work of the Young Men’s Christian Association was an important factor in the life of the post. Every Thursday a vaudeville performance was given in the post auditorium with the aid and cooperation of the War Camp Community Service. Many prominent actors and actresses, as well as local talent, appeared. From tune to time special concerts were put on in the auditorium and in the “Y” hut. Every Saturday night moving pictures were shown in the post auditorium, or, when the weather permitted, on the lawn near the main hospital building. The hut, however, was the real social center of the “ Y” activities. It was open from 8 o’clock in the morning until 10.30 at night, during which time an average of over 600 men made use of its advantages daily. One or more dances were given each week. One of these each month was for officers, nurses, and aides, the others being for enlisted men. Two women members of the Young Women’s Christian Association who were assigned to the hut served light refresh- ments several nights each week in the social room. During 1919, one secretary divided his time between work in the wards, visiting the men and distributing such articles as paper, cigarettes, matches, and candy. In religious work the Young Men’s Christian Association and the chaplain cooperated in conducting services Sunday mornings and evenings, with special music and nationally prominent speakers. The gymnasium in the “Y” hut was the largest on the post, being 50 by 110 feet and 16 feet high. The Young Men’s Christian Association played a large part in the athletic program at the Walter Reed General Hospital. At all times there was at least one physical director, and during the summer months two, one working at the hut and in the outdoor activities and the other in the physiotherapy section of the hospital. The Young Men’s Christian Association used and gave away more than $3,000 worth of athletic equipment. The result of this ample equipment was that the gymnasium was kept busy all the while during the winter months, and the diamonds, courts, and vacant spaces near the post showed great activity in good weather. In its educational work 15 different subjects were taught in the night classes. KNIGHTS OF COLUMBUS. The Knights of Columbus hut opened November 24, 1918, and soon became a scene of a great number of recreational activities, amusements, and pleasures for the many service men and women stationed at the hospital. Arrangements were made whereby three moving-picture shows, an enlisted men’s dance, and officers’ and nurses’ dance were given for entertainment nearly every week. At frequent intervals boxing and wrestling matches were staged by some of the best talent obtainable. Vaudeville shows were also a feature of the activities at the hut. 318 MILITARY HOSPITALS IN THE UNITED STATES. JEWISH WELFARE BOARD. The Jewish Welfare Board maintained headquarters in a house on Butter- nut Street, one-half block from the main entrance to the hospital. This was fitted for a clubhouse especially for the Jewish men. The secretary in charge maintained an excellent program of activities, including both social events and religious services. The secretary of the Jewish Welfare Board visited all wards at regular intervals and contributed to the comfort of patients whenever possible. SERVICE CLUB NO. 1. Service Club No. 1 was opened December 15, 1919, in a building provided by the National Catholic War Council. The construction work on the building ^ O Fig. 98. — Service Club, No. 1, Walter Reed General Hospital. began about the 1st of September. It included a cafeteria service on the lower floor, with a dining room seating 125 persons. The main floor was used for general purposes as a visitors’ house. The upper floor had 11 rooms, rented to transient visitors, particularly to friends and relatives of patients in the hos- pital. A regular program of entertainments and socials was held hi the club. HOSPITAL NEWSPAPER. The hospital newspaper, The Come-Back, published its first number on December 4, 1918. It was frankly aimed to be the spokesman of the patients in the hospital, to be a medium of news for these men, and to present to America the picture of the soldier who, having performed his service, asks nothing of the world but the chance to get back, and who, in spite of wounds and the TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT). 319 heartbreak of absence from home, resolves to put on a brave and contented front. The words of the first editorial, “ This is going to be a cheerful sheet — or bust!” sum up the policy that was maintained throughout. It was through the constant good cheer of this paper that the patient-soldiers took their cue of self-discipline and good humor. Journalistic features were listed in the achievements of the little paper: It originated the ‘“Port of Missing Men,” by which lost men were advertised widely among their old comrades; it led the fight for the abolition of the street salesman in uniform; in its column “The Army in Congress,” it presented an authentic digest of activities relating to the Army; and it inaugurated a series of illuminating articles on insurance and compensation. Two thousand copies of the The Come-Back were distributed free to the patients and personnel of the hospital through the generosity of the American Red Cross. Eventually The Come-Back ran an outside circulation of 30,000 copies. All of the work on the paper was volunteered : no salaries or commissions were paid to the enlisted men, patients, or officers who cooperated in putting the paper together. The profits from the paper were presented to the donation fund in the Surgeon General’s Office. One of the contributions to the Walter Reed General Hospital from these profits was a cylinder press and a printing outfit valued at $13,000. THE LIBRARY SERVICE. The American Library Association founded, equipped, and maintained a library at the Walter Reed General Hospital for the purpose of providing with reading matter all persons connected with the institution. This service had a twofold work: That done in the main library and that done in the wards. The main library, situated in the Red Cross convalescent house, contained about 6,500 books, a large percentage of these being foreign works and up-to- date business and technical books. On the reading tables were most of the popular magazines, besides a large number of scientific and technical periodicals. In addition to books and magazines, were home newspapers from all over the country. This main library was for the use of all and was used by patients, officers, enlisted men, nurses, aides, and the instructors in the vocational school. It was open every day, Sundays and holidays included, from 9 a. m. to 9 p. m., with a trained librarian in charge. From this main library collections were sent to the Young Men’s Christian Association, Knights of Columbus, Jewish Welfare Board, and to the nurses’ Red Cross home, and the reconstruction aides’ club. Separate wards asking for small collections for their sun parlors were also supplied. The American Library Association also subscribed for magazines for the three welfare organizations, the Young Men’s Christian Association, Knights of Columbus, and the Jewish Welfare Board, for use in their houses, and the reconstruction aides’ club. The ward work was the part of the service most carefully planned. Every ward was visited at least twice a week by one of the librarians with a truck of books and magazines from which a man who could not leave his ward or could not carry a book home from the main library could choose the reading he 320 MILITARY HOSPITALS IN THE UNITED STATES. wished. During these visits the men had a chance to ask for any particular books they desired, or the librarian suggested one as helpful to a man in his chosen profession. The isolation wards were also visited, but the books and magazines left there were later destroyed, so some care was taken in the choice of books carried to these wards. There was a close cooperation of the aides and instructors of the schools of the reconstruction department. Many textbooks were furnished, especially where the classes were small and only a few copies were needed, or when a man showed a sudden interest in a particular course and the school text had not arrived. Many men became interested in some subject through a book read and were thus led to study further in the schools or came to the library for supplementary reading after taking a course in the schools. On November 1, 1919, the Army assumed charge of the work of the American Library Association in the Army hospitals, and the library was placed under the educational and recreational branch of the War Department. DEMOBILIZATION. At the beginning of 1919, 1,090 enlisted men were on duty in the hospital, practically all of whom were emergency men. The discharge of these men proceeded slowly, depending upon replacement. Frequently during the year emergency men from other hospitals that had been closed were sent to Walter Reed General Hospital for duty. Hence, the number of men actually discharged, as shown in the table below, is greater than the number of men on duty on January 1. Number of men discharged each month. January 32 February 46 March 60 April 61 May 59 June 188 July 193 August 200 September 110 October 152 November 194 December 83 Total 1.378 For the purpose of determining the urgency of the various claims for discharge on the part of the enlisted men and the needs of the hospital, a board of officers appointed to consider claims for discharge met from time to time, and, in the latter part of the year, weekly. This board ascertained the needs of each case as presented by the application and supporting affidavits, and placed the names of the approved applications on a priority list in the order of the emergency of the case presented. All men were discharged in the order indicated on that list. This order was deviated from only in very exceptional cases where retention in the service would have caused manifest hardship to the applicant and immediate discharge was essential. At the end of the year there were 90 emergency men remaining. Of these about 20 elected to remain in the service. TYPES OF HOSPITALS GENERAL HOSPITAL (PERMANENT) 321 Statistical data, Walter Reed General Hospital, Talcoma Park, D. C., April, 1917, to December, 1919, inclusive. 11 SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate Number of days lost from sickness. From command. From other soufees. Returned to duty. Died. Discharged for disability. | Deserted. Discharged, ex- piration of term. Transferred to insane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Other- wise. Hospital. Quarters. Hos- pital. Quar- ters. 1917. 117 23 70 64 274 63 1 17 65 127 1 3,912 128 12 99 76 315 123 4 1 48 137 2 4,056 June 139 15 201 88 443 170 3 14 1 2 41 209 3 1,004 98 July 212 25 210 31 478 186 1 24 1 20 242 4 6. .586 88 246 25 260 73 604 299 3 25 10 33 233 1 7, 394 61 September 234 28 266 71 599 224 1 2.5 1 7 2 48 288 3 7,918 32 October 291 34 428 79 832 288 6 25 5 10 52 438 8 10, 518 220 446 47 580 95 1. 168 52.5 12 1 9 99 518 4 14, 289 180 522 58 490 78 1,148 361 12 39 .... 3 50 683 11 ’ 733 114 1918. 683 75 777 100 1 , 635 737 27 40 3 1 20 799 8 21,808 248 807 72 876 73 1,828 817 17 26 1 65 893 9 27', 683 279 902 89 946 86 2,023 865 29 31 1 4 33 1,053 7 30, 585 196 1,060 85 1,161 69 2, 37.5 1,046 20 36 1 9 17 1,241 5 34, 197 221 May 1,246 60 '520 313 2, 139 863 14 24 3 i 18 28 1, 182 6 36, 704 167 June 1,188 40 516 414 2, 158 636 7 55 2 i 8 27 1,419 3 .53, 216 242 July 1,422 47 480 521 2, 470 736 5 50 7 i 19 31 1,609 12 46, 192 383 August 1,621 22 347 698 2, 688 873 7 65 7 3 55 19 1,649 10 51,436 319 September 1,659 118 237 911 2, 925 728 14 62 1 1 10 18 2, 063 28 50, 972 337 October 2,1191 252 232 1, 285 3, 860 1,718 124 54 3 6 125 38 1,766 26 64, 802 1,030 N ovember 1,792 77 243 732 2,844 709 10 110 9 5 44 32 1,912 13 55, 319 464 December 1.925 150 173 959 3,207 803 25 134 4 2 372 54 1,793 20 60, 888 422 1919. 1,813 211 394 784 3,202 613 24 89 6 405 87 1 , 963 15 61,426 448 February 1.978 200 204 590 2, 972 492 14 222 1 4 214 55 1,941 29 52; 490 517 March 1 , 970 145 436 481 3.032 675 16 202 1 14 119 79 1,899 27 60,616 902 1 , 926 85 405 312 2,728 416 3 151 1 86 1 , 989 28 56, 109 765 Mav 2,017 70 386 396 2,' 869 332 7 140 26 46 126 2, 163 29 63, 019 983 June 2, 192 58 452 288 2, 990 415 9 1.59 7 1 35 115 2, 222 27 65,313 798 July 2, 249 78 200 416 2.943 325 12 126 5 15 144 2, 276 40 71,534 1,009 August 2, 316 26 106 359 2, 807 302 6 139 6 31 149 2, 133 41 66, 123 l' 271 September 2, 174 40 63 399 2,676 262 4 237 4 17 134 1,989 29 60,688 l' 087 October 2, 018 86 363 276 2,743 248 6 251 7 1 16 160 2,014 40 54, 276 168 November 2,054 84 89 215 2.442 222 2 206 1 20 52 1 , 892 47 59, 182 219 December 1,939 88 49 230 2,306 247 7 187 7 1 42 140 1,641 34 9,269 998 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. W omen . Chil- dren. Total. 1917. April 5 15 14 34 May 5 13 11 29 June 5 13 11 29 July 5 13 11 29 August 5 13 11 29 September 4 17 9 30 October 4 17 9 30 November 4 17 9 30 December 4 17 9 30 1918. January 4 17 10 31 February 4 17 9 30 March 4 18 10 32 April 4 18 10 32 May 4 18 11 33 June 4 IS 11 33 July 4 18 11 33 August 1 10 6 17 Year and month. Men. Women. Chil- dren. Total. September 3 7 7 17 October 3 7 7 17 November 3 7 7 17 December 3 8 7 IS 1919. January 3 8 7 18 February 3 8 7 18 March 1 8 7 16 April 1 8 7 16 May 1 8 7 16 June 1 2 7 10 July 1 8 8 17 August 1 8 8 17 September 1 8 8 17 October 282 342 8 632 November 282 342 8 632 December 2S2 342 8 632 ° Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adju- tant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 45269°— 23 21 322 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, Walter Reed General Hospital, Takoma Park, D . C., April, 1917 , to December, 1919, inc lusive — Continued . PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Civilian employ- ees.' Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1917. April 17 17 145 13 158 31 May 16 16 144 159 38 19 19 23 178 47 July 22 22 197 23 220 44 26 26 208 29 237 52 35 1 36 200 34 234 64 October 37 1 1 39 211 50 261 54 3 November 32 1 1 34 307 53 360 3 December 13 2 1 46 324 67 391 80 i 1918. January 13 2 1 46 366 68 434 85 1 February 53 2 1 56 439 106 545 108 1 March 58 3 2 (53 467 105 572 92 62 4 3 69 529 113 642 149 May 68 4 3 75 597 121 718 140 June 78 5 2 85 730 125 146 July 87 8 3 98 699 133 832 147 August 98 8 5 111 786 164 950 148 i 109 9 5 123 882 161 1.043 146 107 9 6 122 919 170 1 . 089 130 110 13 8 131 992 210 1,202 157 114 12 g 135 1,090 262 1.352 142 1919. 113 13 8 134 1,102 257 1,359 142 130 16 9 155 1,048 229 1,277 125 18 8 151 1.007 203 1,210 163 124 17 14 155 984 176 1,160 148 May 156 11 17 184 919 117 1,036 144 161 21 16 198 911 92 1.003 170 July 172 15 194 900 39 939 177 129 23 10 162 739 SI 820 1S4 109 21 145 642 77 719 October 96 19 122 732 78 810 1S5 i November 93 20 9 122 685 92 777 161 i December 97 17 s 122 686 94 780 165 1 CHAPTER XVI. THE GENERAL HOSPITAL (CONVERTED). GENERAL HOSPITAL NO. 2, FORT McHENRY, BALTIMORE, MD.« Fort McHenry, perhaps the best of the few examples of the “Star Fort’’ type, or bastioned polygon, in this country, is chiefly famous for its protection of Baltimore at the time of the bombardment by the British fleet in 1814. It is also notable as commemorating the occasion upon which Francis Scott Key was inspired to write the poem which afterwards became our national anthem — The Star Spangled Banner. The construction of the fort was begun in 1776 as a shore battery, but it was not until 1794 that the star fort was built. It was named in honor of General Washington’s Secretary of War, James McHenry, of Baltimore, and was constructed during Washington’s administra- tion. In 1795 the Government acquired that part of the reservation on which the star fort stood, and in 1838 the entire reservation was ceded. In 1914 the area was transferred to the city of Baltimore for use as a public park, with the understanding that the fort would be occupied by the Government in time of war. PROCUREMEMT OF STRUCTURES. On June 20, 1917, the Surgeon General recommended that Fort McHenry be turned over to the Medical Department for general hospital purposes. Approval for this was given by the Secretary of War on August 2, following. On the morning of August 22, 1917, a sergeant and 15 enlisted men of the Medical Department arrived at Fort McHenry and unfurled the American flag on the remains of the historic old star fort. On the 29th of the same month a medical officer arrived and assumed duty as commanding officer of t he hospital. From then on various officers reported and were assigned to duties in the different departments of the forming organization. At the time when Fort McHenry was taken over for use as a hospital the buildings and grounds were the remains of a former coast artillery post which had been unoccupied for several years, and in consequence the place was considerably out of repair. The Government was just building three brick buildings to be used as an immigration station. The preliminary efforts of those in charge were to prepare temporary quarters for the administrative forces and barracks for the enlisted men of the Medical Department detachment. The brick building to the right, as one entered the gate to the fort, was the first one to be renovated, and for several months was used as headquarters as well as a barracks and mess hall for the personnel then on duty. In addition to cleaning and repairing the buildings which had been on o The statements of fact appearing herein are based on the “History, General Hospital No. 2, Fort McHenry, Md.,” by Maj. A. P. Herring, M. C., XT. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. 323 324 MILITARY HOSPITALS IN THE UNITED STATES. TYPES OF HOSPITALS GENERAL HOSPITAL (CONVERTED). 325 the post since the Civil War, it was necessary to clean up the grounds, as the roadways and walks were overgrown with grass and weeds. At this time no new construction had been definitely planned, and the future of the hospital was still being determined by the Surgeon General. On October 5, 1917, a group of 60 Medical Department men arrived from Fort Ethan Allen, Vt., and were housed for a while in the chapel and guardhouse, but later were moved to one of the brick barrack buildings which had formerly been used by the Coast Artillery. In this same building a mess and permanent headquarters for the detachment were established. The first patients to be on sick report were two members of the Medical Department detachment who were admitted as patients on October IS, 1917. Fig. 100. — Old Post Hospital, Fort McHenry. Used as first administration building and officer-patients’ quarters. The operating room, equipped for emergency operations, was opened on the 29th, in the old post hospital building, afterwards barracks No. 2. Arrangements had already been made with the Mercy, Johns Hopkins, and the Baltimore Eye, Ear, Nose, and Throat Hospitals to send a group of 10 detachment men at a time to each of these institutions to take a four-weeks’ course of special training, particularly in surgery. Plans were forwarded from Washington on September 2, 1917, for new buildings which, with the three brick immigration buildings, were to be com- pleted and turned over to the Army and which would accommodate 1 ,000 patients. The work on the new cantonment buildings was begun on December 24. How- ever, the 1st of June, 1918, found the hospital occupying temporary quarters in the old brick barracks and any other of the original buildings at the post that could be made habitable. From September to December, 1917, the following 326 MILITARY HOSPITALS I ST THE UNITED STATES. changes had been made, as appear in the report of the commanding officer to the Surgeon General : By December 31, 1917, all of the old buildings had been completely reno- vated; new sewers had been constructed and the old ones cleaned; necessary plumbing had been installed in the buildings ; and the following activities had been placed in operation: Wards with a total bed capacity of 200; the barracks and mess; officers’ quarters and mess; the quartermaster clothing room and the commissary; the bakery; the quartermaster shop; shops for the plumber, the carpenter, the electrician, and the painter; a garage and stable; a post exchange; a reading room; a writing room; a pool room; a tailor shop; and a barber shop. The first new building to be completed was the nurses’ home No. 1. In the meantime construction was going on at a rapid pace on 18 one-story frame Fig. 101. — Cantonment wards. The first to he erected at General Hopital No. 2. buildings, including a central kitchen and mess, a receiving ward, and an isola- tion ward. At the same time that the new buildings were being constructed work on the immigration buildings was being rapidly pushed, and by February, 1918, the new administration building — one of the immigration buildings — was occupied. Word was received that the first group of overseas patients would soon arrive; and as the immigration buildings were not completed and the regular hospital buildings were still in process of construction, it was necessary to pro- vide temporary quarters in one of the old brick buildings which had been in existence since the Civil War. In February, 1918, the immigration buildings were completed, the receiving building having a capacity of 800 beds. The surgical building was completed TYPES OF HOSPITALS GENERAL HOSPITAL (CONVERTED). 327 and equipped with X-ray, eye, ear, nose, and throat apparatus and a modern surgery. On February 22 the second group of 107 overseas patients arrived and on the 28th 248 more patients came. During this period the hospital was used largely as a clearing house, patients arriving from the port of debarkation, Hoboken, on special trains, being reclassified and then transferred to definite points such as New Haven, Conn., Fort McPherson, Ga., and Cape May, N. J., according to the nature of their disabilities. In the spring of 1918, due to the necessity for augmenting every hospital to its fullest extent, buildings with a capacity of 1,200 beds were added to this hospital. Owing to the limited area and the resultant congestion, these build- ings were constructed of tile; whereas, those in the first project were of frame; all, however, were equipped with steam heat and other modern improvements. Additional buildings were subsequently erected to meet new needs, causing further congestion; in consequence of which, considerable fireproofing of the Fig. 102. — Two-story wards constructed of tile. General Hospital No. 2. frame buildings was necessary; and an automatic alarm system, such as was put in all large hospitals, was installed. Construction continued, and by March, 1919, 2,500 beds were available. In the summer following, construction for 200 beds was added, making a total constructed capacity of 2,700 beds. Over 130 separate construction authorizations from the Surgeon General’s Office were necessary to complete this hospital. This number of authorizations was greater than was usually required and was due to the facts that the hospital was developed early and that there was an enforced absorption of old buildings in a confined area. 328 MILITARY HOSPITALS IN THE UNITED STATES. Nurses’ quarters, as well as quarters for all other personnel, were provided on the grounds. In fact, every activity of the hospital was so provided, thus greatly simplifying administration. The first permanent buildings of the Bureau of Immigration were used with practically no alterations. The special buildings for physiotherapy, school, and shopwork for the physical reconstruction service, were not installed until rather late in the con- struction period of this hospital. Special provision for the blind was made until accommodations elsewhere could be effected. A most complete orthopedic workshop, a feature not common to all general hospitals, was added. Special provisions for the treat- ment of maxillofacial, brain, and peripheral injuries were also made. In all, 75 new buildings were added to those originally at the fort, which, with the four buildings of the Bureau of Immigration, made a total of 111. The total cost of this 2,700-bed hospital was $2, 160,000. CHRONOLOGICAL SEQUENCE OF EVENTS. At the close of the first six months, that is, March 1, 1918, there were 187 enlisted men, Medical Department, 33 officers, and 400 patients. Two of the frame buildings were occupied and many others were under construction, but there was still a margin of 400 vacant beds. The three immigration buildings had been occupied for several weeks and were fulfilling every need. On March 6, Base Hospital Unit No. 48, comprising 148 men, the first of several such units to receive their training at this hospital, arrived. The month of March, 1918, was a memorable one in the history of this hospital because it was during this month that the educational department was established. At this time the Government had not adopted any definite policy regarding the reeducation of disabled soldiers, nor had any appropriation for this purpose been made. The establishment of this school was made possible through the liberality of one of Baltimore’s prominent citizens who placed at the disposal of the commanding officer a sum of money to conduct what started to be a department of reeducation of the soldiers at this hospital. From this small beginning schools and shops developed into one of the most complete educational departments. On April 4, 191S, a branch post office and a telegraph station were opened, and on the 27th of the month the first number of the Trouble Buster was printed from the press in the educational department. On May 31 , authorization was received to enlarge the capacity of the hospital to 3,000 patients, the construction to be two-story tile buildings. At about this time a post exchange was established and recreation of various sorts was being given daily for patients. Many relief organizations which had developed in the city were lending their assistance to the hospital in various ways, furnishing many comforts and delicacies which the Government did not provide. A printing press, with full equipment, was donated by the Broadway A ar Relief Association and the American Type Founders Co., establishing the Fort McHenry press, which printed the Trouble Buster and The Medical Bulletin. TYPES OF HOSPITALS — GENERAL HOSPITAL (CONVERTED). 329 During the month of June, 1918, the hospital was very active. Base Hospital Unit No. 48, having been equipped, left on the 20th for duty overseas. Base Hospital Unit No. 78 arrived for mobilization and training. A convales- cent camp on the Severn River was opened for the reception of patients. The cantonment buildings were occupied, grounds about the hospital were being beautified by the planting of flowers and shrubbery, and in spite of the great amount of new construction the hospital presented an attractive appearance. On July 20, a class of instruction for noncommissioned officers was started and lectures were given daily by the various officers. On the 25th, Base Hospital Unit No. 102 arrived for mobilization and training. During this month 30 enlisted men left for overseas. On the 19th, the new psychiatric wards were formally opened. August 4, Base Hospital Unit No. 102, known as the Italian unit, most of its personnel comprising Italian-Americans, embarked from the port of Balti- more for the Italian front. In this unit there were 35 officers and 198 enlisted men. On the 27th, Base Hospital Unit No. 78 left for overseas, taking with it 22 officers and 191 enlisted men. During this month several hundred limited service men arrived for minor operations; and while the active affairs of the hospital were somewhat crippled, the work went on without interruption. The construction of new buildings was constantly going on and hundreds of workmen went in and out daily. Twenty-three two-story tile and concrete buildings were in process of construction and a large amount of debris covered the grounds, necessitating the policing of the entire grounds daily by both personnel and available patients. During the month of September the first annual meet of the Army and Navy Athletic Association was held on Homewood Field at Johns Hopkins University. Athletes from the near-by camps participated. A parade of several thousand soldiers and sailors, with several bands, marched to the field, where 10,000 spectators witnessed the contests. The gate receipts, amounting to nearly $10,000, were used to establish and equip the convalescent camp on the Severn River. It was during this month that the first of the two-story tile buildings was completed and opened. This building was finished within two weeks after the work had started. A central kitchen and mess hall was also completed and opened, with a capacity of over 1,600 men. At this time the influenza epidemic began, and a number of serious cases were admitted to the hospital from Camp Holabird, Md. Every day showed an increase in the number of influenza patients; but, fortunately, few cases occurred among the hospital command. At the end of the month there were 300 influenza and pneumonia patients, overtaxing the wards and requiring officers, nurses, and enlisted men to work overtime. Five surgical wards were given over to the medical service, and all operating ceased for this period. During the month there were admitted 1,052 patients; discharges numbered 730, and deaths 14. During October the epidemic of influenza was still raging, over 1,000 cases having been treated in 30 days. There were 121 deaths among the patients, mostly from pneumonia. Many of these cases came to the hospital in the later stages of the disease. Many autopsies were performed and the involved tissues closely studied. A very large percentage of the autopsies exhibited 330 MILITARY HOSPITALS 1 1ST THE UNITED STATES. an infection with streptococcus hemolyticus. Many cases showed a very earlv pleural exudate, rapidly changing to pus, though some died before the pus became microscopic. Many showed multiple abscesses in the lungs, and a purulent pericarditis. During the month of November an officer arrived to take charge of ath- letics; and new life was instilled into these activities, the officers taking daily exercise in the gymnasium and the patients appropriate exercises to assist them in overcoming their physical handicaps. A bowling alley and shooting gallery were opened; boxing bouts became weekly affairs; and a spirit of com- petition arose which tended to improve the morale of the post. Weekly dances, moving pictures, and other entertainments were given both for the patients and enlisted men. ft was during this month, also, that the local director of the American Red Cross arrived and began his work in the office of the chaplain, pending the completion of the Red Cross building. During December the new laboratory was opened, providing adequate facilities for routine as well as experimental work. The end of the year 1918 found the hospital in a splendid condition, with nearly all of the buildings occupied. At the first of the year 1919, the personnel of the hospital consisted of 78 officers, 123 nurses, a detachment of 863 men, and 947 patients. During the month of January, the maxillofacial service was instituted. The neuro- surgical department had already been in operation a few weeks, and the oper- ating rooms were kept busy all day long. The orthopedic service had been moved into the large immigration building, containing over 300 beds, which, with those in three other hospital wards, made one of the largest services in the hospital. Of the 2,000 patients in the hospital nearly one-half required some form of prosthetic appliance, so that the orthopedic shop was a center of great activity, since practically all of the shoes and appliances were made and fitted there. The department of physiotherapy was operating in full swing with about 50 aides on duty and hundreds of patients receiving daily treatment. During February the new Red Cross building was opened with appropriate exercises, and proved to be a constant source of comfort and pleasure to the personnel of the hospital. The officers’ club was opened, and made an important adjunct to the social life of the post. The Red Cross fitted the rooms of the club with reading tables, writing desks, easy chairs, library, and a small res- taurant. On March 13 the new Young Men’s Christian Association building was opened. This contained a large, well-equipped gymnasium, pool tables, and lounging and reading rooms for the use of both patients and enlisted men. On April 4 Arbor Day was celebrated. The entire staff of officers, en- listed men, and ambulant patients turned out and planted trees and shrubs over the post. Over 2,500 trees and shrubs were planted. The greenhouse was complete and provided an abundance of flowers for the wards. The school of wireless telegraphy was opened and several pupils enrolled. On the 13th, the convalescent camp on the Severn River was formally opened and presented to the hospital, to be used as a camp for convalescent patients. In May 230 orthopedic patients arrived from General Hospital No. 9, Lakewood, N. J., and General Hospital No. 1, Williamsbridge, N. 1. On May TYPES OF HOSPITALS GENERAL HOSPITAL (CONVERTED). 331 31a Memorial Day parade was held in Baltimore in which 7,500 patients from the hospital participated. A large exhibit of the work which was being done at the hospital was sent to the meeting of the American Medical Association held at Atlantic City. The Jewish Welfare Board hut was opened with appro- priate ceremonies. During July the commanding officer organized a central welfare board, which coordinated all the welfare activities of the post, and there was started a series of weekly lectures on American citizenship. In Osier Hall, at the Medical Library, 1211 Cathedral Street, Baltimore, an extensive exhibit portraying the work of the various departments of the hospital was held for a week. The educational department, the maxillofacial, and others, demonstrated by models, photographs, and charts the compre- hensive character of the work being done by the hospital. During July and August patients were being taken to the convalescent camp daily. The Red Cross and other welfare organizations were very active, planning entertainments of various kinds for the patients and providing them with many comforts. The month of November marked the beginning of the end of the hospital’s existence, when the various welfare associations discontinued their activities at the hospital. A detachment men’s service club was organized and took over the Young Men’s Christian Association building as a gymnasium and club house. On the last of the year the personnel of the hospital comprised 81 officers, 173 nurses, 701 enlisted men. There were 1,193 patients. ADMINISTRATION. Registrar’s Office. In this office were kept the records of each patient in the hospital from the time he was admitted thereto until he was ready for final discharge, when his record was completed and sent to the Office of the Surgeon General of the Army. From the time the patient was admitted his record (register card) moved step by step through each subsection of the department. The following figures for the year 1919 will give some idea of the work done in the registrar’s office: The number of register cards for patients admitted to hospital, 14,277 ; the number of complete records sent to the Office of the Surgeon General, 13,048; the average daily number of patients admitted, re- corded, diagnosed, completed, checked, etc., was 40. Personnel Adjutant’s Office. This office handled the records of a shifting personnel of enlisted patients, as to pay, insurance, class A, B, C, D, and E allotments, and Liberty loans, for approximately 21,800 men, or a monthly average of about 2,000. In many instances the records of these men were received in poor condition, 50 per cent of the men who arrived from overseas and were transferred to this hospital having temporary service records and pay cards only, making it essential to execute affi- davits and to interview individual enlisted men to determine the merits of each case. The back pay due some of these soldiers ranged from two months to two 332 MILITARY HOSPITALS IN THE UNITED STATES. years. This department handled the pay, insurance premiums, class A, B, C, D, and E allotments, and Liberty loan bond deductions for the members of the Medi- cal Department, Quartermaster Corps, Utilities, and Motor Transport Corps on duty at this station. This number averaged 850 per month. There were also executed all papers required by demobilization circulars and orders in the discharge of about 250 patient officers and the transfer of 75 to other stations for duty or discharge. In this office were made monthly rosters and musters of officers and enlisted men, the post returns of the command, returns of medical officers, weekly reports, reports of duty status of officers, and a daily report of changes to The Adjutant General of the Army for every change of status of officers and enlisted men, averaging 150 officers and 1,770 men per month. Detachment of Patients. The office of the detachment of patients was charged with the pay of enlisted and officer patients; banking the patients’ money and depositing their valuables in the vault; keeping the service records of patients admitted to hospital, or sending the records to proper organizations with necessary indorse- ments when sick were transferred or returned to duty; completing the service records for discharge; preparing temporary records and pay cards; affidavits when original papers had been lost or destroyed; supervising War Risk allot- ments; preparing surgeon’s certificates of disability; issuing furloughs to pa- tients; and issuing clothing to patients. The greatest part of the work of this office was in connection with keeping the enlisted patients’ records up to date so that the men could be discharged when such was ordered by reason of a disability, or when the patient was returned to duty. The following figures show some of the work accomplished by this office during the year 1919: Patients admitted to hospital with service records, 14,277; patients departed from hospital for discharge, transferred for further treatment, or to a duty status, 13,048; approximate monthly pay of patients in hospital, $35,000; number of furloughs issued to patients in hospital, 1,855. Receiving Ward. One of the busiest places in the hospital was the receiving ward. Here the patients were admitted or discharged, and it was here the medical and surgical officers of the day made their headquarters, where, in the event of an emergency, they would be most readily available. Evacuation Department. The evacuation department consisted at first of three separate and distinct offices, namely, evacuation, demobilization, and transportation. On Sep- tember 22, 1919, they were consolidated into what was later known as the evacuation department. This department was charged with the duties of demobilization, evacuation, and transportation of personnel at the hospital. When a member of the organization was demobilized his records were com- pletely audited by the commanding officer, detachment of patients, and the personnel adjutant, before his papers reached the demobilization office. So soon as the demobilization office received a soldier’s service record he was TYPES OF HOSPITALS GENERAL HOSPITAL (CONVERTED). 333 notified to appear, his papers were completed, and he was then ready for dis- charge. During 1919, approximately 13,000 patients were discharged or other- wise disposed of at this hospital. Sanitation. Fort McHenry was taken over as a general hospital August 22, 1917. At that time the sanitary conditions of the post were very poor as the result of an inefficient sewerage system and the methods of disposal of garbage and refuse. Steps were immediately taken to install an adequate sewerage system, and to correct the existing insanitary conditions. A field incinerator was built for temporary use for the disposal of wastes, and the garbage was deposited on a scow and removed by the city of Baltimore. Water was supplied by the city system. During the months of September, October, November, and December, 1917, and January, February, March, and April, 1918, the above mentioned methods of sanitation were in operation. In June, 1918, a modern steam incinerator was built and efficiently operated for the needs of the hospital. Following this, water pressure tanks were installed and connected with the city water supply. Shortly thereafter, a modern incinerator was built, and it ade- quately cared for the disposal of the waste of the post. In the early part of 1918, as a result of the rapidly increasing size and capacity of the hospital, an officer, selected from the staff, was definitely as- signed as hospital and sanitary inspector. In addition, several enlisted men, Medical Department, were assigned to duty as a part of the sanitary personnel of the hospital and under the direction of the hospital inspector. The duties of the hospital inspector and sanitary squad were: Frequent inspection of the buildings and grounds; the drainage, sewerage, condition of sanitary appliances (incinerators, sterilizers, and filters) ; the amount and pota- bility of the water; the character and cooking of food; and the character and causes of prevailing diseases and measures taken to prevent them. All the wards and corridors were screened as a precaution against mos- quitoes, and the drainage was carefully looked after to prevent the formation of stagnant pools of water. Places which were habitually damp were covered with a fine film of oil. Nursing Service. The first nurse reported for duty at General Hospital No. 2, January 5, 1918. She was detailed as chief nurse. On January 26, 1918, the first duty nurse arrived; the following day two more nurses reported; and by the end of February there were 12. Not many wounded were being brought back to this country at that time so that the number of nurses was increased very gradually. The accommodations in ward 1, provided for the nurses, were soon out- grown and it was necessary to build nurses’ quarters No. 1. These were com- pleted about March 1, 1918. By June, 1918, about 50 nurses were quar- tered in this building, and it then became necessary to have additional quarters, and a dormitory consisting of eight beds. Quarters Nos. 26 and 27 were opened for nurses early in November, 1918, when the roster had increased 334 MILITARY HOSPITALS IN' THE UNITED STATES. to about 75. All these buildings provided private rooms, parlors, and reception rooms for the nurses; and all of the rooms were tastefully decorated and furnished by the Red Cross and other patriotic organizations of Baltimore. The nurses’ rest house on the water front filled a longfelt want. This building included a large living room, with laundry, two small guest rooms, and on three sides a screened porch that proved a delight on hot summer days. The rooms were furnished and decorated attractively by the Red Cross. Apart from being a rest house, it was used as a recreation hall for nurses, officers, and others of the post, and for the entertainment of nurses’ guests. About October 15, 1918, the influenza epidemic was at its height. Twelve wards, with 40 patients to each ward, were in operation. Nurses were arriving daily in large numbers, so that shortly after the roster reached 200. About one half of the nurses were taken sick with the influenza, doubling the work of those remaining on duty. HOSPITAL DEPARTMENTS. Surgical Service. On October 10, 1917, the first chief of the surgical service was assigned. On October 29, 1917, an operating room was planned and equipped for emergency operations in the old post hospital building. The first operation performed at this hospital was on November 23, 1917. The activities of the department of general surgery, which during the early months included the subdivisions of surgery, orthopedics, maxdlofacial, and neurosurgery, were confined to operations of an elective character which included a large number of hernias. The usual acute surgery from the surrounding camps was also taken care of. Beginning in November, a few operations on the late effects of gunshot wounds of bones were performed — removal of sequestra. The majority of the cases of compound fracture arriving from overseas, up to this time, had required only the usual surgical dressing, splinting, etc., and the surgical department had been largely concerned in the study of radi- ography and clinical signs, having in mind the proper selection of cases requiring surgical intervention. The study of the cases requiring surgical intervention necessitated a grouping of surgical conditions in suitable wards in order that these conditions might be more readily and frequently reviewed. It was found that, due to the splendid surgical care given the patients abroad, there were very few malunited fractures, and cases of nonunion were comparatively rare. These cases of nonunion were subjected to bone-grafting operations with very good results. The empyema cases operated upon represented old empyemas of more than six months’ duration. During the month of December, 1918, the department of neurosurgery was formed. During the year 1919, 3,579 operations were performed, with but IS deaths. These figures include a number of operations on general surgical cases which represented long-standing complications that had been transferred on the closing of other general hospitals. One of the innovations during the year was the system of charting, by graphic charts, the results obtained by the orthopedic and physiotherapy depart- TYPES OF HOSPITALS GENERAL HOSPITAL (CONVERTED). 335 merits. Graphic charting of a patient’s improvement not only encouraged and convinced the patient of his progress, but it was a stimulus to the aides and others working on the case. Every effort was made to keep a smooth liaison between all the depart- ments of the surgical service and between each ward and the office of the chief of the surgical service. Eye Department. This department was not well organized until September, 1918. From that time on a system of case records was established and a separate ward opened. The clinic became a large and active one, operating practically all day. The surgical work of the service was of a very high order, consisting of plastic repair of old gunshot wounds, the restoration of cul-de-sacs, fat and fascia orbital implantations, enucleations, and the fitting of artificial eyes. The most marked and interesting cases of repair work were sketched in crayon and colors; plaster casts made before and after the various operative pro- cedures, and the complete collection later became a part of the exhibit of the Museum and library of the Surgeon General’s Office. Otolaryngological Department. This section of the hospital was not well organized until the spring of 1919. During 1918, the clinic was inaugurated and a large number of patients treated and many consultations were held in the wards. As the demand for space for patients of this department became more urgent a separate wand for the service, having a capacity of 80 patients, was established. The section soon became an integral part of the surgical department of the hospital and the clinic ran daily, including Sundays and holidays, from 8.30 a. m. until noon. The service was a very active one, cooperating with the other departments of the hospital and caring for military cases from the city of Baltimore, Aberdeen Proving Grounds, Camp Holabird, and Camp Meade, Md. Many patients from the latter-named points were naturally in the out-patient clinic, and hospitalized when necessary. The operative work, of which there was considerable, was done in the afternoons. The most frequent lesions met with were those of the accessory nasal sinuses, usually postinfluenzal, some following gassing, and others resulting from high explosives and other war injuries. There was a large number of ear affections, principally of the chronic suppurative type, with a very low per- centage of mastoid involvement. Acute mastoid cases were found to be few and far between for such a large clinic. Acute tonsillitis was found to be fre- quent, with a number of cases of peritonsillar abscess, and there were a few cases of Vincent’s angina. Maxillofacial Service. The maxillofacial department, at General Hospital No. 2, was in charge of an officer, with four surgical assistants, and two artists. In all there were about 450 maxillofacial cases; of this number about one-fourth were discharged in practically as good condition as they were before entering the Army. These cases consisted of a great variety of facial injuries, including many with a partial loss of the nose and a few with entire loss of the chin, and a great many 336 MILITARY HOSPITALS IN THE UNITED STATES. with deep deforming scars and loss of bone in many parts of the face. In the repair of these cases it was necessary to have a great many of the appli- ances made hy the dental department. In order that a permanent record of the work might be made, two artists were employed. One was in charge of the plaster and wax work and clay modeling. A cast was made before and after operations in each distinctive case. In many cases, noses and chins were modeled in clay, as a pattern for the surgeon to go by. In a number of cases water colors were made where sketches and casts did not show sufficiently the nature of the injury. Another artist was in charge of the sketching, and made excellent free-hand sketches of all cases, before and after operation. In addition, the department had photo- graphs of all cases, also tracings of X-ray plates and many X-ray films. The dental records consisted of splints mounted on plaster casts, copies of the various Pig. 103. — Plaster models of maxillofacial patients, General Hospital No. 2 appliances used, and pictures of others not deemed worthy of publication. In this way it was possible to place in the Army Medical Museum at Washington a complete record of the work of the department, with a card index of all cases shown, giving a brief history of each. Neurosurgical Service. It was learned from the experience of the Allies, long before we entered the war, that injuries to nerve structures calling for surgical intervention would reach a high percentage. The Surgeon General’s Office then created a division to be known as neurosurgery. There were very few men, at home or abroad, trained in this branch of surgery, and one of the first steps of the new service was to open schools, known as neurosurgical institutes, at several medical centers, to which were sent selected officers for this training. There were also designated, at a later date, certain hospitals in this country to be equipped as neurosurgical TYPES OF HOSPITALS — GENERAL HOSPITAL ( CONVERTED ) . 337 centers. General Hospital No. 2 was one of this group, and in November, 1918, patients with nerve structure injury were being admitted for treatment. It was with the withered hands and feet and arms and legs that this de- partment had to deal. Patients, with very few exceptions, were those in whom partial or complete paralysis had followed gunshot wound of the brain, spinal cord, or the larger nerve trunks. The injuries varied greatly in severity: in some cases a large portion of the brain matter was destroyed or irreparably injured; in others there was nothing more than a bruise. So also was it in cases of spinal-cord injury. With the peripheral nerves the injuries varied from bruises to complete division. The total number of cases treated was 055, of which 550 were peripheral nerve injuries, 103 head injuries, and 12 injuries of the spinal cord. Two hundred and forty-one peripheral nerve cases and 65 head cases were operated on. In addition to the nerve injuries, about 25 per cent of the men had serious injury to bones, tendons, or joints, requiring treatment in some other department. The early recognition of the necessity for cooperation between the ortho- pedic ward surgeons and the departments of physiotherapy and of education was evidenced by the assignment of a liaison officer for this purpose in Novem- ber, 1918. In this manner, by consultation, it was determined what curative or educational therapy should be undertaken in each case. Both of these de- partments proved of inestimable value to the orthopedic department. In connection with the physiotherapy department, and largely due to the efforts of the liaison officer, there were developed apparatus and forms for the measuring and recording range of voluntary motion and the strength of motion in disabilities of the joints and muscles. These instruments were designed from the various forms of apparatus in use in other Army hospitals, supple- mented by improvements worked out by the officer in charge. These measure- ments and records proved of great value not only in stimulating and encouraging the patients, but also in furnishing a definite record of improvement for the information and guidance of ward surgeons and members of the physiotherapy and educational departments. Orthopedic Department. The orthopedic service was organized soon after the first contingent of overseas patients was received, in June, 1918. These patients were placed in a small building afterwards used and outgrown as the appliance shop, becoming the repositorium. As the hospital rapidly filled with patients, other wards were assigned to the service, and to one of these, ward 17, a sun porch was added for the segregation and open-air treatment of orthopedic tuberculous patients. In August, 1918, it was found necessary to establish and equip an ortho- pedic appliance shop. The small building used as the first ward was remodeled for the purpose; and two men, trained at the Army Medical School orthopedic laboratory, were secured to augment the nucleus of mechanics developed locally. The first shop equipment, soon afterwards replaced by a complete Medical Department issue, was secured through the generosity of patriotic organizations and citizens of Baltimore. 45269°— 23 22 338 MILITARY HOSPITALS IN' THE UNITED STATES. In April, 1919, a wing of the physiotherapy building, the gymnasium, was secured and converted into an appliance shop, office, and consultation room. Throughout the remaining months of the year the shop mechanics, all emergency enlisted men of the Medical Department, turned out the required Tig. 104.— Orthopedic shop, General Hospital No. 2. appliances for the entire hospital, with the exception of the cork-sole shoe raises, which required the services of an expert orthopedic bootmaker, and an occasional back, or leg brace. Urological Department. No separate urological department was maintained at General Hospital No. 2 during its early days, all venereal patients being taken care of in a small ward by the general surgical service. It was not until large numbers of venereal patients began to be received from overseas that it became necessar} T to organize a distinct department, though several hundred cases had been taken care of up to September, 1919, when the big influx began. During November, 1919, some 400 venereals were received from overseas, representing all kinds and stages of disease. Department of Roentgenology. One of the most important departments of the hospital was that of roent- genology, located on the first floor of the surgical building. Originally but four rooms were occupied. The largest one was arranged for operating and fluoros- copy, and in it were a Campbell table, Kelly-Koett tube stand, vertical plate changing device, vertical fluoroscopy, and a complete chest for localizing apparatus. Protection from X rays was afforded by lining the walls with heavy sheet lead. In a room opening from the main operating room a Wappler transformer, Belleview model, was installed. Adjoining was the diagnostic room, which contained a built-in view box, plate-filing cabinet, Wheatstone stereoscope, typewriter and table, and a card-filing cabinet wherein a complete record of each patient was kept, a system having been inaugurated by which plates and dates referring to each case might be located promptly. The dark TYPES OF HOSPITALS GEXEBAL HOSPITAL ( CONVEETED ) . 339 room was conveniently arranged and equipped with large developing tanks, the contents of which might be brought to the necessary temperature by means of running hot and cold water. As the hospital grew in size so did the department until it occupied 10 rooms. An additional operating room was installed, the walls of which were lined with heavy lead, and the equipment consisted of a United States Army table, Kelly-Koett tube stand, and vertical plate-changing device. In the adjoining room was a Kelly-Koett transformer. In addition to the above- mentioned equipment there were two portable bedside units. With the increase in work the plate-filing space in the diagnostic room became inadequate and it was found necessary to take over another room for this purpose. In this were a Wheatstone stereoscope, two large built-in plate-filing cabinets, and a view box in which a number of plates could be shown at one time. This room was commodious and afforded an opportunity for studying plates by members of the staff. The work was varied and interesting, a vast majority of the patients hav- ing been injured overseas, and bone injuries were observed in practically every bone of the body. Many other cases, likewise unusual, presented themselves. The number of jiatients examined was 8,002, for which 16,329 plates were filed; 4,855 new cases were examined and 3,147 were old cases reporting for further examination. Of the number of patients examined, 4,616 were found to be pathological. Of this number, 2,636, or 57 per cent of the pathological causes, were fractures. The humerus was found most frequently fractured, there being 351 cases. A fully equipped photographic laboratory was connected with this depart- ment and was under the supervision of the X-ray service. Seven hundred and forty-six patients were photographed, of which there were 2,388 jffates. Dental Service. The dental clinic was established February 15, 1918. At that time it was located in what was known as the surgical building, and there was provided but a single room and one base outfit. It was soon found that supphes and equipment were far too inadequate to cope with the constantly increasing quantity of work to be done, especially when the hospital was designated as a maxillofacial center. On February 1, 1919, the entire upper floor of ward 28 was decided upon as the future place for the dental clinic. Additional dental equipment and sup- plies were immediately requisitioned; gas, water, and air lines were installed; and hasty preparations were made to care for the great number of patients who already filled many of the wards, as well as those constantly arriving with each convoy. The rapid growth of the clinic will be seen in the comparative numbers which follow: On January 1, 1919, there were but 3 dental officers and 3 dental assistants on duty, while in April, there were 19 dental officers and about 25 enlisted men in the clinic. Subsequent to the 1st of January, 1919, 4,365 patients were cared for, 13,000 sittings were given, there were 276 restorations, and about 255 splints for maxillofacial cases were made. A dental officer of the day was designated daily to care for any emergency which might occur within the 24 hours, while each of the other officers had a 340 MILITARY HOSPITALS IN THE UNITED STATES. definite class of work to do. Certain ones were assigned to prosthetic restora- tions, others to operative dentistry, one to the surgical room, where all extrac- tions and other work of a surgical nature were done. One officer was desig- nated as property officer and was responsible for all equipment and supplies, this being in addition to his other duties. Medical Service. The medical service at the hospital was created October 7, 1917. Up to this time the hospital had been in a process of organization, and it was not until October 15 that patients began to appear on sick report. For months the sick rejiort showed a few entries only, representing men from the detachment on duty at the hospital and from the water-front guard near by. It was not until January, 1918, that the first group of patients arrived from elsewhere. At this time the great debarkation and distribution hospitals at the ports were not entirely ready for use, and from January to April, 1918, group after group of patients was sent to General Hospital No. 2, immediately on debarkation from France, for diagnosis and separation into disease classification, on completion of which many of them were transferred to other hospitals for definitive treatment. So it happened that a large percentage of the patients admitted in these early days of the hospital’s existence was assigned to the medical service, and as a result a demand was created for medical officers to rapidl} T build up the personnel of the medical service. The most striking characteristic, speaking in a medical way, of these early groups was the preponderance of the transfer diagnosis of tuberculosis. It soon became evident, however, that many of the cases had been hastily and errone- ously diagnosed overseas; these were kept under observation for a time and usually returned to limited duty. In April, 1918, this hospital ceased to be a distributing center and thence- forward the cases sent remained for treatment. It is interesting to note that never thereafter was a tuberculosis ward (the standard ward of 32 beds) com- pletely filled with undoubted cases of the white plague. Now began the proper and steady work of the medical service. Few changes of officers occurred and there was in consequence an efficient and harmonious staff. The ward facilities, however, were still inadequate. Only four of the can- tonment wards were available for patients, and these had to shelter the growing number of surgical, especially orthopedic, cases, as well as the medical patients. Recourse was had to the use of the big immigration building, a structure poorly adapted in every way for ward purposes. Two of the wards were huge, and con- sequently hard to administer, and the noise of riveting on steel ships night and day, less than half a block distant, prevented sleep for the patient, accurate ausculation for the doctor, and at times ordinary con vernation for everyone. In spite of such drawbacks things went on smoothly, with a service growing to 220 in September, when the medical service was then comfortably housed in the cantonment wards which subsequently constituted the medical row. During the early summer of 1918, Base Hospital No. 78 mobolized at this post and trained to a large extent. On September 3, 1918, they were ordered to the port of embarkation and took with them the chief and four other mem- bers of the medical service. TYPES OF HOSPITALS GENERAL HOSPITAL ( CONVERTED ) . 341 The hospital at Fort McHenry had a double function: In addition to being a general hospital it served as a post hospital for the surrounding camps and posts. The water-front guard, General Hospital No. 7, the ordnance depot at Curtis Bay, and the huge motor transport depot at Camp Holabird, all looked to this post for hospital facilities and furnished a fair proportion of patients. Their dependence on the hospital became the absorbing factor in the activities in mid September, 1918, when the great influenza epidemic began. On the 18th of that month the first cases were received, and the medical service mounted rapidly to its maximum of 754 on October 5. All operating was stopped except in the most urgent cases, and officers were transferred in numbers to the medical service from the surgical service. The whole row of wards from 10 to 18 was thrown open to influenza and pneumonia alone. Inadequate as were condi- tions in Army posts, as they were throughout the country, to meet the emer- gency, this hospital fared as well as any in the proportion of nurses and attend- ants, and its morale was unbroken. The only deaths among the hospital per- sonnel were two enlisted men. None of the officers was seriously ill, and of the 40 or more nurses who were off duty at one time or another during the epidemic not more than two or three caused any real concern. The measures that accomplished this creditable result were those pre- scribed by the Surgeon General’s Office. Masking was ordered and was fairly well carried out. The formation of cubicles by the use of pendant sheets was required and done. The morale of the nurses was maintained partly by frequent automobile trips away from the post. In fact throughout the terrible devasta- tion and depression of the epidemic period the medical service functioned smoothly and well. After the epidemic the most pressing medical question was the proper treat- ment of the sequelae. The unresolved pneumonia consolidation, the vestigial rales at apices, which resembled so much the typical rales of active tuberculosis, and especially the many myocardial changes, furnished many patients for months. From time to time accessions of groups of patients from overseas arrived. The bulk of these were surgical; in fact the medical service, except in time of epidemics, was numerically small compared to the surgical service. The diseases represented at any one time in the medical service were much the same as those in any civilian hospital among young men. The particular war-time maladies were scarce. Pediculosis, trench foot, trench fever, trench nephritis, the neuroses, were rarely seen, practically not at all. A certain portion of the medical cases were the ordinary acute infections, colds, tonsillitis, and the like, of local origin; arthritis was represented by a fairly large group of patients; nephritis, goiter, cardiac conditions causing disorders, were present in their usual proportion. The exanthemata were continuously represented in the wards by 2 to 10 cases, and small epidemics of scarlet fever, measles, and mumps were cared for from time to time. In each epidemic the patients were brought from other posts and no epidemic spread beyond the wards where it was isolated. It was the policy in this hospital for the chief of the medical service to make complete rounds every day and to know personally the history, condition, and progress of every patient. The system of medical supervisors of groups of 342 MILITARY HOSPITALS IX THE UNITED STATES. wards reporting to the chief, who was to be called in only on special cases, was never adopted. The one-man close supervision, moreover, was carried out in such a way that the ward surgeons always felt that they were being supported and advised by the chief rather than being checked up and limited by him. To this was due the feeling and hearty cooperation that characterized the service throughout. Neuropsychiatric Service. The neuropsychiatric service was opened in March, 1918; but adequate facilities were lacking at that time; and it was not until the month of May when the patients were moved into the new standard psychiatric building that the real effective Avork of the service Avas be> 'd o TJ © g © ■d .© U4 o . 5 | c3 © 5 r d © i-t © © *P< • * g ^ !— © © *5 §3 C, s a 3 © ►* <2 © ~ & g w E“< o ©§ W t-i C3 ~ J— i c ■d o © 'd © ‘Z* w s. ? o © 5 . +3 © >> © O *c3 W g *C3 c. © 1917. April... 59 402 461 191 103 4 145 10 2.295 220 155 366 521 363 6 74 2 67 9 4,014 76 22S 304 196 9 37 2.093 289 July.... 44 206 250 1.54 1 43 2 5 1,463 302 50 165 215 136 49 2 23 1 045 205 28 83 50 29 3 1 362 74 4 77 81 44 3 19 15 434 15 125 140 91 1 25 23 671 4 23 124 147 83 1 31 27 620 19 1918. 32 219 251 157 2 4 32 50 6 1,261 113 181 237 139 1 17 3 1,219 69 80 278 358 181 3 43 10 114 2,678 163 April 121 213 334 241 3 45 41 4 2.3.54 140 45 417 462 233 50 9 2 5,049 110 177 386 563 419 2 49 1 92 3,030 60 July... 92 409 501 19 20 184 857 84 187 236 423 299 1 99 1 99 1 3, .581 54 100 94 1 1 196 109 24 58 1,508 106 63 628 425 31 3 157 12 2S7 169 120 289 211 9 8 9 64 2 3,090 73 66 79 145 106 3 28 I 1,225 47 1919. 29 106 135 90 1 1 9 9 24 1 766 103 25 90 62 2 2 21 3 633 93 24 71 3 2 26 6 581 209 April 32 99 131 15 5 30 4 73S SI May 34 85 119 72 2 6 32 824 48 32 79 111 69 2 9 30 i S65 6 July 31 97 128 85 1 7 6 97 2 9.50 9 August 29 125 154 102 35 5 909 109 September 40 209 249 15S 2 9 24 56 2 1. 563 106 58 233 291 198 9 72 2. 192 43 November 72 193 265 161 4 1 6 12 73 i 2,360 23 December 74 196 270 165 1 2 1 11 20 69 1 2, 127 45 a Compiled from monthly returns, and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). TYPES OF HOSPITALS — POST HOSPITAL, 393 Statistical data United States Army Post Hospital , Fort McDowell, Calif., from April, 1917, to December, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscella- neous (Q.M.C., etc.). Total. Medical Depart- ment. Miscella- neous (Q. M. C., etc.). Total. 1917. April 7 40 40 May 10 10 41 41 June 12 12 109 109 4 July 13 13 115 115 4 August 13 13 95 95 5 September 14 14 100 100 5 October 12 12 96 96 5 N ovember 12 12 99 99 5 December 11 11 101 101 1918. January 10 10 106 106 5 February 11 11 115 115 11 March . 11 11 119 119 12 April 14 14 144 144 16 May 16 16 156 16 June 12 12 156 16 July 14 14 170 170 August 14 14 174 174 19 September 15 1S1 181 18 October 16 16 183 1S3 18 November 15 182 182 13 December 12 12 110 110 13 1919. January 8 8 96 96 6 February 9 9 95 6 March . 8 8 83 83 7 April 8 8 92 92 4 May 8 8 93 93 4 June 8 8 78 78 4 J uly 9 9 68 68 4 August 11 11 68 68 4 September 8 8 66 66 4 October 7 1 8 64 64 November 10 1 11 66 66 4 December 9 1 10 68 6S Table No. 20 . — Consolidated numerical reports of sick and wounded, and strength of personnel at United States Army Post Hospitals.' 394 MILITARY HOSPITALS IN THE UNITED STATES. •S 0 O -Aojdtno itbtjiaio joq^o ■sj 05 [joa\ pun sopiy •S0sanjsi •(■oia'-O'M "b) a> sno0n^n0osij^ G •juoin W -^ledaQ iBoipapf 0©*Ot-hCM©COCO>- : / - * :i*r > xco snoounnoosij^ •sdioQ AJB4IUBS OOiO^OH^rtHdr-rJUOININiMNCOiNCO'^^lNNCO'^^CIr h CS • CO CO — CM — — — CO CO •sdiOQ I^Oip0H •P04B0J4 siuoijnd jo jo.qumu X[qjuoui’ uminnnpj -'*CM--ON(»^CING 005 Ninc -HiHOM^^Wr< 0 » 0 ’fWt^L' 5 T}'WiO”?'W-T 0 co t— 1 00 1—1 r-\ ca 1— 1 coco r-i c'a c 0 '/. -XC X - -r - CJ CCI' 0 C 5 C C c C ’? 0 10 X 00 (M CO X 0 -t N Tf UO CO CO 0 0 X - Cl C -r *0 05 ^C 5 C 5 C 5 '!fi 0 C 4 — COiO — U 5 10 c c. X X CO O 00 GO CO Ol OCOCO >0 *0 1 CM 10 s’'r*Ov.«-ccsc^^ H CM »0 CM CM CO CM Tji O — 1 O •Ajnp oj p 0 njn 40 H OcO^HdHCONCMiOCM-fCOTl' - ^ X X X « « 5 h iftx MN MC X OCOC 5 CO CUCOOXCSO C'MDi'Hr rM’fOGXTO'COX-rXiOO/.I' — r O CM c X *rX ~ C CM I' r-- — . CO CM CO'tOOiHrHCM-Ht^CH^COOM’i’NMiO’rXrtCOOW-INCM-.rtCJ-i-rcOOiO-i CM -— >050 cd'ciV-Tid' 1— T i-Tco r-T t-Tcm - Or-TcM~cM’'r-C i-T i-T t-T co' •[^40X o t- e/i - a c >0 ? -r c no x n x cc z / •? nn sc - * n - c x n -o o co 1- -_c <0 os -0 cs ['COiOC-iT-c-rxi — r 1 — r h c -r c i" -o c - co - x cc-r c n o w ? n m r. m cc n ~ '* o “ *“ ~ ^ - co co co co OiOCOiOHCOM'HffitNCONOJfOOM^NOrHrHiONOOr csT^ cm* i— r c^TrjT n CM CM •0sma0qjo - . r» co r~- 00 »o •punuiraoo raoij WCldNXNCJ- OMOPH^lOr NWN'OHOlNr co'cm"' cm~ in' r-T t* CO CM CO - 1-0 r-T (N cm - JCNCNC-TO iccjcooNoc 5 *n _ CO CS X X. ft o OOOOOOOO^C 0000 r c 3 T 3 r d r O r d r ft r O , c 3 s- o 'G g? xj 'tG ,C © - G c o o o o ~ c o - _ Co © ©'G-- ©'G'G'G ^000 ■ © o C3 Q) • fto SPPQ :

— ^ SS = O C fcfi'- OJ ftG ft f -C 5 ft C . s ©ft — -ft •_ >.‘fc ft T-i* © «; © C ~ - 3 ~ ft •PC< fcJD G C 3 *£ Bo O 03 « g? s Ph<^ CO -£ : WS'P cs „<< ■ S o-g-go £ s S3 1 >,’£ ►>' „ ._^.e S cd ,;>G - 3 -2 Sj © ^ o . G r O j ?%£> © >'£ 2 <3 8 see ^ ^ r-=s — s- ~ ’ ra " » ^ ^ C G ft a: c3 o3 o3 c3 -3 s- cj o 3 o3^ W o _Cu DG 5 O s > got 1 1 1 c o © g d < si; .g- (MCO CO Oi I ^SpiiiISIilS3§siSg§ co" uf o'cTp-Tcr eoooVf r-T r-Tofoo* I SISssl§lsS|llssS311S" V ef 3 VhV ™ rn- wVfjf SiiTfiPaPiiiiiiiir 00 l— < V-T' ofV oT»h i-Tco oo co Ss 22 !i i ill II oooosgood; 'U ^ T3 ^ Z. o'O'C'Ci fill SsS S®2 O O O C ^ r r C r & r 3 r O ~ c c O Oja'S o o o S'C p a oooooooooooooh - o - -oo -ooooooooo - -o ’ -1 IZ2 'C ^ 'O 'O T3 T3 T) T3 'O Tp “ 'O ^ Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly itical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). Table No. 20. — Consolidated numerical reports of side and wounded , and strength of personnel at United States Army Post Hospitals. — Continued. 396 MILITARY HOSPITALS IN THE UNITED STATES. *S99 -Boldina xiBifiAio j9q;o •sjaqjOiYv pue sapiy •s9Sjiijs[ sno9n^n 90S TH ■;n9ni -^j'Bdgd I^TPQR' HOOJNONNNWOOOO i X ro - c-i • .o -r © c •(•oja'-o'W '&) sno3tren90srp( "SdjOO XjBqjtlBg J . CO CO CO X r •SdlOQ IB3IP9K sjnauBd jo jaqnnni X[ii}uoui ranurnrrft OHNlOO©' i CO CO CO O* O 01 O i- *P9^9J1 S^U9T^d JO joqnmu A[q:juoui umuxrxepi c *r x x — i- i- s m -o s — ~ ~ s — a: CiNMO-rt-'iO (NCMOt^ O © X X - fNC-H(N(NO)r-iONN DCOOIOOCOOC5C1CDO !■ N O N O 1-0 - X (N N 1- O C - C O - i-O X — CO © CM rr t M •pummnoo thojx lO^cDOOTfOOSiOiCNO -f i.O -f X O O X — ' 05 I'- CM CO ^irjHHHINCOCi-OX ? O — i-O O ci Cl D- H M t- ^ Cl CJ X M O 5C01NXNXCJ X 05 rO £ °5 O ■— i n — ( t^rO . . SHoo ^ 05 00 05 05 § -TL >-.4 05 ^ S 2 05=2 05 ; © o jco^scti ~£©^rC£^~E©~E: c '3 < © T3 3 © O Oh o-Oc © © o 0=3 © o'^'O © O 1 • © © © -- © • *-> O P* O 1 r* So • • » © © c. © ■ © « o © o o :oSfiozn £ 1 ?§• c o O v: O 'C - © ’ 3 o o S-S.S ^ £ o C, c> 3 r=>^ tO o - 03 a C.C3 - » M>, s-= .Srf ^ I© fcXi-H O Cj t. <= ; sffs'g ShS^I^ Sac§ cJ g g o C § I'p o©;.^ -* • a *§0 0 1 ^ O £h , "sh "£h "q. Sf 1 c3 S £ S ^ ^ I © _0 _P r> E 3 c3 cj c3 3 f ^aSi oSii l?S ! jz; fits £ E? “ c _ C3 SuC a ■ s -i ccCa c “Jpl-S-eS ls^js|a rtec.©^ ’ o CO p_ ^ >J o3 ^ O |S|Its a fiSii i >, £ : P C3 i •3 5 S-S- Z lz”i = < = | | !!!§< — __ O ^ QQ - L ! £fe' TYPES OF HOSPITALS POST HOSPITAL. 397 HWOIONJOJOOOHNOHHNCOCON^HO | CO 1-M *0 — Sn08UBI[30STp{ •sdjOQ AjBjraBg •sdjoo tBorpajM CO CM CO CO *P9^B9J1 S^n9]4'Bd JO joqrnnu Xpijuoui' umuiraij^ CCOCOMO- •pai'eaji s^uai^d jo joquinu Ajqjuoui'uiniup^Bj^ Cl 01 — 0 CO to CO CM CO CM Cl CM 00 C CO CO Cl o cr.ro •jo pasodsrp asiAuaq jo •p 0 ia Cl CM 0-0 CM CM 00 0 •^^np oi p9ujrii9n CO 1- 1-0 P- CO OC3CJ CO LCN •[BIOX O O C O t*- OCO to r p- p- o co to — 00 CO P- CO CO 00 *9SIAU9qiO Cl Cl Cl CO CO — PCX 00 CO 1.0 p- T*< to GO O 00 O to CM o -*< . p- •puBunnoo xnoj j too O CO 1-H CO Cl r t>>Cl r s-SsSs C3 r>% £ O "o ^ ^ Cuo £to 3 as Cl Cl 00o>7- 5 — ■> ' ■ . ■ f— ■ * s- p O © o C3 "o O c3 o Cl © Si’S op? o — ^ © c3 O csz i ©~ ! > C : C CL 1 £<- 00 Cl • r-t • • ’co -01 t_roo • ■ S-"2^S® - 3— TW-T ^ h'Sa'a^" rO’^ o' o 3- © . iC3" c3 ’"1 42 „ ^ £ £►»§ 73 9' 5 O 00 • -o 0 ® 22 2S £| gl'ls 222 & ‘O Cc D 'I'gjjj So % Or3fi| CQ ■So C3 - „ (-1 °V§ o © E-ipq C c3 © ^ cT ‘e . - C7S - r O £ JS 3 33 - ->3 p2 ”3 111 03 CG "© x oJ 3^64 -£ O > , W g 3 ■gs Ej; s|S§£oo.g g^.a w ®-,_b £“S g*3§g3 ^ ^ <; <1 co oi w S' -!^§5l«§g >.d S gr , 3^2'o 32.2 622^5 o-g z s-2 >>»r 5 “2 'o S— = “fe s □ _ ® a iSg tcHM o ".2 oP C fc“ w a > a : •g o i'3 o o 1 1 2 Sfi a>E K ML^PlOOPK P ^ 397 46 123 98 3,293; ©©X ©© ©© © © I— 1 TV Cl Cl M © I-OM M i—i © 1-0) —1 X© 1-1 X Cl Cl XX tH Cl Cl d CJO’th.® C5CC0CO HNNCON (NCCC © c > s c c3 April, 1919 March. 1919 December, 1919. . . do. do. C February, 1918 December, 1919. . . April, 1919 December, 1919. . . July, 1918 December, 1919 do do February, 1919 December, 1919 November, 1918. . . February, 1919 : oo ^8S>§£ • O 3 S o3 :e>^ . 05 2 05 M 2 r fe >> IfeTg _g® j: fc! S' e 2E3SE.c_-§.c - i G1-3©o : -pP •'o — ' o "o 5 ^ "o P-S 4 ifa^Gfe «qo5 ftft fe Sx o GC © &Tjjj 2 > 5 > St: o S 53 l§ ° s >*H "-5 ,0,0 s a © © ftft © © uim oo -x 05 05 Q ft §• |*n O 5 ft ' (S 3 a O X'S H ^ _ ® u >^_ 2 •Sfg'a fe a ao .2 13 > o g|o' 3 ^ ■>co caf5> a i- 3 <;ooo E -1 w<^ *3 g-g ft . ©T3 c/d - cj « = £•&£ ■Sa^T-S .2 SJgg > a &§-S < too “ =3 > ;-5S2 A = '|| grc 2 3J C Sill 0-1 5 C3 c offl i< >° Si © _r'fa g SS o •&«> § ,|§ I’tSSs > ^ c > <1 fa? ^ ft S o C XJ1 d© fl Er 1 O __ o ^ S S © © c E-< <3 sx C o tf fl £ ~ Sg £oa| 6 -£,.2 3 -^ ’&a a I gS«J2 32 T< a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office 01 The Adjutant General, on tile, Statistical Division, Adjutant General’s Office (name of hospital). Table 21. — Consolidated numerical reports of sick and wounded, and strength of personnel at United States Army Aviation Hospitals — Continued. 414 MILITARY HOSPITALS IN THE UNITED STATES. •S39 -jtojdine uEijiATo aamo 'SjajpiOA puB sappy •sasuiN •(■opa'-O'K'tl) snoauBnaosipt •}nani -;jBda(i [BOtpapf •(■ 3 U , ' 0 ’W'b) snoauBuaosijy •sdjoo AaBjmBS •sdjoo IBOipapt ■papBau s^uai^d jo jaqttmu Ajqpnoiu" umturmn *C O CO H GO 00 h co co co oo •p01^9Jl siu 0 i:ved jo j 0 qtnnu ^[q;uoui’ uinuipcBK lOCn* CM CN iOH(N CO NO *0 CO ^ « c5 os cm ° ft 1 0 05 o CO 00 co * CM — 1- - •jo pesodsip 0smj0qjo XX — co os p- o »-i •p^a •Apnp oj patunpaH CO CO CO co r- o co — co os •mot. cococoo *o *a x> cm co cc cm OPN rHX cs NOCX coo HNMH 05000*0 CO Or- 1 Xf^X CM CO CO CM — r- x *0 CM • 0 smj 0 q;o CO CM X -r X •pusnraioo raojj CO CO 05 — > — - to CM co coco *o *0 CO C CO I—" CO 1 2 2 2 § ©2 ! Sg2 £ g o o SP^Z O 1 CC 05 O 05 t-. t-< Pid © © © . 0,0 ■O ' -1 £ £ £.e QJ QJ 0 } p s E-s I P PS £ >> o >> o : . ~p- t- _ S gp > £ © p o'd p<^s^ t>.p- © ^2 g 2 n r>> > © P2 O ftPZ p- x 05 05 ftft c^ 5 £ © ~c 4 S ” z ft o w Hft C CD 5 2 bX ►>> EH ex ex ex p _© _© _© P 3 C3 O' r-5 ® tt ft >i © p se s © 9^- P ’© ^ J 2 © • S oiS .£ i£ r ; o •z; 3 fe x Pi c ® ~r © k £ 3 £ c - - c © ; - 'c i •? p o 9 p- MD ■do a> o o ta >5 |s| . c« g.s^> ft^ o ft ^ c 3 T Z O C3 ^ tf S P P H' > © © tC'JL c 3 r> cj ? d .2 ~ C hrb - pjo © c3 .2 p «h; P ex rOcC J C *< CCOft ®'Cd 6 2 Sc ! IlK-lJ | ; b iC‘ S'T u x !5 ft . . O £ d fc- ex c ec_ ° o © __ •- ^ 3 = 2^0 ^ cc xP E-> ft &- 1 TYPES OF HOSPITALS AVIATION HOSPITAL. 415 OO CO CC 2 t-t OI ^ q 03 o3 ^ “ bO '£ ^ fl £ i* ^ - o o ^ P- 1 ^ £>■ (-4 rj S P/^ 3 S° «r°§ pH oPhSS CHAPTER XXI. THE AIRPLANE AMBULANCE. The first known report of any plans to transport patients by airplane was made by Capt. George H. R. Gosman, Medical Corps, United States Army, and Lieut. A. L. Rhoades, Coast Artillery Corps, to the Surgeon General of the Army early in 1910. These officers had constructed a plane at Fort Barrancas, Fla., the first flight of which was made in January, 1910. Shortly thereafter Captain Gosman brought his report to Washington and endeavored to obtain funds from the War Deaprtment for the work of improving upon this plane and using it for carrying surgical dressings and transporting patients. His Fig. 140 Trial flight of the Rhoades-Gosman airplane, January 26, 1910. mission failed, but he was undoubtedly the first to point out the great possi- bilities of the airplane for this purpose. 1 In February, 1912, in France, Doctor Duchaiissoy suggested the use of the airplane ambulance. 3 In April of that year a proposal that our Army use the airplane ambulance was made to the representatives of military aviation, who reported to the Secretary of War on May 23, 1912. So far as known, nothing came of this recommendation. However, during the retreat of the Serbian Army in November and December, 1915, 13 wounded or sick were transported 80 to 200 kilometers. This was an emergency measure, and no special provision was made by the modification of the plane. The maneuver was successful, and not only were the patients safely transported, but they escaped otherwise inevitable capture. In France, during the World War, Doctor Chassaing, a member of the Chamber of Deputies, succeeded in inducing the aviation department to con- struct an airplane ambulance designed for patients in a recumbent position. 416 TYPES OF HOSPITALS AVIATION HOSPITAL (AIRPLANE AMBULANCE). 417 The airplane was first tried out at Villacoublav in September, 1917, and later on the Aisne front. 3 In the United States Army the necessity for this mode of transportation for flyers injured in crashes became prominent soon after flying fields were established. It was evident that an airplane ambulance would not involve the delay and discomfort of the ordinary ambulance at many of our stations where the roads were poor and the distance great. This was especially true of victims of airplane crashes, who, while in a critical condition, frequently had to be carried long distances and by roundabout roads to reach a hospital. In addition, it was seen that a flying ambulance would offer the means of get- ting a medical officer to the patient quickly and in some instances would mean the saving of life. So far as records show, the first Hying field to use the air- plane in transporting medical officers to the site of crashes, and also for trans- Fig. 141.— Airplane ambulance, first used at Gerstner Field, La., January 28, 1918. porting patients, was Gerstner Field, Lake Charles, La. This station was located in low swampy country surrounded by many bayous. Crashes occurred at places which could be reached by no transportation except the airplane, consequently, in February, 1918, the commanding officer at that field author- ized the conversion of a JN-4 airplane into an ambulance, and it was completed and placed in commission during that month. 4 Two officers on duty at the station made the plans and supervised the construction of this ambulance at Gerstner Field. They are entitled to the credit for first transporting patients in an airplane ambulance in this country. One of them in his report states: Up to this time, while we were constructing the airplane ambulance, we used ordinary flying machines to carry doctors to the scene of accidents, and in this way Major Driver was able to save the life of two cadets. In one case a rib punctured the lung, and in one case he arrived in time to stop what would have been a fatal hemorrhage. The surgeon had an emergency kit in the hospital ready to go in the airplane at all times, and the medical ofhcers were ready to fly with any flyers in any machine at any time to the scene of the accidents. They received no flying pay, and their only object was to save life and improve the service by rendering such help as possible to pilots , 4 45269°— 23 27 418 MILITARY HOSPITALS IN’ THE UNITED STATES. The practical utility of the airplane ambulance was at once established; and, based on the reports of actual results at Gerstner Field, the Director of the Air Service, on July 23, 1918, directed the construction of airplane ambu- lances at all flying fields. 5 The necessity for providing prompt medical aid at the site of crashes was also recognized at a very early date at Rockwell Field, San Diego, Calif., as is shown by the following communication from the surgeon at that station on February 12, 1918: 6 Owing to the size of the flying field at this post, sometimes there is considerable delay before the arrival of the ambulance; also, because accidents occur at distant landing fields which may be remote from medical aid, I have this day improvised a first-aid pouch that can be put in an airplane. 2. When an accident occurs, I take the Hospital Corps pouch, enter an airplane that is always standing ready, and, piloted by the chief of the training department, reach the scene of the acci- dent in a few minutes, render such aid necessary until the arrival of the ambulance and assistant surgeon. 3. First Lieutenants Pope, Kramer, and Brooks, M. R . C., have volunteered to answer these calls in my absence and are being trained in such duties. 4. This, I think, will often be the means of saving lives. 5. Owing to the urgency of the situation, I have taken this liberty without first consulting the chief surgeon and am writing to ascertain if this meets your approbation. Major Ream was one of the first medical officers of the United States Army to be designated as a flight surgeon. He was the first flight surgeon to be placed on a flying status. He was killed in an airplane crash at Eppingham, 111., on August 24, 1918, while on duty with the Middle West flying tour. Ream Field, Houston, Tex., tvas named in his honor by the Director of Military Aeronautics in September, 1918. 7 At Ellington Field, Houston, Tex., the first airplane ambulance was com- missioned about April 1, 1918, having been constructed on the plans of the first airplane ambulance at Gerstner Field. s An improved type was soon designed and was commissioned on July 6, 1918. This was the first plane to use the standard United States Army litter. The commanding officer of the field at that time made the following report upon the work of the airplane ambulance at that station : s The first airplane ambulance was put into commission at Ellington Field about April 1, 19 IS. This ambulance was made out of a JX-4D with a Curtis OX-5 engine. Later, when the Signal Corps at San Leon started operation, this airplane ambulance was sent to San Leon and a new airplane ambulance was made out of a JN-4H. The new one was completed and put into com- mission about July 6, 1918. This ambulance was used a great deal at Ellington Field. San Leon, the gunners’ school, was about 17 miles from the main field, and all instruction in aerial gunnery was carried on at San Leon. A great number of crashes occurred at San Leon, and in each instance the injured flyers were transported to the hospital at the main field by means of the airplane ambulance. By bringing the men up in an airplane ambulance the actual time consumed in transportation was about 15 minutes. Had it been necessary to transport these men in a motor ambulance, it would have taken an hour and one-half. Thus it was plain that a great deal of time and possibly lives were saved by using the airplane ambulance. Several instances occurred where men crashed when out on a cross-country trip at distances varying from 50 to 150 miles from the field. Upon telephonic notification the airplane ambulance was sent to the scene of the crash and the injured flyers were brought in with ease and comfort: whereas, to have brought some of these injured men in by motor ambulance would have meant their death from shock and discomfort because of the seriousness of their injuries. One particular instance is recalled where five planes crashed in a hurricane at Brenham, Tex. In this case it would have taken a motor ambulance at least a day to make the return trip over very bad country roads; whereas the two injured flyers were safely in bed in the Ellington Field Hospital two hours TYPES OF HOSPITALS AVIATION HOSPITAL (AIRPLANE AMBULANCE). 419 after the crash, by use of the airplane ambulance. So much use was made of the airplane ambu- lance at Ellington Field that we considered it as necessary to have the airplane ambulance in condition as we did to have the motor ambulance in condition. The surgeon of Ellington Field submitted the following report on Septem- ber 30, 1918: 9 Lieut. C. E. suffered a fracture of the left leg, tibia and fibula, and contusion of the face and head, following an airplane crash at Brenham, Tex., September 27, 1918. lie was imme- diately taken to the local hospital, where splints were applied to the leg and the contusions dressed. On the following day, ambulance ship, Curtis II, left Ellington Field at 1.30 p. m., with pilot and medical officer, and arrived at Brenham at 3.15 p. m. , making the 90 miles in 1 hour 45 minutes, due to adverse winds. On the return trip, left Brenham at 5.50 p. m., and arrived at Ellington Field at 6.45 p. m., making the trip in 55 minutes, with a favoring wind. The patient stated that he felt the take off and landing very slightly. The trip across was very smooth, so much so that he almost went to sleep. The loading and unloading did not bother him at all. The difference between the ease and lack of jarring in the ship and ambulance carry- ing him to the ship was very marked. In April, 1918, the surgeon at Gerstner Field became interested in trans- porting patients by airplane ambulance, and substituted an adjustable reclining Fig. 142. — JN-4H airplane ambulance approaching scene of accident, Ellington Field. chair for the litter, in order that the patient might be placed either in a sitting or reclining position. 4 This device, however, did not prove to be satisfactory. In August, 1918, the surgeon at Eberts Field, Ark., devised a very useful form of litter to be used in the airplane ambulance at his station. This litter consisted of a frame, made of iron pipe, about 6 feet in length, constructed in such a way that each leg of the patient had a separate frame for splinting purposes. Canvas was laced to this frame, and broad canvas straps were provided to firmly fix all parts of the patient’s body to the litter. 1 An article on the “Ambulance Airship” w r as published in the Annals of Surgery for November, 1918. 10 The drawings and plans for the ambulance plane described bear the date of August 8, 1918. These plans of the Mather Field ambulance are practically identical with those for a plane constructed at Eberts Field and commissioned July 6, 1918. The Ellington Field ambulance was an improvement over the one made at Gerstner Field, and the plans for the Ellington Field ambulance were sent to practically all air service stations. Ambulances built after these plans were constructed in the summer and fall of 1918 at Taylor, Post, Mather, Rich, and Carruther Fields, 1 420 MILITARY HOSPITALS IN' THE UNITED STATES. Fig. 143.— JN-4H airplane ambulance. Top removed from fuselage; litter being removed. Fig. 144.— JN-4H airplane ambulance. Rendering first aid to patient, Ellington Field. Fig. 145. — JN-4H airplane ambulance. Preparing to “load patient,” Ellington Field. TYPES OF HOSPITALS AVIATION HOSPITAL (AIRPLANE AMBULANCE). 421 After receiving the instructions noted above from the Director of Air Service, most fields rapidly provided airplanes for transporting sick and wounded. Many of them attempted to improve upon the Gerstner Field and Ellington Field types, developing models of their own, until all flying fields with two or three exceptions were equipped. Ingenious ideas were brought out in the matter of modifying planes and adapting litters. In some a modified Army stretcher was used; in others a Stokes litter in various modifications was used. In most cases the turtle back of the plane was removable, permitting placing the patient inside, or on the fuselage from above; in others from below; while in one model the patient was placed on a coffin-shaped litter and slid into the side of the airplane ambulance similar in manner to sliding the door of a chest. An interesting type was one which used the Stokes Navy litter. The advantages of this form of litter were recognized and emphasized by the flight surgeon at Rockwell Field, in the summer of 19 IS. In the airplane ambulance Fig. 146. — JN-4H airplane ambulance. Placing patient in fuselage, Ellington Field. which he devised, the bottom of the fuselage was lowered at one end, making an inclined plane along which the Stokes litter slid, manipulated by cables and a small windlass. After the litter was lowered and winched up the incline into place, it was raised by another winch to its final position, flush with the bottom of the fuselage, and locked into place. By using this form of litter the patient could be so securely fastened as to permit handling both patient and litter as one object. The Stokes Navy litter appeared to be the best t} T pe devised for the handling of a wounded man, particularly the grave cases usually resulting from an airplane crash. The patient once securely fastened in a Stokes litter did not have to suffer disturbance until placed on the operating table or in his hospital bed. This litter therefore was adopted as the standard type at all flying fields for the use of airplane ambulances. The method, however, of drawing this litter up an inclined plane into the fuselage of the airplane was too complicated for practical use and was abandoned. 1 MILITARY HOSPITALS IN THE UNITED STATES, 422 Fig. 147. — JN-5II airplane ambulance, Ellington Field, showing empty and loadod Iittor. TYPES OF HOSPITALS AVIATION HOSPITAL (AIRPLANE AMBULANCE). 423 Fig. 148.— 'Winching Stokes litter into place in the Rockwell Field airplane ambulance. Fig. 149. — Final position of litter, Rockwell Field airplane ambulance. 424 MILITARY HOSPITALS IN THE UNITED STATES. TORES LITTER FOR DH 4 BUJJ . Fig. 150. — Stokes litter for DH-4 airplane ambulance. Fig. 151.— Stokes litter in place in a DH-4 airplane ambulance. TYPES OF HOSPITALS AVIATION HOSPITAL (AIRPLANE AMBULANCE). 425 From what has been stated above it can readily be seen that the airplane ambulance was extensively used at flying fields in the United States during the World War. It is believed that no other country used it to any extent during the war, since there is little record in the literature outside of what has been mentioned herein. REFERENCES. (1) Report on airplane ambulance, by Col. A. E. Truby, M. C. On file, chief surgeon’s office, Air Service, 20 (Truby, A. E.). (2) Duchaiissoy, Blanchard, R.: Le Transport des blesses en Aeroplane. Medicine , 191G-1917, Paris, xxi, 53-55. (3) Letter from Chief, Military Intelligence Branch, Chief of Staff, to Col. L. P. Williamson, M. C., War College, May 1, 1918. Subject: Ambulance airplane. On file, chief surgeon’s office, Air- Sendee, 451.8 (general). (4) Letter from Capt. Wm. C. Ocker, Air Sendee, to the chief surgeon, Air Sendee, March 21, 1921. Subject: First airplane ambulance in the United States. On file, chief surgeon’s office, Air Sendee, 451.8. (5) Letter from the Director of Military Aeronautics to commanding officers of flying fields, July 23, 1918. Subject: Ambulance plane. On file, chief surgeon’s office, Air Sendee, 452.1 (ambulance planes). (6) Letter from the surgeon, Rockwell Field, San Diego, Calif., to the chief surgeon. Aviation Section, Signal Corps, February 12, 1918. Subject: Attending accidents by airplane. On file, chief surgeon’s office, Air Service, 201 (Ream, W. R.). (7) Office memorandum No. 113, Office of the Director of Military Aeronautics: September 23, 1918. Subject: Names of flying fields. On file, record room, office of Chief of Air Service, 201 (Ream, W. R.). (8) Memorandum from Maj. W. H. Frank, Air Service, to chief surgeon, Air Service, March 16, 1921. Subject: First airplane ambulance at Ellington Field. On file, chief surgeon’s office, Air Service, 451.8. (9) Letter from post surgeon, Ellington Field, Houston, Tex., to Air Sendee Division, S. G. 0., September 30, 1918. Subject: Report on ambulance ship. On file, chief surgeon’s offices Air Sendee, 451.8 (Houston, Tex.). (10) Sharpe, N. W.: The Ambulance Airship, Annals of Surgery, lxviii, No. 5. November, 1918. CHAPTER XXII. EMBARKATION AND DEBARKATION HOSPITALS. As will be seen in more detail in that part of the history which deals with ports of embarkation, troops were shipped or disembarked at 11 different ports in the United States and Canada. While this was so, in ports other than New York and Newport News no special port hospitals were maintained. The problem of taking care of overseas sick and wounded need be considered at the two ports of the first class only, New York and NewportNews, for no such sick and wounded were transferred from abroad to other ports. At minor ports the casual sick and injured, of troops destined for overseas service, as well as of the permanent personnel at the ports, were sent to local hospitals (Army hospitals whenever practicable) ; and the same disposition was made of the casual sick of returning troops. At Charleston, S. C., casual patients, homeward bound, were evacuated to the United States Naval Hospital at that place. 1 When our country entered the World War plans for great ports of embarkation did not exist. It is not to lie wondered at, then, that the Medical PORT HOSPITALS Fig. 152. Department plans were nebulous likewise. Furthermore, throughout the war, no one was prepared sufficiently far in advance to permit the provision of hospitals; to inform the surgeons of ports regarding the number of troops to be embarked month by month; or, even after the armistice, to specify the number of overseas sick and wounded to be shipped back. In consequence, the port surgeons had to estimate both the numbers of embarking troops and the probable number of returning patients. It might be thought that they would have been on firmer ground, so far as the permanent provision of the ports was concerned, but these varied widely at different times. Substandard men were sent to the ports with commands under orders for overseas. Instruc- tions were existent which should have limited tins condition to a relatively minor degree, but once at the ports they had, of necessity, to be culled from the physically acceptable, and to be placed in the port hospitals, and no sys- 426 TYPES OF HOSPITALS- — EMBARKATION AND DEBARKATION HOSPITALS. 427 tem existed which would constantly and promptly free the port hospitals of these physically unlit men. Literally thousands of such men demanded hos- pital care from the port medical departments. The fact that the port surgeons at the major ports estimated so closely what they would need in the way of hospital accommodation so that, except at first, all patients could be well taken care of even at the maximum number with no undue extravagance in hospitali- zation, is an eloquent testimonial to the sound judgment of the officers selected for these difficult duties. At both New York and Newport News those in local charge experienced considerable difficulty in convincing higher authorities of the needs as regards hospitals. HOSPITAL SITUATION AT PORT OF NEW YORK. At New York the first hospital to be made available for Army use was St. Mary’s Hospital, Hoboken. Patients in limited numbers were admitted to this hospital as early as June, 1917. 2 On September 18, 1917, it became known as Hospital, Port of Embarkation, and 200 beds were turned over to the Army; 3 but it was not until July 1, 1918, that the entire hospital, with its 650 beds, was taken over by the port surgeon. 4 During October, 1917, arrangements were made with certain civilian hospitals, Englewood Hospital, Englewood, N. J., North Hudson Hospital at Weehawken, Jersey City, Isolation Christ Hospital and St. Francis Hospital in Jersey City, N. J., for the care of a limited number of Army patients, but the aggregate number of all these was less than 200 beds, and the arrangement was most unsatisfactory. 3 Operative cases were made eligible for admission to General Hospital No. 1, Williams Bridge, N. Y., then a 500-bed hospital, in October, 1917. 5 Briefly, then, there were approximately 400 beds available for the Port of New York on October, 1917. These 400 beds had to suffice for the sick of the permanent cadre of the port, and for those detained on preembarkation inspection of troops en route to Europe. During October, 1917, the number detained was 31 1 . 3 On November 15, 1917, the War Department, predicating its action upon cabled recommendations from General Pershing, that increased effort be made to eliminate venereal diseases from troops embarking for Europe, issued orders directing a preembarkation physical examination of all troops for the detec- tion of venereal disease. 6 Those detained on tins inspection were sent to St. Mary’s Hospital until such time as adequate provision could be made for their disposition. Meanwhile, negotiations were entered into with the New York State quarantine authorities for the use, by the Army, of hospital space in their quarantine hospital at Hoffman Island, 7 as this was the only civilian hospital in New York City which would accept venereal cases. Arrangements were effected whereby approximately 700 beds were thus made available, the institution being designated as United States Army Hospital, Hoffman Island; 8 later, Embarkation Hospital No. 3. 9 The buildings of this hospital were old and the plumbing and heating arrangements left much to be desired; however, the location was ideal for isolation, and an acute situation was very materially relieved by its acquisition. 10 At Camp Mills, Long Island, in the fall of 1917, the 41st Division was quartered in tents, and a camp hospital, also under canvas, was maintained for the sick of that organization. 11 The 42nd Division, which had incurred a con- 428 MILITARY HOSPITALS IN THE UNITED STATES. siderable incidence of contagious disease, had just vacated Camp Mills, leaving behind the potential seeds for disaster. With the advent of cold weather trouble of a serious nature began. Disease in epidemic form made its appearance (scarlet fever, diphtheria, cerebrospinal meningitis, measles, bronchitis, and pneumonia) and the camp hospital, with about 900 beds, was soon filled to overflowing. The water pipes, which had been laid on the sur- face, were frozen, and the means of heating tents were lac kin g. 12 Until this time, War Department plans contemplated control by the Surgeon General of all hospitals in the vicinity of the port of New York, the port surgeon’s jurisdiction being limited to the supervision of embarkation and the piers. On November 23, 1917, following a conference between a repre- sentative of the Surgeon General’s Office and the port surgeon, New York, War Department instructions were issued charging the port surgeon with the responsibility for the distribution of all sick in New York and its vicinity. 13 On the same date the port surgeon received telegraphic instructions from the Surgeon General to relieve the distress at Camp Mills. 14 The tent hospital at Camp Mills was filled to overflowing with sick, a very considerable proportion of whom were contagious cases. The capacity of General Hospital No. 1, with its 500 beds, was soon exhausted, and relief had to be sought in civilian hospitals. 3 After considerable difficulty, bed space was obtained in the fol- lowing institutions: 15 Bellevue, Willard Parker, Greenpoint, Rockefeller, St. Vincent’s, and Mount Sinai Hospitals in New York, and Nassau County Hospital, Long Island. A serious obstacle to the evacuation of sick from Camp Mills was encountered when the railroads refused to transport conta- gious-disease patients; accordingly, it became necessary to transfer such patients by ambulance, obtained from the Red Cross and the Women’s Motor Corps of America, to New York, a distance of approximately 35 miles, through deep snow in almost zero weather. 16 Meanwhile barracks construction was going on at Camp Merritt, N. J., and several organizations (501st, 502nd, and 503rd Engineers) were sent there for equipment in October. It was not until November, 1917, however, that em- barkation troops began passing through this camp in considerable numbers. Before the Camp Mills situation had been relieved epidemic diseases similar to those which had appeared at Camp Mills erupted at Camp Merritt, and here again the port surgeon was confronted with the problem of inadequate bed space. 3 Prior to this time the sick from Camp Merritt had been sent to St. Mary’s Hospital at Hoboken and to other civilian institutions in Hoboken and Jersey City, where a few beds had been made available. These were soon filled, and on December 20, 1917, the isolation ward of the base hospital at Camp Merritt was opened 17 and was filled on the same day. At the Secaucus Hospital suitable space was obtained for patients with contagious diseases, 12S cases of mumps being transferred to that hospital on December IS. 3 The Secaucus Hospital was later (January 9, 191S) taken over by the Army and operated as a contagious-disease hospital under the direction of the port surgeon . 18 No hospital train being available at that time , 3 the transfer of con- tagious cases from Camp Merritt was made by ambulances and by a hospital car rented from the Erie Railroad. The base hospital at Camp Merritt was officially opened January 9, 191S, with a bed capacity of 416. 19 These beds were rapidly filled, but they mate- TYPES OF HOSPITALS EMBARKATION" AND DEBARKATION HOSPITALS. 429 rially relieved the situation. On May 1, 1918, this hospital was increased in bed capacity to 1,200, and eventually (November 1, 1918) it became a 2,500- bed hospital. 20 On December 23, 1917, Hospital Train No. 1 was sent to the New York port 21 and pressed into service for the relief of the overcrowded situation at the Camp Merritt hospital, and patients were evacuated thence to general hospitals at Fort Ontario, N. Y., Lakewood, N. J., Fort McHenry, Baltimore, and Walter Reed, Washington. At all times the War Department was slow in being convinced of the needs of New York in regard to hospitals, and between the date of the approval for more hospitals and the time when these hospitals were actually needed for use a sufficiently lengthy period was not allowed for the construction work required to put the buildings in order for occupancy. It was therefore neces- sary in the emergency to place patients in hospitals before the facilities for their proper care could be completely provided. In one hospital in particular the messing arrangements and appliances were in such a state of incompletion that it was immeasurably difficult to have cooked and served food sufficient for the wants of the patients. Debarkation Hospital No. 3, at the Greenhut Building, New York City, which was made available for patients on November 23, 1918, and Debarkation Hospital No. 5, at the Grand Central Palace, New York City, which opened on December 22, 1918, furnish splendid examples of what may be accomplished in the way of adapting modern commercial buildings to hospital use. The hospitals at the port of New York, with the date of opening of each, were as follows: 22 Date of opening. Embarkation Hospital No. 1, Hoboken, N. J July 1, 1918.“ Embarkation Hospital No. 2, Secaueus, N. J Dec. 18, 1917. Embarkation Hospital No. 3, Hoffman Island, N. Y Nov. 1, 1917. Embarkation Hospital No. 4 (Polyclinic Hospital^ New York, N. Y Oct. 20, 1918. Debarkation Hospital No. 1, Ellis Island, N. Y Mar. 8, 1918. Debarkation Hospital No. 2, Fox Hills, Staten Island, N. Y Aug. 2, 1918. 6 Debarkation Hospital No. 3 (Greenhut Building), New York, N. Y Aug. 2, 1918. Debarkation Hospital No. 4, Long Beach, Long Island, N. Y Sept. 8, 1918 . 0 Debarkation Hospital No. 5 (Grand Central Palace), New York, N. Y Jan., 1919. Auxiliary Hospital No. 1, New York, N. Y Aug. 24, 1918. General Hospital No. 1, New York, N. Y Sept. 1, 1918 . d Nurses’ mobilization station, Ellis Island, N. Y June 15, 1917. Base Hospital, Camp Mills, Long Island, N. Y Dec. — , 1918. Base Hospital, Camp Merritt, N. J Jan. 9, 1918. HOSPITAL SITUATION AT PORT OF NEWPORT NEWS, VA. In the early days of the war, conditions, so far as hospitals were concerned, were no better at the port of Newport News than were the conditions described above at the port of New York. One of the first questions taken under consideration by the port surgeon was the location and the construction of a hospital for the port. At the time of the selection of Newport News for a port of embarkation the medical mem- a Partly used by the Army from June 9, 1917. b Operated as clearing hospital, Fox Hills, from May 10, 1918. c Date of designation. This hospital was not actually used as a debarkation hospital. <* Date it was placed under the control of the port surgeon. 430 MILITARY HOSPITALS IN THE UNITED STATES. ber of the board appointed for the selection of the port advised that a hospital be constructed on vacant land on the water front, known as the Casino. This land was owned by the Old Dominion Land Co. and was held at a high rental, $15,000 a year. In the opinion of the port surgeon this site for a hospital would have been excellent from many standpoints, and its selection as such was ap- proved by him. However, its selection was disapproved by the Secretary of War personally at an inspection which he made of the port August 1, 1917. Another site for a hospital on leased land at the north end of the town was sug- gested; but placing a hospital at this point would have caused its separation by a considerable distance from the largest camp of the port, Camp Stuart. A tract of land at Camp Stuart was ultimately chosen as a site for an embar- kation hospital, and a hospital of 200 beds was planned. 23 On August 22, 1917, the port surgeon addressed a letter to The Adjutant General, in which he reported the fact that 16.7 acres, at Camp Stuart, had been set aside as a site for a hospital, and indicated the length of time requisite to perfect a smoothly operating organization for the care of the sick. He strongly recommended that immediate steps be taken to build a hospital and start its organization. This letter was conveyed to Washington by the commanding general of the port, personally, and indorsed back to the port surgeon, with the inclusive statement that a hospital of 200-beds capacity would be constructed on the selected site at Camp Stuart. 24 On August 23, 1917, a resident physician of Newport News submitted a proposition to rent his private hospital of 120 beds to the Government for a yearly rental of $10,000. 25 This was disapproved by the Surgeon General. The number of troops at the port of embarkation utilized for guard duty and various other purposes was now gradually being increased. No hospital facilities for the sick among these men were available, except at Fort Monroe. Sick call was held in the attending surgeon's office, Newport News, and at other places when required, and patients were transported by motor ambulances, and occasionally by trolley car, to the hospital at Fort Monroe. Since the gar- rison at Fort Monroe was likewise increasing in strength, it required greater hospital facilities; in consequence, the only hospital available to the troops at Newport News became overcrowded about November 1, 1917. 26 Transporta- tion of patients to Fort Monroe was effected by road, which was in wretched condition and proved a severely trying experience for the sick. 26 Many of the negro stevedores, assigned to the Stevedore Regiment at the port, were taken sick; for them, space was rented in the Whittaker Memorial Hospital, Newport News. About 40 beds were thus made available. 26 In spite of frequent personal and official requests, made by the port surgeon, for hospital facilities, and emphatic statements of the importance of early completion of the embarkation hospital, construction work was considerably delayed. 27 This delay resulted from a variety of causes, but principally from difficulty in securing material and labor and the necessity for rushing other work. In the meantime, Camp Hill, at the north end of Newport News, had been completed and was filled with troops; many stevedores were encamped to the north of Camp Hill, and Camp Stuart was about to be filled with troops. Two small infirmary buildings at Camp Hill, having a capacity of about 50 patients, were operated as hospitals. 28 Fort Monroe was unable to accept further admissions from Newport News after November 1. 1917. 26 TYPES OF HOSPITALS — EMBARKATION AND DEBARKATION HOSPITALS. 431 Fig. 153. 432 MILITARY HOSPITALS IN THE UNITED STATES. About November 10, 1917, the port surgeon succeeded in securing the equipment of two company groups of barrack buildings, for hospital purposes, at Camp Stuart. Medical property had already been secured for equipping 200 beds; 13 medical officers, 75 enlisted men, Medical Department, were assigned, and by the evening of the 13th, 100 patients were being treated. 23 The buildings which were assigned to the Medical Department were the ordinary temporary barrack type, without water or sewer connections, and accommo- dated 20 patients on each floor. An operating room was established in one of the wardrooms wherein emergency surgical work was performed as required. 23 This extemporized hospital was gradually augmented until it held over 600 patients. Shortly before January 1, 1918, plans for the embarkation hospital, at Camp Stuart, had been changed, increasing its bed capacity from 200 to 500, various additions having been requested meanwhile. 29 All this time, too, on account of the inadequacy of the hospital, whenever patients temporarily increased in number beyond the capacity of the hospital, these barracks had to be used for hospital purposes. This state of affairs was true of Camp Hill as well as Camp Stuart. This forced use of barracks, though absolutely essen- tial, was most unsatisfactory from every standpoint. Finally, in the latter part of March, 1918, a battalion block of barracks, having a troop capacity of 1,000, was turned over to the Medical Department for hospital use. 30 This block was so near the hospital proper that it was quite as useful from that point of view as if it had been originally constructed for hospital purposes. While it was never used for patients, except convalescents, its component barracks housed nearly all enlisted hospital personnel, as well as convalescents from time to time as necessary. The enlisted personnel of the Medical Department being removed from the hospital proper and quartered in the barracks liberated their quarters at the hospital which it was then possible to convert into wards. After April 1, 1918, barracks were never again used for seriously sick, even during the epidemic of influenza in the fall of 1918. Dating from April 1, then, hospitali- zation at the port of Newport News was for the first time on a satisfactory basis. A great deal remained to be done, it is true, but subsequent to that time available hospital beds always outnumbered patients instead of the reverse, which had formerly been the case. Local conditions at Newport News differed decidedly from those which obtained at its larger, sister port, from the hospital standpoint as well as from every military standpoint involving its use as a port: No buildings were available either in the city of Newport News or its vicinity, for use as hospitals; nor were there civilian hospitals sufficiently large to warrant taking them over for Army use. The Hotel Chamberlain at Fort Monroe received some consideration as a possible hospital ; but while this large building would have fulfilled this pur- pose very well, the port commander opposed using it because of its exposed site. The only other possibility was the beautiful Soldiers’ Home, at Hampton, Va., which was ultimately secured, but only after authorization by a congres- sional enactment, and not until immediately prior to the armistice . 31 While measures for securing the Soldiers’ Home were being pursued, and during the summer of 1918, it was necessary to go to Richmond, Va., 85 miles distant, to obtain the nearest satisfactory building convertible to hospital use. 32 In this connection, it should be stated that the peninsula, upon which TYPES OF HOSPITALS EMBARKATION AND DEBARKATION HOSPITALS. 433 Newport News is located, is a swamp, the only high ground of which is near Newport News. Extensive filling was required even at the Embarkation Hos- pital, and further hospital construction at the port would have involved budding in a swamp. Furthermore, there were too many activities already in operation on the peninsula, and on the Norfolk shore. Conditions in these respects were no better on the Norfolk shore than at Newport News. To secure adjacent hospital facilities, in the face of all these almost insur- mountable difficulties, one other possibility presented itself: This was taking over Morrison Aviation Camp in its entirety for a hospital of approximately 5,000 beds. 33 Because of the armistice this project was not carried to a point of completion. DIFFERENCES BETWEEN PORT AND OTHER MILITARY HOSPITALS. The hospitals at both New York and Newport News formed groups, in this sense being more like the hospital centers in France, than base or general hospitals in the United States, where each operated independently. In order that each port hospital might play its proper part in group action, the port surgeons exercised direct control over them for the purpose of coordinating their work. Like all activities in a port of embarkation, all the hospitals connected therewith operated constantly under high pressure; instead of fol- lowing the more or less routine of the ordinary home base or general hospital, port hospitals were so organized and administered as to meet totally unexpected demands at any and all times. Intended, as they were, mainly for temporary care rather than definitive treatment of patients, and thus involving constant and rapid changes, the administrative rather than the professional side of the hospital was emphasized. In respect to the patients culled from troops de- parting for overseas, the administrative duties of the hospitals, in their connec- tion with these physically unfit, were emphasized. They must be cared for and then properly safeguarded no matter how they came to hospital. Many were admitted to hospital for conditions which were temporarily disabling, necessitating their return in the greatest possible number to their respective commands prior to the time for sailing, at the same time exercising the utmost care to eliminate any who might prove a burden or a source of danger through contagion. In the hurry of departure, when there was a tendency on the part of the troops to forget or disregard every regulation, it was felt that the admin- istrative functioning of the port hospitals could not be too strongly emphasized. When the current of the sick and injured was reversed, and they began to return from overseas, the administrative problems were more difficult. There were missing records to be replaced, and the disposition of cases by classification and their transfer to inland hospitals to be accomplished. All the many records, having to do with the payment of the patients, had to be made out, and payment actually made. Following this, the patients were gone over again carefully to prevent sending away any unfit to make the proposed journey to some other hospital. The last state, in the administrative details connected with sorting and transferring patients from the ports, had to do with placing them on the hospital cars with such information to the receiving surgeons as would enable them to give any needed treatment en route. The observance of infinite tact was requisite, though this was not solely a characteristic of 45269°— 23 28 434 MILITARY HOSPITALS IN THE UNITED STATES. hospitals of the ports. Many patients were in such a mental state, when de- barked, that they were exceedingly difficult to manage. Especially was this true of the officer patients. This mental condition was fostered by the fact that, after the armistice a great many patients were returned from overseas who, upon arrival, were practically well and in a mood resistant to the neces- sary routine connected with their passage through the port hospitals. Not with the patients alone was tact necessary: their well-wishers varied from the wise to the foolish, and regulations had to be formulated which would encourage the continuance of the valuable assistance of the former, and at the same time curb the activities of the latter to an extent sufficient at least to prevent actual injury to the patients. The port hospitals, during the war, were by no means on the same plane of activity; quite the contrary. Some of them received only overseas patients, such as the debarkation hospitals, the Greenhut Building and the Grand Central Palace in New York, and the National Soldiers’ Home at Hampton, and the great debarkation hospital of the port of Newport News. Certain hospitals in New York were set aside for special purposes such as for the care of con- tagious diseases; other hospitals, at both ports, discharged a set of functions which combined those of a base hospital with the modifications imposed by the peculiar character of their relation to the culling out of noneffectives from troops going overseas, and the reception of debarking sick and wounded. REFERENCES. (1) Letter from the Surgeon General to the port surgeon, Charleston, S. C., January 4, 1919. Subject: Hospital facilities at the port. On file, Record Room, S. G. 0., 680.3 (Charleston, S. C.), N. (2) Letter from Sister Justa, superintendent St. Mary’s Hospital, Hoboken, X. J., to the Surgeon General, July 27, 1917. Subject: Account for hospital care and treatment, officers and enlisted men, June 9 to July 19, 1917. On file, Record Room, S. G. O., 193776(01d Files). (3) Report of activities of the office of the surgeon, Port of Embarkation, Hoboken, X.J. On file, Historical Division, S. G. 0. (4) Letter from the commanding officer, Embarkation Hospital Xo. 1, to the Surgeon General, March 7, 1919. Subject: Report of hospital for the year 191S. On file, Historical Division, S. G. O. (5) Letter from the commanding officer, General Hospital Xo. 1, to the department surgeon, Eastern Department, October 1, 1917. Subject: Patients. On file, Record Room, S. G. 0.. 187538-7 (Old Files). (6) Letter from The Adjutant General to the commanding generals of all d visions, all depart- ments in the United States, all ports of embarkation, and to all staff departments, Novem- ber 15, 1917. Subject: Inspection for venereal diseases before troops are embarked. On file, Record Room, S. G. 0., 726.1-1 (General (7) Letter from the Surgeon General to Dr. L. E. Gofer, chief quarantine officer. Rosebank, New York City, October 26, 1917. Subject: Facilities at Hoffman Island for use of the Medical Department. On file, Record Room, S. G. O., 632 (Emb. Hosp. Xo. 3), I. (8) G. 0. No. 37, Hdqrs., Port of Embarkation, Hoboken, X. J., November 27, 1917. (9) G. 0. No. 88, Hdqrs., Port of Embarkation, Hoboken, X. J.. August 2, 191S. CIO) Report of Special Sanitary Inspection, U. S. Army Hospital, Hoffman Island, X. \ June 27, 1918, by Col. A. E. Trubv, M. C. On file, Record Room. S. G. O., 721 (Emb. Hosp. No. 3), I. (11) Telegram from Brown to the Surgeon General, October 27, 191/ . Subject: Hospital facilities at Camp Mills. On file, Record Room, S. G. 0., 632 (Camp Mills), D. (12) Letter from The Adjutant General to the Surgeon General, November 22, 1917. Subject: Congestion. Camp Hospital, Camp Mills, N. Y. Onfile, Record Room. S.G.O., 705 (Camp Mills), I). TYPES OF HOSPITALS EMBARKATION AND DEBARKATION HOSPITALS. 435 (13) 3d Ind. from The Adjutant General to the Surgeon General, November 23, 1917. Subject: Disposition of patients in New York Harbor. On file, Record Room, S.G.O., 701 (New York, N. Y.), F. (14) 1st Ind. from the Surgeon General to The Adjutant General, November 23,1917. Subject: Congestion at Camp Mills, N. Y. On file, Record Room, S. G. O., 705 (Camp Mills), D. (15) Telegram from Kennedy to the Surgeon General, January 3, 1918. Subject: Hospital facilities. On file, Record Room, S. G. 0., 701 (New York, N. Y.), F. (16) Letter from the division surgeon, 41st Division, Camp Mills, N. Y., to the Surgeon General, November 21, 1917. Subject: Hospital facilities at Camp Mills. On file, Record Room, S. G. 0., 632 (Camp Mills), D. (17) Letter from Col. J. M. Kennedy, M. C., surgeon. Port of Embarkation, to Col. J. D. Glennan, M. C., December 12, 1917. Subject: Hospital facilities. On file, Record Room, S. G. O., 701 (New York, N. Y.), F. (18) Report of special sanitary inspection of the Army Hospital, Secaucus, N. J., June 24, 1918, by Col. A. E. Truby, M. C. On file, Record Room, S. G. O., 721 (Secaucus, N. J.), I. (19) Telegram from Sloat to the Surgeon General, January 2, 1918. Subject: Estimate time when buildings will be completed at CampMerritt. On file, Record Room, S. G. 0., 652 (Camp Merritt, N. J.), C. (20) Shown on “Bed reports. ” On file, Record Room, S. G. 0., 632 (U). (21) Telegram from Reitz to the Surgeon General, December 23, 1917. Subject: Movement of Hospital Train No. 1. On file, Record Room, S. G. 0., 322.3 (IIosp. Train No. 1), 1. (22) Shown on monthly report of sick and wounded (Form 51). On file, Medical Records Section, World War Division, A. G. 0. (name of hospital). (23) Report of operations of the surgeon's office ; Port of Embarkation, Newport News, Va., from July 16, 1917, to March 21, 1918. On file, Medical Records Section, World War Division, A. G. 0., 314.7, retained records, surgeon’s office, Newport News, Va. (24) Letter from the surgeon, Port of Embarkation, Newport News, Va., to The Adjutant General, August 22, 1917, and indorsement thereto. Subject: Hospital at Port of Embarkation. On file, Record Room, S. G. 0., 632 (Newport News, Va.), N. (25) Letter from Dr. Joseph T. Buxton, Newport News, Va., to the Surgeon General, August 23, 1917. Subject: Rental of hospital for use of the Government. On file, Record Room, S. G. 0., 201 (Buxton, Joseph T.). (26) Letter from the surgeon, Port of Embarkation, Newport News, Va., to all medical officers, October 31, 1917. Subject: Care of sick. On file, Record Room, S. G. 0., 701 (Newport News, Va.), N. (27) Letter from the surgeon, Port of Embarkation, Newport News, Va., to the commanding general, Port of Embarkation, September 21, 1917; and indorsements thereto. Subject: Embarka- tion hospital. On file, Record Room, S. G. 0., 632 (Newport News, Va.), N. (28) Letter from the surgeon, Port of Embarkation, Newport News, Va., to Maj. II. H. Johnson, M. C., Surgeon General's Office, January 8, 1918. Subject : Situation in regard to hospital facilities at this port. On file, Record Room, S. G. 0., 632 (Newport News, Va.), N. (29) Letter from the surgeon, to the commanding general, Port of Embarkation, Newport News, Va., December 10, 1917; and indorsements thereto. Subject: Embarkation hospital. On file, Record Room, S. G. 0., 600.1 (Newport News, Va.), N. (30) Letter from the commanding general, Port of Embarkation, Newport News, Va., to the Chief of the Embarkation Sendee, Washington, D. C., July 8, 1918. Subject: Prolusions for housing enlisted personnel, Medical Department, at Embarkation Hospital. On file, Record Room, S. G. 0., 632 (Newport News, Va.), N. (31) Bulletin No. 60, War Department. November 20, 1918, publishing act of Congress approved November 7, 1918. (32) Letter from the surgeon, Port of Embarkation, Newport News, Va., to the Surgeon General, July 16, 1918. Subject: Hospital needs at Port of Embarkation, Newport News. On file, Record Room, S. G. 0., 721.6 (Newport News, Va.), N. (33) Letter from the surgeon, Port of Embarkation, Newport News, Va., to the Surgeon General, November 23, 1918. Subject: Hospital accommodations. On file, Record Room, S. G. O., 721.6 (Newport News, Va.), N. CHAPTER XXIII. DEBARKATION HOSPITAL NO. 3, NEW YORK CITY.“ PROCUREMENT AND ALTERATION OF BUILDINGS. Debarkation Hospital No. 3 comprised the following four properties: The Greenhut Building, on Sixth Avenue, extending from Eighteenth to Nineteenth Streets; the Cluett Building, 19-23 West Eighteenth Street, and 22-28 West Nineteenth Street, adjoining the Greenhut Building: a building occupving 30-32 West Nineteenth Street, adjoining the Cluett Building; and the Trow- mart Inn, Twelfth and Hudson Streets. The Greenhut Building, the main building of the hospital, was leased, effective July 1, 1918, at $300,000 per year. It had been formerly the Siegel- Cooper Building, a well-known department store, and occupied the full width of the block between Eighteenth and Nineteenth Streets on Sixth Avenue, to a depth eastward of 500 feet. It was a six-story, brick and steel structure: and in addition to the six floors and basement, there were subbasements, several large penthouses, a large glass-inclosed conservatory on the roof, and a seventh story at front and rear. The total floor area was 650,000 square feet. The building was relatively convenient to the transport docks; near by was a Hudson tube entrance: a subway station was in the basement ; and elevated and surface lines passed it on Sixth Avenue. The. selection of this property as a hospital gave rise to some surprise and criticism based on the facts that the elevated trains ran by the building and that the locality was generally a noisy one. However, these detractions had been appreciated when the property had been selected, and it was felt that, since it was planned to keep the debarking sick here only sufficiently long (not over 10 days) to properly prepare them for their transfer to the general hospital nearest their homes, where their definitive treatment was to be given and their convalescent period spent, the poor features of the property had no real import. The Cluett Building, an 11-story brick and steel structure immediately adjoining the Greenhut Building, was leased, effective October 16, 191S. for $76,500 per year. It was used for housing the personnel of Debarkation Hospital No. 3, and the Medical Department personnel necessary for the man- ning of the hospital trains operating between New York and the various Army hospitals throughout the United States. a The statements of fact appearing herein are hased on the “ History, Debarkation Hospital No. 3, New YorkCity." by Capt. Henry L. Hayes, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. 436 TYPES OF HOSPITALS DEBARKATION HOSPITAL. 437 The Trowmart Inn, at Twelfth and Hudson Streets, formerly a hotel for working girls, was leased, effective October 1, 1918, as quarters for the nurses on duty at Debarkation Hospital No. 3 and nurses awaiting embarkation. Fig. 154. — Debarkation Hospital No. 3, Greenhut Building, New York City. The relatively small building, 30-32 West Nineteenth Street, located in the same block as were the Greenhut and Cluett Buildings, was leased at $1 per year from the Mutual Life Insurance Co. of New York. The Surgeon General requested the leasing of the Greenhut Building on April 23, 1918; and when the lease was executed in June, 19 IS, to be effective 438 MILITARY HOSPITALS IN THE UNITED STATES. July 1, the work of planning the necessary alterations was begun. An estimate of cost was prepared, and approval of the necessary funds, $306,400, was requested July 11, 1918. The expenditure of these funds was approved by the Secretary of War on July 31, 1918; and on August 12 the local constructing quartermaster was credited with the allotment, and the alteration work was started. This alteration work was completed on November 23, 82 working days later, the total cost of which was $280,000. In May and June, 1918, when plans for the alteration of the buildings were being studied, in anticipation of the acquisition of the buildings, it was concluded to divide the floor space into large wards, to utilize and conserve outside light as much as possible and to minimize plumbing and interior partitioning. The use of such large wards was a decided innovation; and against their adoption was the possibility of increased cross-infection, and uncontrol- lable noise. In the favor of their adoption was the knowledge that natural light and ventilation would be proportionately greater the more minimized was the partitioning of the floors into small wards; that there would be greater accuracy in the construction of the diet kitchens, utility rooms, toilets, etc., at a few large centers on each floor; and that, in this hospital especially, the stream of patients, in and out, could be made to move more smoothly the larger the groups. The isometric plan, Figure 155, shows how a portion of the first floor, with entrance and exit on Eighteenth and Nineteenth Streets, respectively, was re- modeled for receiving and forwarding the sick. On the left and fronting on Sixth Avenue a portion of this floor was turned over to the American Red Cross for a theater and other activities. The mezzanine floor was used for offices, with little alteration. The second floor was altered so as to provide for the general kitchen, diet kitchen, mess halls, and five wards. On the third floor 10 wards were provided. On the fourth floor the surgical operating rooms, facilities for X-ray, dental, ophthalmological, and allied specialities were installed, and eight general surgical wards and the dispensary were provided. The fifth and sixth floors were rearranged for wards solely, 10 on the fifth and 9 on the sixth. The conservatory on the roof was set aside for recreation. A penthouse on the roof was converted into a laboratory for the port of embark- ation, and adjoining it was the laboratory animal house. In the basement the refrigeration, light, and power plants were left intact, and facilities for repair, storage, barber shop, hospital exchange, and disinfection were prepared. The Cluett Building was not greatly altered; an aperture was made in the wall, which separated it from the Greenhut Building, on the kitchen floor of the latter to facilitate food service and intercommunication generally. This building was cleaned, painted, and repaired, lavatories installed, and old partitions removed, each floor being left open, making the living quarters similar to dormitories. The first floor contained a recreation room and gym- nasium, with a specially built room for handball and basket-ball and shower baths. On the second floor was the mess hall, which had a seating capacity for 1,200. Debarkation Hospital No. 3, when completed, had a bed capacity of 3,500: its largest ward contained 157 beds; and in its kitchen food could be prepared for over 5,000. Its receiving section was so organized as to permit the orderly • NlNf.Tr. r.NTfi • ,‘STPr.rT Fig. 155.— Isometric plan of first floor, Debarkation Hospital No. 3. - LIGHTEXNTH • 5TRLLT • y TR.E.LT 440 MILITARY HOSPITALS IN THE UNITED STATES. dd?o □ □.□y^nMcV plBOD’ □□ Q 0 □ ]□□□□□□□ 0 □ □ □ 0 }□□□□□□□ DO&OD DDQOD □ □000 □□□□□□ !□□□□□□ □ □□,□□ □□□□□□ □□ODD □□□□□□ & : Jljjsis irfr ml □on □□□do □□□□□□u □□□□□ io □ □ □ □ □ □ □□□□□ jO □ □ □ □ □ Q □□□□□' (PDQDDEl □□□□□ ]□□□□□□□ □□□□□ □□□□□□□ □□□□□ □□□□□□□ □□□□□ □□□□□□□ □□□□□ □□□□□□□ □ □□□□ □□□□□□ Q □□□□□ □□□□□□□ □□□□□' .□□IlDDq, □□□□□□; □ □□□□□ □□□□□□ □ □□,□□□ □□□□□□; □ □□□□Of □□□□□□' nnnnnn.nnnnnn i □ rf □ □ □ □ □ Dr o □ □ y □ □ !i □□□□□□] oD □ g □ □ □ z 0 0 □ □ □ □ Q <□00000 f □ Q o o □ I □□□□□□ S' ° □ □ 0 □ □ □ moi C ~s-\ aiODODDD b cJ *J < - 5 □ □□□□□'□□□□□□ □□□□□a □□□□□afc ODODDO □ □ □ □ □ or oonoon □□□□□oi □□□□□□ □ □ □ □ □ Of sflllUsS* s flljlsis □ □□□□□□ □□□□□[] □□□□□□□ □□□□□□ □□□000 □□□□□□□ □□□□□□ □□□□□□□ □□□□□on □□□□□□ □□□□□□ □□□□□□□ □□□□□□ 3 “ □□□□□□ < i£ 0 □ □ □ 00 □□□□□□ □ □□□□□□, oopoop > g □ □ □ □ o □□□□□□□ nnnnnnn fmnnnnn ®nnnnnnn® _ | B S OQi TYPES OF HOSPITALS DEBARKATION HOSPITAL. 441 reception of enough patients in a single day to half fill the hospital, and its forwarding section was designed to effect the discharge of a like number. Furthermore, the design of these sections was such that when necessary they could be combined so that patients could be either received or discharged through them. Fig. 157. — One of the large wards at Debarkation Hospital No. 3. ORGANIZATION. On July 18, 1918, two officers from the Hospital Division of the Surgeon General’s Office, together with an officer from the office of the surgeon, port of embarkation, were directed to effect plans for adapting the Greenhut Building to hospital use. Civilian help was employed, and with a few enlisted men of the Medical Department on duty, the building was rapidly cleaned out and construction work begun. On August 2, 1918, General Orders, No. 58, Head- quarters, Port of Embarkation, Hoboken, N. J., was issued, officially designating this hospital as United States Army Debarkation Hospital No. 3. OCCUPATION OF BUILDINGS. On the day of the signing of the armistice, the hospital was ready for patients; the first being received November 23, 1918. During the interval, November 11, 1918, to November 23, 1918, preliminary rehearsing and training, regarding the reception and handling of the patients, were given officers and enlisted personnel. GENERAL EQUIPMENT. Immediately subsequent to the arrival of the commanding officer of the hospital, July 15, 1918, he caused to be made requisitions for the vast equip- ment essential for conducting so large an institution as this hospital. Shortly 442 MILITARY HOSPITALS IN’ THE UNITED STATES. thereafter trucks by the hundreds, loaded with supplies, arrived and the work of outfitting the wards was begun. The hospital wards were large and roomy and they were left open to permit of free ventilation and light. Diet kitchen and linen rooms were made parts of each ward; a gas range and a large ice box were installed in each diet kitchen, with the necessary coo kin g utensils and serving dishes. Ample shelving space was provided in each linen closet. Large, well-lighted toilet rooms were also installed as a part of each ward, in some of which ventilation was provided by means of vent shafts. These vent shafts were about feet square, the forced draft being maintained by means of electrically driven fans on the hospital roof. PERSONNEL. In December, 1918, after the hospital had been completed, there were over 800 enlisted men on duty. These men were assigned to the following departments of the hospital: Ambulance service 10 Chaplain’s office 1 Barracks 10 Dental laboratory 6 Detachment office 10 Detachment property office 3 Detachment sick call 4 Dispensary 10 Elevators 30 Evacuation office 9 Guards 80 Interpreter 1 Kitchen and mess hall 190 Medical supply and linen room 20 N ewspaper office 2 Office of officer of day 3 Operating room 10 Orderlies (barracks) 20 Orderlies (door) 6 Detachment of patients (office) . 5 Patient’ s^property room 30 Personnel adjutant’s office 30 Post exchange 11 Post office 18 Quartermaster 4 Receiving ward 3 Registrar - ’ s office 12 Sanitary fatigue 24 Sergeant-major’s office 17 Special details 3 Telephone operators 2 Wardmasters and orderlies (day) 140 Wardmasters and orderlies (night 90 X-ray room 5 Young Men’s Christian Association 1 There were 1 66 nurses on duty at the hospital at this time. HOSPITAL DEPARTMENTS. SURGICAL SERVICE. The surgical service occupied the second, third, fourth, and sixth floors of the hospital. The function of the hospital being the separation of debarking patients into groups for transfer to inland hospitals for treatment, the work ot the surgical service was not as active as the size of the hospital would seem to indicate, and it consisted mainly in placing the patients in the best possible condition to enable them to travel. It was the established policy of the port surgeon to restrict the number of operations to the minimum, preferably trans- ferring operative cases to base or general hospitals. Ward 6, on the fourth floor, was completely equipped for the Carrel-Dakin treatment of infected wounds, and with Balkan frames for the proper treatment of fractures. Oper- ating rooms were established on the fourth floor. TYPES OF HOSPITALS DEBARKATION HOSPITAL. 443 EYE, EAR, NOSE, AND THROAT. The eye department of the hospital was organized on December 1, 1918. It was located on the fourth floor, or main surgical floor, of the hospital, and occupied one room of sufficient size to permit doing refraction and other work connected with the eye. The equipment was sufficient for general clinical work on the eye. The ear, nose, and throat department was likewise organized on December 1, 1918, and was adequately equipped to permit doing general clinical work on the ear, nose and throat. X-RAY DEPARTMENT. The X-ray department included 14 rooms on the fourth floor, with a total door space of 3,520 square feet. An elaborate equipment was installed, current for the machines being supplied by the Edison Electric Co. The commissioned personnel of the X-ray department consisted of 2 med- ical officers; in addition there were 5 enlisted men and 1 civilian, a stenographer. DENTAL DEPARTMENT. The dental department was first represented by two officers of the Dental Corps, who reported for duty on November 23, 1918. They were assigned an operating room, 13 by 24 feet, on the fourth floor, for which there was a north- ern exposure. In addition, a small office and supply room, 10 by 12 feet, and directly across a corridor from the larger room, was given to this department. The first two weeks subsequent to their arrival these two officers occupied themselves with the installation of equipment comprising two base dental outfits and one laboratory equipment. The first great influx of patients occurred the latter part of November, during which time a chief of the dental service was assigned, November 25. Under the supervision of the chief of dental service, March 13, 1919, one additional base dental outfit was installed in the main office. An auxiliary office, on the sixth floor of the hospital, was established at the same time, its equipment comprising two base dental outfits. With five operators and five outfits, the activities of the dental service increased materially and was able to cope with the large numbers presented for treat- ment. On April 3, 1919, oral examination was begun of every patient received in the hospital, this constituting a part of the routine physical examination upon admission. All cases were classified, and in each instance were recorded on an auxiliary form — Form 55 M. D. Patients requiring emergency treat- ment- were given immediate attention: others were given appointment for work to be done later, when necessary. The greatest handicap noted in the treatment of cases was their short stay at the hospital, which was unavoidable under the circumstances, but never- theless in many instances patients were transferred before much dental work could be accomplished. The mouths of 22,560 patients were examined by the officers of this department; the number of officers and enlisted men treated was 2,677, necessitating 4,101 sittings; and others treated number 168, for whom 236 sittings were given. 444 MILITARY HOSPITALS IN THE UNITED STATES. MEDICAL SERVICE. The fifth floor of the hospital was given over to the medical service, for which there were 11 wards, the total bed capacity of which was 788. Of these 1 1 wards, 4 were special wards assigned respectively to cases of tuberculosis, pneumonia, diphtheria, and influenza; the remainder being for general medical cases. It was found to be neither desirable nor possible to classify the patients according to diseases in a manner practiced in a base hospital, where wards were smaller and where patients were ordinarily kept for considerable periods for observation and treatment. In Debarkation Hospital Xo. 3 it was possible to segregate the contagious from the noncontagious only, and practically only four classes of communicable diseases were handled: Tuberculosis, pneumonia, diphtheria, and influenza. Other cases of contagious diseases, especially mumps, scarlet fever, and measles, appeared spasmodically, but they were promptly removed to other hospitals where isolation could be more effectively carried out. SICK AND WOUNDED DEPARTMENT. The sick and wounded department concerned itself with the maintenance of an accurate record of all patients in the hospital, as well as a medical record of the personnel on duty. The work of the department dovetailed, in many instances, that of other administrative departments, particularly the personnel office, the office of the detachment of patients, the receiving office, as well as the medical and surgical wards; for, whenever information was required con- cerning either the medical or personal status of a patient, it was necessary first for the sick and wounded department to ascertain whether the patient con- cerned was at the time, or any other time, in the hospital. It was, therefore, the purpose of this department to keep an accurate directory in which was given the exact location of each patient in hospital. This was made possible by using a filing system composed of cards, 3 by 5 inches, on which were recorded the name, rank, and hospital location of separate patients. Subse- quent to the transfer of a patient from the hospital this card was placed in a “dead file.” The cards were made immediately after the admission of a patient to hospital and contained pertinent abstracts from the clinical brief, or Form 55 a, Medical Department, the first sheet of the patient’s clinical record. A carbon copy of Form 55a was kept on file, in this department, for each patient in hospital. At the end of the day, after the patients, who had been admitted, had had cards made, a nominal list of their names was prepared. This list showed, in addition to the names, the rank and organization, location in hospital, and the name of the transport from which the patients had been received. Copies of the nominal list were distributed to the following officers: Two copies to the sick and wounded department, headquarters, Port of Embarka- tion, Hoboken; one copy to the post office of Debarkation Hospital Xo. 3: one copy to the personnel officer; one copy to the hospital representative of the Red Cross; one copy to the hospital newspaper, Home Again; one copy to the patients’ property office; and one copy filed with retained records. While patients were in hospital a sick and wounded register was kept which consisted of a card for each patient. When patients were transferred from the hospital, a list, similar to the nominal list of admissions, was TYPES OF HOSPITALS DEBARKATION HOSPITAL. 445 compiled containing the names of all patients evacuated during the day. Copies of this list were distributed in exactly the same manner as were those showing admissions, and the files of the department were adjusted to accord with the changes. On the completion of each case, the clinical record, which had been in the keeping of the ward surgeon, was completed and filed in the sick and wounded department. This clinical record was frequently referred to to obtain information regarding a patient’s condition even after he had left hospital. Field medical records, which accompanied the patients from over- seas, were also handled in this department, when patients, for whom they had been prepared, were transferred. The administrative details, connected with the transfer of patients with communicable diseases from Debarkation Hospital No. 3 to an isolation hospital of the port, were effected by this department, as were those concerning the transfer of patients from ward to ward within the hospital. A regular numerical morning report of the patients in hospital was com- piled each morning, copies thereof being transmitted to the news officer, the Red Cross representative, the chief nurse, and the adjutant. A weekly report was made every Friday morning for the information of the surgeon of the port. This weekly report included data regarding the number of personnel of the hospital taken sick during the week concerned, grouped by diseases. The monthly sick and wounded report, consisting of a separate card for each patient treated during the previous month, was made and forwarded to the Surgeon General not later than the 5th of the month. The work of the sick and wounded department required the constant services of 12 enlisted men and 4 civilian typists. The total number of admissions recorded is 36,880, of which 35,850 were patients received from overseas. The largest number of admissions, on any one day, was 2,235 on March 24, 1919, received from one transport, steamship Artigan. The largest number of evacuations in one day was on March 25, 1919, when 1,458 patients were transferred to inland hospitals. PROCESS OF ADMISSION. Usually, when patients were received at the hospital, they came in large numbers from the debarkation piers in ambulances. The ambulatory patients were met at the front door of the hospital by orderlies who carried the patients’ hand luggage, and who escorted the patients to chairs and benches located in the rotunda on the main floor of the hospital. On these occasions members of the American National Red Cross were requested to assist in seating the patients pending their admission to hospital. In the routine of admission, the patient was conducted by an orderly to the first room of the receiving ward, where Form 55 A, Medical Department, was prepared in triplicate, as well as an evacuation card. At this point, each patient was requested to deposit any valuables, in his possession, with an officer especially detailed to receive them, a receipt being furnished for any valuables so deposited. In the event a patient had valuables, which he did not desire to deposit for safekeeping, he was required to sign a statement showing he had been given the opportunity, the advantage of which he refused to take. From this room, the patient passed into another, fitted with benches, where he removed all his clothing, being assisted in this by an orderly when it was necessary; and passed into an adjoining 446 MILITARY HOSPITALS IN THE UNITED STATES. room, in which he was submitted to an inspection by medical officers, the pur- pose of which was to determine the nature of his injury or illness and the possible existence of vermin infestation and communicable disease. In this room his assignment to a ward of the hospital was made, a notation of the ward to which he had been assigned being made on his Form 55 A. His clothing was examined, and if found to be louse infested, was subjected to a delousing process; likewise, if the patient was found to be louse infested, he was deloused in a room provided especially for this purpose. The clothing was checked and, after being deloused. was placed in specially constructed bins in the patients’ property room, the patient retaining a duplicate check. When the patient was not found to be vermin infested, his clothing was checked and sent to the sterilizing plant in the base- ment, whence it was returned, as soon as possible, to the clothing bins, there to be left until needed. From the physical inspection room, the patient passed to the shower-bath room, where he was required to bathe, attendants being present to afford assistance when necessary. Following his bath, the patient was given slippers, a clean suit of pajamas, a pair of socks, and a bathrobe, after which he passed out into a main corridor through the only possible exit, where a throat culture was obtained by one of the laboratory staff, and where a dental officer made a mouth inspection to determine the necessity of imme- diate dental treatment. From this point an orderly conducted the patient to one of the many elevators and to the ward to which he had been assigned. Arriving at the ward, the patient was again examined by the ward surgeon. The patient’s evacuation card, which he had brought with him from the admis- sion room, was then completed and sent to the evacuation office. The process of admission required 45 minutes for each patient; and, during the admission of a large number, the detail of the following personnel: Thirty officers, 15 typists, 3 clerks, 70 orderlies, 30 clothing checkers, 5 laboratory assistants, and 4 dentists. Having arrived at his designated ward, the patient was assigned a bed. and, his physical condition having been determined to warrant it, he was given the liberty of the hospital. Within 24 hours after having entered the hospital, the patient’s uniform had been sterilized and reclaimed by him. In the meantime, each ward surgeon had made requisite clinical notations on the patient’s clinical record and field medical card. The ward surgeon, deeming it advisable and the patient’s condition permitting it, the commanding officer, detachment of patients, was authorized to issue passes to patients after their first 24 hours in hospital. These passes permitted patients to leave the hospital between the hours of 10 a. m. and 5 p. m. regularly, an additional pass being required when they desired to leave the hospital in the evening. Before being granted this freedom, however, it was required that each patient going on pass be paid in full. This was accomplished by obtaining the patient’s affidavit, on which was set forth information as to when he embarked overseas, when he was last paid, all deductions for allotments and insurance, and his rate of pay. From these data a pay roll was accomplished and the patient paid in full. EVACUATION DEPARTMENT. The steps necessary to be taken to effect the transfer of a patient from the hospital to other hospitals were begun, immediately on admission, with the preparation of the evacuation card. On this card were noted a patient's name. TYPES OF HOSPITALS DEBARKATION HOSPITAL. 447 rank and organization, date of admission to this hospital, ward and floor to which assigned, home address of the patient, and a general diagnosis. This card was sent to the evacuation office immediately after a patient reached the ward, and the information it contained was certified to by the president of the physical examining board. In the evacuation office, these evacuation cards were arranged according to the States, as indicated by the home address of the patients, and were so classified that a patient might be transferred to the hos- pital nearest his home. Numerical and nominal lists of the hospitals designated were then prepared and forwarded to the office of the port surgeon. These lists gave information regarding the number and names of the patients, their respective physical conditions, and the hospital to which they were to be sent. They also contained sufficient data to indicate required professional attention en route, and whether the patients should be assigned upper or lower berths on the hospital train. When the lists were completed, duplicate stubs were prepared on which were noted the names, rank and organization, ward and floor of the hospital to which the patient was assigned, and the destined hospital: the stubs being then filed according to destinations of patients. When the nominal lists were sent to the office of the port surgeon, requests for travel orders or special transportation accompanied them; and when the travel orders were received from the headquarters of the port of embarkation, each patient listed was given a number which was inscribed on one of the stubs described, the stub in turn being tied to a button of the patient’s blouse. The retained stub in the evacuation office was given a similar number. Copies of the travel orders were distributed to the various departments of the hospital; notice of the evacuation being sent to ward surgeons concerned, apprising them the hour when the patients to be transferred should secure breakfast and their valuables. The mess officer was notified to enable him to have breakfast served in ample time prior to the departure of the patients. When the transfer had been con- summated, the field medical card, or a transfer card, was forwarded to the hos- pital for which the patient was destined. At the hour of evacuation, all patients, selected for transfer to a particular hospital, were placed in the charge of an escort assigned to accompany them. A check of the patients was then made and a receipt for them obtained from the officer in charge of the escort. Evacuation cards of patients who, for one reason or another, failed to depart at the time designated were put aside for reclassification on the next list; the names of the absentees were fur- nished the adjutant, the commanding officer, detachment of patients, the registrar, and the personnel adjutant. THE MESS DEPARTMENT. The hospital kitchen and mess halt were located on the second floor of the Greenhut Building, occupying all the space on the east side of the rotunda. The mess hall was adequately lighted by large windows on both the Eighteenth Street and Nineteenth Street sides, and large motor-driven exhaust fans in four of the windows maintained the air of the room in a constantly satisfactory condition. The mess hall was divided into halves by a central corridor, which extended from the entrance doors at one end to the steam serving tables at the other. 448 MILITARY HOSPITALS IN THE UNITED STATES. The corridor was divided into four aisles, each aisle corresponding to a door at the entrance, the two inner aisles being used for incoming patients and the outer ones for outgoing patients. Midway of the mess hall and adjoining the outer aisles of the central corridor were two dish-washing rooms, each 20 by 20 feet, containing a dish-washing machine. These rooms had two intake windows, one at each end, through which the used dishes were passed by the patients, each of whom carried his table utensils to the dish-washing room as he left the mess hall. Beyond the central corridor, on each side, were the spaces for the dining tables, the tops of which were made of three boards, the middle board being removable to permit their sanitary maintenance. Fixed benches were provided the tables. There were 102 of these tables in the mess hall, each accommodating 16 patients, providing a total seating capacity of 1,632. The kitchen was fully equipped with modern labor-saving devices, all of the cooking utensils consisting of heavy aluminum. In addition to the usual tables, chopping blocks, racks, etc., the equipment composed the following articles: Twenty gas ranges, set back to back, in two batteries; two 60-gallon, ull jacketed stock kettles; five 80-gallon, two-thirds jacketed stock kettles; five 35-gallon vegetable boilers; three 3-compartment vegetable steamers and boilers; four 60-gallon coffee urns; one whipped-cream machine with full equip- ment; one vegetable peeling machine; one meat chopper; one fish bowl; two dish-washing machines; one ice-breaker; one freezer and brine tank; one bread slicing machine; three steam tables, each 12 feet long and having eight contain- ers; one meat slicing machine; one hardening room, with zero temperature, for the ice cream plant; and one cold storage plant for meats, etc., cooled by the refrigerating plant in the hospital basement. The mess hall was conducted on the cafeteria system, and all able-bodied ambulatory patients were served at the double steam table placed across the upper end of the mess hall. Ambulatory patients who were unable to serve themselves because of physical disability had their meals served them at the mess tables. Bed patients were served in the wards from especially designed mess carts. As the ambulatory patients completed their meals they carried their used eating utensils by the dish-washing rooms, through the intake win- dows of which they passed, them. The cleaned and dried dishes were taken as they emerged from the dish-washing machines, and were passed out a third window onto a hand truck in which they were conveyed back to the steam serv- ing tables; and thus a constant circuit was maintained from the steam tables to the washing room, thence back again to the serving tables. The cafeteria serving system proved to be so expeditious that, even when the hospital was filled to capacity — 1,000 patients — it seldom happened that all the dining tables were required, as there was a constant stream of incoming and outgoing diners, and the same table was used over and over again as sepa- rate seats became available. The number of men served at each steam table was about 25 per minute, or 1,500 each hour. Adjoining the general kitchen was the diet kitchen, wherein there was a trained corps of dietitians, who prepared all the special diets for the hospital, distributing them in the mess carts. TYPES OF HOSPITALS DEBARKATION HOSPITAL. 449 In the general kitchen the food for the duty personnel of the hospital was prepared. This was carried to the detachment mess hall, located on the second floor of the adjoining Cluett Building, through the opening made in the inter- vening wall, and served in a manner similar to that just described. Adjoining the office of the mess officer, on the mezzanine floor of the Green- hut Building, were the butcher shop, the vegetable and other rooms, fitted with the necessary ice boxes and refrigerating apparatus. The commissioned personnel of the mess comprised 3 officers, and the en- listed personnel numbered about 204, among whom there were 36 cooks di- vided into 3 shifts, one working at night, the others alternating in the day work. During the fiscal year ending June 30, 1919, the mess officer expended $452,444.46 for food. The number of meals served was 2,170,527. PATIENTS’ PROPERTY. The property of all the patients in hospital was cared for by the officer in charge of patients’ property, with the exception of valuables which were deposited for safe-keeping in the hospital safe under the care of an especially detailed officer. The patients’ property department was made responsible for the issuance of new clothing to patients who desired them. New cloth- ing of an approximate value of $800,000 was thus issued; each transaction was entered on the patients’ individual clothing and equipment record and was receipted for by them on Quartermaster Form 165. HOSPITAL ANNEXES. The post exchange was established November 27, 1918, and equipped with the usual supplies found in a post exchange. Connected with it were a barber shop, containing 11 chairs, a shoe-shining department with 8 chairs, a tailor shop, and a photograph gallery. Much credit is due the Red Cross for the exceptionally fine morale of the patients in this hospital. A well equipped recreation room was conducted by its representatives for the entertainment of the patients. Each night at 7.15 an entertainment was given in the Red Cross theater, with a seating capacity of 1,600. A recreation bureau was maintained for providing the patients with theater tickets, bus rides, dinner parties, etc. Allied with the Red Cross was the American Library Association, with a well-equipped library of over 20,000 books. The Library Association also distributed books and the various popular magazines to patients who were confined to bed. 45269°— 23 29 450 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Debarkation Hospital No. 3, Greenhut Building, New York, N. Y., from August, 1918, to July 15, 1919, inclusive. 11 SICK AND WOUNDED . b Year and month. Remaining from last month. Admissions. Total to be accounted for. ! Completed cases. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. By trans- fer. Otherwise. 1918. 3 3 47 47 14 October 7 65 1 73 46 November 5 66 4 75 50 1 8 91 120 219 70 7 1919. January 76 161 251 488 111 19 February 178 198 307 683 151 10 March.. I 186 250 292 728 180 April 222 205 310 737 188 14 2 231 110 1, 364 1. 705 1. 142 10 1 June 173 64 1, 211 1 l' 449 l' 176 15 July 63 13 14 90 12 13 Remaining. Aggregate number of days lost from sickness. 180 336 320 302 379 194 65 177 186 222 230 173 63 1 1 1 4,035 5, 177 0, 926 7,650 6, 651 4, 982 1, 374 50 31 36 46 19 19 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total . 1919. 1919. 42 42 6 79 85 3 58 61 5 79 84 5 79 84 5 79 84 April 5 80 85 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscella- neous (Q.M.C., etc.). Total. Medical Depart- ment. Miscella- neous (Q.M.C., etc.). Total. 1918. 2 1 1 4 63 63 September 5 1 1 139 139 15 2 1 IS 167 167 60 2 2 64 650 December 92 2 2 96 853 35 8S8 166 1919. January 90 6 3 99 960 64 1,024 274 February 91 6 4 101 880 106 9S6 261 March 90 6 4 100 SSO 99 979 262 April 97 4 106 913 913 270 May 87 5 4 96 877 S77 273 June 64 4 3 71 70S 70S 270 a Compiled from monthly returns andsiek and wounded reports (Form 52) to the Office of the Surgeon General, on file Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). b Sick and woimded figures, above, do not include patients invalided to the United States from Europe and held in hospital for a few days only while awaiting transfer to other hospitals. (Letter from The Adjutant General to command- ing generals, ports of embarkation, on disposition of medical records for patients invalided to the United States. A. G. O., “E. E.” Misc, Div.) CHAPTER XXIV. EMBARKATION HOSPITAL, NEWPORT NEWS, VA.“ LOCATION. The embarkation hospital at Newport News, Va., was located to the east of the city of Newport News, along the shore of Hampton Roads and adjacent to Camp Stuart on the northeast, the total area occupied by the hospital being in the neighborhood of 35 acres. As 19 of the wards of the hospital were constructed along the north shore of Hampton Roads, within a few feet of the water’s edge, a beautiful outlook was afforded. The advantages of the location, however, were somewhat offset by the presence of Salters Creek, a small tidal stream which skirted the boundary of the hospital grounds and created a considerable expanse of lowland marsh. The creek was also disadvantageous in that it was the means of conveying a large amount of sewage from the northeastern portion of the city of Newport News; and the marshes required a great amount of drainage and filling in in order to prevent them from becoming a serious menace by reason of the favorable conditions they presented for mosquito breeding. The terrain was flat and the country open for the greater part of the hospital site. This ground had formerly been used for a truck garden and was in a high stage of cultivation. Its soil was of sand and as the hospital site was exposed there was a resultant high degree of discomfort from flying dust in dry weather, ameliorated somewhat by subsequent planting of grass and flowers. The climate was moderate in winter and the heat of summer was tempered by breezes. Good roads of concrete or macadam ran directly to the hospital, making for ease of access from the camps and the city of Newport News, and a main line of the street-car system passed directly through the northeast corner of the hospital grounds. BUILDINGS. Construction of the hospital continued through five projects. It was originally designed to accommodate about 250 beds, and consisted of 8 wards with the necessary kitchens, mess halls, quarters, latrines, and storehouses, but before they were ready for occupancy it became necessary to increase the number of wards to 16. Six wards were of the standard one-story type, designed for base hospitals, with screened porches on the front and one side. The second addition to the hospital was begun early in the spring of 1918, and consisted of three two-story barrack wards, one of wood and two of hollow tile a The statements of fact appearing herein are based on the “ History, Embarkation Hospital, Newport News, Va.,” by Maj. W. C. Rucker, U. S. P. H. S., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General's Office, Washington, D. C. — Ed. 451 EMBARKATION HOSPITAL NEWPORT NEWS, VA. 452 MILITARY HOSPITALS IN THE UNITED STATES. TTTBT-8 HiHOU TYPES OF HOSPITALS EMBARKATION HOSPITAL. 453 and stucco construction. At the same time, the original buildings designed as barracks for the detachment of the Medical Department were converted into wards, made possible by utilizing camp barrack buildings for barracks for the hospital personnel. The third addition to the hospital was started early in the summer of 1918, and comprised three isolation wards, six two-story barrack wards and five two-story standard wards. In addition to these wards, one prison-ward building, one large kitchen and mess hall, and additional nurses’ quarters were developed by the conversion of the buildings originally designed as storehouses; and one building was especially designed for the housing of the activities of head surgery, the dental department, and the department of eye, ear, nose, and throat. The fourth addition was started before the completion of the third, in the midsummer of 1918, and consisted of the development of the necessary Pig. 159. — Headquarters, Debarkation Hospital, Newport News, Va. utilities to serve the increased capacity of the hospital. Additional officers’ quarters, storehouses, and the conversion of two standard one-story wards into a building for the accommodation of patient officers were included. This last phase of construction was completed about January 1, 1919. A specially designed laboratory, a large two-story hollow tile and stucco building completely equipped for this special purpose, was erected during the winter of 1918. Early in the spring of 1918 a detention camp for venereal disease was constructed in block 17 of Camp Stuart, to the northwest of the hospital grounds. This detention camp was composed of 103 tent frames, a large mess hall, and a treatment house, the entire camp being surrounded by an 8-inch wire-mesh fence. 454 MILITARY HOSPITALS IN THE UNITED STATES. During the fall of 1918 two more camps of a similar nature were designed, and these were erected on a tract of leased property to the west of Camp Stuart, and extended from Hampton Roads northward for one-half mile. Construc- tion of these two later camps was completed early in December, 1918. The bed capacity of the hospital at its completion was 1,754 in the hos- pital proper, and 1,800 in the three venereal camps, making a total bed capacity of 3,564. In a general way, the main line of wards extended directly along the shore of Hampton Roads; and the buildings used for administrative purposes, mess ft Fig. 160. — General view of Embarkation Hospital, Newport News, Va., showing central heating plant. hall, quarters for officers, quarters for nurses, storehouses, etc., extended inland from the wards, all buildings being connected with covered corridors. OCCUPATION OF BUILDINGS. The first group of overseas patients arrived on the U. S. S. George Wash- ington, on January 18, 1918, and on January 21, 1918, the hospital proper was opened, but the barracks in block 2 of Camp Stuart continued to be used for hospital purposes until finally closed and turned back to the camp authorities on April 2, 1918. HOSPITAL WATER SUPPLY. The hospital water supply was identical with that of Camp Stuart and the city of Newport News; the supply for Camp Stuart was taken directly from the city mains. Three large storage tanks located near the entrance to the camp guaranteed an adequate reserve and sufficient pressure for emergencies and for fire protection. TYPES OF HOSPITALS — EMBARKATION HOSPITAL. 455 SEWAGE. The sewage from the hospital drained into the main sewer of Camp Stuart, through which it was carried to two septic tanks, the affluent flowing into Salter Creek and then to the James River. The septic tanks were of suffi- cient size to allow for five to six hours settling time, which was adequate to render the affluent free of harmful organic matter. Surface drainage of the grounds was maintained by ditching and by storm sewers which emptied from one main outlet directly into the James River. HOSPITAL GARBAGE DISPOSAL. Garbage and other wastes were separated into the following classes : Fats, bone, paper, bottles, rope, tin cans, and other garbage. Most of this waste was turned over to the reclamation service, the remainder being disposed of by a private concern. LAVATORIES AND BATHS. All the wards except the temporary wards had separate bathrooms with shower and tub baths, washbowls, urinals, and closets. The temporary wards, venereal tent hospital, and barracks for enlisted personnel were equipped with standard latrines adapted for camp use. These latrines furnished toilet facili- ties and were also fitted with shower baths and the necessary apparatus for heating water. All of the hospital baths and latrines were fitted with modern plumbing and drained into the general sewerage system of the camp. HEATING. The hospital was steam heated from a central plant, which also furnished hot water for the various wards and kitchens by a high and low pressure sys- tem. The plant was equipped with 10 boilers. There was in addition a sepa- rate smaller plant for maintaining the sterilizers and for heating the operating rooms in case of emergency. HOSPITAL LIGHTING. The buildings and the grounds of the hospital were lighted by electricity, which was obtained from Newport News. For lighting purposes this was adequate, but much difficulty was encountered in securing the current neces- sary for the successful operation of the X-ray apparatus. HOSPITAL KITCHEN AND MESS. The hospital mess comprised three separate establishments : One for officers, one for nurses, and one for the patients and enlisted personnel. The officers’ mess consisted of two kitchens and mess haffs, each of which had its own organization and management. The nurses’ mess comprised one kitchen and mess hafl, located in the nurses’ quarters, and was operated under the super- vision of the chief nurse. For the feeding of the enlisted personnel and patients seven kitchens and mess halls were maintained under the direction of the hospital mess officer. Five of these kitchens were of the standard type, built 456 MILITARY HOSPITALS TN THE UNITED STATES. for the various camps and cantonments, for the feeding of troops, two of them being used for feeding the detachment of enlisted men, and three were con- nected with the venereal camp hospital and the temporary wards, where the patients were suffering only from such ailments as would not prevent their going a short distance for their meals. The remaining two kitchens were for feeding patients at the hospital proper. One of these, a smaller kitchen origi- nally designed for the mess of the detachment, prepared only regular diets for patients from wards 14 to 19. All of the other cooking was accomplished at the main kitchen, which was located centrally and was equipped with mod- ern kitchen appliances, such as steam boilers, ranges, and dish-washing machinery. One of these rooms was entirely devoted to the preparation of Fig. 161. — Interior of power and heating plant, Embarkation Hospital, Newport News, Ya. special diets, with a trained dietitian in charge. The main storeroom for food supplies and for meats was also located at this place. Foods to be served in the wards were conveyed from the kitchen in food carts. Each ward had a small diet kitchen, equipped with an electric stove and steam table, where the food received from the main kitchen could, if necessary, he reheated and served. Easily cooked articles, such as eggs, were prepared hi these ward kitchens, and cutlery and dishes for use in the wards were also cleaned and stored there. An additional kitchen and mess hall to be used exclusively for wards containing patients suffering from contagious diseases was later con- structed. TYPES OF HOSPITALS EMBARKATION HOSPITAL. 457 HOSPITAL LAUNDRY. Although a building was erected for use as a hospital laundry, it was never placed in operation because of the impossibility of obtaining essential machinery. A large steam sterilizer for the sterilization of clothing and bed- ding occupied one end of this building, the remaining space being used largely for storage purposes. The need of a laundry for the hospital was felt greatly, as the laundry at Camp Stuart was often overtaxed and therefore unable to to render the prompt service necessary to meet hospital demands. QUARTERS. Officers on duty at the embarkation hospital were furnished quarters at the hospital. Two buildings were in use for this purpose and were known as Fig. 162— Nurses’ recreation building. Embarkation Hospital, Newport News, Va. officers’ quarters No. 1 and No. 2. Officers’ quarters No. 1 was the building originally designed for housing the officers, but, although additions were made later, it proved entirely inadequate, and on April 1, 191S, officers’ quarters No. 2 was established in the barracks originally occupied by officers of one of the Infantry regiments. The hospital then had quarters for the accommodation of about 90 officers. The buildings were partitioned into rooms, each of which was occupied by two officers. Bathrooms and mess halls were located in each building. A four-room cottage pleasantly located on the back, overlooking Hampton Roads, was set aside for quarters for the commanding officer of the hospital. The rapid growth of the hospital, requiring, as it did, increased quarters for officers, likewise soon led to a shortage of quarters for nurses. As originally planned the nurses’ quarters were identical in size and construction with the 458 MILITARY HOSPITALS IN THE UNITED STATES. officers’ quarters and did not permit of further additions. Consequently, authority was requested and granted to make the changes necessary to convert storehouse No. 1, located near by, into a suitable nurses’ quarters. This was done and they were occupied on July 6, 1918. Storehouse No. 2 was trans- formed into quarters with an accommodation of about 150 nurses. The nurses’ quarters were very comfortable and well heated. A recreation house for the nurses was supplied by the American Red Cross and was completed in October, 1918. It was located in a very desirable place on the water front and was a source of great pleasure and usefulness to the nurses. HOSPITAL STOREHOUSES. There were two large storehouses connected with the hospital. One of these storehouses was used for the storage of Medical Department supplies and one for the storage of quartermaster property. They contained the offices of the medical supply officer and the quartermaster, respectively. Storage space, however, was entirely inadequate and it was necessary to use temporary structures for this purpose. FIRE PROTECTION. At its inception the embarkation hospital had practically no protection against fire. Four telephones were installed in November, 1917, providing the only means of communication through Camp Stuart to the nearest fire company, a municipal company on Twenty-fifth Street. No additional telephones were installed until January 1, 1918, when an order was issued causing the installation of a switchboard and 20 telephones. In December, 1918, owing to the rapid growth of the hospital, anew switchboard to accom- modate 100 telephones was authorized, although this was not installed until April, 1919. While not comparable in rapidity and accuracy with fire-alarm boxes for the report of a fire to the engine house, the telephone system, until April 15, 1919, was almost the only communication with fire-engine companies. In January, 1918, Engine Company No. 3, consisting of 15 men, was recruited from among the firemen of the larger cities and placed in commission at Camp Stuart on the 25tli of that month. Engine Company No. 4, in Camp Stuart, recruited from post organizations, did not go into commission until September, 1918. The first fire-alarm boxes were installed but their installation was not completed until September 28, 1918. They were placed at long intervals and were completely omitted from the isolation and Chestnut group of buildings. In the fall of 1918 the constructing quartermaster began work on the roads and fire trails around and through the hospital. Previous to that tune two tarvia roads had been built, one in front of officers’ quarters, adminis- tration building, and receiving wards, and the other running past the power plant and nurses’ quarters to storehouses Nos. 4 and 5. Necessarily, in muddy weather, a great portion of the hospital could not be reached by the heavy fire trucks, so beginning in October, 1918, ramps were cut across all corridors and tarvia fire trails were built, thus making fire hydrants easily accessible to fire-fighting apparatus. One fire trail was greatly delayed in the building because of the hydraulic fill. In place of the tarvia road over this fill, a road- way of 2-inch lumber was built from the laundry, thus making the fire hydrants TYPES OF HOSPITALS — EMBARKATION HOSPITAL. 459 in that section easy of access. In January, 1918, three hose reels were installed by the constructing quartermaster, one on the corridor of ward 6, one at ward 16, and the other at officers’ quarters No. 2. In January, 1918, seven months after the opening of the hospital, the first chemical fire extinguishers were put in, numbering about 70. Six months later 50 additional extinguishers were obtained, but it was not until March, 1919, that the hospital was able to secure chemical carts, at which time 14 40-gallon pumps were delivered and placed advantageously about the corridors. The full equipment in April, 1919, comprised 309 3-gallon extinguishers, 14 40-gallon chemical trucks, and 3 hose reels, complete. Until October, 1918, one 6-inch main from Camp Stuart furnished the hos- pital with water. In this month an additional 8-inch main was connected with the hospital system, the two mains giving ample water supply when Camp Stuart was not full of troops, but when many water outlets were in use those farthest from the main could not get water at all. Camp Stuart itself had but one 12-inch main until April, 1919, when an additional 16-inch main was laid. In April, 1919, the Aero Fire Alarm Company completed the installation of the fire-alarm system. This system was both automatic and mechanical. The automatic part consisted of circuits of one-sixteenth-inch copper tubing, ter- minating in unit sets of fire-alarm boxes. This tubing, strung over the ceilings of rooms and corridors, contained air at atmospheric pressure which, expanding when subjected to heat, vibrated a delicate diaphragm releasing a drop, thus completing the circuit to the transmitter which, in turn, transmitted the cur- rent to all the devices that rang the gongs and punched the recording tapes at all such installed apparatus. An automatic interlocking device prevented any confusion resulting from simultaneous alarms, one alarm being held until the other was completed, allowing an appreciable interval, when the second alarm was released and recorded by gongs and tape. An automatic device recorded the air pressure so as to prevent false alarms resulting from a sudden rise in temperature due to natural causes. In the embarkation hospital the automatic-alarm system comprised 62 circuits, using approximately 95,000 feet of tubing. The whole hospital was thoroughly wired, and the 62 unit sets were placed one in each ward and at frequent intervals elsewhere about the hospital. Gongs were placed in the home of the commanding officer, in the administration building, in the main mess hall, in officers’ quarters No. 1, and in the nurses’ quarters. Punch registers, which accurately recorded the number of the box sending in the alarm, were placed in the administrative building and in the mess hall. So far as equipment went, the embarkation hospital was not completely protected until after the hospital had been in service 17 months. During the construction period the heaps of debris from carpenter work constituted a dangerous fire hazard. 7 405 June 471 46 557 70 1,144 403 11 66 1 22 119 497 10 14, 698 246 July 507 42 497 91 1,137 378 4 44 1 1 127 1 15. S71 306 575 40 853 130 1,598 696 6 122 6 13 136 619 17,415 126 619 27 807 113 1,566 681 6 66 8 101 699 5 19,408 181 October 704 32 817 126 1,679 630 7 151 2 8 6 123 746 6 25’ 238 244 November 752 54 590 125 1,521 7 113 2 3 104 730 4 22,491 140 December 734 42 704 144 1,624 496 8 152 1 15 3 105 S3S 6 19; 060 151 1918. January 844 50 776 109 1,779 745 14 140 3 90 10 10, 185 17 February 787 30 567 81 1,465 525 7 94 4 7S 9. 21,317 205 March.." 757 54 580 125 1, 516 522 2 94 3 114 773 8 22, 344 351 April 781 41 715 128 1,665 614 13 92 1 1 3 120 810 11 25, 143 259 May 821 29 571 133 500 2 59 4 12S 6 26, 540 297 June 861 26 953 124 1,964 699 4 37 2 101 1,108 13 5.183 289 July 1,121 40 873 158 2, 192 851 9 47 4 149 1,124 8 36, 114 213 August 1,132 34 146 1,879 630 7 3 138 1,042 14 227 September 1,056 21 327 103 1 , 507 565 6 57 1 2 96 17 297 October '775 120 1,009 176 2 , 080 716 44 42 1 135 1,114 18 421 November 1, 132 54 470 108 1,764 729 33 43 168 770 16 26. 101 415 December ' 7S6 64 920 173 1,943 619 19 132 6 276 886 5 27.7S2 449 a Including patients on a civilian status. l> Compiled from monthly returns and sick and wounded reports (Porm 52) to the Office of the Surgeon General, on file, Medical Records Section,' Adjutant General's O ffiee: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS 493 Statistical data , United States Army General Hospital, Presidio of San Francisco, Calif., from April, 1917, to December, 1919 , inclusive — Continued. SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for . Completed cases. Remaining. Aggregate number of days lost from sickness. From command From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. Hospital. Quarters. 1919. 891 91 943 232 2,157 744 19 82 16 260 1,001 35 31,842 899 1,036 53 629 202 1 , 920 520 16 89 1 224 l]026 44 28' 305 1,161 1,070 52 659 211 1, 992 433 5 84 1 16 249 1, 143 61 33 '83 7 l] 502 1,204 50 655 244 2 , 153 414 ctober 11 1 2 14 110 10 120 20 N ovember 14 1 1 16 163 12 175 25 December 27 2 1 30 191 24 215 34 1918. January 22 2 1 25 189 23 212 41 February 32 2 1 35 239 44 2,83 48 March 51 3 3 57 291 90 381 71 April 56 3 3 62 436 99 535 102 May 58 4 3 65 393 93 486 130 June 58 2 3 63 378 92 470 134 July 62 3 2 67 369 94 463 133 August 62 5 2 69 465 95 560 112 September 70 5 2 77 417 95 512 150 October 59 6 3 68 431 72 503 145 N ovember 67 8 4 79 467 70 537 153 December 74 10 4 88 498 93 591 128 1919. January 73 9 5 87 000 107 662 107 February 79 s 5 92 491 111 602 112 March 81 9 5 95 522 102 624 113 April 79 9 3 91 481 S3 .564 126 May 72 8 3 83 45S 62 520 124 June - 58 10 5 73 437 29 466 131 July 45 12 4 61 427 1 42S 13S 51 3 54 409 5 414 145 32 32 363 6 369 104 4 4 1 1 1 GENERAL HOSPITAL NO. 4. FORT PORTER. BUFFALO, N. Y. General Hospital No. 4 was located at Fort Porter, N. Y., in the city of Buffalo, between Massachusetts and Connecticut Streets, on the north and south, and Front Street and Niagara River on the east and west. Being situated on a 60-foot bluff at the northeast end of Lake Erie, where the lake opens into its outlet, the Niagara River, the site commanded an excellent view of Lake Erie, Niagara River, and the Canadian shore. The reservation covered about 28^ acres and was practically a continuation of the north end of one of Buffalo’s parks, “The Front.” Fort Porter had been an Infantry garrison, and there were about 40 post buildings comprising 20 sets of quarters for officers and noncommissioned officers, four barracks, a hospital, several storehouses and magazines, a head- quarters building, a bakery, stables, sheds, etc. These buildings faced either outwardly upon the surrounding city streets, or inwardly upon two open OTHER GENERAL HOSPITALS. 499 areas — the drill ground and the parade ground. The post used the light, sewerage, and water systems of the city of Buffalo, and the buildings were heated, for the most part, by separate steam-heating plants. 19 The hospital site was exposed to much high wind, principally winds from the southwest and west. The winters were severe, with sudden changes in temperature, but the summers were delightfully cool. The average tempera- ture for the entire year was 48°. On October 16, 1917, the Surgeon General requested the use of Fort Porter for general hospital purposes. 20 This request was approved by the Secretary of War 10 days later, and on November 10 the post was named General Hospital No. 4, and as such was opened at once. 21 Some renovation, repair, alterations, and additions had already been instituted by the Surgeon General, but con- siderably more was necessary. No great expansion was contemplated because of the limited area available, and plans for remodeling were left to the local commander. In the spring of 1918 the commanding officer of the hospital furnished the Surgeon General a plan of development, which plan was approved by the War Department only in part, and construction based on the modified plan was requested. As it was impossible to economically make a large hospital at the place, it was decided to develop only the existing buildings and use the hospital for the special treatment of the insane. 22 Meanwhile, improvements and alterations were being accomplished. Compared with other general hospitals, relatively little construction work was done here, and the most of it was accom- plished in the later months of 1917 and the early months of 1918. During this time the hospital had been fully operating as a general hospital; and subsequent to November 10, it had been caring for the sick except during a period of two weeks in January, 1918, when it was closed for repairs. At first, general medical and surgical cases of a minor character were sent to this hospital for treatment ; later, its activities were restricted to the care of mental cases only, the first patients of this class being admitted in February, 1918. 23 Later still, after better facilities for the treatment of the insane had been provided at General Hospital No. 43, Flampton, Va., all mental cases were transferred from General Hospital No. 4 to that hospital, and the treatment of neuroses only was continued at General Hospital No. 4, until the date of its closure, November 9, 1919. 24 500 MILITARY HOSPITALS IN THE UNITED STATES, Statistical data, United States Army General Hospital No. 4, Fort Porter, N. Y.,from November, 1917 , to October, 1919, inclusive . a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. Hospital. v: C3 1917. November 13 12 25 8 10 y 204 December 7 17 20 44 26 5 13 485 1918. January 13 9 11 33 25 1 3 1 3 246 13 February 3 5 27 6 41 6 1 31 3 19 March 34 17 28 3 82 24 5 1 52 1,930 April 52 35 38 5 130 60 2 30 1 36 1 1 340 15 May 37 9 97 2 145 27 27 2 89 1 944 3 J une 89 7 69 7 172 16 1 26 2 1 126 3,223 July 126 95 16 237 18 1 4 i 168 4, 736 August 168 20 125 9 322 42 1 55 13 3 206 2 5 949 28 September .. 208 30 112 11 361 46 35 2 228 6 . 598 85 October 233 71 173 17 494 160 9 50 1 15 2 250 9 385 353 November 257 23 249 14 543 52 5 57 141 6 280 2 144 December 282 17 242 7 548 38 37 3 30 204 1 234 1 6,354 38 1919. January 235 46 54 6 341 55 2 40 1 1 4 4 228 6 6 767 161 February 234 35 90 3 362 94 1 43 5 36 2 1S1 1 . 069 March 181 48 82 7 318 34 2 10 2 4 2 261 3 8, 275 149 April 264 70 43 4 381 74 2 22 2 11 3 263 4 176 May 267 51 91 7 416 53 2 22 10 1 320 s 8. 038 96 June 328 27 79 4 438 1 73 1 119 193 1 7,871 101 July 194 34 174 8 410 119 81 193 2 6,546 5, 660 53 August 195 23 100 2 320 93 69 1 10 145 September 147 22 42 2 213 30 57 118 1 6,446 76 October 119 10 5 2 136 20 1 59 2 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 1919. 1 34 12 47 1 50 6 1 34 12 47 February 1 49 32 16 48 1 33 16 49 April 1 60 34 16 50 May 40 50 97 July 33 14 47 13 64 4 81 35 15 50 July 6 49 4 59 1 30 17 48 13 64 4 81 47 62 September 13 64 4 SI 50 15 65 0 0 0 0 December 54 6 60 a Compiled from monthly returns, and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS. 501 Statistical data, United States Army General Hospital No. 4. Fort Porter, N. Y.,from November, 1917 , to October, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M.C., etc.). Total. 1917. 4 4 22 35 57 5 1 1 7 22 32 54 1918. January 6 2 1 9 37 28 February 5 2 1 8 51 33 84 12 March 8 2 1 11 114 39 153 12 April 10 2 2 14 127 46 173 11 May 10 2 2 14 148 45 193 15 .1 une 11 2 2 15 172 45 217 15 July 13 2 2 17 151 55 206 14 August 10 4 3 17 144 54 198 15 September 10 4 3 17 142 56 198 15 October 12 4 2 18 170 48 218 15 November 11 5 2 IS 165 55 220 41 December 12 5 3 20 168 65 233 34 1919. January 11 5 3 19 193 72 265 33 February 19 5 3 27 195 72 267 31 March 17 5 4 26 262 60 322 29 April 18 5 5 28 254 54 308 37 May 19 5 5 29 246 39 285 32 June 19 3 5 27 235 27 262 37 July 21 3 3 27 233 14 247 34 August 20 3 3 26 200 26 226 30 September 16 2 4 22 177 35 212 28 October 6 2 1 9 36 37 73 27 GENERAL HOSPITAL NO. 5. FORT ONTARIO, N. Y. Fort Ontario is located in the city of Oswego, county of Oswego, New York State, at the mouth of the Oswego River. The Oswego River, the south- western boundary of the reservation, empties into Lake Ontario. The lake is the north and northwestern boundary of the reservation, and the city of Oswego, on the south, is the southeastern boundary . 25 The tract owned by the Government at Fort Ontario comprises 55 acres. It is about 275 feet above sea level and was graded and filled to a depth of about 6 feet. The contour of the land is such, ranging in elevation from 50 feet above the level of Lake Ontario, at the northwest corner, to 18 to 20 feet above the lake level along the eastern boundary, that it has a natural drainage. 25 Fort Ontario was built by the English under Governor Shirley, in 1755, captured and destroyed by the French under Marquis de Montcalm, in 1756, rebuilt by the English under Lord Amherst, in 1759, destroyed by the Ameri- cans about 1788, and again rebuilt by the English in 1792 and surrendered by them to the Americans in 1796, it being the last military post to be evac- uated by the English in the United States after the War of the Revolution . 25 Ever since the year 1796 Fort Ontario has been a United States military post, garrisoned by United States troops, and the site upon which it was located has been owned by the United States Government. During the year 1814 it was captured and destroyed by an English fleet under Admiral Yeo, and was rebuilt of earth and timber construction by the United States Gov- ernment in the year 1839. It was again rebuilt of stone and concrete con- struction about 1863. As constructed in 1839 and reconstructed in 1863, the post occupied only a small part of the tract of land owned by the Government, 502 MILITARY HOSPITALS IN THE UNITED STATES. and that part which was utilized was situated in the northwest corner of the reservation and was referred to as the "Old Fort.” In 1903 the reservation property was again improved; the "Old Fort” was abandoned and practically all that part of the land which had previously been used was filled and regraded and utilized either as building sites, for roads, or for the parade ground. New buildings of brick structure were erected, water lines and sewage systems were installed, and the capacity of the post was increased to accommodate a battalion of Infantry. 25 Being located on the shore of Lake Ontario in rather an exposed position, Fort Ontario was subjected to high winds from off the lake; in winter it was usually quite cold, with considerable snow, though in summer a moderate temperature obtained. The country surrounding the fort was of the rolling, partially wooded type, and was principally farm land. Tig. 169— Portion of General Hospital No. 5, Port Ontario, N. Y. The soil was a mixture of gravel and lime, of rather a clay type, and there was very little dust in dry weather or mud in rainy weather. The grounds of the reservation were cultivated and covered with a good variety of grass. The roads of the reservation were macadam, a crushed stone base with an oil binder, and were well kept. Those of the city were brick, concrete, macadam, or good dirt roads. There was but one main stream in the vicinity, the © Oswego River. The parade ground, located in the center of the post, was about 600 feet wide and extended from a point about 800 feet from the southwest corner to a point about 800 feet from the northwest corner of the post. The post of Fort Ontario made a desirable place for hospital purposes: and on July 3, 1917, the Secretary of War, upon request of the Surgeon General, authorized the use of "such barracks as may be necessary for base or general hospital purposes.” 26 On the day of the approval of his request the Surgeon General wired the surgeon, Eastern Department, to direct the post surgeon, OTHER GENERAL HOSPITALS. 503 Fort Ontario, to plan a base hospital and to make telegraphic request for necessary additional buildings. In the late summer work on remodeling and improving the existing buildings was begun. In the fall some common wards, X-ray facilities, additional barracks, and a heating plant were authorized. 27 On March 1 , 1918, a fairly comprehensive schedule of construction was called for, consisting of a receiving building, a laboratory, an operating pavilion, a mess and kitchen, an officers’ ward, barracks and wards planned to add 280 beds to the hospital capacity. This request came from the field and was estimated to cost $131,922. Twelve days later the cantonment division of the Quartermaster General’s Office informed the Surgeon General that $145,300 would be required. The expenditure of this amount was approved. On April 23, due to a change in the wording of the appropriation, it was necessary to return the approved request to the Surgeon General’s Office for the approval of a still greater sum. By this time 10 per cent had to be added to the esti- mated cost, due to an increase in prices since the project was initiated March 1, increasing the total to $192,910. This sum was approved by the Surgeon General’s Office and the request returned for construction May 3, 28 and on June 10 actual construction work began. In August additional construction, buildings, corridors, the installation of equipment, etc., caused the total expenditures to be $281, 550. 29 In all, 30 new buildings of frame material were constructed. They were located by local authority and so placed about, and at the rear of, existing buildings that the parade ground remained free for recreation purposes, and the whole was connectible by closed corridors. The permanent barracks buildings and other post buddings were of stone foundation, brick buddings with slate roofs. The buddings put up as addi- tional for hospital use were of the standard temporary construction used in all camps. The operating pavilion was located on the first floor of one of the permanent barracks buildings and consisted of three operating rooms, anesthet- izing rooms, sterilizing room, instrument room, scrub-up rooms for officers and one for nurses, linen closets, and a recovery ward, completed September 1, 1918. 30 All the construction authorized was completed by January 22, 1919. The water used at Fort Ontario was purchased from the water department of the city of Oswego and supplied from water mains extended from the city mains. The water was obtained from Lake Ontario, the intake pipe being about 1 mile from the shore, from which place it was pumped to the pumping station, where it was oxygenated by spraying into a reservoir and chemically treated by the chlorination method. 31 This water was piped to all wards. Water lines were extended to supply the newly constructed buildings and to furnish a greater supply of water to the hydrants for fire protection. The sewerage system in existence was extended so that all newly constructed buildings were properly provided for. The mam sewer was sufficient in size to take care of the extensions and additions to the system. 32 In the beginning, before the mess halls and kitchens had been erected, the detachment and patients’ messes were separate, one barracks building being used as a mess and kitchen for the detachment, while one ward in the perma- nent barracks building, which was supplied with stoves, was used as the patients’ kitchen and mess hall. 33 Later a large building was completed, which contained a kitchen, diet kitchen, and mess hall, with accommodations for 504 MILITARY HOSPITALS IN THE UNITED STATES. about 700 persons at one time. The detachment and patients then messed in the same hall and the menu only was different. Bed patients confined to wards were fed also from the main mess hall. 34 The carriers used were larse containers built on the thermos principle for the purpose of keeping food hot or cold as the case might be. Mess for all patients was under the observation of the ward surgeon and all messes were under the direction of the mess officer. The officers’ quarters comprised seven brick buildings, six of which were double houses, and a single house used by the commanding officer. Under ordinary circumstances these quarters were used for 13 officers and their families; however, with the large number of officers at this post they were divided up so that a few married officers with their families were assigned two or more rooms and single officers one room. At first the nurses were quartered in two of the officers’ quarters 33 but sub- sequently nurses’ quarters were erected, 30 which in addition to one of the officers’ quarters caused only one or two nurses, rarely more, to occupy one room. The detachment, enlisted personnel, was quartered at first in the perma- nent barracks, and later, when these were required for wards, the new tem- porary barracks were used, 33 each having a capacity of 46 men. At one time it was necessary to establish a camp for the use of the detachment and the men were then quartered in tents. This hospital functioned as a general hospital for the treatment of medical, surgical, and venereal cases, 35 and as a reconstruction hospital. On September 1, 1919, it ceased to exist as a general hospital. Statistical data, United States Army General Hospital No. 5, Fort Ontario, N. Y.,from November, 1917 , to September 3, 1919, inclusive. a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. Hospital. B 1917. November 170 67 89 1 327 156 60 1 1 5 1 101 3, 72S 144 103 46 26 6 181 92 22 67 2,617 48 1918. B7 54 172 293 69 2 11 1 210 210 210 67 5 282 99 1 21 i 158 2 5,118 S 100 38 9 4 211 59 1 61 90 3, 567 Vnril 90 33 10 133 53 37 2 41 1, 7S3 Mo v 41 35 11 45 3 37 2 1, 105 s Ii]nu 39 49 56 144 43 2 1 98 2,293 1 July 98 49 233 70 1 162 3, 801 1 02 43 798 1,003 129 2 2 S70 13, 761 .870 158 030 l' 664 468 23 3 1 1,169 2S, 270 1 1 0Q 115 38 1,322 61 4 3 5 593 30, 376 *593 43 253 889 195 ii 2 10 671 19, 695 s 671 48 194 1 914 2 2 1 35 2 327 16, 957 1919. 327 69 179 1 134 1 IS 1 1 1 105 16 299 6, 019 2QQ 180 1 84 1 3 1 1 53 11 407 3,864 407 1 1 1 500 61 1, 145 169 4 4 6 360 602 18,501 002 99 316 1, 182 149 1 23 111 363 21,994 May 035 66 571 190 1, 362 113 2 16 10 402 S19 18, 264 81 Q 60 688 l, 822 297 2 616 885 25, 242 July 39 270 1 65 9 289 3 3 19 719 626 27, 487 020 28 9 123 779 149 16 270 315 2S i 14, 582 28 1 2 31 8 16 13 16 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General s Office (name of hospital). OTHER GENERAL HOSPITALS. 505 Statistical data , United States Army General Hospital No. 5, Fort Ontario, N. Y., from November, 1917, to September 3 , 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Y ear and month. Men. Women. Chil- dren. Total. 1917. November 2 45 17 64 December 2 43 17 62 1918. January 1 37 14 52 February 1 30 14 51 March 1 39 1.5 55 April 1 11 12 24 May 1 11 12 24 1 11 12 24 July 1 11 12 24 August 1 11 12 24 September 1 11 12 24 October 2 11 12 25 Year and month. Men. Women. Chil- dren. Total. 1918. November 2 9 12 23 December 2 11 n 24 1919. January 2 14 8 24 February 2 14 8 24 March 3 35 12 50 April 2 22 10 34 May 2 32 10 44 J urie 35 36 10 81 July 73 34 10 117 August 66 16 10 92 September 66 4 10 80 PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total . Nurses. 1917. November 19 1 20 155 24 179 24 20 1 21 172 21 193 12 1918. 19 1 20 185 21 22 206 17 February 20 1 21 191 213 25 21 1 22 22 195 24 219 25 21 1 196 26 222 27 21 1 22 201 27 228 22 20 1 21 208 25 233 18 July... 19 1 20 228 25 253 16 20 4 1 25 214 27 241 33 26 4 1 31 307 35 342 56 25 5 1 31 534 53 587 105 27 4 3 34 433 486 96 28 4 1 33 568 53 621 91 1919. 23 7 1 31 581 54 635 75 25 7 2 34 596 54 650 71 34 6 2 42 798 32 S30 71 30 6 2 38 761 31 792 60 31 6 2 39 45 731 19 750 63 38 5 2 715 16 731 61 July 30 5 3 38 516 17 533 71 26 2 4 32 345 15 360 50 2 2 12 12 GENERAL HOSPITAL NO. 6, FORT McPHERSON, GA. Fort McPherson, 4 miles to the southeast of Atlanta, was named in honor of Gen. J. B. McPherson, commander of a corps of Sherman’s army. The terrain is hilly and heavily wooded with red oak and pine. The soil is a sandy red clay, sticky when wet and easily carried, but the excellent condition of the grounds obviated this. The roads of the post were well watered and oiled, which prevented dust from scattering in dry weather. The climate, during the period covered by the history of the hospital, offered no extremes in seasons, the summers being warm but not oppressively so. During summer the days were hot, but the nights were cool, and the 506 MILITARY HOSPITALS IN THE UNITED STATES. GENERAL HOSPITAL NO. 6 FORT MCPHERSON GEORGIA H PERMANENT BUILDINGS. WWft TEMPORARY >1 WELFARE .■» Fig. 170. OTHER GENERAL HOSPITALS. 507 humidity was seldom high. The winter cold rarely started before January. There was little snow, but considerable sleet and ice, which was more in the nature of frozen mist. The winds were frequently high in wintry weather, sometimes extending into early spring. The roads consisted of macadam, asphalt, and tarvia. The Dixie High- way passed the eastern side of the post. While the road construction was good, the maintenance was very poor, the condition of the main highway leading to the hospital being at times dangerous to traffic. The first important step in the establishment of the hospital was taken on June 23, 19 17, 38 when the Secretary of War, through The Adjutant General of the Army, directed “ that the permanent barracks of Fort McPherson * * * be made available for general or base hospital use. ’ ’ A little over a month later, on July 31, the commanding officer of Fort McPherson was directed to "get in touch with the commanding officer of the hospital to be established at Fort McPherson, and endeavor to arrange a complete transfer of administra- tion to the hospital authorities” simultaneously with the withdrawal of his troops. 36 Within a few weeks — on August 20 — the transfer was effected, 36 the post being turned over to the senior medical officer, by the commanding officer of the Seventeenth Infantry, on the departure of that regiment — and thus began the base hospital at Fort McPherson. On December 2, 1917, it was directed by telegraphic information that the base hospital at Fort McPherson be designated General Hospital No. 6, this being confirmed a few days later by receipt of General Orders, No. 150, War Department, November 29, 1917. The permanent buildings consisted of a guardhouse, a two-story head- quarters building, a two-story officers’ clubhouse, and 18 two-story houses (for officers) extending along the northern side of the parade ground. Fourteen of these houses were double, being designated east and west. There was also a row of two-story brick barracks extending along the southern side of the parade- ground, which had verandas on both floors and a northern and southern expo- sure, and 2 two-story double machine-gun barracks, one facing north and the other facing west. Along the southeastern margin of the post, skirting the Dixie Highway, were the various quartermaster buildings. 37 In addition to these brick buildings, there was a number of frame buildings located in differ- ent portions of the post and used for storehouses by the Quartermaster Depart- ment, which were frame buildings originally erected on the parade ground for the reception of patients during the Spanish American War. General Hospital No. 6 had its beginning in the post hospital, a two-story brick building, with 2 one-story wings, one running south and the other run- ning north. This was the original post hospital, the central two-story portion serving as the administrative offices of the hospital, and the wings as medical and surgical wards, each accommodating about 20 patients. Early in the summer of 1917 the Surgeon General sent plans for the build- ing of certain wards and storehouses to be used as a base hospital, and it was directed by The Adjutant General of the Army that the commanding officer, the surgeon, and the quartermaster should constitute a board of officers to locate these buildings. They were a receiving ward, female nurses’ home, en- listed men’s barracks, two isolation wards, two single sets of wards, two double 508 MILITARY HOSPITALS IN THE UNITED STATES. sets of wards, operating pavilion, two psychiatric wards, a medical storehouse and a morgue. On August 20, 1917, on the departure of headquarters and the six com- panies of the Seventeenth Infantry, the post was turned over to the ranking medical officer, in accordance with instructions of The Adjutant General referred to above. Later in the fall of 1917 a battalion of the Seventeenth Infantry returned to Fort McPherson for guard duty in the city of Atlanta and occupied barracks in the training camp buildings. After the officer who com- manded this battalion left, a junior officer of Infantry was left in command, and, with the approval of the department commander, assumed command of the whole post, 36 under the provisions of the One hundred and twentieth Arti- cle of War, notwithstanding the fact that the last clause of the One hundred and twentieth Article of War clearly states that “unless otherwise directed by the President”. After considerable correspondence with The Adjutant General through the Surgeon General’s Office, this situation was rectified and about December 2, 1917, the hospital became a general hospital, and about March 5, 1918, the Medical Department’s jurisdiction was clearly defined. The water supply of the hospital was obtained from deep wells, supple- mented by Atlanta water, piped from the Chattahoochee River. 38 The inde- pendent water supply was of great service in 1918, when the Atlanta water sup- ply was found to he contaminated, causing a small epidemic of typhoid and paratyphoid fever in the city of Atlanta and in neighboring commands. Only temporary gastrointestinal disturbance was experienced among the inhabitants of the post and this was carefully investigated by a special detail of officers. Until the condition of the Atlanta water supply was pronounced good by the hospital laboratory, water wagons delivered water, drawn from the wells, to the wards and mess hall. 38 It is believed that more serious illness was averted by this precaution. Incineration of the sewage was practiced until recent years. To meet the demands of the increased population, a large modern sewage-disposal plant was built on the northwestern corner of the post, 39 part of the land lying out- side the post boundary. Two large stone filtration beds received the effluent in alternating automatic sprays through which it filtered into a small streamlet, the spring of the recipient water shed having been filled in to prevent drinking. There were no latrines in use at the hospital, flush closets and urinals, with modern plumbing, being used throughout. Connected with the permanent barracks were toilets, tubs, and shower baths, either in the basement of the main building or in the basement of adjoin- ing: buildings. In order to make these barracks available for wards for the care of bed patients, it was necessary to introduce in or near the ward running water with wash basins and slop sinks. This was accomplished by screening off a portion of each ward. There was erected a small frame building with toilets, basins, and shower baths, originally designed for the use of the Medical Corps, who were to have been housed in a building immediately adjoining this. Owing to the growth of the hospital, it was found more practical to assign these buildings for the use of colored patients. The heating of the hospital buildings was accomplished by two heating plants (steam). The first of these was authorized October 12. 191 7, 40 and completed OTHER GENERAL HOSPITALS. 509 December 9, 1917. This plant heated some of the permanent hospital buildings and the newly constructed frame wards. The nurses’ and officers’ quarters, consisting of a clubhouse, and 20 separate buildings (houses) as well as some permanent barrack buildings, were heated by individual furnaces and open fireplaces. To heat these buildings and the nurses’ Red Cross Building, and additional living quarters, mess hall and kitchen, and infirmary for nurses, a second steam heating plant was authorized September 19, 1 9 1 8. 41 In this connection it is of interest to mention that the authorization for the first heating plant came so late (Oct. 12, 1917) that completion in time to meet the winter cold would have been impossible. The commanding officer, foreseeing this, ordered the construction of the heating plant without authorization and later was commended by The Adjutant General for his action. The hospital was lighted by electricity, the power being supplied by the Georgia Railway & Power Co., Atlanta. In August, 1917, the mess of the hospital at Fort McPherson comprised three kitchens, two of which were for patients and the other for the enlisted personnel of the hospital. At that time about 400 patients and Medical De- partment enlisted men were being cared for in these three kitchens, the equip- ment of which consisted of regular garrison equipment but no modern labor- saving devices. When the barrack buildings, vacated by the Seventeenth In- fantry, were remodeled and made into wards, a kitchen was opened for each building in which there were two wards. When the new buildings to be used as surgical wards were completed, they were connected with the large gynasium and post exchange building by a runway. The stage of the gymnasium was remodeled and made into a large kitchen for these surgical wards; and the gym- nasium proper was converted into a large mess hall for the convalescent patients from the adjoining wards and for the men of the detachment, Medical Depart- ment. The equipment was meager at first, but was soon replaced by up-to- date appliances. This large institution, in addition to being a hospital, soon assumed the nature of an Army medical school, for both scientific and military training. The officer personnel was divided into a permanent staff of headquarters, medi- cal, sanitary, and quartermaster officers, and comprised the commanding officer, the chief of the surgical service and 40 ward surgeons, the chief of the medical service and 25 assistants, the chief of the laboratory service with laboratory technicians, and the quartermaster with nine assistants. It continued in existence as a general hospital until December, 1919, when it reverted to the status of a post hospital. 510 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army General Hospital No. 6, Fort McPherson, Ga.,from December, 1917 , to December, 1919, inclusive SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. d d O o a o t-4 From other sources. >*> d d 0 d a 3 © d © S '•3 0 . r d -*-» © ^3 u-- g c3 0 s d © © Q x g © £ © d H d 0 — %d 5 “ ° P ^ 5 d — © >> J3 % 2 w B c 'd d rk t 2 «2 T £ 0 EH *5 © 0 3 d . t- •— 4-i ^ '% s o *c3 O a © cJ O | 1917. December 400 118 831 15 1,424 663 14 11 1 11 724 - 19,968 24 1918. January 724 142 744 H 1,621 617 13 42 8 941 25 999 February 941 106 578 16 1, 641 734 4 39 3 2 1 2 12 8-14 March 844 177 385 16 1,422 668 2 79 6 2 3 36 626 90 ry>n April 626 195 828 16 869 17 21 4 48 1 706 24^ 42.5 May 706 175 822 15 1,718 731 5 34 2 1 72 873 26 872 June 873 115 561 28 1,577 5.56 3 46 33 1 71 867 9a' 398 July 867 74 725 107 1, 773 450 2 97 21 1 140 1 062 .21 1Q1 August 1, 002 45 367 129 1 , 603 366 4 140 3 135 31* 448 September 955 72 352 133 1,512 239 2 173 1 3 171 923 October 923 238 625 244 2, 030 388 20 124 31 8 124 1,335 47* 733 November 1,335 101 629 157 2, 222 452 5 211 3 126 1 425 42* 465 December 1,425 126 843 331 2, 725 389 10 276 8 39 457 341 1,205 43; 262 1919. January 1,205 168 1,158 376 2,907 251 2 202 20 48 539 291 52 125 February 1,554 100 797 268 2, 719 666 3 150 23 257 1,605 39* 972 March 1,605 92 990 292 2, 979 723 10 196 9 1 10 292 1 738 52 692 - April 1,738 70 531 311 2, 650 514 3 219 6 18 357 1 533 47* 253 May 1,533 64 887 304 2', 788 526 6 226 16 320 1 694 .50* 544 J une 1,694 52 1,976 248 3; 970 1,127 243 18 17 280 2 278 64^ 038 10 July 2, 278 75 835 333 3^ 521 914 20 87 39 1 22 240 2, 198 74* 604 August 2, 198 89 567 312 3, 166 9 354 29 11 330 l’ 968 62 248 September 1,968 60 228 331 2, 587 552 10 270 25 48 376 1,306 October 1,306 92 588 333 2, 319 237 8 228 20 1 203 1,622 42 619 November 1,622 82 388 203 2, 295 601 212 15 4 202 l’ 256 43 565 December 1 , 256 84 68 190 1,598 301 195 18 15 407 655 27,339 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1917. 1919. 23 20 24 67 11 66 132 February 17 73 53 143 1918. March 17 77 54 148 23 20 24 67 April 17 148 60 40 14 114 May IS 149 43 39 14 96 IS 149 57 39 14 110 IS 149 57 39 14 110 18 149 105 69 53 227 September IS 77 54 149 July 6 73 61 140 October 18 149 69 128 November IS 14S 66 126 December IS 76 14S October 5 66 55 126 N 0 vember 8 71 00 134 December 6 66 55 127 o Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS. 511 Statistical data, United States Army General Hospital No. 6, Fort McPherson, Ga.,from December , 1917, to December, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. N urses . Aides and workers . Other civilian em- ployees. Medical Corps. Sanitary Corps. Miscella- neous. (Q.M.C., etc.). Total. Medical Depart- ment. Miscella- neous. (Q.M.C., etc.). Total. 1917. 29 1 30 307 307 1918. January 33 1 1 35 344 344 59 February 36 1 1 38 394 394 59 March 45 1 6 52 401 179 580 77 April 56 1 7 64 516 193 709 88 May 48 2 7 57 506 198 704 83 64 3 6 73 521 205 726 90 75 9 89 459 244 703 98 66 7 9 82 444 240 684 98 8 6 65 231 986 105 October 56 o 8 73 737 29.2 959 129 November 62 8 8 78 742 244 9S6 112 66 14 December 88 8 8 104 728 336 1,064 136 87 15 1919. January 76 9 10 95 842 329 1, 171 129 111 15 February 79 8 10 97 886 345 1,231 184 80 14 March 85 8 8 101 983 434 1,417 178 86 14 April 85 8 S 101 902 300 1,202 177 85 15 May 60 8 9 77 8S1 262 1, 143 164 91 17 June 62 7 3 72 894 200 1,094 170 119 19 July 63 6 10 79 S66 163 1,029 190 127 17 August 60 6 10 76 S06 173 979 179 137 16 September 50 6 21 77 743 191 934 176 135 15 < ictober 34 6 15 DO 646 199 845 193 130 12 November 38 6 15 59 603 226 829 161 December 40 8 14 62 539 225 764 147 GENERAL HOSPITAL NO. 7. BALTIMORE, MD. The Garrett Estate, located in the northern suburban portion of Baltimore, was in the early fall of 1917 generously tendered the Government by its owner for use as a hospital for the blind. 42 The estate comprised 50 acres of land, beautifully landscaped and wooded, on which were located several sumptuous dwellings, separately known as Evergreen, Evergreen, Junior, and The Wilson Home. These structures were adequate to house 50 patients and the necessary personnel and supplies. Adjacent to the Garrett Estate was a tract of land, consisting of 2 acres, which was also offered the Government, and this and the offer of the Garrett Estate were accepted by the War Department at the nominal rental of $1 per year. 43 Much study was devoted to the incidence of blindness, both total and partial, in the armies of the allies. Varying reports were received in the Surgeon General’s Office; conflicting statistics were analyzed, and direct per- sonal reports were secured. The application of this experience to our own forces was a difficult matter and required considerable care, lest wrong conclu- sions be reached. Even with the care exercised, the estimated number of the blinded, to be expected in our forces, varied widely, dependent on the point of view of the one making the estimate, as well as upon the grounds used for his calculations. In consequence, many studies were made, and data from all quarters were considered in evolving plans for the necessary additional build- ings at this hospital. It was desired to provide facilities to teach advanced vocational subjects to the blind; but there were no known institutions in the 512 MILITARY HOSPITALS IN' THE UNITED STATES. United States giving instruction of this sort; and considerable difficulty and delay were encountered while sufficiently definite building plans were being prepared. Some of these plans were developed at the hospital and some were prepared in the Office of the Surgeon General. Three main construction items, initiated in the Office of the Surgeon General, were consolidated into two, and their execution was begun in April, 1918 , and January, 1919 , respectively, and completed in November, 1918 , and March, 1919 . The hospital, however, was organized as General Hospital No. 7 on Novem- ber 27 , 1917 , with the primary purpose of physical, mental, and vocational reconstruction of economically blinded soldiers, sailors, marines, and civilians in the Government service. 44 When completed, this institution, which was virtually a school, consisted of two school buildings, two manual training buildings, one recreation building, Fig-. 171. — Swimming pool in gymnasium, General Hospital No. 7, Baltimore. one physical recreation building, five barracks, and the necessary utility struc- tures in addition to the buildings originally on the estate. The ultimate capacity of the hospital was 300 , and the cost of its construction was 8300 , 000 . In addition to teaching Braille, various trades suitable for the blind were taught. Certain of the men were also given intensive training in vocations with which they had become identified prior to their entrance into the service. The physical recreation building at the hospital was found to be of a decided advantage; its swimming pool, especially, engendered self-reliance and lent poise to the patients. It was learned that after a blind man became able to calmly dive from an elevated spring board into the pool he had gone a long way in overcoming that physical timidity which is so common. Strangely enough, the bowling alleys were put to good use, and the benefit in developing a sense of direction was often remarked. OTHER GENERAL HOSPITALS. 513 Soldiers who had received injury to the eyes were cared for in General Hospital No. 2, Baltimore, so long as medical or surgical attention was required, after which they were sent to General Hospital No. 7. While these soldiers were in General Hospital No. 2, however, it was the practice to begin reeducation of them so that no time would be lost. In April, 1919, following a visit of Sir Arthur Pearson, who told of the methods and success of St. Dustan’s in England, which he, a blinded man, had founded and was operating, it was decided to demilitarize General Hospital No. 7. All the blind soldier inmates were discharged from the service ; and as a result of their civilian status, with total disability, they were drawing a com- pensation greater in amount than their active pay had been. This increased their morale markedly. Such was not the case with the officer patients, how- ever; but they were few in number. In order to continue the work at this institution the Medical Department entered into an agreement with the Ameri- can National Red Cross whereby the Medical Department held the property on lease, but turned over the buildings to the Red Cross on a revocable license so that that organization, in cooperation with the Federal Board for Vocational Training, could carry on the instruction of the blind. Statistical data, United States Army General Hospital No. 7, Baltimore, Md.,from December, 1917, to December, 1919, inclusive .« SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted fcr. Completed cases. ining. Aggregate number of days lost from sickness. r d a cS O o B o (h From other sources. h o r d 05 Sh d 05 P "d s *3 o . 3 ~cs & o S ■3 05 C 05 05 ft Pi • x a © S ~ © 'rStZ 05 O C3 O ft ’rt ©ri ft S-i P ° s ^3 ft O' >> gs “ a C3 ^ G 1/1 EH o -*-< . "3 T3 ft © o £ft OT 3 Pft ss ’B o 05 ft 05 o ft O Rome d c3 . +=• ^ 5>> P a3 S 05 A O "3 ft o M u. _Q5 3 3 O' Is ft o M 05 03 3 O’ 1917. 1 1 1 1 1918. January 18 18 15 3 28 8 8 6 2 2 5 7 6 1 1 5 3 9 5 4 36 1 May 4 5 i i 11 4 1 6 115 Julie 6 1 5 12 2 3 7 185 July 7 2 2 11 1 1 1 8 269 August 8 3 1 i 13 2 1 10 269 September 10 8 11 i 30 7 23 544 October 23 14 3 1 41 12 3 25 1 796 November 26 8 7 1 42 8 2 31 1 892 7 December 32 13 45 3 93 13 1 16 63 1,636 14 1919. January 63 21 28 73 185 18 7 69 89 2 3,765 7 February 91 28 3 36 158 23 8 1 44 82 2, 752 30 March.L 82 11 3 131 227 5 4 77 141 996 7 April 141 11 6 33 191 13 8 1 103 615 3 May 103 4 7 114 2 73 25 9 5 2, 020 June 5 3 6 14 2 7 2 1 2 34 5 July 2 5 7 5 2 66 August 2 1 3 1 2 45 September 2 2 4 2 2 60 October 2 1 3 1 2 62 November 2 2 2 60 December 2 2 2 2 2 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 45269°— 23 33 514 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army General Hospital No. 7, Baltimore, Md., from December, 1917, to December, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Y ear and month. Men. Women. Chil- dren. Total. 1919. 1919. 2 12 14 1 1 2 February 2 14 16 August 1 1 2 March. /_ 2 10 12 September 1 1 April 2 10 12 October 1 1 2 10 12 November 1 1 1 1 2 December PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M. C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M. C., etc.). Total. Nurses. 1917. 1 1 1 3 11 3 14 1918. 1 2 1 4 49 8 57 February 1 2 1 4 50 8 58 2 2 1 5 52 10 62 April 2 2 1 5 52 12 64 2 2 1 5 17 92 2 2 1 5 74 16 90 July 1 2 1 4 16 SI 3 1 2 1 4 61 15 76 3 2 1 1 4 62 16 78 3 3 2 1 6 62 16 7S 3 2 2 11 62 IS so 3 7 2 2 11 70 32 102 6 1919. 6 2 2 10 95 33 128 6 8 2 3 13 89 45 134 10 9 2 3 14 91 43 134 10 6 2 3 11 90 37 127 5 5 2 2 9 59 5 64 5 3 2 1 6 49 5 54 July. 2 2 1 5 35 5 40 1 1 1 3 27 3 30 1 1 1 3 21 3 24 1 1 1 3 17 3 20 1 1 2 n 3 14 GENERAL HOSPITAL NO. 8, OTISYILLE, N. Y. This hospital had its inception in a conference at Otisville, in the fall of 1917, between representatives of the Surgeon General’s Office, the New York City Sanatorium for Tuberculosis, and the office of the commissioner of health, New York City. As a result of this conference, the city of New York, on December 10, 1917, granted to the War Department the exclusive temporary occupancy of about 40 acres of unimproved land adjoining the New Tork City Sanatorium for Tuberculosis in the outskirts of Otisville, N. 4 . The property acquired was on the rather steep southern slope of Shawangunk Mountain, overlooking the town on the north. Three additional small tracts of land were obtained in order to secure an avenue of entrance, a heating plant, and reser- voirs for the water supply. Later, and after the hospital was in operation, it was necessary to lease three additional properties: for farming purposes, recreational and occupational features, and quarters for officers and recon- struction aides. OTHER GENERAL HOSPITALS. 515 On September 9, 1917, in a letter to The Adjutant General’s Office the Surgeon General requested authority to have constructed a 500-bed hospital for the treatment of tuberculosis. 45 This authority being received, the Surgeon General on October 24 sent plans to the Construction Division and requested the erection of a 300-bed hospital. 46 This was to be the first hospital for the treatment of the tuberculous. Much time was now given to the study of the wards to be used. Although preliminary plans for the hospital had been transmitted to the Construction Division, study was continued on the design of various types of wards to be adopted and upon the various classes of wards for the varying clinical conditions of the sick. This premature request for construction served its purpose, as the Construction Division utilized the time in estimating materials and starting them to the site, in securing authority for the expenditure of the necessary funds, in surveying, and in organizing for the project. Meanwhile, opinions from the best authorities available were con- Fig. 172. — General Hospital No. 8, Otisville, N. Y. sidered and decisions made from time to time, as a result of which substitutions in the original request were made. Negotiations, for the lease of the land, which as yet had not been secured, were going forward. During this period, however, there was evidence of much misunderstanding of the purpose of the Surgeon General, as his office received letters charging that he was providing accommodations for the tuberculous identical with those in the large military camps then being completed. Before construction was begun, the erection of six more special wards was added to the request. Construction began on this (now a 500-bed hospital) early in February, 1918, and by July, 1918, it was finished. 48 In the summer of 1918, the necessity for more space for the tuberculous was evident, and eight open-air wards, four infirmary wards, one barracks, additions to the laboratory, nurses’ quarters, and head surgery building and other miscellaneous construction items, were called for. 49 The water being unsatisfactory, an ultraviolet ray sterilizer was installed and some months later filtration and sewage disposal plants were installed. 50 Great difficulties 516 MILITARY HOSPITALS IN THE UNITED STATES. in construction were experienced, especially in the winter and spring, but the work was prosecuted with energy and dispatch. The land was situated near the tracks of the Erie Railroad. It was not possible to run a spur up the mountain into the hospital; so to save hauling coal the heating plant was built down by the tracks; and the sick, arriving as they did by train, were carried the short distance from the station to the hospital by ambulance. Construction work ceased early in 1919 with a total normal capacity of 1,000 beds. In the main, the wards were built for three clinical classes: Bed cases, ambulatory cases, and a class midway between these two. For the first class, infirmary wards were built, for the second class, ambulatory wards, and for the middle group, semi-infirmary wards. 51 The cost was approximately one and one-half million dollars, or $1,500 a bed. The hospital was opened in June, 1918, and within a month over 500 sick were constantly under treatment. 52 The number remained at about 600 until March, 1919, when it began to increase, and by April it had reached 800, where it remained until September, when a rapid decline began. 52 This decline was furthered by the decision to close the hospital on November 15. 53 This decision was approved and carried out; and the remaining patients requiring further treatment were transferred to other tuberculosis hospitals, namely, General Hospitals, Nos. 19, 20, and 21. 54 Statistical data , United States Army General Hospital No. 8, Otisville, N. Y., from May, 1918, to December, 1919, inclusive . a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. I Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- ' fer. Otherwise. Hospital. Quarters. Hospital. w t- © u 1918. 2 2 2 15 7 153 160 2 922 3 July 158 12 502 672 11 3 2 1 655 12,000 655 24 96 1 18 9 11 737 1 21. 812 738 15 41 794 42 3 6 2 7-11 22,099 s 741 51 20 812 32 15 33 732 23,076 14 732 26 72 830 56 15 3S 156 564 1 17,851 565 16 57 638 36 51 3 53S 16, 679 6 1919. 538 92 91 5 726 135 13 17 4 551 1 35 552 28 133 1 714 57 89 11 4 14, 521 546 53 246 102 41 3 685 17^622 685 29 251 1 966 11 70 1 15 20, 687 805 38 130 973 63 14 67 2 1 36 2 7SS 22', 316 20 788 33 281 1, 102 59 15 161 9 3 855 24.394 10 July 855 9 144 2 1,010 5S 14 139 1 12 2 7S4 25,799 784 10 189 3 986 17 14 91 3 16 845 25, 0S3 845 22 36 1 904 19 168 251 1 45S 19,961 458 16 18 2 494 11 4 135 1 19 3 319 2 11,559 68 321 12 1 1 335 9 2 35 279 9 1 1, too 1 1 1 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS. 517 Statistical data, United States Army General Hospital No. 8, Otisville, N. Y.,from Hay, 1918, to December, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 5 7 12 1919. April 12 5 7 12 May 5 7 12 5 7 12 June 5 7 12 5 7 12 J uly 5 7 12 August 5 7 12 1919. September 20 19 39 5 7 12 October 20 19 39 5 7 12 N ovember 12 57 5 7 12 December 46 46 PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. Nurses. 1918. 14 3 1 18 71 12 83 16 4 1 21 225 23 248 n 23 5 2 30 237 23 260 34 27 7 2 36 314 27 341 44 28 7 2 37 316 35 351 43 29 7 4 40 314 52 366 64 31 7 5 43 306 52 61 32 10 4 46 415 68 483 1919. 29 10 3 42 371 67 438 50 37 11 3 51 399 94 493 75 March 46 12 5 63 376 81 64 39 12 5 56 379 57 436 61 37 12 6 352 35 387 62 37 12 5 54 387 11 398 60 July 33 13 6 52 257 5 262 79 25 9 41 227 34 261 81 27 8 6 41 226 34 260 64 October 14 4 3 21 203 33 236 50 2 2 1 5 48 32 80 REFERENCES. (1) Report of Sanitary Inspection of Army and Navy General Hospital, Hot Springs, Ark., on December 23, 1918, by Lieut. Col. H. B. McIntyre, M. C. On file, Record Room, S. G. 0., 721 (Army and Navy Gen. Hosp.) K. (2) Correspondence relative to land and buildings at Hot Springs, Ark., for hospital sites. On file, Record Room, S. G. O., 601 (Hot Springs, Ark.) S. (3) Shown on weekly bed reports. On file, Record Room, S. G. 0., 632 (U). (4) Outline Description of Military Posts and Reservations in the United States and Alaska and of National Cemeteries. Washington, Government Printing Office, 1904, 53. (5) Letter from Surg. Gen. George M. Sternberg, to the Secretary of War, July 7, 1899. Subject: Sanitarium for Soldiers Suffering from Tuberculosis. On file, Record Room, S. G. 0., 60225 (Old Files). (6) Shown on weekly bed report. On file, Record Room, S. G. 0., 632 U. (7) Letter from Lieut. Col. Edward P. Rockhill, M. C., co mm anding officer, General Hospital, Fort Bayard, to Maj. E. H. Bruns, M. C., S. G. 0., February 2, 1918. Subject: Opening of wards. On file, Record Room, S. G. 0., 632 (Gen. Hosp. Ft. Bayard) (K). (8) Letter from Lieut. Col. Edward P. Rockhill, M. C., to Lieut. Col. E. H. Bruns, M. C., S. G. 0., August 4, 1918. Subject: Occupation of wards. On file, Record Room, S. G. 0., 632 (Gen. Hosp. Ft. Bayard) K. (9) Annual Report of the Surgeon General U. S. Army, 1919, Yol. II, 50. (10) Annual Report of the Surgeon General U. S. Army, 1900, 29. 518 MILITARY HOSPITALS IN' THE UNITED STATES. (11) Shown on weekly bed reports. On file, Record Room, S. G. 0., 632. (12) Shown on “block plan,” Letterman General Hospital. On file, Hospital Division, S. G. 0. (13) Sixth indorsement from the Surgeon General to The Adjutant General, November 19, 1917. Subject: Request construction of permanent building for psychiatric wards. Also: Eighth indorsement from The Adjutant General to the commanding general, Western Department. Subject: Authorizing construction of permanent building for psychiatric wards. On file, Record Room, S. G. 0., 632.11 (Letterman General Hospital) K. (14) Tentative plan for Columbia University to aid the medical and surgical defense of New York, suggested by J. Bentley Squier. Published in the New York Times, April 3, 1917. (15) Report from Lieut. Col. P. W. Gibson, M. C., commanding officer, General Hospital No. 1, Williamsbridge, N. Y., to the Surgeon General, October 18, 1919. Subject: Report of activities of General Hospital No. 1. On file, Historical Division, S. G. 0. (General Hospitals). (16) Letter from F. A. Goetze, treasurer, Columbia University, to the Secretary of War, June 15, 1917. Subject: Offer of use of war hospital for military purposes. On file, Record Room, S. G. O., 187538 (Old Files). (17) Letter from the Surgeon General to the Secretary of War, June 25, 1917. Subject: Offer of war hospital by Columbia University, N. Y. Approval of Secretary of War indorsed thereon. On file, Record Room, S. G. O., 187538 (Old Files). (18) G. O. No. 103, W. D., Washington, August 6, 1917. Par. 1. (19) Report of Sanitary Inspection of General Hospital No. 4, at Fort Porter, N. Y., on April 25, 1919, by Col. E. R. Schreiner, M. C. On file, Division of Sanitation, S. G. 0. (20) Letter from the Surgeon General to the Chief of Staff, October 16, 1917. Subject: L T se of Fort Porter, N. Y., for general hospital purposes. On file, Record Room, A. G. 0., 323.7 (Gen. Hosp. No. 4) K. (21) Letter from commanding office, General Hospital No. 4, Fort Porter, N. Y., to the Surgeon General, November 11, 1917. Subject: Duties. On file, Record Room, S. G. 0., 323.7-5 (Gen. Hosp. No. 4) K. (22) Letter from the Surgeon General to The Adjutant General, February 8, 1918. Subject: Accommodations for troops returning from Europe. On file, Record Room, S. G. 0., 680.1 (General Hospitals) K. (23) First indorsement from United States Army General Hospital No. 4, Fort Porter, N. Y., to the Surgeon General, April 8, 1918. Report on psychiatric service at this hospital. On file, Record Room, S. G. 0., 702 (Gen. Hosp. No. 4) K. (24) Memorandum from Lieut. Col. T. D. Woodson, M. C., for the Chief, Morale Branch, General Staff, July 7, 1919. Subject: General Hospital No. 4, Fort Porter, N.Y. On file, Record Room, S. G. 0., 652 (Gen. IIosp. No. 4) K. (25) Outline Description of Military Posts and Reservations in the L’nited States and Alaska and of National Cemeteries. Washington, Government Printing Office, 1904, 356. (26) Telegram from The Adjutant General to the commanding general, Eastern Department, July 3, 1917. Subject: Use of barracks at Fort Ontario. On file, Record Room, S.G. 0., 176795-2 (Old Files). (27) Letter from the Surgeon General to the commanding officer, Base Hospital, Fort Ontario, N. Y., October 17, 1917. Subject: Hospital construction. On file, Record Room, S. G. 0., 621.-1 (Ft. Ontario) (N). (28) Letter from the Surgeon General to the commanding officer, General Hospital No. 5, Fort Ontario, N. Y., May 3, 1918. Subject: Additional hospital buildings and improvements. On file, Record Room, S. G. 0., 632 (General Hospital No. 5) K. (29) Letter from the Chief of Construction Division, to the Surgeon General, October 3, 191S. Subject: Construction work, General Hospital No. 5, Fort Ontario, N. Y. On file, Record Room, S. G. 0., 652 (Gen. Hosp. No. 5) (K). (30) Letter from the chief of surgical service, to the commanding officer, General Hospital No. 5, January 20, 1919. Subject: Report of surgical work for year 1918. On file, Record Room, S. G. 0., 319.1-2 (Gen. Hosp. No. 5) K. (31) Report of Sanitary Inspection of United States Army General Hospital No. 5, Fort Ontario, N. Y., made on August 29-30, 1919, by Col. Paul C. Hutton, M. C. On file, Record Room, S. G. O., 721.-1 (Gen. Hosp. No. 5) K. (32) Report on Sanitary Inspection of General Hospital No. 5, at Fort Ontario, N. Y., April 26, 1919, by Col. E. R. Schreiner, M. C. On file, Record Room, S. G. 0., 721 (Gen. Hosp. No. 5) K. OTHER GENERAL HOSPITALS. 519 (33) Letter from Lieut. Col. F. W. Weed, M. C., to the Surgeon General, February 7, 1918. Subject: Sanitary inspection General Hospital No. 5, Fort Ontario, N. Y. On file, Record Room, S. G. 0., 721 (Gen. Hosp. No. 5) K. (34) First indorsement from United States Army General Hospital No. 5 to the Surgeon General, June 4, 1919. Subject: Conditions at the hospital. On file, Record Room, S. G. O. 333. (General Hosp. No. 5) K. (35) Memorandum from Col. Robert E. Noble, M. C., to all officers of the Surgeon General’s office, April 29, 1918. Subject: Designation of hospitals as points to which patients will be sent, according to their classification. On file, Record Room, S. G. O., 632 (General). (36) Letter from commanding officer, General Hospital No. 6, to Surgeon General, December 6, 1917. Subject: Conditions at Fort McPherson, Ga. On file, Record Room, S. G. 0., 322.3 (Lawson Gen. Hosp.) K. (37) Shown on chart of Fort McPherson, Ga. On file, Record Room, S. G. O., 168795- A (Old Files). (38) Monthly sanitary reports from General Hospital No. 6, for months of June, July, August, and September, 1918. On file, Record Room, S. G. 0., 721.5 (Gen. Hosp. No. 6) P. (39) Letter from the Surgeon General to The Adjutant General, October 16, 1917. Subject: Operation of sewage disposal plant at Fort McPherson, Ga. On file, Record Room, S. G. 0., 672 (Ft. McPherson, Ga.) N. (40) Letter from the commanding officer, General Hospital No. 6, to the Surgeon General, May 27, 1919. Subject: Report of activities. On file, Historical Division, S. G. O. (Gen. Hosp. No. 6). (41) Letter from the chief of Construction Division, to the Surgeon General, September 27, 1918. Subject: Installation of steam heating plant at General Hospital No. 6, Fort McPherson, Ga. On file, Record Room, S. G. 0., 674 (Lawson General Hospital) K. (42) Letter from Mrs. T. Harrison Garrett to the Surgeon General, April 10, 1917. Subject: Offer of property to Government for use as a hospital. On file, Record Room, S. G. 0., 601 (Balti- more, Md.) S. (43) Letter from the Surgeon General to the Quartermaster General , November 1, 1917. Subject: Lease of Mrs. T. Harrison Garrett’s estate. On file, Record Room, S. G. O., 601 (Baltimore, Md.) S. (44) Memorandum from Maj. H. H. Johnson, M. C., to Personnel Division, November 28, 1917. Subject: Personnel of General Hospital No. 7 now being organized. On file, Record Room, S.G. 0., 210.31-1 (General Hospital No. 7) K. (45) Letter from the Surgeon General to The Adjutant General, September 12, 1917. Subject: Hospital for tuberculosis. On file, Record Room, S. G. 0., 204575 (Old Files). (46) Letter from the Surgeon General to the Quartermaster General, October 24, 1917. Subject: Tuberculosis Hospital, Otisville, N. Y. On file, Record Room, S. G. 0., 632-1 (Gen. Hosp. No. 8) K. (47) Letter from the Surgeon General to the Secretary of War. February 15, 1918. Subject: Tuberculosis Hospital, Otisville, N. Y. On file, Record Room, S. G. O., 632 (Gen. Hosp. No. 8) K. (48) Letter from Maj. W. G. Hammer, M. C., General Hospital No. 8, to Col. George E. Bushnell, M. C., S. G. 0., July 11, 1918. Subject: Progress report. On file, Record Room, S. G. O., 322.3 (Gen. Hosp. No. 8) K. (49) Letter from the Surgeon General to Construction Division, War Department, August 15, 1918. Subject: New construction, General Hospital No. 8, Otisville, N. Y. On file, Record Room, S. G. 0.,632 (Gen. Hosp. No. 8) K. (50) Letter from the Surgeon General to the commanding officer, General Hospital No. 8, Novem- ber 7, 1918. Subject: Water supply. On file, Record Room, S. G. 0., 671 (Gen. Hosp. No. 8) K. (51) Shown on plans of General Hospital No. 8. On file, Hospital Division, S. G. 0. (52) Shown on weekly bed reports. On file, Record Room, S. G. 0., 632 (U). (53) Letter from the Surgeon General to The Adjutant General, October 9, 1919. Subject: Discontinuance of Gen. Hosp. No. 8, Otisville, N. Y. On file, Record Room, S. G. O., 323.72-3 (Gen. Hosp. No. 8) K. (54) Letter from commanding officer, General Hospital No. 8, to the Surgeon General, November 16, 1919. Subject : Final report of hospital. On file, Record Room, S. G. 0., 323.72-3 (Gen. Hosp. No. 8) K. CHAPTER XXVI. GENERAL HOSPITALS, NOS. 9, 10, 11, 12, 13, 14, 15, 16, 17, AND 18. GENERAL HOSPITAL NO. 9, LAKEWOOD, N. J. The Lakewood Hotel, which was the nucleus of General Hospital Xo. 9, was situated at Lakewood, N. J., 69 miles southeast of New York City. It was in the pine region and winter resort section of the State, and was easily acces- sible to both New York City and Philadelphia by means of the Central Rail- road of New Jersey. The hotel was leased from the Resort Hotel Co. in Jan- uary, 1918, for $50,000 per year. 1 The soil was sandy, the terrain gently rolling, affording excellent natural drainage. 2 Fig. 173. — General Hospital No. 9, Lakewood, N. J . To augment the bed capacity of the hospital, additional neighboring properties were subsequently leased. These were the Florence-in-the-Pines Hotel, the Aeolian Building, and an adjacent small tract of unimproved land. 1 The Lakewood Hotel, the largest of the leased properties, was a five-story building of brick exterior, but of otherwise noniireproof construction. Its design was attractive, in the shape of the letter U , the arms of which pointed to the south. Its first floor, with extensions rearward, contained the lobby, dining rooms, kitchen, billiard rooms, etc., and porches by which it was com- pletely surrounded. 3 The area of the first floor was 86,000 square feet, that of each of the floors above, 40,000 square feet; and there were, in all. 500 rooms. 3 The lease of this property covered not only the grounds, but all buildings, furniture, linen, silverware, dishes, etc. 1 The Florence-in-the-Pines Hotel was a three-story frame building, much smaller in size than was the Lakewood Hotel; and in its lease, there were also included all buildings, furniture, linen, silverware, dishes, etc. 4 520 OTHER GENERAL HOSPITALS. 521 The Lakewood Hotel was used as the hospital proper ; 2 the Florence-in- the-Pines Hotel was utilized as quarters for nurses on duty at the hospital ; 4 and the Aeolian Building was converted into a garage and storehouse . 5 On the unimproved tract of land temporary buildings were constructed to afford additional bedspace . 3 On January 4, 1918, a small detachment of Medical Department personnel arrived at the Lakewood Hotel; and on January 10, it was formally taken over by the War Department. 5 By February 1, when it was officially designated General Hospital No. 9, 6 it had been placed in a reasonably satisfactory degree of readiness to receive a limited number of patients, the first of which, however, did not arrive until February 14, when 139 cases of scarlet fever were received, by transfer, from the hospital at Camp Merritt. 5 The principal construction project entered into, in order to physically balance the hospital, comprised five two-story ward barracks, the addition of considerable kitchen equipment, and a heating plant to heat the newly con- structed buildings as well as to augment the inadequate heating plant of the Lakewood Hotel building . 7 The total cost of this construction work was about $180,000. Much other construction and repair work, not included in the above statement, was done from time to time, which comprised screening, sanitary flooring, resetting of boilers in the hotel heating plant, improvement in the plumbing, the installation of operating rooms, physical reconstruction, and other special facilities. Prior to the completion of this work, the capacity of the hospital was 650 beds, but with the additional beds the capacity of the hospital was augmented to 1,0004 General Hospital No. 9 was not a special hospital in any sense, the major portion of the patients treated being general medical and surgical cases, though it was designated to receive arthritis and orthopedic cases, and, on June 6, 1918, was made a center for cardiovascular diseases. 8 Its use as a general hospital was discontinued on May 31, 1919. Statistical data, United States Army General Hospital No. 9, Lakewood, N. J., from February 4, 1918, to May 31, 1919, melusive. a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. Hospital. Quarters. 1918. February 14 139 4 157 16 141 2, 171 March. 141 23 37 201 18 183 4,609 ApriL 183 46 150 12 391 157 17 2 10 205 6,705 May 205 51 141 397 80 2 18 3 38 256 8 275 J une 256 16 33 89 394 69 35 4 30 40 216 6 888 July 216 22 1S7 107 532 66 2 20 3 1 2 17 421 9 104 5 August 421 25 197 61 704 66 1 36 4 1 8 24 564 10 961 3 September 564 82 143 113 902 132 4 34 4 1 2 119 604 2 15 223 50 October 606 239 279 145 1,269 388 13 52 i 2 1 9 127 673 3 24,716 149 November 676 56 259 201 1,192 188 3 72 2 4 154 767 2 21 626 120 December 769 42 216 164 1 , 191 111 2 132 2 1 103 237 603 58,940 16 1919. January 603 62 315 166 1,146 103 6 7 12 216 746 25 332 2 February 746 80 414 127 1,367 109 1 46 1 9 32 301 868 10 298 6 March 868 99 384 147 1,498 126 2 78 4 72 2 67 309 838 25 983 April 838 74 126 109 1, 147 68 1 94 1 45 7 48 256 627 8’ 224 15 May 627 34 31 65 '757 59 3 160 3 44 1 360 127 1R 178 “ Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on fde, Medical Records Section, Adjutant General's O ffice; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 522 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data , United States Army General Hospital No. 9, Lakewood, N. ./., from February 4, 1918, to May 31, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. W omen . Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total 1918. 1918. February 8 10 18 11 38 March 20 45 12 39 51 April 20 65 May 15 49 64 1919 June 15 49 64 12 36 48 July 24 51 8 83 10 47 August 15 57 77 March . . \ 8 45 53 September 15 44 59 8 45 October 14 33 47 May 42 49 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps.' Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1918. February 25 1 26 74 27 101 39 March 29 1 30 66 28 April 31 1 32 147 28 29 1 30 150 30 June 31 1 32 163 30 July 43 1 44 212 34 246 68 August 40 4 3 47 223 60 283 85 September. 45 6 2 53 334 67 401 79 October 49 10 2 61 329 63 392 87 November 61 10 2 73 356 90 446 11S December 54 12 3 69 359 109 468 111 1919. J anuary 64 10 3 77 363 11S 481 80 February 67 10 5 82 44 L 120 561 73 March 68 10 6 84 423 89 512 78 April 70 10 6 S6 422 /o 497 89 May 35 5 3 43 30 47 77 6S GENERAL HOSPITAL NO. 10, BOSTON, MASS. General Hospital No. 10 was located in the city of Boston, Mass., and com- prised two groups of buildings, and a separate building used for quarters and storage purposes. Of the two main groups, one was situated on Parker Hill in Boston and comprised the Robert Bent Brigham Hospital, which was leased by the Government from the trustees of that institution; a hospital especially constructed by the Benevolent and Protective Order of Elks, as a reconstruction hospital for the use of the War Department; and the Massachusetts Woman's Hospital, a short distance from the other buildings, but likewise on Parker Hill, which was leased from the trustees of that institution for use as nurses’ quarters. The second group of buildings comprised the whole of the west department of the Boston City Hospital, situated in the suburb of West Rox- bury, which was leased by the War Department from the city of Boston. In addition to these two groups of hospital buildings, a single large, two-storied barracks was leased from the Wentworth Institute of Boston. This barrack building had been erected for the use of student officers of the Reserve Officers’ Training Corps. Its lower story was used by the hospital for the storage of supplies and the upper floor as quarters for the detachment, Medical Depart- ment. The two main groups, on Parker Hill and in West Roxbury, respec- tively, were separated by approximately 7 miles; the barracks at the Went- worth Institute was three-quarters of a mile from the summit of Parker Hill. 9 OTHER GENERAL HOSPITALS. 523 The Robert Bent Brigham Hospital, with its equipment, drugs, and fix- tures, was leased from the trustees at $55,000 per year. 10 Its bed capacity was 200. Immediately adjoining it, and on the same hill, commanding a beautiful view of the city, the Benevolent and Protective Order of Elks con- templated erecting a 250-bed hospital, the use of which they had tendered the Government. This offer was made in March of 1918 and was accepted by the War Department on the 26th of that month at a nominal lease of $1 per year. 11 At that time, however, the hospital had not been built; but representatives from the Elks, in consultation with officers of the Surgeon General’s Office, obtained requirements and suggestions, and, proceeding upon this, they con- structed the hospital, which was completed in the following December. These two institutions, the Robert Bent Brigham Hospital and Elks’ Hospital, formed the backbone of General Hospital No. 10. The Massachusetts Woman’s Hospital, leased from the Woman’s Charity Club at $2,500 per year, 10 and the Wentworth Barracks, leased from the Wentworth Institute at$l per Fig. 174. — Portion of General Hospital No 10, Boston. year, 10 the former for nurses and the latter for enlisted men and storage, com- pleted the group of buildings in the city proper. The west department of the Boston City Hospital, tendered to the Government and leased at $1 per year, 12 from the city of Boston, had a capacity of 300 and was intended as a convalescent department of this general hospital. Leases on the Robert Bent Brigham property, 10 the Woman’s Hospital, 10 and the West Roxbury property 12 became effective on October 1, 1918, and occupancy was assumed soon thereafter. The hospital as a whole was opened for patients in December, 1918, although the Elks’ Hospital, not being com- pleted until that month, was not utilized until January, 1919. The convales- cent department at West Roxbury was opened at about the same time as the Elks’ Hospital. 13 The Robert Bent Brigham Hospital consisted of six three-story brick and stone buildings of modern design, and was fully equipped. 10 The Elks' Hospital, 524 MILITARY HOSPITALS IN THE UNITED STATES. of semipermanent two-story pavilion type construction, consisted of one large main building with three wings, and three additional buildings in the rear, and was connected to the Robert Bent Brigham Hospital by corridor and tunnel, 10 the latter carrying the heating mains from the central heating plant in the Robert Brigham Hospital. The west department of the Boston City Hospital, consisting of 14 buildings of mixed character of construction, was beautifully situated and well adapted to the care of convalescents. 14 The construction and alteration work done in connection with the estab- lishment of this hospital consisted principally of corridor construction, con- necting certain buildings in the west department and the installation, in that group, of messing facilities. Little alteration or addition was required in the group in the city. The total cost of this work was $46,000. The original authorized capacity was 900 beds, but tliis was later reduced to 700 beds . 15 The hospital opened in December of 1918, and by February, 1919, 500 sick were being constantly cared for. It remained at this level for about one month, when the number rapidly increased to 800, near which it remained until May of that year . 16 On May 28, 1919, the Surgeon General recommended the cancellation of all leases and the abandonment of the hospital, effective June 15, 1919. 17 Prior to the latter date the comparatively few patients requiring further treatment were sent to other general hospitals. 18 Statistical data, United States Army General Hospital No. 10, Boston, Mass., from October, 1918, to June 17, 1919, inclustve.a SICK AND WOUNDED. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 1919, 18 IS January 129 129 97 97 February ISO ISO 116 116 March. 165 16S 16S May 67 67 i Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS. 525 Statistical data, United States Army General Hospital No. 10, Boston, Mass., from October, 1918, to June, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Aides and workers. Other civilian em- ployees. Medical Corps. Sanitary Corps. Miscella- neous. (Q.M.C., etc.) Total. Medical Depart- ment. Miscella- neous. (Q.M.C., etc.) Total . 1918. 3 1 4 4 5 1 10 9 21 8 2 31 60 11 71 33 42 14 2 58 578 62 640 36 1 1919. January 45 14 2 61 467 63 530 38 1 43 15 5 63 435 81 516 2 45 15 5 504 81 585 55 2 47 12 6 468 60 528 69 2 May 38 11 6 55 467 42 509 80 2 GENERAL HOSPITAL NO. 11, CAPE MAY, N. J. The Hotel Cape May was located on the Ocean Drive, at the eastern end of the city, and within 100 feet of the beach of the Atlantic Ocean. It was a large H-shaped, eight-story building of brick and stone construction, and contained 338 rooms, 19 125 fresh and salt water baths, two large lobbies, spacious dining rooms, kitchen, and storage facilities. To its rear, and component parts of the property, were a brick boiler house, a garage, and a laundry building. 19 The laundry was a three-story frame building, on the first floor of which there was a complete equipment for laundry work; and on the second and third floors were rooms which had been used as quarters for the hotel employees. Still farther removed to the rear, and also belonging to the hotel property, were 20 cottages, and several vacant lots. 19 The hotel had its separate sewerage system, 19 which discharged into Dela- ware Bay; and its own lighting system, 19 the energy of which was obtained from the central heating plant. Its water supply was that of the city of Cape May, which was obtained from artesian wells. 20 The soil was very sandy, leaving no subsequent traces of rain, and there was, in consequence, no mud problem with which to deal. The seasons of the year were well tempered by the adjacent ocean, so that during the summer there were few hot days, with the nights always cool, and during the winter, moderate weather, with high winds only in March and April. The roads about the place were constructed principally of gravel and were maintained in an excellent condition. 20 The general sanitary condition of the neighborhood was satisfactory; the hotel was quite separate from the city proper; and there was no marsh land near by, though in summer the far-famed Jersey mosquitoes abounded in great numbers. On December 18, 1917, the Surgeon General recommended that the War Department authorize the leasing of the Cape May Hotel for use as a general hospital. 21 This property had been offered by the Cape May Hotel Co. at a rental of $99,000 yearly, 22 and it had been investigated by representatives of the Surgeon General’s Office. The lease was approved by the Secretary of 526 MILITARY HOSPITALS IN THE UNITED STATES. War, and was executed by the Quartermaster General’s Office, January 15, 1918, to be effective on January 20, at the yearly rate quoted. 23 The hotel had not been occupied for a year or two, and had been greatly neglected. The pipes of the water and heating systems throughout the main building were in bad condition; many of them had become broken, due to the settling of the walls; and having been incased in the walls, the resultant leaks had caused unsightly discolorations, and dampness in many parts of the build- ing. These defects were difficultly located and repaired, many in fact not being discoverable until after the building had been put into use. The work of alteration and repair comprised principally the correction of the defects in plumbing, though adequate measures in this regard were not instituted at the time the control of the building was assured by the War Department. There had been considerable expression of objection, outside the War Department, to what was claimed to be an excessive rental agreed to in Fig. 175. — General Hospital No. 11, Cape May, N. J. the lease. Based on these statements was the War Department’s conclusion to discontinue the lease of the property on June 30, 1918, though the Inspector General’s Office had reported the hotel as being well suited for hospital purposes, recommending at the same time, however, that it be obtained for a rental of not over $60, 000. 19 Throughout the controversial period, the Surgeon General’s Office had maintained that $99,000 was not considered an excessive amount. Ultimately, the owners of the hotel agreed to an annual rental of $50,000, for any time it might be used after June 30, 1918; and the War Department reversed its decision not to make further use of the property, approving, on August 7, 1918, a renewal of the lease, at $50,000 a year, effective July 1, 1918. 24 Because of the condition of uncertainty, which lasted until August 7, as to what the final status of the hotel would be, in so far as the W ar Depart- ment’s use of it was concerned, progressive activity in the hospital was at a standstill, and comparatively few patients were admitted. In the fall of 1918, however, work on the needed repairs and alterations was resumed. OTHER GENERAL HOSPITALS. 527 Opened first as General Hospital No. 16, the designation was changed to General Hospital No. 11, March 14, 1918. 25 The hotel building was used prac- tically exclusively for patients, and its authorized bed capacity was 750. Of the 20 cottages, 5 were used as isolation wards, and the remainder for quarters for officers, nurses, and reconstruction aides. 19 The enlisted personnel were quartered in tents which were located to the rear of the laundry building. 20 After the definite status of the hospital had been established, its number of patients was increased, and by October, 1918, 600 sick were under treat- ment. 26 During the months following, until July, 1919, the number of patients varied from 500 to 690. 26 In addition to a large number of general medical and surgical cases, this hospital cared for the following special types of cases: Deafness, eye, ear, nose, and throat diseases, maxillofacial injuries, organic diseases of the nervous system, peripheral nerve injuries, speech defects (not neurotic), and wounds or injuries of the skull or brain and spinal cord. On July 20, 1919, due to the fact that the inflow of sick and wounded from the American Expeditionary Forces had practically ceased, and that the Medical Department now possessed sufficient facilities or Government owned property to adequately care for the sick of the Army, General Hospital No. 11 was abandoned, and all activities under Medical Department control were removed. 27 The lease, however, could not be terminated at this time, and the payment of rental until August 23, 1919, was essential to afford adequate time for the removal of all Government property. 28 Statistical data, United States Army General Hospital No. 11, Cape May, N. J.,jrom February, 191S, to August 4, 1919, inclusive. 11 SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. 10 10 4 1 5 5 22 27 22 5 5 76 47 3 131 49 1 2 79 79 38 47 2 166 55 12 3 96 96 18 32 13 159 28 18 2 20 91 91 37 39 182 29 1 4 31 117 117 21 64 23 225 47 1 3 22 152 152 53 125 35 40 6 2 6 96 215 215 46 457 81 799 4 16 3 5 36 639 1 640 37 245 89 1,011 82 51 113 196 569 569 39 382 195 1,185 104 445 581 581 71 212 319 1,183 52 48 209 182 692 692 57 214 166 1, 129 236 1 26 5 198 655 1 656 38 187 183 l’ 064 206 26 12 167 652 1 653 189 150 1,048 173 1 28 33 201 607 7 614 36 120 192 962 162 1 46 19 147 576 11 587 15 25 124 751 139 2 45 47 45 473 5 47S 7 12 497 30 28 428 10 1 1 1 1 Aggregate number of days lost from sickness. ft 8 » 1918. February... March April May June July August September. October November.. December. . 1919. January February... March April May .1 line July August 205 1,913 2,851 2,817 3,545 4,456 8, 664 12,688 17,512 18,606 19,047 8, 773 20, 080 18,041 20, 306 16, 805 3,032 3 6 9 29 31 28 31 118 237 102 19 “ Compiled from monthly returns and sick and wounded reports ( Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, The Adjutant General’s Office (name of hospital). 528 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army General Hospital No. 11, Cape May, N. J from February , 1918, to August 4, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 1919. February 12 87 1 100 January 1 55 March 19 24 1 44 February 3 April 6 24 30 March..”. 8 57 May 3 30 2 35 April 20 61 81 J une 2 14 16 May 33 66 99 2 17 19 June 116 3 17 20 July 35 42 3 29 32 34 3 37 October 3 33 36 November 3 37 40 December 2 44 46 PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M. C., etc.). Total. Nurses. 1918. 2 2 4 31 76 March.." 13 3 1 17 42 45 87 31 17 2 1 20 151 44 195 24 2 1 2 7 154 43 197 36 5 2 43 178 43 221 July 12 3 1 16 116 43 159 16 17 4 1 22 150 43 193 32 18 7 2 27 15S 40 198 33 21 8 2 31 206 52 25S 41 26 35 7 3 36 206 69 275 52 11 3 49 249 82 331 51 1919. 46 11 3 60 328 S6 414 50 46 12 3 61 315 84 399 52 45 11 5 61 335 79 414 54 46 11 5 62 331 62 393 DO 41 10 7 58 328 37 365 60 36 8 7 51 323 21 344 54 July 2 2 5 9 1SS 1SS 2 1 2 3 3 3 GENERAL HOSPITAL NO. 12, BILTMORE, N. C. At Biltmore, N. C., on the site of the old Kenilworth Inn, which was de- stroyed by fire in 1908, there was being erected, in the fall of 1917, a new struc- ture, the design of which was that of a modern, high-class, resort hotel. On December 20, 1917, the Surgeon General recommended that this building be leased from the Kenilworth Co. at 8115,000 per year for the first year of gov- ernmental occupancy, and at 875,000 rental for each succeeding year'. 29 The recommendation was approved by the Secretary of War on January 2, 1918, and the control of the property was assumed by the Medical Department. 0 The inn was located in Buncombe County, about 2 miles from the business center of Asheville, a town with an estimated permanent population of 35,000, though, because of its international popularity as a health resort, there was fre- quently an increase of its population to 150,000. The Asheville plateau upon which Kenilworth was situated, is a circular plateau, comprising 2,000,000 acres, the perimeter of which is a complete circle of mountain peaks. The rolling hills, generous plateaus, and wide valleys of OTHER GENERAL HOSPITALS. 529 the locality afforded an ideal place at which to locate a hospital. The soil was composed principally of a sandy loam with, here and there, outcroppings of light gravel, which obviated the possibility of flying dust. The average mean tem- perature, as observed, was 35°; and the air was dry and invigorating. The city of Asheville had 45 miles of paved streets, all connecting with the roads which led to Kenilworth. The roads through Kenilworth connected with Biltmore Avenue at the west entrance, and with Swannanoa River Road at the south entrance. Both of these roads were of concrete. Surrounding the Kenilworth Inn was a tract of land, 15 acres in extent, belonging to the hotel company, on which was located a group of dwellings. These were particularly desirable as adjuncts to the hotel, since they had been placed upon the same knoll as had the inn. Authority was therefore obtained to lease some of them — five cottages, a two-story residence, and a building, Rig. 176. — General Hospital No. 12, Biltmore, N. C. called the All Souls’ Crescent — for officers’ quarters, and three dwellings for quarters for nurses. Two buildings in Biltmore were leased; one of them, adjacent to the rail- road station, for receiving, storing, and issuing supplies; the other, two blocks distant, for quarters for the personnel of the Quartermaster Corps on duty at the hospital. The main hotel building, a splendid five-story structure, roughly T-shaped in design, faced south, overlooking a mountainous country of great beauty. It was built of hollow tile and cement and was considered fireproof. It had many features which made it highly desirable for a hospital, among which were an excellent water supply, an adequate sewerage system, an independent electric-light plant, freight and passenger elevators, and broad and attractive verandas especially well adapted for the care of the sick. Immediately adja- cent to the building there was sufficient room for the erection of an adequate number of temporary buildings for expansion. 31 45269°— 23 34 530 MILITARY HOSPITALS IN THE UNITED STATES. Little construction or alteration work was done at this place, the majority being accomplished in the spring and summer of 1918. It consisted of installa- tion of cooking equipment, inclosing verandas, installing temporary partitions, painting, and other minor details incident to the completion of the construc- tion to suit Government needs rather than those of the hotel company. The total cost of this work was $30,000. It was designated a general hospital March 14, 1918, 32 and was opened for sick in the following May. 33 In the basement a laboratory, dispensary, mess hall for the detachment, Medical Department, the steam heating plant, Young Men’s Christian Association, various offices, etc., were located. 34 On the first floor, in addition to the offices for the administrative work of the hospital, one of the largest wards, 52 beds, was located. This was to have been the hotel parlor, and it was a very light, spacious, and attractive room. On this floor some smaller wards and the dining rooms for patients and officers were also located. 34 The second, third, and fourth floors were practically similar, and there the majority of space was divided into small wards of one, two, and three beds each. 34 A noteworthy feature of the hospital was the spacious verandas which surrounded a large part of the first floor. 34 The actual capacity of the hospital proved to be 450 beds, and in this respect it did not meet the expectations of those who made the preliminary surveys. It was opened for sick in May, 1918, with a capacity of 200 beds, 35 and by June the maximum capacity, 450 beds, had been provided. 30 By July the number of sick receiving treatment had reached 400, at which point it remained until November, when it suddenly dropped to 250, and then fluctu- ated between this point and 400 until August, 19 19. 37 Although surgical facilities were provided, little surgery was done until 1919, at which time a considerable number of empyema cases was concentrated here, and from then on surgical work was confined to the treatment of empyemas. On September 1, 1919, the hospital was closed 38 on the recommendation of the Surgeon General, which had been made May 28, 39 and approved by War Department June 6; 40 and in conformity with the act of Congress, March 3, 1919, it was transferred to the United States Public Health Service. 41 OTHER GENERAL HOSPITALS, 531 Statistical data, United States Army General Hospital No. 12, Biltmore, N. C.,from April, 1918, to August 31, 1919, inclusi.ve.a SICIC AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. | Deserted. Discharged, expi- j ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. Hospital. Quarters. 1918. 12 12 11 1 38 1 17 7 2 27 12 15 70 84 15 11 216 8 250 18 1 2 229 2 451 July 229 12 88 10 339 35 2 1 26 275 8 583 275 6 218 50 549 89 12 3 2 1 397 11 290 397 13 41 23 474 66 1 4 22 381 13 147 381 46 28 26 481 87 3 5 5 366 11 '284 366 36 37 16 455 84 1 8 3 193 166 7 644 166 31 140 57 394 47 3 37 6 90 2L0 1 6' 851 1919. 211 57 55 82 405 140 6 25 9 3 24 197 1 7,309 198 16 128 20 362 66 2 28 9 2 29 226 5,669 226 15 189 24 454 28 5 15 2 7 50 347 7,906 347 29 148 52 576 34 3 40 4 7 115 373 10' 227 373 20 93 85 571 37 1 32 12 8 124 357 11,616 4 357 21 73 84 535 26 2 16 4 12 150 325 9' 99S 325 15 63 90 493 20 48 4 7 93 321 10 321 9 8 32 370 26 1 103 2 131 107 5,443 PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscella- neous (Q. M. C., etc.). Total. Medical Depart- ment. Miscella- neous (Q. M. C., etc.). Total. Nurses. 1918. April 21 2 1 24 181 7 188 May 20 3 1 24 184 13 197 27 June 21 3 1 25 142 13 155 45 July 24 4 1 29 179 13 192 47 August 21 4 1 26 189 23 212 48 September 21 4 1 26 188 41 229 59 October 18 5 1 24 178 22 200 50 November 20 5 1 26 175 24 199 53 December 1919. 25 5 2 32 217 29 246 52 January 29 6 4 39 190 29 219 47 February 26 5 4 35 191 37 228 45 March 27 5 5 37 183 32 215 44 April 32 5 5 42 203 25 228 43 May 32 6 8 46 220 12 232 40 June 27 6 7 40 226 6 232 57 July 24 5 5 34 217 6 223 56 August 13 4 4 21 71 2 73 49 a Compiled from monthly returns, and sick and wounded reports (Form 52) to the Office of the Surgeon Geneml, on file, Medical Records Section,' Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). GENERAL HOSPITAL NO. 13, DANSVILLE, N. Y. On December 20, 1917, the Surgeon General requested the authority of the War Department to lease, for hospital purposes, the Jackson Sanatorium at Dansville, N. Y., with all its furniture and equipment. 43 This was approved on January 2, 1918, 43 and a lease was executed on the 18th of that month to be effective on February 1. The yearly rental was $49, 880. 44 532 MILITARY HOSPITALS IN THE UNITED STATES. The property consisted of one main building, a large four-story brick structure, and a number of smaller ones. 43 The main building was intended for the hospital proper and the other buildings were to accommodate other necessary activities. Seven frame cottages, near by, were planned for quarters for medical officers; one large frame cottage was to be used for nurses, and two large frame buildings for the enlisted personnel. It was believed that the property could be operated as a 500-bed general hospital, and was designated as General Hospital No. 18, and personnel and supplies were sent there. 46 Several thousand dollars were authorized for some minor repairs and alterations, and some of this money was expended in preparing the hospital for early occu- pancy by the sick. However, as General Hospital No. 18 it never opened for sick. It now became apparent that the capacity of this place had been overrated and that it would not be adequate for the care of more than 200 or, at the most, 300 sick. The conviction that only large hospitals should be established now became more and more pronounced in the Surgeon General’s Office, con- sequently, early in May, the Surgeon General recommended to the War De- partment that the lease on this property be canceled. 47 It was evident that the hospital could not be economically operated, at least at a rental of 849,880 a year, and that the enlargement, by new construction, to a capacity of 1,000 beds was not warranted. Cancellation of the lease was promptly approved 45 and the owner notified. There appears to have been a misunderstanding between the agents of the War Department and the owner as to the intention of the Government. Although the lease terminated June 30, 1918, the president of the Sanatorium Co. stated in effect that he had been led to understand it -was the War Depart- ment’s agreed intention to renew the lease annually until the war was over. Negotiations were entered into anew with the owner, a new lease was agreed upon, and its approval was requested by the Surgeon General on June 29, 191S. 49 The new lease, however, did not become effective until July 18, and it carried an annual rental of 820,000 instead of 849,880, and included some additional property not orignially obtainable; 50 otherwise it was essentially the same as the first lease. In the meantime, the medical personnel and property had been removed to Richmond, Ya., to establish there, on other leased property, a hospital for the Port of Embarkation, Newport News. 51 A new organization, consisting of officers, nurses, and men, was sent to Dansville, and preparation was made anew for the opening of what, in the meantime, had become General Hospital No. 13. 52 Any idea of developing here a large hospital had been given up. It was found that the place would serve admirably as a hospital for psychoneuroses and was accordingly so announced to the ports of debarkation. The total ex- penditure at this place did not exceed 86,000. Though little was done in physical alteration or repair, the hospital was slow in opening. However, in November, 191S, it was ready for the reception of 275 sick; and 100 patients, afflicted with psychoneuroses, were at once sent there for treatment. 53 In a few weeks the number had been increased to over 200, and the hospital continued to operate at about that capacity until March, 1919. By this time problems of the Medical Department, relating to the OTHER GENERAL HOSPITALS. 533 accommodation of the sick returning from France, had been practically solved, and it was determined to discontinue the use of this hospital, and the cancella- tion of all leases was recommended on March 12. 54 The United States Public Health Service had expressed its desire to acquire this property, and, in accord- ance with the act of Congress, March 3, 1919, its transfer to that service was effected on April 21. 55 Statistical data, United States Army General Hospital No. 13, Dansville, N. Y., from March, 1918, to March, 1919, inclusive , a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. Hospital. Quarters. 1918. 5 1 6 4 2 50 2 8 2 12 11 1 25 1 9 3 3 3 1 4 2 1 1 38 1 6 100 107 4 1 102 658 102 14 135 251 8 2 2 2 234 3 5,941 10 1919. 237 31 268 21 42 4 197 1 6,879 46 198 43 32 273 35 67 6 165 4,976 165 13 178 19 44 109 6 2,532 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total . 1918. 1919. 13 20 33 9 9 11 25 36 7 11 22 33 18 18 7 14 1 1 2 2 December 9 9 PERSONNEL ON DUTY. Year and month . Officers. Enlisted men. Nurses. Aides and workers. Other civilian em- ployees. Medical Corps. Sanitary Corps. Miscella- neous (Q.M.C., etc.). Total. Medical Depart- ment. Miscella- neous (Q.M.C., etc.). Total. 1918. March 15 4 1 20 80 9 89 24 April 12 3 1 16 80 12 92 26 May 7 3 1 11 61 20 81 23 June 7 3 1 11 76 20 96 July 1 1 16 16 August 1 i 2 16 16 September 1 2 i 4 27 27 October 5 5 2 12 31 i 32 November 10 4 3 17 149 39 188 26 6 December 17 4 3 24 202 66 268 30 9 1919. January 19 4 3 26 202 69 271 27 7 February 15 4 3 22 166 82 248 25 16 March 1 3 2 6 30 58 88 24 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Officeof the Surgeon General, on file. Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Ad- jutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 534 MILITARY HOSPITALS IN THE UNITED STATES. GENERAL HOSPITAL NO. 14, FORT OGLETHORPE, GA. Prior to the war Fort Oglethorpe had been used as a permanent garrison for a regiment of cavalry. It comprised approximately 75 buildings, the major portion being of brick construction, the remainder of frame material. The build- ings included a permanent post hospital, post headquarters, barracks, officers’ quarters, etc.., for which there were a post sewer system and a water supply, the latter having connections with the water supply of the city of Chattanooga. 58 Included in the general plan of the Surgeon General to procure the build- ings of permanent garrisons in then - entirety for use as hospitals, a specific request was made for the use of the buildings at Fort Oglethorpe on May IS, 1917. 57 Favorable action was taken by the War Department on June 23, and the Secretary of War caused a telegram to be sent to the commanding general of the Southeastern Department directing him to ‘‘ make available the perma- nent barracks at this station for general base hospital use.” 58 On June 25, 1917, the Surgeon General telegraphed the surgeon, South- eastern Department, to direct the post surgeon at Fort Oglethorpe to make plans for converting the post into a general hospital and to send, by telegram, informa- tion concerning any additional temporary buildings which he might think would be needed. 59 Prior to this time, the Surgeon General had authorized the con- struction of four temporary wards, five frame storehouses, and a frame mess hall and kitchen, to provide adjuncts to the post hospital; and, in addition, had per- mitted certain repairs to and alterations of the original post hospital building to improve its condition. 60 A regimental infirmary had also been constructed. 60 This physical expansion was to provide hospitalization facilities for the sick of the increasing number of troops then stationed at Fort Oglethorpe. Because of its increased activities, the hospital at Fort Oglethorpe func- tioned somewhat as a base hospital, but it was actually administered as a post hospital, this status obtaining until July 14, 1917, when it was changed to a provisional base hospital, by General Orders, No. 23, issued from headquarters, Fort Oglethorpe, on that date. Beginning in September, and continuing throughout the fall of 1917, authorizations for IS temporary hospital buildings, and many smaller proj- ects comprising alterations and repairs, were approved by the Surgeon General. During the winter 1917-18, and the following spring and summer, an equal number of additional temporary buildings, together with many small projects for improvements, were authorized. 61 In all, 42 buildings were added to the post; and a maximum capacity of 2,000 beds was reached in the summer of 191S. On November 15, 1917, the commanding general, Southeastern Department, complying with instructions which he had received from The Adjutant General's Office, changed the status of the provisional base hospital back to that for post hospital . 82 The Surgeon General then endeavored to have it made a gen- eral hospital, but he was unsuccessful in his efforts until March 14, 191S, when, with over 1,200 patients under treatment, it became General Hospital No. 14. 63 No specialties were accentuated at this hospital, although a complete physical reconstruction service was developed. General medical and surgical cases were treated. On May 22, 1919, the Surgeon General recommended the discontinuance of General Hospital No. 14, and its reorganization into a post hospital. 64 OTHER GEXERAL HOSPITALS. 535 Fig. 177. 536 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army General Hospital No. 14, Fort Oglethorpe, Ga.. from March 17 , 1918, to June 6, 1919, inclusive. a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. c; S Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. o hj Quarters. Uospital. | 1918. March 1,243 114 1,716 39 3,112 1.643 14 33 3 1 37 1,327 38 722 6 April 1,327 109 1, 316 90 2,842 1,436 21 59 4 98 37 1 187 25' 242 4 May 1, 187 38 1,514 63 2,802 1, 3S6 15 44 3 28 35 1,291 31 421 24 .T urie 1,291 28 1 , 375 37 2,731 1,380 29 32 72 F213 41 731 15 July 1,213 60 1,446 2, 764 1 . 344 8 41 9 20 32 1,310 36 779 19 1,310 59 1,917 33 3,319 1,862 7 45 2 25 62 1,316 44,394 September 1 , 316 49 2,405 35 3, 805 1.649 54 40 141 1,914 44 936 October 1,914 356 4, 120 23 6,413 3, 816 487 41 10 9 83 12 800 1 ’ 967 113 1,292 15 3,387 1,687 88 47 21 215 1,319 lfv 48 930 352 1 , 329 120 1,183 17 2,649 1,583 14 86 6 75 7 8S0 32 062 100 1919. 885 118 796 27 1,826 727 15 24 100 19 885 28 726 24 885 58 429 14 1, 386 320 1 78 172 78 21 708 8 22,698 199 716 61 523 29 1,329 521 3 84 35 10 27 4 22 565 120 649 37 450 41 1,177 507 3 83 42 24 3 17 895 113 518 29 344 36 927 446 1 58 14 43 365 11 600 99 365 8 38 8 419 65 9 335 3.796 CIVIL LiN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. 1918. 108 217 101 426 105 218 101 424 104 327 109 540 97 123 101 321 July 99 178 111 388 96 175 105 376 96 173 117 386 92 87 174 117 3S3 169 113 369 92 167 115 374 Year and month. Men. Women. Chil- dren. Total. 1919. January 83 164 107 354 February 76 160 103 339 March. 82 163 109 354 162 105 334 63 157 122 342 62 155 121 338 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps . Sanitary Corps. Miscel- laneous (Q-M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1918. 94 94 52S 52S 10 April 84 3 1 88 528 1 529 12 May 96 3 2 101 558 1 559 13 June 97 3 3 103 565 20 5S5 11- July. no 3 3 116 613 613 14 111 3 117 762 762 l2i 121 6 3 130 744 744 16t 124 3 132 SS6 SS6 19: 132 7 3 142 905 905 20 9S 10 4 112 1,039 1,039 15; 1919. 86 8 3 97 926 926 9 7S 8 1 87 817 S17 S- 67 8 3 574 7 ' 5S 9 72 502 6’ May 44 s 3 401 401 41 o Compiled from monthlv returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file. Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). Other general hospitals. 537 GENERAL HOSPITAL NO. 15, CORPUS CHRISTI, TEX. On January 25, 1918, the Surgeon General recommended that the Corpus Beach Hotel and Bathing Pavilion, at Corpus Christi, be leased for use as a hospital. 65 In addition to the hotel, there were small cottages and other frame buildings, 10 in all, and 17 acres of unimproved land potentially useful for hospital expansion purposes, the whole being leased for $6,000 a year. 65 It was the primary intention of the Surgeon General to have established here either a convalescent hospital, 65 or a reconstruction hospital as the term was then used. But the place at best was small, and especially so when com- pared with other properties that were being developed or to be developed. It did have, however, the advantages of climate that could not be well disre- garded in the treatment of the large number of convalescents which it was reasonable to expect from a war of first magnitude. After the lease of the hotel had been approved and executed, the first work looking to the physical development of the hospital was authorized by the Surgeon General in March, 1 918 ; 66 and a few additional items covering altera- tions and repairs were authorized in the spring and summer following, but they were of a minor nature, and the cost of the whole did not exceed $3,000. On March 21, 1918, the hospital was designated General Hospital No. 15, 67 and it was opened for the reception and care of the sick on April 7, 1918, 68 at a bed capacity of 100. Within a few weeks thereafter the entire property was made available for use, thus increasing its bed capacity to 215, which, without crowding, was the maximum. The development of the hospital, beyond the potential capacity of the existing available buildings, was adversely decided upon, for the time being, and, on July 26, 1918, it was rated as a convalescent hospital only, the surgeons, ports of debarkation, being so informed in order that they would select suitable cases for transfer thereto. 69 Neither reconstruction activities nor specialties were developed. The hospital soon filled, and for a part of the summer of 1918 its capacity was exceeded, but the average number of patients under treatment at the hospital was 200. 70 On February 26, 1919, the abandonment of the hospital was directed by the War Department. 71 Active steps were at once taken to carry this measure into effect, and on February 28 all patients requiring further treatment were transferred to the hospital at Camp Travis, Tex. While the abandonment was being effected, Congress enacted legislation which necessitated the United States Public Health Service assuming control of the hospital. There was some delay incident to the transfer of the control of the hospital, due to unfa- miliarity with the requirements of the new law, but it was finally accomplished on May 31, 1919. 72 538 MILITARY HOSPITALS IN THE UNITED STATES, Statistical data, United States Army General Hospital No. 15, Corpus Christi, Tex., from April, 1918, to May, 1919, inclusive a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. 1 | 1918. 4 126 130 130 653 130 9 161 2 302 63 234 4, 351 234 26 33 14 307 121 1 1 10 174 6,412 Julv 174 12 174 13 373 S4 1 1 1 286 7,848 286 37 7 10 340 61 1 2 13 4 259 8,008 259 5 27 25 316 144 1 17 154 10 346 154 25 24 258 48 1 6 1 11 186 2, 718 186 7 32 14 239 101 1 6 1 17 113 10, 399 113 19 8 175 80 4 1 20 70 7,377 1919. 70 20 107 26 223 93 4 2 2 3 31 88 1,600 88 11 54 24 177 82 1 1 75 18 3,880 3 2 5 3 1 1 60 1 1 1 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 1919. January 28 3 31 1 7 8 February 28 3 31 24 3 27 March. .’. 2 2 23 3 26 April 1 1 23 3 26 May 1 1 September 23 3 26 26 3 29 26 3 29 December 27 3 30 PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. Nurses. 1918. 12 1 1 14 7 10 11 1 2 14 53 6 10 10 1 2 13 106 S 114 12 July 10 1 1 12 115 11 126 12 12 1 1 14 110 10 120 14 12 2 1 15 104 17 121 13 12 2 1 15 100 17 117 14 11 3 1 15 100 16 116 3 12 3 1 16 100 36 136 1919. 14 2 1 17 96 131 12 9 2 1 12 88 49 137 11 2 1 4 18 39 1 1 i 3 14 20 34 1 1 1 3 2 1 3 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS. 539 GENERAL HOSPITAL NO. 16, NEW HAVEN, CONN. The William Wirt Winchester Memorial Tuberculosis Hospital was situated 2 miles west of New Haven, Conn., on a spur of the New York, New Haven & Hartford Railroad. It was a small hospital, which had just been completed, but it embodied modern ideas of the required facilities for the treatment of tuberculosis. It was connected with the city by macadam road and an electric railway; and the buildings, comprising a three-story administration building, an east ward, a west ward, two dormitories, a private ward, and a nurses’ home, were situated oil a wooded knoll which afforded a pleasant outlook on the city and the surrounding country. The buildings were of brick, colonial in design, and were connected by corridors, but were not fireproof. The hos- pital had been constructed by the General Hospital Society of Connecticut Fig. 178. — Open-air tuberculosis ward, General Hospital No. 16, New Haven, Conn. for the especial purpose of treating cases of tuberculosis, and was affiliated with Yale University. Its capacity was estimated as being 200 beds. 73 On February 8, 1918, the Surgeon General recommended that this hospital be leased with the view to its use as a general hospital for the treatment of tuberculosis. 74 His recommendation was approved by the Secretary of War on February 12, and the lease was executed on the 26th, the monetary con- sideration being $26,000 per year. 75 On March 21, 19 IS, the hospital was designated General Hospital No. 16, 76 and was opened and used, as it had been originally constructed, for the care of 200 sick. In April the 200 beds were almost fully occupied. 77 At this time there was great need for increasing the total number of available beds for the tuberculous, and it was decided to enlarge General Hospital No. 16; consequently, negotiations were entered into and leases secured for suitable 540 MILITARY HOSPITALS IX THE UNITED STATES. adjoining property upon which temporary buildings could be constructed. On March 18, the construction of 10 open-air wards, a kitchen and mess hall for the sick, nurses’ quarters for 26 nurses, a storehouse, a hospital exchange, three barracks, a kitchen and mess hall for the enlisted personnel of the Medical Department, and a guardhouse were authorized by the Surgeon General. 78 The construction of these additional buildings was begun on May 21, and within a month some of them had been completed and occupied. By September 5, they had all been finished and occupied. Later it was necessary to add four more buildings, 79 which were completed on October 1, 1918; but some other minor construction and alteration work was found necessary from time to time. The total cost of the work done on the hospital was 8350,000; and 500 beds for the sick were provided. 80 Nineteen hundred and sixty-eight patients were admitted to the hospital. Of this number, 719 were nontuberculous, among whom there were 267 in- fluenza patients; of the 1,249 tuberculosis patients, 435 were returned to duty, 428 were discharged on surgeon's certificate of disability, 280 were transferred to other hospitals for treatment, and 106 died. 81 On May 18, 1919, the Surgeon General recommended that the hospital be abandoned on August 1 , 1919. 82 This recommendation was approved; and in accordance with law the Surgeon General was directed to transfer the control of the hospital to the United States Public Health Service. It was soon found, however, that it would be impracticable to close the hospital on August 1, and its abandonment was deferred one month. 83 Two hundred sick remaining in the hospital, and requiring further treatment in military hospital, were distributed, by transfer, to General Hospitals Nos. 8, 19, and 21. Statistical data, United States Army General Hospital No. 16, New Haven, Conn., from March, 1918, to August, 1919, inclusive. 11 SICK AND WOUNDED. Y ear and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration o f term . Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. *3 c Quarters. Hospital. | 1918. 25 52 1 78 22 542 56 18 117 1 192 16 1 1 1 173 4,974 Mnv 173 22 49 2 246 27 12 42 Tiitip 165 18 29 38 250 31 2 3 1 21 192 5, 737 T'lly 192 53 10 115 17 272 52 1 5 6 20S 6.266 208 15 6 344 3S 1 8 297 7)211 297 36 189 5 527 41 4 2 10. s76 465 144 60 17 94 18 2 1 2 13 556 IS. 176 556 25 51 8 640 100 2 14 1 13 510 15. 34S 510 14 20 6 550 6S 8 20 11 438 14, S37 1919. 4.28 41 76 562 77 9 6 10 445 14. 787 445 15 62 4 526 51 5 10 9 1 450 12. 1S3 450 19 40 3 512 10 18 13 3 403 12.903 403 13 109 9 534 42 IS 10 6 458 12, 13S 16 90 2 566 24 10 16 6 19 491 13. 402 491 30 81 11 613 75 12 21 1 31 n 462 14,652 .Tilly 462 17 117 7 603 51 13 34 8 25 472 15,463 August 472 . 26 2 25 525 49 4 210 4 214 31 13 9,637 a Compiled from monthly returns and sick and wounded reports (Form 521 to the Office of the Surgeon General, on file, Medical Records Section, ‘Adjutant’s General Office; and monthly statistical returns made to the Office of The Adjutant General, onfile, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS. 541 Statistical data, United States Army General Hospital No. 16, New Haven, Conn., from March, 1918, to August, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 1919. 27 27 54 54 29 29 February 54 54 27 27 March 54 54 26 26 April 59 59 30 30 May 57 57 44 44 64 64 40 40 July 70 70 53 53 August 53 53 96 96 December 63 63 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscella- neous (Q.M.C., etc.). Total. Medical Depart- ment. Miscella- neous (Q. M. C., etc.). Total. 1918. 12 3 15 57 11 68 25 April 17 3 1 21 109 11 120 27 May 17 2 1 20 118 10 128 26 June 50 3 l 54 215 19 234 21 July. 68 8 1 77 243 21 264 26 August 71 6 2 79 200 24 224 47 September 57 6 2 65 276 29 305 54 October 74 7 4 85 308 29 337 56 November 72 6 2 80 306 35 341 71 December 35 10 2 47 349 40 389 53 1919. January 49 8 2 59 333 33 366 49 February 46 8 2 56 312 44 356 49 March 37 10 3 50 307 43 350 50 April 31 9 3 43 292 61 353 49 May 35 9 2 46 277 51 328 48 June 31 9 3 43 314 46 360 .54 July 33 10 3 46 315 16 331 60 8 6 1 15 9 GENERAL HOSPITAL NO. 17, MARKLETON, PA. The Markleton Sanatorium was situated in the mountainous region of west- ern Pennsylvania, at an altitude of 1,700 feet above sea level. It was adjacent to the railroad station of Markleton, on the main line of the Baltimore & Ohio Railroad, and was six hours, traveling time, west of Washington and three hours east of Pittsburgh. The town of Markleton comprised, mainly, the railroad station, 2 stores, and about 20 small dwellings located along the rail- road tracks to a coal mine about three-fourths of a mile distant. The nearest town of any size was Rockwood, about 7 miles away. 84 The sanatorium was nestled among the mountains, which shut it in on both the east and the west, and was, therefore, not exposed to the cold winds of the winter. Its main building was a five-story, steam-heated, brick struc- ture, with north and south frame wings, each of which was 150 feet long. There were 150 rooms in the building, all in a poor state of repair. In January, 1918, the sanatorium was offered to the Government, for lease or sale. 84 A representative of the Surgeon General’s Office inspected it, and, on February 5, the Surgeon General recommended that it be leased for use as a 542 MILITARY HOSPITALS IN' THE UNITED STATES. general hospital in the care and treatment of tuberculosis. 85 The recommenda- tion was approved, and the lease was executed February 25, 1918. 88 Included in the transaction were the sanatorium, with its complete equipment, a laundry and cold-storage plant, a power plant, outbuildings, several farmhouses, and 100 acres of land, all obtained for a rental of $20,000 a year. 84 Under a sepa- rate agreement, some cottages were leased for use as quarters for nurses on duty at the hospital. The designation General Hospital No. 17 was given on March 21, 1918; 87 it was opened in the following month, with a bed capacity of 100, 86 and was soon filled. At the time General Hospital No. 17 was secured, the need for additional beds for tuberculosis patients in general hospitals was pressing, and it was Fig. 179. — General Hospital No. 17, Markleton, Pa. exceedingly difficult to find suitably located places that could be used for the treatment of tuberculosis, and even more difficult to induce owners of properties to lease them: they were decidedly averse to the use of them for hospitals for the tuberculous. These almost unsurmountable difficulties influenced the selec- tion of the comparatively undesirable Markleton Sanatorium. It was not v eil suited to general hospital purposes; it was small and would not have permitted of an economical expansion by the construction of a sufficient number of build- ings to constitute a hospital that would be on a par with the general hospitals then being provided. It was estimated that between 300 and 400 patients could be cared for; however, the subsequent history of the hospital, not unlike those of General Hospitals Nos. 13, 15, and IS, proved the fallacy of this estimate. OTHER GENERAL HOSPITALS. 543 On March 4, 1918, personnel was sent to the hospital, and its renovation and alteration were begun. 86 Following this, the construction of six tuber- culosis wards, in the vicinity of the main building, was authorized and started. 86 This temporary construction was stopped, however, after three buildings had been built. At one time, in the summer of 1918, the abandonment of the hos- pital was considered; but the entertainment of the idea was dropped: 88 there was too much uncertainty regarding future military necessities. It developed at this time, too, that the lessor had been led to understand that the sanatorium had been leased for not only the period of the war, but one year thereafter, and that it was mainly because of this understanding that he had been induced to permit the discontinuance of the sanatorium, as such, and to enter into a lease with the Government. Later in the fall available bed space for the tuberculous became critical, and further construction at this hospital was requested, but, because of the armistice, was not consummated. The maximum bed capacity of the hospital was 200. 89 This bed capacity had been attained by August, 1918, coincident with the number of patients under treatment. Both bed capacity and the number of patients remained at that figure until the hospital was closed on March 27, 1919. 90 Being a hospital for the treatment of tuberculosis, the development of physical reconstruction activities was attempted, but, due to the small size of the hospital, the results, as obtained elsewhere, were not secured. 91 Statistical data, United States Army General Hospital No. 17, Markleton, Pa., from March, 1918, to April 9, 1919, inclusive ,® SICK AND AVOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. Hospital. Quarters. 1918. 3 1 4 2 1 1 2 1 3 72 76 3 72 1 599 23 73 33 106 1 105 2, 411 5 105 41 146 2 144 144 1 17 1 163 8 1 3 11 140 4, 433 140 3 16 2 161 10 7 3 141 4, 302 141 4 31 1 177 5 1 1 3 167 4, 663 167 31 78 6 282 18 3 4 1 3 253 6, 591 253 3 49 1 306 58 3 38 207 6, 568 207 2 35 1 245 24 3 25 2 2 189 6, 059 1919. 189 25 48 262 25 20 11 1 205 6, 018 205 6 9 1 221 11 18 1 9 1 1S1 5, 570 182 5 3 2 192 6 3 53 125 2 3 3i 576 3 3 2 1 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section,' Adjutant General’s Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 544 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army General Hospital No. 7, Markleton, Pa., from March, 1918, to April 9, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 1918. January October 2 9 2 7 9 March 6 8 14 1 8 April 3 2 5 6 2 8 1919. 2 6 8 2 7 9 July 2 8 10 2 6 8 2 9 11 March 2 5 7 2 9 11 April 1 1 PERSONNEL ON DUTY; Officers. Enlisted men. Y ear and month. Medical Corps. Sanitary- Corps. Miscel- laneous (Q. M. C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M.C., etc.). Total. Nurses. 1918. 3 1 4 3 10 11 6 1 7 32 39 12 6 1 7 34 11 12 9 1 10 108 11 119 14 July 14 1 15 114 11 125 19 12 1 13 113 11 124 17 13 1 14 111 11 122 19 11 3 14 70 11 81 14 10 5 15 12 S7 20 December 13 1 19 109 10 119 18 1919. 14 6 1 21 115 13 12S 23 14 6 1 21 114 22 136 22 9 i 10 60 21 SI GENERAL HOSPITAL NO. 18, WAYNESVILLE, N. C. General Hospital No. 18 was established in a heterogeneous group of buildings scattered along the north bank of Richland Creek in the outskirts of the town of Waynesville. The various buildings which composed the hospital were an old hotel, its annex, a pavilion and spring house, five small outbuildings, and some separately located cottages. The hotel building was three stories high, of brick construction, and had porches extending along the front and both sides for the first, and second floors, with smaller porches (pat the rear. It had been constructed in E883"and contained 80 rooms. The /“"annex was a wooden building, 3 stories high, fronted toward the main building 100 yards distant, and had 40 rooms. The pavilion and spring house had formerly been used as a dance hall for the guests of the hotel, and was about 300 yards distant. The grounds surrounding the hotel comprised 144 acres, upon which was located the White Sulphur Springs that possessed a local reputation for being beneficial in the cure of rheumatism and skin diseases and was used as an attractive feature by the hotel. Adjacent to the hotel property there was a 167-acre farm, which was obtained and used by the educational and recrea- tional department of the hospital. The terrain was more or less level and was a part of Richland 4 alley, which, at this point, was about 3 miles in width, being delimited on either OTHER GENERAL HOSPITALS. 545 side by mountains of the Blue Ridge Range. Picturesque brooks traversed the valley and afforded ample drainage throughout. The mean average temperature for the year was 59° F. The thermometer rarely dropped below the freezing point in winter, and seldom rose above 80° in summer. During summer days there were usually cool breezes blowing from the mountains, and it was extremely infrequent that blankets were not required at night. During the winter the nights were frosty, but the days were usually sunshiny and almost balmy; snow rarely lay for more than a very few hours. On March 14, 1918, the property was investigated by a representative of the Surgeon General; and, based upon his recommendation, it was leased on March 26, at the rate of $10,000 a year. 93 There was an acute necessity at this time for the provision of hospital space for the care and treatment of cases of tuberculosis in the military service; the necessity for distributing these tuberculosis hospitals throughout the United States added to the difficulties attending the acquisition of suitable space; and the advisability of strongly considering the location of them in places popularly known to be beneficial made the problem even more perplex- ing. It was difficult to lease readily convertible properties, even though unsuit- able, for the treatment of tuberculosis, and it was seldom possible that first class buildings could be secured. It was neither the desire nor the intention of the Surgeon General to greatly enlarge General Hospital No. 18 at the time when it was organized: 94 it was expected that ere long space would become available in the semipermanent tuberculosis hospitals then being especially constructed. So, in order to temporarily increase the bed capacity of General Hospital No. 18, that it might be utilized to the greatest extent in increasing the total number of available beds for the tuberculous, enlisted men on duty at the hospital were quartered in tents. 95 In August, 1918, however, the erection of three additional buildings was recommended, 96 and the construc- tion of these was completed in January, 1919. Some additional expenditures were made in the alteration and repair of certain of the buildings; and the heating arrangements, being insufficient or totally lacking in some of the buildings, were rectified. A reconstruction service was provided and established in the pavilion but it was not developed to any great extent. Opening with a capacity of 250 in April, 19 18, 97 100 sick were sent there and within a very short period the hospital was completely filled. During the summer the capacity was constantly increased by better interior organiza- tion, by the housing of attendants in tents, and by the renovation of additional acquired space until in the late summer a capacity of 600 was reached. 98 Dur- ing this period the hospital was completely full and remained so until about November of that year when, due to the acquisition of additional general hospital space for tuberculosis elsewhere, the number of sick fell to the less disturbing figure of 350, near which it remained until March, 1919. 98 On May 7, 1919, upon the recommendation of the Surgeon General, this hospital was abandoned and the property returned to the lessor. 99 45269°— 23 35 546 MILITARY HOSPITALS IN' THE UNITED STATES, Statistical data, United States Army General Hospital No. 18, Waynesville, N. C.,from April, 1918, to March 81, 1919, inclusive a SICK AND WOUNDED. Year and month. 1918. April May June July August September. October November.. December. . 1919. January February. . . March..! 3 236 270 339 472 598 643 341 387 343 Admissions. From other sources . 1 242 38 79 153 137 78 57 62 6 252 282 363 520 630 707 709 411 432 352 1 Completed cases. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. 3 8 1 7 4 3 1 4 12 2 7 1 2 35 2 10 1 26 1 1 3 1 27 15 1 2 17 2 265 18 3 77 4 1 13 6 2 2 1 61 6 8 10 4 82 1 41 228 i Remaining. Aggregate number of days lost from sickness. 1 236 270 339 472 597 643 341 387 343 2 4,297 1,022 1,348 2, 468 1, 585 1,374 588 684 475 CIVILIAN POPULATION WITH THE COMMAND. Y ear and month. Men. Women. Chil- dren. Total. Year and month. Men. W omen. Chil- dren. Total. 1918. 2 10 12 1918. 1 25 26 2 14 16 1 26 27 2 14 16 July 2 23 25 1919. 39 39 1 22 23 22 22 1 20 21 26 26 PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps.' Miscel- laneous (Q.M.C, etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. Nurses. 1918. 3 2 5 2S 4 32 10 7 2 9 79 79 32 12 3 126 126 36 July 12 1 IS 1S2 1S2 36 19 5 2 26 184 184 40 20 3 28 1S1 181 39 22 4 3 29 1S3 1S3 58 25 4 3 32 243 243 58 23 4 33 275 42 1919. 19 7 3 29 263 263 36 3 4 2 9 78 7S 1 1 1 3 13 13 a Compiled from monthly returns and sick and wounded reports ( Form 52) to the Office of the Surgeon General, on file. Medical Records Section, Adjutant General’s Office, and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General s Office (name of hospital). OTHER GENERAL HOSPITALS. 547 REFERENCES. (1) Letter from Maj. Win. C. Williams, I. G. D., to the Inspector General of the Army, January 25, 1919. Subject: Inspection of United States Army General Hospital No. 9, Lakewood, N. J. On file, Record Room, S. G. 0., 333 (General Hosp. No. 9) K. (2) Report of sanitary inspection of General Hospital No. 9 at Lakewood, N. J., on April 7-8, 1919, by Col. E. R. Schreiner, M. C. On file, Record Room, S. G. O., 721 (Gen. Hosp. No. 9) K. (3) Report from Capt. Francis S. Paterno, Q. M. C., to Chief of Construction Division, February 25, 1919. Subject: Completion report of construction work at United States Army General Hospital No. 9, Lakewood, N. J. On file, Historical Division S. G. 0. (Gen. Hosp. No. 9) K. (4) Letter from the commanding officer, General Hospital No. 9, Lakewood, N. J., to the Surgeon General, April 8, 1918. Subject: Lease of the Florence-in-the-Pines to be used as nurses’ quarters. On file Record Room, S. G. 0., 481 (Lakewood, N. J. ) F. (5) Report from Col. Charles F. Mason, M. C., to the Surgeon General, January 16, 1919. Sub- ject: Annual Report of General Hospital No. 9, Lakewood, N. J. for 1918. On file, His- torical Division, S. G. 0. (6) Second indorsement from The Adjutant General to the Surgeon General, February 1, 1919. Subject: Designation of general hospital. On file, Mail and Record Division, A. G. 0., 322.3 (Misc. Sec.). (7) Report of sanitary inspection of United States Army General Hospital No. 9, Lakewood, N. J., made by Col. W. F. Truby, M. C., on October 20, 1918. On file, Record Room, S. G.O., 721 (Gen. Hosp. No. 9) K. (8) Letter from the Surgeon General to commanding officer, Base Hospital, Camp Meade, Md., June 6, 1918. Subject: Treatment of cardiovascular diseases at General Hospital No. 9. On file, Record Room, S. G. 0., 702 (Gen. Hosp. No. 9) K. (9) Report of sanitary inspection of General Hospital No. 10, Parker Hill, Boston, Mass., by Col. Jere B. Clayton, M. C., on May 5, 1919. On file, Record Room, S. G. 0., 721-1 (Gen. Hosp. No. 10) K. (TO) Shown in lease. Copy on file, Hospital Division, S. G. 0. (General Hospital No. 10). (11) Sixth indorsement from The Adjutant General to the Surgeon General, March 26, 1918. Subject: Approval of lease of Elks’ Hospital, Boston, Mass. On file, Record Room, S. G. 0., 322.3 (Gen. Hosp. No. 10 ) K. (12) Shown in lease. Copy on file, Record Room, S. G. 0., 601 (Boston City Hall, Mass.) S. (13) Letter from Col. John T. Clarke, M. C., to the Surgeon General, August 29, 1920. Subject: Report of activities of General Hospital No. 10, Boston, Mass. On file, Historical Lfivision, S. G. O. (Gen. Hosp. No. 10). (14) Letter from Maj. Charles L. Greene, M. C., to the Surgeon General, November 18, 1918. Subject: Report on conditions affecting physical reconstruction at General Hospital No. 10, Parker Hill. On file, Record Room, S. G. 0., 356 (Gen. Hosp. No. 10) K. (15) Letter from the Surgeon General to the Commanding officer, General Hospital No. 10, May 10. 1919. Subject: Reduction in bed capacity. On file, Record Room, S. G. 0., 721-1 (Gen. Hosp. No. 10) K. (16) Shown on weekly bed reports. On file, Record Room, S. G. O., 632 (U). (17) Letter from the Surgeon General to the Director of Operations, General Staff, May 28, 1919. Subject: Cancellation of lease. On file, Record Room, S. G. 0., 481 (Gen. Hosp. No. 10) K. (18) Letter from Secretary of War to Hon. Henry Cabot Lodge, United States Senate, June 20, 1919. Subject: General Hospital No. 10, Boston, Mass. On file, Record Room, S. G. 0., 323.7 (Gen. Hosp. No. 10) K. (19) Letter from Lieut. Col. W. L. Reed, I. G. D., to the Inspector General of the Army, June 20, 1918. Subject: Inspection of General Hospital No. 11, Cape May, N. J. On file, Record Room, S. G. 0., 333.1 (1) (Gen. Hosp. No. 11) K. (20) Report of sanitary inspection of General Hospital No. 11, Cape May, N. J., December 3, 1918, by Col. W. F. Truby, M. C. On file, Record Room, S. G. 0., 721-1 (Gen. Hosp. No. 11) K. (21) Letter from the Surgeon General to The Adjutant General, December 18, 1917. Subject: Cape May Hotel, Cape May, N. J. On file, Record Room, S. G. 0., 601 (Cape May N. J.) S. (22) Letter from W. R. Ramsey, attorney, Washington. D. C., to the Surgeon General, November, 30,1917. Subject: Cape May Hotel. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 11) K. 548 MILITARY HOSPITALS IN THE UNITED STATES. (23) Letter from Quartermaster, headquarters, Eastern Department, to the Quartermaster General, January 18, 1918. Subject: Lease of Cape May Hotel. On file, Record Room, S. G. 0., 601 (Cape May, N. J.) S. (24) Copy of renewal lease. On file, Record Room, S. G. 0., 481-1 (Gen. Hosp. No. 11) K. (25) Letter from The Adjutant General to the Surgeon General, March 14, 1918. Subject: Gen- eral hospitals. On file. Record Room, S. G. O., 322.3 (General Hospitals) K. (26) Shown on weekly bed reports. On file, Record Room, S. G. 0., 632 (U). (27) First indorsement from General Hospital No. 11, Cape May, N. J., to the Surgeon General, August 5, 1919. Subject: Closing of hospital. On file, Record Room, S. G. 0., 602.1 (Gen. Hosp. No. 11) K. (28) Letter from Chief of Real Estate Service, War Department, to Cape May Hotel Co., Cape May, N. J., July 21, 1919. Subject: Cancellation of lease. On file, Record Room, S. G. 0., 481-1 (Gen. Hosp. No. 11) K. (29) Letter from Surgeon General to The Adjutant General, December 20, 1917. Subject: Kenilworth Inn, Kenilworth, N. C. On file, Record Room, S. G. 0., 481 (Asheville, N. C.) F. (30) Second indorsement from A. G. O. to the Surgeon General, January 2, 1918. Subject: Ap- proval of lease for Kenilworth Inn. On file, Record Room, S. G. 0., 481 (Asheville, N.C.) F. (31) Letter from Col. H. C. Fisher, M. C., to the Surgeon General, undated. Subject: Report on Kenilworth Hotel, Biltmore, N. C. On file, Record Room, S. G. 0., 601 (Biltmore, N. C.) S. (32) Letter from Adjutant General to the Surgeon General, March 14, 1918. Subject: General hospitals. On file, Record Room, S. G. 0., 322.3 (Gen. Hosp.) K. (33) Letter from commanding officer, General Hospital No. 12, to the Surgeon General, May 25, 1918. Subject: Arrival of patients. On file, Record Room, S. G. 0., 705 (Gen. Hosp. No. 12) K. (34) Letter from Maj. A. Y. Moschovitz, M. C., to Col. Raymond P. Sullivan, M. C., January 13, 1919. Subject: Report of consultation visit to General Hospital No. 12, Biltmore, N. C. On file, Record Room, S. G. 0., 333-1 (Gen. Hosp. No. 12) K. (35) Shown on weekly bed report, May 15, 1918. On file, Record Room, S. G. O., 632 U. (36) Shown on weekly bed report, June 26, 1918. On file, Record Room. S. G. 0., 632 U. (37) Shown on weekly bed report, compiled in Surgeon General’s Office. On file, Record Room, S. G. O., 632 (U). (38) First Indorsement from S. G. O. to Quartermaster General, Director, Purchase and Storage, October 17, 1919. Subject: General Hospital No. 12 was discontinued September 1, 1919. On file, Record Room, S. G. 0., 210.8-1 (Gen. Hosp. No. 12) K. (39) Letter from Surgeon General to General Staff, War Department, May 28, 1919. Subject: Cancellation of leases. On file, Record Room, S. G. 0., 481 General. (40) Letter from Adjutant General to the Surgeon General, June 6, 1919. Subject: Abandon- ment of General Hospital No. 12, Biltmore, N. C. On file, Record Room, S. G. 0.. 602 (Gen. Hosp. No. 12) K. (41) Letter from the Surgeon General to the commanding officer. General Hospital No. 12, Biltmore, N. C., September 8, 1919. Subject: Transfer of General Hospital No. 12 to Public Health Service. On file, Record Room. S. G. 0., 323.7-5 (Gen. Hosp. No. 12) K. (42) Letter from the Surgeon General to The Adjutant General, December 20, 1917. Subject: Jackson Sanatorium, Dansville, N. Y. On file, Record Room. S. G. 0., 601 (Dansville, N. Y.) F. (43) Second Indorsement from A. G. 0. to Surgeon General, January 2, 1918. Subject: Approval of lease for Jackson Sanatorium, Dansville, N. 5'. On file, Record Room, S. G. 0., 601 (Dansville, N. Y.) F. (44) Letter from quartermaster, headquarters, Eastern Department, to Quartermaster General, January 18, 1918. Subject: Execution of lease for Jackson Sanatorium. Dansville. N. Y. On file, Record Room, S. G. 0., 601 (Dansville, N. Y.) F. (45) Letter from Lieut. Col. W. L. Pyles, M. C., to the Surgeon General, November 23, 1917. Subject: Report of inspection, Jackson Sanatorium, Dansville, N. Y. On file, Record Room, S. G. 0., 601 (Dansville, N. Y.) S. (46) Letter from Maj. A. H. Crosbie, M. R. C., commanding officer, General Hospital No. 13. Dansville, N. Y., to the Surgeon General, February 23, 1918. Subject: Report of prog- ress. On file, Record Room, S. G. 0., 323.7-5 (Gen. Hosp. No. 13), K. OTHER GENERAL HOSPITALS. 549 (47) Letter from the Surgeon General to the Chief of Staff, May 9, 1918. Subject: Cancellation of the lease of General Hospital No. 13, Dansville, N. Y. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 13) K. (48) First Indorsement from A. G. 0. to the Surgeon General, May 13, 1918. Subject: Approval of request to cancel lease of Jackson Sanatorium, Dansville, N. Y. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 14) K. (49) Letter from Surgeon General to the Chief of Staff, June 29, 1918. Subject: New lease for General Hospital No. 13, Dansville, N. Y. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 13) K. (50) Copy of lease. On file, Hospital Di-vision, S. G. 0. (Dansville, N. Y.). (51) Letter from Acting Surgeon General to Adjutant General, June 12, 1918. Subject : Transfer of personnel and equipment from Dansville, N. Y. to Richmond, Ya. On file, Record Room, S. G. O., 323.7-5 (Gen. Hosp. No. 13) K. (52) Letter from Acting Surgeon General to commanding officer, General Hospital No. 13, Dansville, N. Y., September 17, 1918. Subject: Organization of General Hospital No. 13. On file, Record Room, S. G. 0., 323.7-5 (Gen. Hosp. No. 13 K. (53) Letter from commanding officer, General Hospital No. 13, to Surgeon General, November 24, 1918. Subject: Report of transfer of patients. On file, Record Room, S. G. 0., 705 (Gen. Hosp. No. 13) K. (54) Letter from the Surgeon General to Construction Di-vision, War Department, March 12, 1919. Subject: Cancellation of lease and abandonment of General Hospital No. 13. On file, Record Room, S. G. 0., 323.7 (Gen. Hosp. No. 13) K. (55) Letter from commanding officer, General Hospital No. 13, Dansville, N. Y. to Surgeon General, April 28, 1919. Subject: Abandonment of General Hospital No. 13. On file, Record Room, S. G. 0., 323.7 (Gen. Hosp. No. 13) K. (56) ‘'Outline Description of Military Posts and Reservations in the United States and Alaska and of National Cemeteries.” Washington, Government Printing Office, 1904. (57) Letter from the Surgeon General to The Adjutant General, May 18, 1917. Subject: Use of permanent barracks of certain posts for hospital purposes. On file, Mail and Record Di-vi- sion, A. G. 0., 2600303 (Old Files Section). (58) Letter from The Adjutant General to the commanding general, Southeastern Department, June 23, 1917. Subject: Use of permanent barracks at certain posts for general or base hospital accommodations. On file, Record Room, S. G. 0., 176795 (Old Files). (59) Night letter from the Surgeon General to the department surgeon, Southeastern Department, June 25, 1917. Subject: Request for plans of a base hospital at certain posts. On file, Record Room, S. G. 0., 176795 (Old Files). (60) Letters from the Surgeon General to the Quartermaster General, various dates. Subject: Temporary hospital buildings at Fort Oglethorpe, Ga. On file, Record Room, S. G. 0., 176796 (Old Files). (61) Letters from the Surgeon General to the Construction Division, W 7 ar Department, various dates. Subject: Alteraton and construction of buildings. On file, Hospital Division, S. G. 0., (Gen. Hosp. No. 14, General Hospital Requests). (62) Telegram from Kirkpatrick, Fort Oglethorpe, Ga., to the Surgeon General, November 24, 1917. Subject: Hospital administration. On file, Record Room, S. G. 0., 323.7 (Post Hospital, Fort Oglethorpe) N. (63) Letter from The Adjutant General to the Surgeon General, March 14, 1918. Subject: Gen- eral hospitals. On file, Record Room, S. G. 0., 323.3 (General Hospitals) K. (64) Letter from the Surgeon General to the Director of Operations, General Staff, May 22, 1919. Subject: Closing of General Hospital No. 14 as such. On file, Record Room, S. G. 0., 320.2 (Gen. Hosp. No. 14) K, (65) Letter from the Surgeon General to The Adjutant General, January 25, 1918. Subject: Lease of Beach Hotel, Corpus Chris! i. Tex. On file, Record Room, S. G. 0., 601 (Corpus Christi) F. (66) Letter from Surgeon General to commanding officer, hospital, Corpus Christi, Tex., March 2, 1918. Subject: Instruction for establishment of hospital. On file, Record Room, S. G. 0., 323.7-5 (Gen. Hosp. No. 15) K. (67) First Indorsement from War Department, A. G. 0., to the Surgeon General, March 21, 1918. Subject: Designation of hospitals. On file, Record Room, S. G. 0., 323.7 (General Hospitals) K. 550 MILITARY HOSPITALS IN THE UNITED STATES. (68) First Indorsement from commanding officer, General Hospital No. 15, to the Surgeon General, December 27, 1918. Subject: Statistical information. On file, Record Room, S. G. O., 730 (Gen. Hosp. No. 15) K. (69) Letter from the Surgeon General to chief surgeon, Port of Embarkation, Hoboken, N. J., July 26, 1918. Subject: Use of General Hospital No. 15 for convalescent patients. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 15) K. (70) Shown on weekly report compiled in the Surgeon General’s Office. On file, Record Room, S. G. 0., 632 (U). (71) Letter from The Adjutant General to the Surgeon General, February 26, 1919. Subject: Abandonment of General Hospital No. 15, Corpus Christi, Tex. On file, Record Room, S. G. 0., 602 (Gen. Hosp. No. 15) K. (72) Letter from commanding officer, General Hospital No. 15 to the Surgeon General, May 31, 1919. Subject: Transfer to Public Health Service. On file, Record Room, S. G. 0., 602 (Gen. Hosp. No. 15) K. (73) Report on property tendered for hospital purposes. New Haven Hospital inspected by Col. G. E. Bushnell, M. C., January 16, 1918. On file, Record Room, S. G. 0., 601 (New Haven Hospital, West Haven, Conn.) S. (74) Letter from the Surgeon General to the Chief of Staff, February 8, 1918. Subject: Lease of New Haven Hospital, New Haven, Conn., for tuberculosis. On file, Record Room. S. G. 0., 601 (New Haven, Conn.) F. (75) Memorandum for Acting Chief of Staff for Assistant Secretary of War, February 11, 1918. Subject: Lease of New Haven Hospital for tuberculosis hospital. Approved February 12, 1918. On tile, Record Room, S. G. O., 601 (New Haven, Conn.) F. Also: Telegram from George P>. Lummer, New Haven, Conn., to the Surgeon General, February 26, 1918: “Lease signed for hospital today.” On file, Record Room, S. G. 0., 601 (New Haven, Conn.) F. (76) First Indorsement from War Department, A. G. 0. to the Surgeon General, March 21, 1918. Subject: Designation of hospitals. Onfile, Record Room, S. G. 0., 323.7 (General Hospitals) K. (77) Shown on weekly bed reports compiled in the Surgeon General’s Office. On file, Record Room, S. G. 0., 632 (U). (78) Letter from the Surgeon General to The Adjutant General, April 3, 1918. Subject: Au- thority to construct additional wards and buildings at the United States Army General Hospital No. 16, New Haven, Conn. On file, Record Room, S. G. 0., 652 (Gen. Hosp. No. 16) K. (79) Third Indorsement from War Department, S. G. 0. to Construction Division, War Depart- ment, July 23, 1918. Subject: Additional construction, General Hospital No. 16. On file, Record Room, S. G. 0., 652 (Gen. Hosp. No. 16.) K (80) Letter from Surgeon General, United States Army, to Siugeon General, Public Health Service, August 15, 1918. Subject: Transfer of General Hospital No. 16, New Haven, Conn. On file, Record Room, S. G. 0., 323.72-3 (Gen. Hosp. No. 16) K. (81) Compiled from sick and wounded reports, General Hospital No. 16. Now on file, World War Div., A. G. O. (82) Letter from the Surgeon General to the Chief of Staff, May 28, 1919. Subject: Cancellation of leases. On file, Record Room, S. G. 0., 481 General. (83) Letter from Surgeon General to The Adjutant General, June 18, 1919. Subject: Abandon- ment of General Hospital No. 16, New Haven, Conn. On file, Record Room, S. G. O., 602 (Gen. Hosp. No. 16) Iv. (84) Letter from M. B. Barnett, Marble ton, Pa., to the Siugeon General, United States Army, January 29, 1918. Subject: Sale or lease of Markleton Sanatorium. Onfile. Record Room, S. G. 0., 601 (Markleton, Pa.) F. (85) Letter from the Surgeon General to The Adjutant General, February 5, 191S. Subject: Lease of Markleton Sanatorium, Markleton, Pa. On file, Record Room, S. G. O., 601 (Markleton) F. (86) Letter from Col. W. L. Reed, I. G. D., to the Inspector General of the Army, June 13, 1918. Subject: Inspection of General Hospital No. 17. On file, Record Room, S. G. 0., 333 (Gen. Hosp. No. 17) K. OTHER GENERAL HOSPITALS. 551 (87) First Indorsement from War Department, A. G. 0., to the Surgeon General, March 21, 1918. Subject: Designation of hospital at Markleton, Pa. On file. Record Room, S. G. O., 322.3 (Gen. Hosp. No. 17) K. (88) Letter from Brig. Gen. Robert E. Noble, M. C., to Senator Boise Penrose, United States Senate, September 18, 1918. Subject: Markleton Sanatorium, General Hospital. On file, Record Room, S. G. 0., 601 (Markleton, Pa.) F. (89) Shown on weekly bed reports compiled in the Surgeon General’s Office, On file, Record Room, S. G. 0., 632 (U). (90) Letter from commanding officer, General Hospital No. 17, Markleton, Pa., to Col. Roger Brooke, M. 0., March 28, 1919. Subject: Transfer of patients. On file, Record Room, S. G. 0., 323.7 (Gen. Hosp. No. 17) K. (91) Reports from Chief of Educational Service, General Hospital No. 17, to the Surgeon General, various dates. Subject: Report of educational work. On file, Record Room, S. G. 0., 456 (Gen. Hosp. No. 17) K. (92) Report on special sanitary inspection of General Hospital No. 18, Waynesville, N. C. Made on August 8, 1918, by Lieut. Col. F. W. Weed, M. C. On file, Record Room, S. G. 0., 721 (Gen. Hosp. No. 18) K. (93) Telegram from Gorgas to J. B. Sloan, Waynesville, N. C., March 26, 1918. Subject: Sec- retary of War has approved leasing of hotel at rate of $10,000 per year. On file, Record Room, S. G. 0., 481 (Waynesville, N. C.) F. And: Telegram from Dunn to Surgeon General. March28, 1918. Subject: Justreceived word that lease was signed in Charleston, yesterday. On file, Record Room, S. G. 0., 481 (Gen. Hosp. No. 18) K. (94) Letter from the Surgeon General to commanding officer, General Hospital No. 18, Waynesville, N. C. June 27, 1918. Subject: Administration. On file, Record Room, S. G. 0., 322.3 (Gen. Hosp. No. 18) K. (95) Letter from quartermaster to commanding officer, General Hospital No. 18, July 31, 1918. Subject: Buildings for use at this hospital. On file, Record Room, S. G. 0., 652 (Gen. Hosp. No. 18) K. (96) Second indorsement from War Department, S. G. 0. to Construction Division, War De- partment, August 13, 1918. Subject: Additional construction General Hospital No. 18, Waynesville, N. C. On file, Record Room, S. G. 0., 652 (Gen. Hosp. No. 18) Iv. (97) Telegram from Davis, commanding, to the Surgeon General, April 24, 1918. Subject: Hospital ready to receive patients. On file, Record Room, S. G. O., 705 (Gen. Hosp. No. 18) K. (98) Shown on weekly bed report compiled in the Surgeon General’s Office. On file, Record Room, S. G. 0., 632 (U). (99) Letter from commanding officer, General Hospital No. 18, to the Surgeon General, May 7, 1919. Subject: Official closing of United States Army General Hospital No. 18, Waynes- ville, N. C. On file, Record Room, S. G. 0., 323.7 (Gen. Hosp. No. 18) K. CHAPTER XXVII. GENERAL HOSPITALS, NOS. 19, 20, 22, 23, 24, 25, 26, 27, 28, AND 29. GENERAL HOSPITAL NO. 19, OTEEN (AZALEA), N. C. Early in the year 1918 all hospital space for Army tuberculous patients was, with the exception of the Fort Bayard General Hospital, in relatively unsuitable leased properties. These converted hospitals had, at that time, very little remaining available space; and the accumulation of the tuberculous in the base hospitals of the camps was not only highly undesirable but demanded relief; consequently additional space was vitally required. At this time the lease and purchase of certain tracts of land in the mountainous regions of North Carolina, to be used for hospital purposes, was begun under the authority of the Secretary of War. 1 When completed, about 400 acres had been acquired. 2 The land so secured was situated 1 mile from Azalea, 5 miles from Biltmore, and 7 miles from Asheville. Following its acquisition, plans were developed for the construction of a large tuberculosis hospital to consist of over 60 frame buildings having a capacity of 1,000 beds. 3 On March 2. 1918. the Secretary of War authorized the construction of the hospital, and work upon it was insti- tuted. 1 In the fall of 1918, when the original project was being rapidly com- pleted, and when occupation of the buildings had begun, the construction of an additional group of 200 buildings, with a capacity of 500 beds, was re- quested and authorized. 4 In the first group the wards were of the infirmary and the ambulatory types, 3 and were grouped about a culinary and administrative center. The 500-bed group consisted of ambulatory wards 5 for the most part, which, with but few exceptions, were located on a hill some distance from the main kitchen and mess hall. Between these two main groups a third group of 12 buildings was located. At first all ambulant patients in the hillside group of wards were required to walk to the mess halls, three-fourths mile distant. 6 This was done with a view to hardening and more rapidly rehabilitating them. The scheme was found to be impracticable, and later a mess hall and kitchen were constructed in close proximity to this detached class of sick. As at General Hospital No. 8, the wards were of three types'" — infirmary, ambulatory, and semi-infirmary, the latter type being a compromise between the first two and was determined upon as the construction and use of the wards developed. Much study was given to the subject and every effort was made to provide the facilities for the satisfactory treatment, after care, and instruction of the tuberculous; and all of the usual services of a complete general hospital were provided. In all, 100 buildings, with heating, lighting, plumbing, and sewer connections, were erected, the majority not connected by umbrella walks, and all but one — the heating plant — were of frame construc- tion. In area covered, if not in capacity, this was the largest temporary general hospital constructed during the war. Some conception of its magni- tude may be gained from the fact that 40 miles of the following utilities were 552 OTHER GENERAL HOSPITALS. 553 installed: Roads, sewers, water and steam mains, and electric transmission and distribution lines. The designed capacity of the hospital was 1,500 beds; 7 as actually operated, however, this capacity was not fully realized, due mainly to the fact that the ambulant and infirmary sick were not in the exact ratio anticipated in the construction. It had been estimated that 33 per cent of the tuberculous would be infirmary cases and 55 per cent ambulatory; but it developed that they were about equally divided; and late in the war experience, even the reverse of the original ratio obtained. The total cost was $2, 750, 000. 8 On May 25, 1918, it was designated General Hospital No. 19. 9 It was opened to the sick in September, 19 18, 10 and the number under treatment rapidly rose, reaching 1,000 on January 1, 1919. 10 The peak, 1,175, was reached in the following May. 10 The number varied between 948 and 1,192 throughout the year 1919. 10 554 MILITARY HOSPITALS IN THE UNITED STATES Statistical data, United States Army General Hospital No. 19, Oteen (Azalea), N. C., from Sep- tember, 1918, to December, 1919, inclusive SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi-, ration of term. Transferred to in- sane asylums. Transferred to other hospitals. •3 o otJ .50 © ? o 3 ^ By trans- " fer. Otherwise. ‘ft CO c Quarters. Hospital. C/2 3 1918. September 57 456 513 26 1 486 October 486 63 315 864 81 5 1 1 4 763 N ovember 770 26 226 1 1,029 95 6 1 927 5 260 December 927 77 189 1 1, 194 178 8 7 9 9 1 9S9 5^327 1919. January 989 108 374 5 1,476 285 10 27 5 5 1, 144 9 858 February 1,144 71 281 3 1,499 267 19 39 3 1 l' 170 7, 599 March., j 1, 170 48 167 5 1,390 226 21 81 6 6 12 1 ' 038 8 609 April lj 038 58 392 3 1,491 132 25 42 1 84 15 1, 192 8 467 May l' 192 60 229 3 1,484 220 20 20 18 1 051 8’ 607 June 1,051 36 278 2 1,367 126 17 144 3 1 10 1,066 8 701 July 1,066 28 98 11 1, 203 79 27 104 2 29 14 948 AUgUSt '948 21 258 20 1,250 54 23 160 1 9 35 968 9 111 September 968 19 227 9 1, 223 24 13 2 15 1,089 4, 254 October 1,089 26 93 5 1,213 22 18 64 3 21 28 1,057 3,977 November 1,057 27 185 16 1, 285 16 32 31 4 1 25 23 1, 153 5, 68S December 1, 153 31 41 18 1, 243 30 22 252 6 1 2 20 '910 3, 114 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. W omen. Chil- dren. Total. Year and month. Men. W omen. Chil- dren. Total. 1918. 1919. 4 4 8 April 181 Cl 949 5 8 13 May 1S5 64 249 7 17 24 Juiie 231 88 319 7 38 1 46 July 173 125 298 172 90 262 1919. 2S2 30 312 7 37 1 October 215 130 345 4 54 58 November 250 199 1 373 200 61 261 December 150 90 240 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Aides and workers. Other civilian em- ployees. Medical Corps. Sanitary Corps. Miscella- neous (Q.M.C., etc.). Total. Medical Depart- ment. Miscella- neous (Q.M.C., etc.). Total. 1918. 29 6 1 36 263 33 296 52 38 7 3 48 265 33 29S 37 7 5 49 390 41 431 62 41 11 6 58 592 109 701 61 1919. 50 16 5 71 5SS 151 739 78 53 15 75 586 1S3 769 108 48 16 11 593 176 769 108 47 17 12 76 547 160 707 100 45 15 11 71 522 10S 630 9S 52 13 10 499 22 521 107 1 J uly 51 14 14 79 498 12 510 118 1 43 14 9 66 400 405 116 1 45 10 9 64 398 s 406 128 35 6 46 324 6 330 151 40 6 6 52 315 8 323 142 December 42 6 5 53 464 s 472 129 a Compiled from monthly returns and side and wounded reports (Form 52) to the Office of the Surgeon General, on file. Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office" (name of hospital). OTHER GENERAL HOSPITALS. 555 GENERAL HOSPITAL NO. 20, WHIPPLE BARRACKS, ARIZ. Whipple Barracks had been located 1 mile northeast of Prescott, Ariz., in a bowl-shaped basin among the mountains, at an altitude of about 5,000 feet. 11 Between the years 1903-1906 permanent brick and concrete buildings had been erected to provide facilities for quartering a battalion of troops. In 1911 it was practically abandoned as a result of the transfer of troops to the Mexican border. In Febi'uary 6, 1918, the Surgeon General recommended the transfer of the post to the Medical Department for use as a general hospital for the treat- ment of tuberculosis. 12 On February 15 the transfer was authorized, 13 and on May 25 it was designated “General Hospital No. 20” by the War Depart- ment. 14 The renovation of the post was begun at once, but for some time Fig. 181. — Sun porch, General Hospital No. 20, Whipple Barracks, Ariz. only small expenditures were made for this purpose and for slight alterations. It was apparent, however, that much more space would be required for the treatment of tuberculosis than would be afforded in the altered existing build- ings. These were studied, and a plan was evolved whereby certain additional buildings in new construction were to be added, which, with the existing buildings, would give a capacity of approximately 1,300 sick. Based upon this plan, a request was made in July for the construction of a total of about 30 buildings, most of which were to be wards of three types — infirmary, semi- infirmary, and ambulatory; 15 all buildings to be of tile and stucco, to have modern improvements, and to be so grouped about the existing buildings as to serve the greatest purpose. The general scheme and plan were altered from time to time, but eventually the project was greatly reduced, the following buildings being actually constructed: 5 two-story wards, 2 one-story wards, and 1 nurses’ building, which brought the total capacity of the hospital up to 500 beds. This work was not completed until July, 1919. In the meantime 556 MILITARY HOSPITALS IN THE UNITED STATES. there was much to disturb the progress of the project: the ever present diffi- culty of designing and placing new buildings so as to function well with those existing, and the advent of the armistice, which changed the aspect of the problem but did not serve to obviate entirely the necessity for the construction. A portion of the construction was obviated, however, and the capacity was never increased beyond 500 beds. The change from the larger project to the smaller one was effected in January, 1919, when it could be safely predicted that facilities as originally contemplated would not be required. Reconstruction activities were provided and all the services of a general hospital were started, some completed, others finished on a reduced scale. The hospital opened for sick in June, 1918, 16 with a capacity of 150 beds, most of which were at once filled. While the constructed capacity was 500 beds, this actually was never reached in operation. By October the actual capacity had reached 400 beds, and by that time the patients had increased to an equal number. From this time on until the end of 1919 the hospital was practically full, patients seldom falling as low as 300 in number and oftentimes coinciding with the capacity . 17 Statistical data, United States Army General Hospital No. 20, Whipple Barracks, Ariz., from June, 1918, to December, 1919, inclusive .a SICK AND WOUNDED Y ear and month . Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command . From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. C L. Hospital. e3 3 1918. 4 72 76 4 72 168 72 7 105 184 5 178 1 4,346 20 179 11 33 1 224 11 1 211 1 56 212 1 101 314 4 2 1 2 305 7,464 305 89 16 1 411 49 12 2 345 3 10 507 17 348 67 29 7 451 S3 14 3 2 349 11,666 December 349 57 26 2 434 57 4 18 2 1 3 3 346 10,285 1919. 346 26 29 1 402 28 2 44 9 9 310 9,777 310 29 17 356 32 78 3 1 241 1 7.647 9 242 55 312 14 4 44 250 7,004 4 250 21 73 344 19 1 26 1 4 1 292 May 292 19 33 3 347 23 1 37 20 259 8,317 259 21 65 22 367 16 1 44 2 39 265 7,583 July 265 17 113 34 429 11 1 43 i 1 50 322 n. 2 ’-9 322 10 76 53 461 12 5 55 2 47 340 2,187 340 10 40 30 420 6 3 47 15 25 323 1 l' 926 11 324 13 48 17 402 10 2 33 9 19 329 1,383 329 23 83 20 12 2 19 6 27 389 2,722 December 389 19 18 17 443 6 2 6S 63 301 1 4,951 10 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Y ear and month. Men. Women. Chil- dren. Total. 1918. 1919. 1 3 4 1 6 1 3 4 1 6 1 5 6 42 47 1 6 July 42 47 August 1919. September SO 171 12 263 1 5 6 October so 171 12 263 1 5 6 so 171 12 •263 March. 1 5 6 December so 170 11 261 o Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General ’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS. 557 Statistical data, United States Army General Hospital No. 20, Whipple Barracks, Ariz.,from June, 1918, to December , 1919, inclusive — Continued. PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M. C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. Nurses. 1918. 3 3 1 7 59 9 68 July 8 3 2 13 65 31 96 11 August 12 3 2 17 115 31 146 11 September 13 4 5 22 117 31 148 10 October 16 5 5 26 164 29 193 76 November 17 6 5 28 165 29 194 69 December 20 4 5 29 195 46 241 22 1910. January 17 4 5 26 172 74 246 18 February 19 3 8 30 172 75 247 22 March 19 4 10 33 159 43 202 22 April 21 4 14 39 147 41 188 31 May 24 5 14 43 166 39 205 41 June 26 4 14 44 214 13 227 42 July 26 5 15 46 187 5 192 41 August 23 5 11 39 164 6 170 44 September 14 5 7 26 158 25 183 43 October 11 4 5 20 158 31 189 44 November 14 4 5 23 155 87 212 44 December 16 3 6 25 149 83 232 42 GENERAL HOSPITAL NO. 22, PHILADELPHIA, PA* On January 19, 1919, the mayor and the director of health and charities of Philadelphia formally offered a portion of the Philadelphia General Hospital to the War Department for hospital purposes at a nominal rental of $1 per year. A board of officers representing the Chief of Staff, the Surgeon General, and the Chief of the Construction Division inspected the various buildings offered, and reported that the property could be adapted to hospital use within a very short period at a cost of $65,000 and that it would provide a capacity of 500 beds. 18 The leasing of this property had already been approved on January 6 by the Secretary of War, who desired that it be developed with the least practicable delay. 18 The portion offered the Government was the 80-year old group of buildings which had been used in part, for the insane. The group for purposes of description may be divided into five sections: a 3-story brick building sit- uated west of the west wing of the administration building; a 4-story brick building comprising the west wing of the administration building of the hos- pital; a 4-story brick building comprising the east wing of the administration building of the hospital, 600 feet distant over outside walks from the nearest wards; and second floor of the east section of the nurses’ home. Section 1 was converted into quarters for the enlisted personnel and into storage space for medical and quartermaster supplies; section 2 was renovated and converted into wards; section 3 was converted into wards and mess and administrative offices; section 4 was made into a kitchen; and section 5, with the use of some paint and the installation of some toilet facilities, became a very good nurses’ home. The construction work cost slightly in excess of $65,000 and consisted, in conjunction with the work above referred to, of painting, caleimining, the re- finishing of old floors which had been laid many years previously; the installa- *After General Hospital No. 22 (Richmond College) was converted into Debarkation Hospital No. 52, the former number was used for this hospital. (See p. 825.) 558 MILITARY HOSPITALS IN' THE UNITED STATES. tion of diet kitchens, utility rooms, and dish washers; the replacement of many steam rinsers and some radiation, plastering, and wiring; the removal of iron bars and grating from many of the outside windows, and many other general items of repair and refurnishing. No reconstruction activities were installed in this hospital as it was intended that general medical and surgical cases and venereal diseases would be treated there. The development of General Hospital No. 22 was unique in at least one respect, and it presented a good example of what could be done in rapid altera- tion and organization. The Medical Department in January, 1919, did not feel the need of developing general hospital facilities at Philadelphia, and did not originate the request for the use of this institution. However, in a reso- lution adopted in common council in Philadelphia, January 16, which had been approved by the mayor, it was stated that the War Department desired to use Fig. 1S2. — General Hospital No. 22, Philadelphia, Pa. certain buildings and portions of buildings of the Philadelphia General Hos- pital. 19 At about the same time the Director of Operations, General Staff, stated in a memorandum for the Assistant Secretary of War that the develop- ment of a hospital in Philadelphia would be particularly appropriate, judging from the strong desire of its citizens for the return of the local wounded to the vicinity of their homes. 18 The actual development of the hospital took place in a most expeditious fashion, as had the execution of the lease and the authorization of funds. The project was approved by the Secretary of War on January 6, 1919; the $65,000 was allotted on January 9, and the same day a contractor was recommended for the work. On the following day the contractor received orders to proceed with the work and on January 14 actual funds were transferred to the local contracting quartermaster; complete plans for alteration were prepared; and the work was practically completed by February IS, when additional funds were called for and were made available on the following day. By February 2S OTHER GENERAL HOSPITALS. 559 the alteration work had been entirely finished and the organization of the hos- pital was completed and it was ready for sick five days later. This was indeed very rapid work when contrasted with many similar projects carried out early in the war period when it was not uncommon to triple or quadruple this length of time in executing the lease, developing plans, securing funds, and completing the construction. The hospital opened on March 5, 1919, with a capacity of 450 beds 20 and within a fortnight 400 sick were being cared for. In the meantime, however, the problem of how to acquire hospital space had changed to one of liowto dispose of hospital space, and 10 general hospitals had been closed. On May 28, 1919, the Surgeon General recommended the abandonment of this hospital. 21 The recommendation was approved June 5, the abandonment to be accomplised on or before June 30. 22 All sick were transferred prior to June 30, on which date the hospital ceased as a military institution and the control of it was returned to the city of Philadelphia. 2 Statisdcal data, United States Army General Hospital No. 22, Philadelphia, Pa., from February, 1919. to June, 1919, inclusive .“ SICK AND WOUNDED. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1919. 1 1 1919. May 15 6 6 11 3 14 10 10 PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscella- neous (Q. M.C., etc.). Total. Medical Depart- ment. Miscella- neous (Q. M. C., etc.). Total. Nurses. 1919. February 19 1 20 218 14 232 25 27 2 29 235 26 261 46 27 2 29 227 999 24 251 43 27 1 28 16 238 June 8 1 9 45 3 48 21 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General's Office (name of hospital). 560 MILITARY HOSPITALS IN THE UNITED STATES. GENERAL HOSPITAL NO. 23, HOT SPRINGS, N. C. The Mountain Lake Park Hotel was located in the town of Hot Springs, N. C., 38 miles distant hy railroad from Asheville. The site of the hotel was on a plateau, popularly called the “dimple” because of the fact that it was com- pletely surrounded hy the close-in Southern Appalachian Mountains. The property included a tract 100 acres in extent, quite flat, and triangular in out- line. On it were well arranged shade trees that bordered the roads and walks, and approximately one-fifth of it was cultivatible. The soil was sandy and the subsoil was a mixture of rock and clay. After rains the surface dried rapidly and there was a constant freedom from mud and dust. The site was well protected from high winds, being surrounded as it was by the mountains. The French Broad River formed the northeastern boundary of the area, and the tracks of the Southern Railway the southern boundary, as well as the divid- ing line between the property and the town of Hot Springs, a village of 400 inhabitants. The climate was mild, usually dry, and very invigorating. The mean summer temperature was found to be 80° F. and the maximum winter tempera- ture 30° F. The hotel, a four-story frame building, erected in 1880, had been used by the Department of Labor as an internment camp for alien enemies. This department had constructed quite a number of additional temporary buildings in the vicinity of the hotel, the group being divided into two areas: Camp A, consisting of the hotel and some additional barrack buildings, with a capacity of 900, and occupied by ships’ officers and the staff of the Department of Labor; and camp B, consisting of 11 barrack buildings, with a capacity of 1,100, occupied by seamen. 24 The Secretary of Labor inquired of the Secretary of War as to whether this property could not be profitably used by the War Department for hospital pur- poses, as it was the intention of the Department of Labor to discontinue the use of the camp. 25 At the inception of the negotiations for the transfer it was not represented that the place was undesirable for the purposes of the Department of Labor, but the reason given for its abandonment by that department was that the interned Germans were offensive to the civilians of the community and it was feared that some untoward incident might occur that would prove embarrassing to the United States. The property was inspected by representatives of the Surgeon General’s Office, and the gist of their reports was to the effect that, while it was not ideal in location, its water supply was not entirely satis- factory as to quality and quantity, and the temporary buildings and the hotel itself were not in good condition, nevertheless the property should be acquired for hospital purposes. They reported further that for a comparatively small amount of money the whole could be economically converted into a com- paratively good military hospital. 26 In the spring of 1918 there was every indication that the continuation of war would be prolonged and there was urgent need of providing a large number of general hospitals. Moreover, it was reported that there would be adequate space for 1,200 beds at Hot Springs; so on May 22, the Surgeon General recom- mended that the property be obtained; and, as it was already under lease by OTHER GENERAL HOSPITALS. 561 the Government, that the War Department take over the existing lease, which carried a rental of $18,000 per year. 27 The lease was then transferred from the Department of Labor to the War Department as of July 1, 1918. 28 It was the intention of the War Department to transfer the interned alien enemies to Fort Oglethorpe, but in July, when this transfer was about to take place, an epidemic of typhoid fever appeared among them, the first cases occur- ring in camp B on July 20; 150 cases developed, with 17 deaths. All originated in camp B, where, upon investigation, it was found that the cause was due to the use of water from a proscribed well into which seepage had occurred from the French Broad River. There were no cases in camp A. 24 While part of the Medical Department personnel had arrived they had not yet begun to function when this epidemic occurred, which, of course, caused delay in removing the prisoners. Meanwhile, the Surgeon General had re- quested the development of the place for hospital purposes, and the various plans in connection with this work were under way. Although it was not very satisfactory, as has already been indicated, and notwithstanding subsequent reports of inspections, made by representatives of the Surgeon General’s Office during the summer and fall, which did not approve the selection, in view of the increasing need for general hospital beds, the work of development was not given up. The expenditure of the funds, which had been requested in June, was not authorized until August (during which month the hospital was designated General Hospital No. 23) ; and, as a result of further unavoidable delays, actual construc- tion work was not begun until October 1. Prior to October 1 , about $100,000 had been allotted for the development of this hospital; subsequently an additional sum was estimated as necessary for the correction of the water supply. This was disconcerting as it had been understood in the Surgeon General’s Office that only a small expenditure would be required to provide excellent water from an un- questionable source not far distant. The development of this source of water was not approved. 29 Alteration work was under way at the time of the armistice, and although most of it was accomplished it had not been advanced sufficiently to make the buildings completely available for use. The commanding officer, however, re- ported an available capacity for 300 ambulatory and 125 bed cases, 30 but this space was never fully utilized. The greatest number of sick was 122 in the month of February, 1919. 31 In January, 1919, the Surgeon General felt that the general hospital situa- tion was secure and that an emergency which would make the use of this hos- pital necessary was unlikely to occur in the future. It was therefore recom- mended on January 31 that it be abandoned. 32 This was approved on February 1 0 ; 33 and on March 15 the hospital was abandoned, 34 the few remaining sick hav- ing been transferred to General Hospital No. 12, Biltmore, N. C. 45269°— 23 36 562 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army General Hospital No. 23, Hot Springs, N. C., from August, 1918 to March 15, 1919, inclusive a SICK AND WOUNDED. Year and month. Men. Women. Children. Total. 1918 October 2 2 November December PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps.’ Miscel- laneous (Q. M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M.C., etc.). Total. 1918. 3 3 1 7 40 21 61 September 4 4 1 9 40 21 61 15 5 1 21 111 20 131 15 4 2 21 111 20 131 December 10 4 2 16 303 27 330 26 1919. January 16 4 2 22 261 21 2S2 27 February 2 2 2 6 126 IS 144 25 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). GENERAL HOSPITAL NO. 24, PARKVIEW STATION, PITTSBURGH, PA. The hospital was located in the reconstructed buildings of a county institu- tion, formerly called the North Side Home, Hoboken, or the Warner House, Claremont; and in an adjacent institution, the Allegheny Workhouse. These buildings were on the north bank of the Allegheny River, on an area of ground 850 feet in width on the riverfront and 3,700 feet deep, and had been constructed on a terrace 1,100 feet back, thus affording an outlook of marked attractiveness. The terrain in the rear of the buildings was rolling; the newest portion with an upward slope, contained the farm buildings and an old orchard : the northernmost OTHER GENERAL HOSPITALS. 563 portion was in grain land. The soil was mostly clay with deposits of gravel; the flats along the river were an alluvial deposit from river floods. The climate was much the same as that of Pittsburgh, with a higher veloc- ity of wind, due to the exposed position. The region was hot in summer and was subject to electrical storms of great intensity. On April 8, 1918, the Allegheny County commissioners offered the North Side Home to the Medical Department for use for hospital purposes. They proposed a rental of $20,000 per year, though they stated that if this rental seemed too high they would accept any terms deemed proper by the Govern- ment. 35 There were, exclusive of farm houses, 8 buildings in all, 3 of which— the administration building, the men’s building and the women’s building— were large brick structures with 3 floors, attic and basement; the other 5 were smaller structures situated in the rear and comprised the mortuary and laundry, bakery, heating plant, shop, and residence. The “home” had not been oceu- Fig. 183. — General Hospital No. 24, Parkview Station, Pittsburgh. pied for about two years; the heating system was old, the floors were badly worn, the buildings were gas lighted and in a state of ill repair. The place had been inspected by a representative of the Surgeon General’s Office, the condi- tions were known, and it was realized that a considerable sum ($100,000 was the original tentative estimate) would be required to rehabilitate it to afford facilities for the care of from 750 to 1,000 sick. 36 While a rental figure had been proposed, it was within the knowledge of the Surgeon General’s Office that the chamber of commerce, the mayor, and the people of Pittsburgh gener- ally desired to offer this property free to the Government, and a nominal lease was accordingly recommended. 36 This was approved by the Secretary of War May 2, 1918, to be effective July 1, 1918. 37 On July 19, an allotment of $126,000 was made to develop the hospital. Thorough study was given and every effort made to reduce construction and to impress upon those in direct charge of the new hospital and the alteration work that the object was to secure a satisfactory temporary hospital at minimum cost and not to develop, by extensive alteration and durable improvements, an ideal hospital at excessive costs. Subsequent to the above allotment $17,000 more 564 MILITARY HOSPITALS IN THE UNITED STATES. was spent on repairs and alteration; and $62,000 was expended in constructing two new buildings for nurses, the only new buildings added, bringing the total to $205,000. The work progressed slowly during the late summer, fall, and early winter of 1918. The difficulties encountered were not lessened by the labor situation, which was a constant source of trouble, and at times it was necessary to detail the enlisted men on construction work. On August 26, 1918, the hospital was designated General Hospital No. 24 38 and in October 200 beds were available; 39 in December, 350; 39 in January, 1919, 600; 39 an d in April the maximum, 700, had been provided. 39 It opened for sick in October and the number of sick in hospital increased pari passu with the capacity of the hospital. 39 The bed capacity of this hospital was originally estimated at 750-1, 000. 36 Subsequent events demonstrated that at least 750 beds should have been made available. The actual capacity developed, exclusive of potential space for 100 patients, vicariously secured by constructing new buildings for 100 nurses, was 600. Experience showed that, with buildings of the character of those at the North Side Home, with a high percentage of basement and attic space, and many small rooms to be utilized, at least 40 per cent of the total floor space could be covered with beds for patients, giving each bed 100 square feet. In this hospital, space was given storage, offices, waiting rooms, dining rooms, the receiving and surgical services, disproportionate to that allotted to beds. On June 15, 1919, after it had been determined to abandon the hospital, the United States Public Health Service requested its transfer to that service. On July 15 the transfer was affected, all patients having been transferred else- where in the meantime. 40 • Statistical data, United States Army General Hospital No. 24, Parhview Station, Pittsburgh, Pa., from July, 1918, to July 22, 1919, inclusive .“ SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospitals. t» o Hospital. £ 3 1918. 5 5 3 3 3 13 lip 1 8 4 s 4 27 2 33 21 2 2 1 3 21 28 6 58 19 1 36 9 116 31 38 54 260 1 353 111 1 28 2 211 3,409 29 1919. January 211 54 419 689 56 2 IS 21 S 21 374 1 1 . 028 February 374 53 338 7 772 60 1 20 92 17 5S2 14.264 March.. . 582 46 115 17 760 47 2 4 3 27 93 14 569 l 19. 977 10 April 570 28 172 21 791 36 1 25 2 52 24 l 16. S23 5 575 22 152 19 768 65 3 25 76 15 32 18.662 552 17 272 15 856 30 104 48 70 14 590 19. 073 July 590 10 5 3 608 26 135 80 352 6.709 a Compiled from monthly returns and sick and wounded reports (Form 52) to the. Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adju- tant General, on file, Statistical Division, Adjutant General’s Office' (name of hospital). OTHER GENERAL HOSPITALS. 565 Statistical Data, United States Army General Hospital No. 24, Hoboken, Allegheny County, Pa., from July, 1918, to July, 22, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. W omen. Chil- dren. Total. Y ear and month. Men. Women. Chil- dren. Total. 1919. 1919. May 58 45 103 15 30 45 June 58 45 103 15 44 59 July 58 45 103 April 10 40 50 PERSONNEL ON DUTY. Year and month. 1918. July August September October November December 1919. January F ebrua'ry March April May June July Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M. C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. i 1 5 76 12 88 5 2 7 77 12 89 6 2 8 77 12 89 8 4 3 15 127 18 145 9 13 4 3 20 140 19 159 32 21 4 4 29 468 30 498 28 26 6 4 36 370 33 403 37 36 7 8 51 355 49 404 46 37 7 11 55 351 49 400 61 44 8 8 60 352 45 397 71 45 8 4 57 346 42 388 69 44 7 5 56 339 22 361 66 1 3 4 1 1 GENERAL HOSPITAL NO. 25, FORT BENJAMIN HARRISON, IND. The site upon which Fort Benjamin Harrison had been located, in 1902, was a tract of land consisting of approximately 2,415 acres, and 'was about 13 miles, by railroad, northeast of Indianapolis. It was an ideal site in many ways; there were a magnificent first growth of forest trees, running streams, and moderately rolling land with green valleys and level fields. The soil was a rich, black loam, and the subsoil was principally gravel. Permanent buildings had been constructed on the post for domiciliating a regiment of Infantry, and among them were included a permanently con- structed post hospital of 66 beds capacity, and an isolation pavilion of 38 beds. 41 The first efforts, on the part of the Medical Department, to secure the whole of Fort Benjamin Harrison for general hospital purposes, were made in May, 1917. 42 During this month the post was included in a general request, and, in addition, two specific requests for it were made upon the Secretary of War . 43 In June, 1917, the commanding general, Central Department, was directed by the Secretary of War to make available as many permanent barracks at Fort Benjamin Harrison as were needed for base or general hospital purposes; and to provide tents at first, and later cantonments, for the well troops thus dispossessed. 44 In August, however, the department commander stated that it was his intention to use all of the post for the second training camp and, therefore, he had no space for hospital purposes. Later in the same month, the Secretary of War informed the department commander that 500 beds would 566 MILITARY HOSPITALS IN THE UNITED STATES. Fig. 184. OTHER GENERAL HOSPITALS. 567 be satisfactory for the Medical Department’s use; and asked if the provision of that number in the post hospital and additional available buildings would interfere with the training work, to which the department commander replied 15 days later in the affirmative, stating that no space would be available for hospital purposes. On October 15, 1917, The Adjutant General placed all of the buildings at this post at the disposal of the department commander for Infantry winter quarters after the closure of the training camp, which was to take place November 25. 45 In the meantime, as a result of the instructions of the Secretary of War, which he had issued to the department commander in June, to make the permanent barracks available, the department surgeon was directed by the Surgeon General on June 30, to have a base hospital planned at Fort Benjamin Harrison and to make request for any additional buildings that might be required. 46 It had been the desire of the Surgeon General to avoid hospital construction, by using this post, along with others, for hospital purposes, and he felt that funds might thus be conserved by putting well troops in temporary barracks, at the same time housing the sick in the more com- fortable, permanent buildings. Nothing came of this plan for a base hospital, however; nor was anything done at this post for a long time thereafter in the way of providing a general hospital; and the post buildings were continued in use for training camp purposes. On September 21, 1918, Fort Benjamin Harrison was at last designated “General Hospital No. 25”; 47 and in the following month the Secretary of War again directed the department commander, Central Department, to transfer the whole post to the Medical Department that it might be used as a general hospital, with the exception of the following buildings: The storehouse and other buildings, then being used by the Quartermaster Corps, the post adminis- tration building, the post exchange, the guardhouse, two barracks, and five officers’ quarters . 48 These instructions were very explicit, and they would permit neither nullification nor discretionary action on the part of any subor- dinate commander. Plans were at once prepared, in the Office of the Surgeon General, for the construction of a large number of temporary buildings, which, with the use of the existing and available post buildings, would have given a bed capacity of 2, 500. 49 The project was much reduced, however, before it had been approved, and was ultimately modified so as to provide but 500 beds in the temporary buildings. This reduced plan was approved by the Secretary of War but was not carried into effect. The urgency of the situation had passed. The commanding officer of the hospital was instructed to do the minimum amount of alteration, to proceed on the assumption that the hospital would not be required for a long period for the treatment of mental cases, and to limit requests for funds for alterations to $5,000 until further orders. The only work that was done, in addition to some temporary wards erected about the post hospital in May, 1917, for post use, was the renovation and alteration of some of the post buildings for hospital use. The hospital operated under the name and organization of a post hospital until September 21, 1918, when it became a general hospital. Up to that time the sick had varied from 100 to 300 and the capacity had not exceeded 500. 30 In October, however, with the use of the post buildings turned over, the capacity was temporarily greatly increased, and about 1,600 sick had been sent there within 568 MILITARY HOSPITALS IN THE UNITED STATES. a month. 50 It was deemed wise not to crowd this hospital as it had been denied complete construction facilities and the number of sick was allowed to fall, in another month, to about 900, near which figure it constantly remained throughout the rest of its existence as a general hospital. 50 This hospital when opened treated general medical and surgical cases, but during the winter of 1918-19 it was used for the treatment of mental cases, drug addicts, inebriates, epileptics, and mental defectives. Still later the special work was discontinued and general medical and surgical cases of the more ordinary sort where sent there. On August 4, 1919, it was recommended that the hospital be discontinued as such on September 1, and revert to its former status; 51 the approval of the War Department was given on August 8 52 and the discontinuance was carried into effect, as contemplated, on September l. 53 Statistical data, United States Army General Hospital No. 25, Fort Benjamin Harrison, Ind., from September, 1918, to August, 1919, inclusive A SICK AND WOUNDED. last Admissions. o 'd Year and month. g from onth. From command. From other sources. d 3 o © © | S & a © PH By trans- fer. Otherwise. © o c3 O e< 1918 September 248 1,103 13 5 1,369 ( ictober 9(50 2,020 32 24 3,036 November 482 491 15 1 989 1 >ecember 408 431 93 932 1919. January 341 252 183 10 786 February 410 92 211 28 741 March 472 74 272 25 843 April 525 65 241 11 842 May 548 64 328 15 955 bine 643 86 643 26 1,398 July 782 69 403 34 1,288 August 561 61 44 37 703 Completed cases. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. | Otherwise dis- posed of. 358 2 32 si 17 2,338 570 1S9 4 3 20 4 4 2 1 576 9 6 345 3 14 5 9 238 4 20 5 2 250 40 10 18 160 2 97 22 13 210 79 4 19 438 1 140 2 13 22 362 3 170 30 208 2 229 2 189 50j Remaining. 73 © CL C C? 960 482 408 341 410 525 548 643 782 561 ! 23 Aggregate number ol days lost from sickness. 6 9, 576 19,148 14,592 10,217 13,462 12,018 15, 568 24,456 26, 133 21,486 23,000 IS, 095 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 1919. 36 75 26 137 116 20 191 36 75 26 137 February 116 20 191 36 75 26 137 March. 183 20 258 36 75 26 137 April 190 50 20 260 May 310 50 20j 380 June 325 50 20 395 July 275 70 20 365 August 63 27 90 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS. 569 Statistical data, United States Army General Hospital No. 25, Fort Benjamin Harrison, Ind.. from September, 1918, to August, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. 191S. September October November December 1919. January February March April May June July August Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M. C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M. C., etc.). Total. 30 3 33 175 175 34 37 3 40 150 150 50 26 4 1 31 150 150 65 31 8 2 41 461 461 60 34 8 2 44 455 455 53 35 7 2 44 430 430 68 36 6 2 44 437 437 67 35 6 1 42 414 414 59 38 4 1 43 401 401 69 39 5 2 46 392 392 66 39 5 2 46 395 395 62 28 1 29 176 176 53 GENERAL HOSPITAL NO. 26, FORT DES MOINES, IOWA. Fort Des Moines was located within 5J miles of the city of Des Moines, Iowa, on a rolling terrain that was slightly wooded with dwarf timber. The soil was a rich, black loam fully 3^ feet thick, superimposed upon a clayey loam — the “Iowa glacial” drift. The soil was readily metamorphosed into an almost impalpable dust, which was easily carried by the winds in dry weather, and in wet weather it became a tenaceous mud; but as the post was well sodded and pro- vided with gravel roads and cement walks, no real inconvenience was caused by mud. The summers were usually hot and dry, and the winters severely cold and attended by much snow; the falls were ideally pleasant, but the springs were usually cold and damp, with much rain and occasional cyclonic storms. The early history of the general hospital, which was finally established at this station, is drawn out over a long period of time, as the following chronologically arranged events will bear testimony: On July 2, 1917, 54 the Sui’geon General requested the use of the permanent buildings at Fort Des Moines for hospital pur- poses, and on the day following, the Secretary of War authorized the depart- ment commander, Central Department, to turn over the necessary barracks at Fort Des Moines for base and general hospital purposes. 55 On the same day, July 3, 56 the Surgeon General directed the department surgeon, Central Depart- ment, to make plans for a large base hospital at Des Moines and to call for any additional buildings required. On September 11, 1917, 57 the Surgeon General requested the construction of two psychiatric wards and two isolation wards, the conversion of a storehouse into a receiving ward, the conversion of four stables into barracks, and a mess hall for Medical Department men, and the con- version of the post exchange and gymnasium into a dispensary, eye, ear, nose, and throat and dental building, and funds for this work were allotted in October, 1917. This was the first project of any size contemplated at this place, but the construction was delayed and the work was not completed until May, 1918, when a bed capacity of 1,100 had been obtained. 570 MILITARY HOSPITALS IN THE UNITED STATES. GENERAL HOSPITAL NO. 26 FORT BE S MOINES IOWA PERMANENT BUILDINGS TEMPORARY o WELFARE «» SCALE-TEST O 200 AOd 600 AOO Fig. 1S5. OTHER GENERAL HOSPITALS. 571 On October 15, 1917, 58 the Secretary of War telegraphed the department commander that Fort Des Moines would be at his disposal when the Reserve Officers’ Training Camp and Medical School ended on the same date, but that only one battalion of Infantry would be stationed at the post. On November 7, 1917, the Surgeon General requested the use of the whole post for general hospital purposes; 59 and on January 4, 1918, 60 he requested the designation of Fort Des Moines as a general hospital, the same request being repeated in the following February. On March 14, 1918, 61 the Secretary of War disapproved this request. In April the post hospital was designated as a base hospital. On May 13 82 the Surgeon General again recommended that this station be desig- nated a general hospital. There was space here now for sick, and it was desired to use it to the very best advantage. In August the station was designated a department base hospital. On September 11, 1918, 63 the Surgeon General again requested that this post be made a general hospital; and on September 21 the request was approved. 64 A number of projects for the further development of this post were then studied and a satisfactory construction project was developed contemplating 10 buildings and some alterations in existing buildings, all of which would have provided additional beds for 1,000 sick; but because of the armistice this work was disapproved. Complete reconstruction facilities were provided in this hospital, and special facilities, including prosthetics, for the treatemnt of amputation cases were developed. In April, 1918, when it was designated a base hospital, the capacity was 300. With some additional permanent post buildings and new construction the capacity rose to 1,150 by June. In August it was increased to a maximum of 1,500. A trivial number of sick was cared for in this hospital at the time the above designation was made, but the number soon rose to 500, where it remained until September 25, 1918. It now became a general hospital and was put to good use, for, by November 15, it was filled with over 1,400 sick. The number ran along between about 1,200 and 1,800 until May, 1919, when a decline began, and by October of that year only 673 sick were in the hospital. 65 On September 8, 1919, the Surgeon General recommended the discontin- uance of this general hospital, and its reversion to a post hospital, effective October 15. 66 This recommendation was approved September 13, 67 and the change was duly carried out. 572 MILITARY HOSPITALS IN THE UNITED STATES, Statistical data, United States Army General Hospital No. 26, Fort Des Moines, Iowa, from September 2A, 1918, to October 19, 1919, inclusive SICK AND WOUNDED. Y ear and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. ft 8 Quarters. Hospital. * 1918. September 441 36 366 33 876 86 2 74 1 32 681 14,019 October 681 138 689 26 1,534 137 12 54 6 24 1,301 November 1,301 89 380 32 1,802 167 20 29 180 91 1 314 1 41 174 5 December 1,315 64 324 126 1,829 72 6 36 527 82 1, 106 37,600 1919. January 1 , 106 72 225 43 1,446 79 3 27 441 31 865 31, 183 February 865 52 319 10 1,246 62 2 35 105 54 988 26, 045 March 988 72 319 122 1,501 63 71 142 203 1,022 29,848 April 1 , 022 34 403 206 1,665 56 1 121 195 195 1* 097 31,819 May 1,097 29 159 164 1,449 27 4 136 93 168 1,021 31,770 June 1,021 36 293 86 1,436 28 1 311 114 97 31,849 July 885 40 452 108 1 , 485 35 2 174 230 139 905 28. 140 August 905 23 405 117 1,450 43 1 204 1 225 126 850 26,763 September 31 118 125 1, 124 52 1 132 2 211 116 610 October 610 13 50 673 33 141 493 6 5,654 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 1919. 105 48 35 1S8 March 7 63 58 128 105 48 35 188 April 7 63 58 128 105 48 188 May 7 63 58 128 7 63 57 127 June 7 63 58 128 July 7 63 5S 128 1919. Aujpist 7 63 5S 128 7 63 58 128 September 63 58 128 February 7 63 58 128 October 7 63 58 128 PERSONNEL ON DUTY. Officers. Enlisted men. Nurses. Civilian employ- ees. Year and month. Medical Corps. Sanitary Corps.' Miscel- laneous (Q. M. C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M. C., etc.). Total. 1918. September 55 7 2 64 681 S3 764 S6 1 < ic'tober 57 9 3 69 675 82 757 90 1 N ovember 63 8 2 73 657 103 760 114 1 December 77 13 2 92 662 117 779 111 1 1919. January 86 12 3 101 660 109 769 118 1 February 66 13 3 S2 605 115 720 99 2 March 60 13 5 7S 5S3 99 682 9S 1 60 11 9 SO 501 S7 SS 61 10 9 80 492 54 546 105 50 10 10 70 549 44 593 105 July. . . 46 8 9 63 4S5 30 102 50 6 7 63 457 30 487 102 SepTember 37 6 7 50 450 31 4S1 77 a Compiled from monthly returns and sick and wounded reports ( Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS. 573 GENERAL HOSPITAL NO. 27, FORT DOUGLAS, UTAH. Fort Douglas is located in the foothills of the Wasatch Mountains, 3? miles southeast of Salt Lake City, which it overlooks from an added elevation of 800 feet. The terrain is practically level, with a gentle sloping away from the mountains to the rear of the post. The soil is sandy, thus insuring the absence of mud following rains and a freedom from dust during the times when the winds blow. Fort Douglas had been a permanent garrison for a regiment of Infantry and there were an excellent post hospital, barracks, officers’ quarters, and other complementary buildings. In the early summer of 1918, it appeared that this post would make a particularly desirable acquisition as a general hospital: there were no general hospital facilities, other than for the treatment of tuberculosis, in all that vast area lying between the Pacific Coast and the Central States. So, early in July an informal arrangement was made between the Surgeon General and the Director of Operations, General Staff, that the permanent buildings at Fort Douglas, except six designated structures, would be used for general hospital purposes. 68 On August 3, 1918, 69 the buildings were made actually available to the Medical Department. They consisted chiefly of two groups of barracks and a group of storehouses, a stable, etc. Though they, in themselves, would not make a large hospital, it was thought they would do very well as a beginning in this geographical region; and obtaining them marked the beginning of what was designated by the War Department, September 2 f , General Hospital No. 27. 70 In the meantime, a commanding officer for the general hospital to be developed was ordered to take command. To start the project his original instructions were to submit at once a comprehensive but moderate estimate of funds necessary to renovate and occupy the existing buildings, which had been turned over, and to contemplate only minor alterations, and no new construc- tion if it could possibly be avoided; the probability of future extension by new construction was pointed out and present action was not to interfere with that eventuality. The Secretary of War had stated that no additional space would be given this hospital until the buildings already made available were full of sick. Estimates were then submitted for the adaptation of the existing build- ings and for the construction of 14 new buildings. The new construction was greatly reduced and the following was authorized on October 14 by the Secre- tary of War: The construction of two temporary barracks and one general mess and kitchen; alterations and repairs covering the inclosing of porches in temporary wards; necessary heating equipment, plumbing fixtures, repairs, etc., for the existing barrack buildings; alterations to furnish quarters and a mess for officers; and screening, painting, calcimining, and miscellaneous general repairs. 71 In due time this work was begun but it was never completed: with the demobilization of troops and the abandonment of portions of the canton- ments following the armistice there was found to be sufficient hospital space to obviate the necessity for completing this work. The effect of these events was not felt at once, but in February, 1919, the work was stopped. This 574 MILITARY HOSPITALS IN THE UNITED STATES. hospital, though organized on the basis of a large hospital and prepared for expansion, never emerged from the small hospital class nor exceeded 500 beds in capacity. The total cost was $284,479. On June 18, 1919, it was felt that General Hospital No. 27 could be dis- pensed with by the first of the following August. Its discontinuance was rec- ommended to the Secretary of War, who approved it two days later. 72 By July 15, 73 however, it was found to be impracticable to close the hospital, by reason of the lack of sufficient beds properly located elsewhere to permit of a comfortable and orderly transfer of the sick; therefore, its discontinuance was deferred until September 1, on which date it was closed and a reduced post hospital reestablished in its stead. 74 Statistical data, United States Army General Hospital No. 27 , Fort Douglas, Utah, from September 25, 1918, to September 1, 1919, inclusive SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged; expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. | Otherwise. Hospital. 1 p Hospital. ©a p 1918. 79 3 82 18 1 2 61 394 61 59 536 656 368 21 1 .. 5 261 6,061 261 29 228 518 297 6 3 1 2 209 209 31 116 229 24 23 7 73 3 , 901 1919. 73 20 ISO 273 77 3 10 17S 3, 739 178 19 184 4 385 79 1 1 11 4 289 7, 818 March.. I 289 27 248 7 571 193 2 16 26 8 326 13^ 651 326 22 247 12 607 181 35 14 5 372 Id, 916 372 19 96 10 497 164 1 49 16 12 15, 819 255 10 398 14 677 134 49 9 480 18,285 July 480 21 75 576 212 136 53 15 160 15, 892 160 9 41 4 214 52 1 51 96 14 5' 572 PERSONNEL ON DUTY. Year and month. 191S. September October November December 1919. January February March . .' April May June July August Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps.’ Miscella- neous (Q.M.C., etc.). Total. Medical Depart- ment. Miscella- neous (Q.M.C., etc.). Total. 18 IS 106 106 12 4 19 130 130 14 4 1 19 152 10 162 59 13 4 1 IS 156 21 177 47 11 4 1 16 137 20 157 42 17 6 2 25 124 24 14S 44 20 6 3 29 196 21 217 54 23 5 6 34 194 SO 274 46 25 5 4 34 181 66 247 45 23 4 4 31 177 62 239 44 19 4 4 27 156 54 210 41 13 4 1 IS 94 51 145 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General on file. Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL, HOSPITALS. 575 GENERAL HOSPITAL NO. 28, FORT SHERIDAN. ILL. Fort Sheridan had been abandoned practically since 1913. Almost the entire garrison had in that year been sent to the Mexican border, and the largest number of troops stationed at the post from that time until the spring of 1917 was one squadron of Cavalry. The general upkeep of the large and well- appointed reservation naturally suffered, and the buildings and grounds became somewhat shabby from lack of proper care. Shortly after the war began an officers’ training camp, containing approx- imately 5,000 candidates, was established at this post. The old post hospital, which had been partially closed, was reopened, completely and thoroughly cleaned, but very little money was spent upon it. Four separate wards, con- nected by covered porches and heated by a separate plant, were built to the west of the hospital. These wards were temporary buildings, lined with beaver board, and they were to be used for the normal expansion anticipated in a garrison of that size. In making provisions for the large number of wounded who were expected to begin arriving from France in the fall of 1918, it was decided in the Surgeon General’s Office that Fort Sheridan was excellently located for the establishment there of a large general hospital. Steps were taken providing for the turning over of most of the post of Fort Sheridan to the Medical Department, to be used as a nucleus for this general hospital. 75 Plans were made for the erection of a large number of temporary buildings for wards, etc., 76 with the intention of giving the hospital a capacity in round numbers of 5,000 beds. The Medical Department assumed control September 21, 1918, of that part of the post which had been transferred to it. Construction work for the remodeling of the old buildings and the erection of the new was begun October 2, 1918. At first the organization of the hospital was not planned carefully, and for several months it was only an expansion of the post organization which had been in existence since the beginning of the war. Patients from overseas began to arrive at the hospital November 17, 1918, and by January 1, 1919, there were 1,241 under treatment. 77 A number of old stables on the post were remodeled to be used as barracks for the detachment, Medical Department, on duty at this hospital ; 78 but they were not completed until March, 1919, and the men were, naturally, very uncomfortable until the proper changes had been made. These detachment men were compelled also to eat in the already crowded mess halls 78 of the hospital until February 5, 1919, when the detachment kitchen and mess hall had been completed. The nurses and officers were accommodated in the officers’ quarters 79 and were fairly comfortable from the beginning, though crowded to a certain extent. The nurses’ mess was established in the old officers’ club, and the commanding officer’s residence was remodeled into a duty officers’ mess. The educational department was established in January, 1919, in one of the Cavalry barracks, which had been remodeled for the purpose . 80 The physiotherapy department was established in a small ward in one of the perma- nent buildings until the temporary buildings were constructed, when it was moved to the first floor of building No. 129 and there, completely established with every convenience, became a well administered department. 576 MILITARY HOSPITALS IjST THE UNITED STATES. GENERAL HOSPITAL NO. 28 FORT SHERIDAN lake at ILLINOIS Fig. 186 . OTHER GENERAL HOSPITALS. 577 General Hospital No. 28 became the largest general hospital provided in the United States during the war. It consisted of practically all of the perma- nent buildings of Fort Sheridan and 27 new two-story frame buildings, erected upon the parade ground, and all connected by corridors. The first wards to be occupied were those established in the permanent buildings, in addition to the post hospital and its outlying wards. On February 19, 1919, the first of the temporary wards was occupied, and in April, 1919, the last remaining ward building was completed and occupied. The hospital, as finally organized, and with practically its full capacity in use, was arranged in such a way that the administrative features were handled to promote simplicity and efficiency. By reference to Figure 1S6, it can be seen that this hospital, with a capacity of 4,S00 patients, covered less ground than the average base hospital in a cantonment, the capacity of which was about 2,000. Division of the hospital into sections was carefully made so as to group special classes of cases together, not only tending to promote better adminis- trative control but the simplification of professional treatment. The hospital, during January of 1919, averaged about 1,000 patients. 77 This number increased gradually until June, at which time there were 4,987 patients. 77 From then until the first of September the increase was very rapid, and on August 1, 1919, there were 5,295 patients in the hospital. 77 This was the largest number cared for at one time, and throughout the following fall the reduction in number was rapid and steady. In November there was a con- siderable increase in the number of patients, caused by the sending home from France of a large number of genitourinary patients who had been held in deten- tion there. Altogether 1,200 such patients were received. Statistical data, United States Army General Hospital No. 28, Fort Sheridan, III., from September 24, 1918, to December 1919, inclusive , a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. Hospital. Quarters. 1918. October 295 124 5 28 452 334 35 2 80 1 4,199 112 November 81 254 2 87 424 274 8 12 1 2 2 125 4, 117 32 December 125 158 11 377 671 120 1 1 549 1919. January 549 255 87 572 1 . 463 192 1 2 2 1 3 2 1,260 50,723 February 1,260 209 385 20 1,874 544 2 50 2 20 12 1,244 35, 731 March 1,244 237 1,376 30 2,887 653 3 70 10 24 17 154 1, 956 April 1,956 175 1,092 177 3,400 680 3 74 13 24 28 243 2,335 72 027 May 2 , 335 125 l' 379 248 4,087 620 9 210 13 22 70 290 2,853 76, 700 June 2,853 69 1,765 300 4, 987 79 9 262 59 862 413 3,288 88 996 July 3,288 1,914 548 5^ 815 89 9 12 407 593 443 3,617 113 419 August 3,617 87 1, 101 490 5; 295 100 10 748 5 364 373 757 2, 938 110 502 September 2,938 82 '384 711 4, 115 123 9 430 258 130 659 2, 506 107 665 October 2, 506 50 1, 138 590 4' 284 77 5 298 223 29 696 2 922 34 76 171 319 November 2 , 956 78 529 4, 121 110 5 260 244 23 692 2 , 787 117 ; 788 1,028 December 2,787 65 164 591 3,607 102 8 327 323 14 1,240 1,593 75^347 “ Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 45269°— 23 37 578 MILITARY HOSPITALS IN THE UNITED STATES. Statistical, data, United States Army General Hospital No. 28, Fort Sheridan, 111., from September 24, 1918, to December, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. September 73 61 74 208 73 263 75 411 October 73 61 74 208 79 280 78 437 November 73 61 74 208 79 280 78 437 73 61 74 208 70 280 78 428 August 70 280 78 428 1919. September 70 2S0 78 428 January 73 61 74 208 70 2-80 78 428 February 73 263 74 410 70 280 78 428 March 73 263 74 410 70 2S0 78 428 PERSONNEL ON DUTY. Y ear and month. Officers. Enlisted men. Nurses. Aides and workers. Other civilian em- ployees. Medical Corps. Sanitary Corps. Miscella- neous. (Q.. M. C., etc.). Total. Medical Depart- ment. Miscella- neous. (Q.M.C., etc.). Total. 1918. October 32 32 77 16 25 4 29 161 161 14 51 6 57 1,025 1,025 14S 1919. 68 13 81 983 30 1,013 173 90 17 7 114 951 23 974 215 136 17 6 159 1,293 27 1,320 264 135 19 13 167 1,125 26 1,151 293 1 May 139 18 19 176 1)011 62 1,073 392 1S5 431 June 157 18 23 198 998 61 1,059 332 259 525 154 20 19 193 977 59 1,036 465 1 18 21 195 1,045 58 1 , 103 4S9 115 12 25 152 '940 54 '994 483 105 6 15 126 896 81 977 454 112 14 133 844 147 991 806 December 102 7 13 122 766 161 927 244 GENERAL HOSPITAL NO. 29, FORT SNELLING, MINN. Fort Snelling is situated 1 mile southeast of Minneapolis, a city of approximately 364,000 inhabitants, and immediately across the Mississippi River from St. Paul, a city of 292,000 inhabitants, and the State capital. The military reservation is a tract of land about 2,000 acres in extent, extending from the point of conlluence of the Mississippi and Minnesota Rivers in a general southwesterly direction between the two rivers. The part of the reservation occupied by the buildings of the post and hospital is a high plateau, 790 feet above sea level, bounded on two sides by steep declivities extending down to the two rivers, and strongly fortified b} r nature. The plateau is beautifully wooded, as are the bottom lands beyond, which were cut by many natural ravines. The soil of the greater part of the reservation is a light sandy loam, shading into a richer loam to the southwest. The edges of the cliff at the promontory show a deep subsoil of clay, gravel, and soft sandstone. Although there was a considerable amount of sand in the surface soil, the paving of the roads and the vegetation prevented the Hying of much dust in dry weather and the carrying of any considerable amount of mud after rains. OTHER GENERAL HOSPITALS. 579 The climate of the region was found to be temperate, with the exception that there was usually some rigorous weather in the middle of the winter. This, however, did not extend over periods of any considerable length of time. The hospital site was well protected against the wind on three sides, but was exposed on the west. The main road through the post was tarvia-macadam, the other roads being of dirt and gravel, rolled down, which were very well kept up. The grounds were bordered on the north by the Mississippi River and on the east and south by the Minnesota River. Fort Snelling was included in the list of posts for which the Surgeon General made request in June, 1917, that they might be used as general hospitals; 81 but on October 15, 1917, 82 the Secretary of War placed Fort Snelling at the disposal of the department commander for use as Infantry winter quarters, thus elimi- nating it from possible use by the Medical Department. The Surgeon General reiterated his request to the Secretary of War on November 7, 1917; 83 but, in view of the fact that accommodations for 25,000 sick had already been provided elsewhere, this latest request was disapproved. In the following summer, August 12, 1918, 84 the department commander turned the post over to the post surgeon for hospital use; and in September, the extemporaneous use of the post buildings, which included three temporary wards and a mess hall and kitchen that had been added to the post hospital in June, 1917, permitted the provision of space for 500 beds. At this time a plan was recommended looking to the complete adaptation of the post for general hospital purposes. This was the first real step toward the enlargement of the hospital and the provision of additional general hospital space, so much needed. The plan included 85 the glazing of porches on six double barracks, and their connection with glass-inclosed corridors; the installation of necessary toilet facilities and ward accessories on the first and second floors of all barracks; the erection of a general kitchen and mess hall and its connection with a chain of renovated barracks; the construction of a kitchen and mess hall for the hospital attendants; the alteration of quarters and the provision of messing facilities, for nurses; and other necessary general utilities and miscellaneous improve- ments and alterations. On September 21, 1918, the hospital was designated “General Hospital No. 29.” 86 The work of adaptation was delayed somewhat. Unfortunately, the winter was near at hand and the severe weather added difficulties; nevertheless, the construction work was pushed throughout the winter, alterations were installed, the new buildings erected, and a capacity of 1,100 was secured. In September, 1918, the hospital contained 250 beds and 51 sick. In October, both the capacity of the hospital and the number of sick had increased to over 1,500, only to fall again in November. In December, the number of sick increased and, coincidently, the capacity of the hospital, now being enlarged by alteration and construction. In January, 1919, the maximum number of beds, 1,100, was available, and 900 sick were under treatment. From this time until June the sick varied between 900 and 1,100. 87 In addition to general medical and surgical work, special care for the following kinds of cases was provided: Amputations, orthopedic conditions, 580 MILITARY HOSPITALS IN THE UNITED STATES. injuries to the peripheral nerves, skull, brain, and cord; organic diseases of the nervous system, mental defects, drug addicts, inebriates, and epileptics. Pro- visions for full physical reconstruction activities were also made. On June 6, it was apparent that this hospital would be abandoned in the late summer, and accordingly the commanding officer was given advance information to this effect. 88 On June 18, 1919, the Surgeon General recommended to the Secretary of War that the hospital be discontinued on August l; 89 and, the Secretary of War’s approval being given two days later, appropriate steps were taken to accomplish the work. On August 1 this institution was discontinued and normal post work for a battalion was resumed in the original post hospital. 90 Statistical data, United States Army General Hospital No. 29, Fort Snelling, Minn., from September 21, 1918, to August 8, 1919, inclusive. 11 SICK AND WOUNDED. Year and month . Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- ‘ fer. Otherwise. Hospital. o 2 1918. 51 79 249 2 381 89 1 1 3 1 285 1 286 437 997 6 1,726 1,412 53 2 7 251 1 252 62 801 1 1, 116 404 8 4 79 621 621 183 687 1 1,492 574 3 1 1 113 170 629 i 1919. 630 268 444 8 1,3.50 195 2 68 2 317 717 4 721 110 432 92 102 1 124 1 184 141 802 802 91 384 153 1,430 170 4 126 245 SS5 885 52 419 162 \\ 518 120 6 103 2 286 987 14 1,001 167 251 33 1.452 1 211 2 3 301 854 13 7 867 155 490 30 1 ’ .542 9 218 2 392 8 July - - - 863 104 33 30 1,030 39 347 12 269 363 363 1 '364 3 34 1 316 10 Aggregate number of days lost from sickness. 1.759 n 16,(144 48 12, 101 36 IS, 011 44 23,550 23,510 27, SOI 71 2S. 568 247 30, 551 550 27.948 22. S32 110 2, 576 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 1919. 44 30 35 109 March 40 3S 34 112 44 30 37 111 April 40 3S 34 112 44 30 37 111 May 40 38 34 112 40 38 34 112 June 40 3S 34 112 July 40 38 34 112 1919. August 40 38 33 111 January 40 39 36 114 February 40 38 34 112 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file. Medical Records Section, Adjutant General's Office, and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER GENERAL HOSPITALS. 581 Statistical data. United States Army General Hospital No. 29, Fort Snelling, Minn., from Septem- ber, 21, 1918, to August 8, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M. C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M.C., etc.). Total. 1918. September 22 2 4 28 378 65 443 40 October 21 2 8 31 443 73 516 49 November 26 4 10 40 477 106 583 71 December 39 6 10 55 568 143 711 00 1919. January 50 5 9 64 670 139 809 53 February 61 7 10 78 651 139 790 62 March 66 7 9 82 666 73 739 87 April 60 7 8 75 633 61 694 88 May 47 8 7 62 634 55 689 88 June 44 7 6 57 598 67 665 103 July 46 7 9 62 598 69 667 93 11 2 13 33 73 106 REFERENCES. (1) Letter from the officer in charge of cantonment construction to Surgeon General, March 15, 1918. Subject: 1,000-bed tuberculosis hospital for Azalea, N. C. On file, Record Room, S. G. 0., 632 (Gen. Hasp. No. 19) K. (2) Letter from Chief Real Estate Section, Purchase, Storage, and Traffic Division, General Staff, to the Surgeon General, November 25, 1918. Subject: Purchase of 404 acres of land upon which General Hospital No. 19, Azalea, N. C., is located. On file, Record Room, S. G. 0., 601 (Azalea, N. C.) S. (3) Letter from the Surgeon General to the Quartermaster General, for the officer in charge of cantonment construction, March 16, 1918. Subject: Plans for 1,000-bed hospital to be constructed at Azalea, N. C. On file, Record Room, S. G. O., 632 (Gen. Hosp. No. 19) K. (4) Telegram from Gorgas to commanding officer, General Hospital No. 19, Azalea, N. C., July 29, 1918. Subject: Authority to enlarge hospital by 500 beds. On file, Record Room, S. G. 0., 600.4 (Gen. Hosp. No. 19) K. (5) Shown on plans of General Hospital No. 19. On file, Hospital Division, S. G. 0. (6) Report of sanitary inspection of General Hospital No. 19, at Oteen (Azalea), N. C., on De- cember 9, 1918, by Col. J. B. Clayton, M. C. On file, Record Room, S. G. 0., 721 (Gen. Hosp. No. 19) K. (7) Letter from commanding officer, General Hospital No. 19, to the Surgeon General, Decem- ber 13, 1918. Subject: Recommendations relating to additions to this hospital. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 19) K. (8) Letter from the Surgeon General to the Chief of Staff, March 25, 1919. Subject: Change of status, General Hospital No. 19. On file, Record Room, S. G. 0., 680.1 (Gen. Hosp. No. 19) K. (9) First indorsement from War Department, A. G. 0. to the Surgeon General, May 25, 1918. Subject: Designation of hospitals. On file, Record Room, S. G. 0., 322.3 (Gen. Hosps.) K. (10) Shown on weekly reports compiled in the Surgeon General’s Office. On file, Record Room, S. G. 0., 632 (U). (11) Letter from Col. W. F. Lewis, M. C., to the Surgeon General, May 16, 1918. Subject: Sanitary inspection, Whipple Barracks, Ariz. On file, Hospital Di-vision, S. G. 0. (Gen. Hosp. No. 20 inspection reports). (12) Letter from the Surgeon General to The Adjutant General, February 6, 1918. Subject: Use of Whipple Barracks by Medical Department for tuberculosis purposes. On file, Record Room, S. G. 0., 680.2 (Whipple Barracks, Ariz.) N. (13) Letter from The Adjutant General to the commanding general, Southern Department, Feb- ruary 15, 1918. Subject: Assigning Whipple Barracks to the Medical Corps. On file, Record Room, S. G. O., 601 (Whipple Barracks, Ariz.) N. 582 MILITARY HOSPITALS IN THE UNITED STATES. (14) First indorsement from War Department, A. G. 0. to the Surgeon General, May 25, 1918. Subject: Designation of general hospitals. On file, Record Room, S. G. O., 322.3 (General Hospital) Iv. (15) Letter from the Surgeon General to the Construction Division, War Department, July 5, 1918. Subject: Additional hospital buildings, General Hospital No. 20. On file, Record Room, S. G. 0., 632 (Gen. Ilosp. No. 20) K. (16) Telegram from commanding officer, General Hospital No. 20, to the Surgeon General, June 19, 1918. Subject: Hospital accommodations. On file, Record Room, S. G. O., 705 ( Gen. Hosp. No. 20) K. (17) Shown on weekly bed report. On file, Record Room, S. G. O., 632 (U). (18) Memorandum from Assistant Chief of Staff, Director of Operations, to the Assistant Secretary of War, January 6, 1919. Subject: Army hospital for city of Philadelphia. Approval of Assistant Secretary of War indorsed thereon. On file, Record Room, S. G. O., 481 (Gen. Hosp. No. 22) Iv. (19) Copy of resolution. On file, Record Room, S. G. 0., 481 (Gen. Hosp. No. 22) Iv. (20) Report of sanitary inspection of General Hospital No. 22 at Philadelphia, Pa., April 4-5, 1919, by Col. E. R. Schreiner, M. C. On file, Record Room, S. G. 0., 721 (Gen. Hosp. No. 22) Iv. (21) Letter from Surgeon General to Director Purchase, Storage, and Traffic, General Staff, May 28, 1919. Subject: Closing of General Hospital No. 22, Philadelphia, Pa. On file, Record Room, S. G. O., 323.7 (Gen. Hosp. No. 22) Iv. (22) Letter from The Adjutant General to the Surgeon General, June 5, 1919. Subject: Aban- donment of General Hospital No. 22, Philadelphia, Pa. On file, Record Room, S. G. 0., 323.7 (Gen. Hosp. No. 22) Iv. (23) Telegram from commanding officer, General Hospital No. 22, Philadelphia, Pa., to the Sur- geon General, July 1, 1919. Subject: Report of closing. On file, Record Room, S. G. O., 602-1 (Gen. PIosp. No. 22) Iv. (24) Letter from Capt. E. J. Tucker, Sanitary Corps, to Lieut. Col. Wm. C. Hoad, Sanitary Corps, September 24, 1918. Subject: Report on water supply, General Hospital No. 23, Hot Springs, N. C. On file, Record Room, S. G. 0., 671 (Gen. Hosp. No. 23) Iv. (25) Letter from the Acting Secretary of Labor to the honorable the Secretary of War. April 23, 1918. Subject: Internment camp at Hot Springs, N. C. On file, Record Room, S. G. 0., 601 (Hot Springs, N. C.) S. (26) Letter from Lieut. Col. Wm. A. Smith, M. C., to the Surgeon General, May 8, 191S. Subject: Inspection of internment camp, Hot Springs, N. C. On file, Record Room, S. G. 0., 601 (Hot Springs, N. C.) S. (27) Letter from the Surgeon General to the Chief of Staff, May 22, 191S. Subject: Renewal of lease on internment camp at Hot Springs, N. C. On file, Record Room, S. G. O., 601 (Hot Springs, N. 0.) S. (28) Copy of lease. On file, Record Room, S. G. 0., 481 (Hot Springs, N. C.) F. (29) Letter from the Chief of Construction Division to the Surgeon General, December 4, 191S. Subject: Water supply for General Hospital No. 23, Hot Springs, N. C. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 23) Iv. (30) Letter from commanding officer. General Hospital No. 23. to the Surgeon General, Janu- ary 30, 1919. Subject: Request information as to policy determined for this hospital . On file. Record Room. S. G. 0., 632 (Gen. Hosp. No. 23) Iv. (31) Shown on weekly bed reports. On file, Record Room, S. G. 0., 632 (U). (32) Letter from the Surgeon General to the Director of Operations, Office of the Chief of Staff, January 31, 1919. Subject: Cancellation of lease, General Hospital No. 23, Hot Springs, N. C. On file. Record Room, S. G. 0., 481 (Gen. Hosp. No. 23) K. (33) Letter from The Adjutant General to the Surgeon General, February 10, 1919. Subject: Abandonment of General Hospital No. 23, Hot Springs, N. C. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 23) Iv. (34) Letter from the commanding officer, General Hospital No. 23, Hot Springs, N. C., to the Surgeon General, March 15, 1919. Subject: Abandonment of General Hospital No. 23. On file, Record Room, S. G. 0., 323.7 (Gen. Hosp. No. 23) K. (35) Letter from county commissioners of Allehgeny County, Pa., to the Surgeon General, April 8, 1918. Subject: Rental of North Side Home, Hoboken, Pa. On file. Record Room. S. G. 0., 601 (North Side Home, Hoboken, Pa.) S. OTHER GENERAL HOSPITALS. 583 (30) Letter from the Surgeon General to the Chief of Staff, April 15, 1918. Subject: General hospital at Pittsburgh, Pa. On file, Record Room, S. G. 0., 601 (North Side Home, Ho- boken, Pa.) S. (37) First indorsement from War Department, A. G. O. to the Surgeon General, May 4, 1918. Subject: Approval of Secretary of War of lease of North Side Home, Hoboken, Pa., dated May 3, 1918. On file, Record Room, S. G. 0., 601 (North Side Home, Hoboken, Pa.) S. (38) Second indorsement from War Department, A. G. O., to the Surgeon General, August 26, 1918. Subject: Designation of general hospital. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 24) K. (39) Shown on weekly bed report. On file, Record Room, S. G. 0., 632 (U). (40) Letter from the commanding officer, General Hospital No. 24, to the Surgeon General, August 2, 1918. Subject: Closing of hospital. On file, Record Room, S. G. O., 602-1 (Gen. Hosp. No. 24) K. (11) Report from Maj. E. L. Ruffner, M. C., to the Surgeon General, May 12, 1917. Subject: Report on use of Fort Benjamin Harrison as a general hospital. On file, Record Room, S. G. 0., 174571-11 (Old Files). (42) Letter from the Surgeon General to The Adjutant General, May 18, 1917. Subject: L T se'of permanent barracks of certain posts for hospital purposes. On file, Record Room, S. G. 0., 632 (General). (43) Letter from the Surgeon General to The Adjutant General, May 23, 1917. Subject: Authority for use of barracks at Forts McPherson, Oglethorpe, and Benjamin Harrison for base hospitals. On file, Mail and Record Division, A. G. O., 2604162 (Old Files Section). And : Letter from the Surgeon General to The Adjutant General, November 7, 1917. Subject: Use of posts as general hospitals. On file, Record Room, S. G. 0., 680.3 (General). (44) Letter from The Adjutant General to the commanding general, Central Department, June 23, 1917. Subject: Use of permanent barracks at certain posts for general or base hospital accommodations in connection with post hospitals. On file, Record Room, S. G. 0., 176795 (Old Files). (45) Telegram from The Adjutant General to the commanding general, Central Department, October 15, 1917. Subject : Use of certain posts as winter quartern. On file, Record Room, S. G. O., 176795 (Old Files). (46) Letter from the Surgeon General to the department surgeon, Central Department, June 30, 1917. Subject: Plans for base hospitals at certain posts. On file. Record Room, S. G. 0., 176795 (Old Files). (47) Second indorsement from War Department, A. G. O., to the Surgeon General, September 21, 1918. Subject: Designation of certain general hospitals. On file, Record Room. S. G. 0., 322.3 (Gen. Hosp.) K. (4S) Third indorsement from War Department, A. G. 0., to the commanding general, Central Department, October 26, 1918. Subject: Transfer of buildings at Fort Benjamin Harrison to the Medical Department. On file, Record Room, S. G. O., 632 (Gen. Hosp. No. 25) K. (49) Letter from the Surgeon General to Capt. II. W. Cutler, Sanitary Corps, October 19, 1918. Subject: Construction program General Hospital No. 25. On file, Record Room, S. G. 0., 632 (Gen.. Hosp. No. 25) K. (50) Shown on weekly bed reports. On file, Record Room, S. G. 0., 632 (U). (51) Letter from the Surgeon General to The Adjutant General, August 4, 1919. Subject: Abandonment of General Hospital No. 25. On file, Record Room, S. G. 0., 323.7-5 (Gen. Hosp. No. 25) K. (52) First indorsement from War Department, A. G. O., to the Surgeon General, August 8, 1919. Subject: Abandonment of General Hospital No. 25 approved. On file. Record Room, S. G. 0., 323.7-5 (Gen. Hosp. No. 25) K. (53) General Order No. 17, Headquarters, General Hospital No. 25, Fort Benjamin Harrison , Ind., August 31, 1919. Copy on file, Record Room, S. G. 0., 323.72-3 (Gen. Hosp. No. 25) K. (54) Letter from the Surgeon General to the Chief of Staff, July 2, 1917. Subject: Use of permanent buildings for hospital purposes. On file, Mail and Record Division, A. G. 0., 632 (Misc. sec.) (55) Telegram from The Adjutant General to the commanding general, Central Department, July 3, 1917. Subject: Use of permanent buildings at Fort Des Moines for base or general hospital purposes authorized. On file, Record Room, S. G. O., 176795 (Old Files). (56) Telegram from the Surgeon General to the department surgeon, Central Department, July 3, 1917. Subject: Plans for base hospital at Fort Des Moines, Iowa. On file, Record Room, S. G. 0., 176795 (Old Files). 584 MILITARY HOSPITALS IN THE UNITED STATES. (57) First indorsement from the Surgeon General to the officer in charge of cantonment construc- tion, Quartermaster Department, September 11, 1917. Subject: Conversion and construc- tion of buildings at Fort Des Moines, Iowa. On file, Record Room, S. G. 0., 176796-134 (Old Files). (58) Telegram from The Adjutant General to commanding general, Central Department, October 15, 1918. Subject: Use of certain posts. On file, Record Room, S. G. 0., 176795 (Old Files ). (59) Letter from the Surgeon General to The Adjutant General, November 7, 1917. Subject: Use of posts as general hospitals. On file, Record Room, S. G. 0., 680.3 (General). (60) Memorandum from the Surgeon General to The Adjutant General, January 4, 1918. Subject: Hospital at Fort Des Moines, Iowa. On file. Record Room, S. G. 0., 322.3 (Hospital, Ft. Des Moines) C. (61) Letter from The Adjutant General to the Surgeon General, March 14, 1918. Subject: General hospitals. On file, Record Room, S. G. O., 323.7-5 (General). (62) Letter from the Surgeon General to The Adjutant General, May 31, 1918. Subject: Request that Fort Des Moines be designated a general hospital. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 26) K. (63) Letter from the Acting Surgeon General to The Adjutant General, September 11, 1918. Subject: Designation of general hospitals. On file, Record Room, S. G. 0., 322.3 (General Hospitals) K. (64) First indorsement from War Department, A. G. O., to the Surgeon General, September 21, 1918. Subject: Designation of general hospitals. On file, Record Room, S. G. 0., 322.3 (General Hospitals) K. (65) Shown on weekly bed reports. On file, Record Room, S. G. 0., 632 U. (66) Letter from the Surgeon General to The Adjutant General, September 8, 1919. Subject: Discontinuance of General Hospital No. 26. On file, Record Room, S. G. 0., 680.1-1 (Gen. Hosp. No. 26) K. (67) Letter from The Adjutant General to the Surgeon General, September 13, 1919. Subject: Discontinuance of General Hospital No. 26, Fort Des Moines, Iowa. On file. Record Room, S. G. 0., 323.72-3 (Gen. Hosp. No. 26) K. (68) Letter from Adjutant General to the Surgeon General, July 12, 1918. Subject: Permanent buildings for use of Medical Department at Fort Douglas, Utah. On file, Record Room. S. G. 0., 680.2 (Ft. Douglas) N. (69) Third indorsement from War Department, A. G. 0., to Surgeon General. August 3, 1918. Subject: Permanent buildings at Fort Douglas, Utah, assigned to Medical Department. On file, Record Room, S. G. 0., 680.2 (Ft. Douglas) N. (70) First indorsement from War Department, A. G. 0., to the Surgeon General, September 21, 1918. Subject: Designation of general hospitals. On file, Record Room, S. G. 0., 322.3 (General Hospitals) K. (71) Letter from Chief of Construction Division to the Surgeon General, October 26, 1918. Subject: Construction authorized at Fort Douglas, Utah. On file, Record Room. S. G. 0., 652 (Gen. Hosp. No. 27) K. (72) Letter from Surgeon General to The Adjutant General, June 18, 1919. Subject: Abandon- ment of General Hospital No. 27, Fort Douglas, Utah. On file, Record Room, S. G. O., 323.7 (Gen. Hosp. No. 27) K. (73) Letter from the Surgeon General to commanding officer, General Hospital No. 27, July 15, 1919. Subject: Abandonment of hospital. On file, Record Room, S. G. 0., 680.1-1 (Gen. Hosp. No. 27) K. (74) Telegram from Foster, Fort Douglas, Utah, to the Surgeon General, September 3, 1919. Subject: Closing of General Hospital No. 27. On file, Record Room, S. G. 0., 323.72-3 (Gen. Hosp. No. 27) K. (75) Letter from The Adjutant General to commanding general Central Department, August 7, 1918. Subject: Assignment for the use of the Medical Department of permanent post at Fort Sheridan, and Fort Benjamin Harrison. On file, Record Room, S. G. 0., 632 (Gen. Hosp. No. 28) K. (76) Letter from the Surgeon General to Construction Division, War Department, September 7, 1918. Subject: Hospital construction at Fort Sheridan, 111. On file, Record Room, S. G. 0., 652 (Ft. Sheridan) N. (77) Shown on weekly bed reports. On file, Record Room, S. G. O., 632 U. OTHER GENERAL HOSPITALS. 585 (78) Report of special sanitary inspection, General Hospital No. 28, Fort Sheridan, 111., made by Lieut. Col. H. B. McIntyre, M. C., December 17. 1918. On file, Record Room, S. G. O., 721 (Gen. Hosp. No. 28) K. (79) Report of sanitary inspection of General Hospital No. 28, Fort Sheridan, 111., March 7, 1919, by Col. W. P. Chamberlain, M. C. On file, Record Room, S. G. 0., 721 (Gen. Hosp. No 28) K.] (80) Letter from chief educational officer, General Hospital No. 28, to the Surgeon General, April 22, 1919. Subject: Sketch of educational service. On file, Record Room, S. G. 0., 353.91-1 (Gen. Hosp. No. 28) K. (81) Letter from the Surgeon General to The Adjutant General, May 18, 1917. Subject: Use of permanent barracks of certain Army posts for hospital purposes. On file, Record Room, S. G. 0., 632 (General). (82) Telegram from The Adjutant General to commanding general, Central Department, October 15, 1917. Subject: Use of certain posts. On file, Record Room, S. G. 0., 176795 (Old Files). (83) Letter from Surgeon General to The Adjutant General, November 7, 1917. Subject: Use of posts as general hospitals. On file, Record Room, S. G. 0., 680.3 (General). (84) Letter from commanding officer, U. S. Army Hospital, Fort Snelling, Minn., to the Surgeon General, August 14, 1918. Subject: Transfer of post to Medical Department. On file Record Room, S. G. 0., 323.7 (Ft. Snelling) N. (85) Letter from Chief of Construction Division to the Surgeon General, November 1, 1918. Subject: Fort Snelling, Minn., project. On file, Record Room, S. G. O., 652 (Ft. Snelling) N. (86) First indorsement from War Department, A. G. 0., to Surgeon General, September 21, 1918. Subject: Designation of general hospital. On file, Record Room, S. G. 0., 322.3 (General Hospital) K. (87) Shown on weekly bed reports. On file, Record Room, S. G. O., 632 U. (88) Telegram from the Surgeon General to the commanding officer, General Hospital No. 29, Fort Snelling, Minn., June 6, 1919. Subject: Closing of hospital. On file, Record Room, S. G. 0., 323.7 (Gen. Hosp. No. 29) K. (89) Letter from the Surgeon General to The Adjutant General, June 18, 1919. Subject: Abandon- ment of General Hospital No. 29, Fort Snelling, Minn. On file, Record Room, S. G. 0., 323.7 (Gen. Hosp. No. 29) K. (90) Letter from commanding officer, General Hospital No. 29, to the Surgeon General, August 4, 1919. Subject: Closing of hospital. On file, Record Room, S. G. 0., 323.7-5 (Gen. Hosp. No. 29) K. CHAPTER XXVIII. GENERAL HOSPITALS, NOS. 30, 31, 32, 33, 34, 35, 36, 37, 38, AND 40. GENERAL HOSPITAL NO. 30, PLATTSBURG BARRACKS, N. Y. Plattsburg Barracks is located on the west shore of the northern por- tion of Lake Champlain, and within 1 mile of the city of Plattsburg. The plan and distribution of its buildings was that of a typical Army regi- mental post; there was a large parade with the officers’ quarters along one side, facing the lake, the hospital and barracks in continuation along another, with the administration building at the southwest corner. The country along the lake front, north and south of the post, and for 15 miles west to the foothills of the Adirondacks, forms a lowland sloping gently toward the lake. The soil is uniformly sandy, affording good drainage and freedom from dust and mud. The roads throughout the reservation were of macadam and were connected with the well-maintained roads of the State; the New York-Albany-Montreal highway passed just without the gates. The Surgeon General desired to use this post for general hospital purposes, for in addition to the permanent post buildings, 35 temporary barracks had been added from time to time for the training camps which had been conducted at this station. In June, 1917, 1 authority of the War Department was given to use the permanent buildings of the post; but, not unlike Fort Benjamin Harrison, Fort Des Moines, Fort Sheridan, and others, the buildings, being used for other purposes, were acquired very slowly. During the summer, fall, and winter of 1917 the hospital operated as a post hospital; but in the spring and summer of 1918 additional space became available, and some alteration and renovation, to adapt the buildings for hospital purposes, were authorized. The question of the establishment of a general hospital was again brought up and authority was given to use certain additional temporary buildings; 2 but they were not then made available, because of the local activities requiring their use. On September 21, 191S, the Secretary of War designated this station as General Hospital No. 30. 3 Prior to this time, the Surgeon General had requested (in April, in August, and on September 16 and 20) a total of over 8200,000 for alterations and repair work necessary for the adaptation of the post to general hospital purposes. 4 The work called for in April was com- pleted in September, and part of that called for in August and September was finished in February and March; but a portion of the work was never com- pleted, as construction and alteration were discontinued in March, 1919. A maximum capacity of 1,200 beds had been provided, including reconstruction facilities and all activities essential to general hospital work. The total cost was $225,000. 586 OTHER GENERAL HOSPITALS. 587 In the fall of 1918 it became imperative to send mental and nervous cases and epileptics to this hospital for treatment. 5 Though unsatisfactory, the facili- ties for their treatment were better there than elsewhere. So long as troops were kept at this place for training it was impossible to prevent intermingling of the ordinary sick with the mental cases; and this condition, though rela- tively temporary, was unavoidable. The department inspector recommended that a decision be reached by the War Department as to the future of this post; that it be used either as a general hospital with no other activities to interfere, or, that another location be selected for the treatment of mental cases; and that construction and alterations already requested, looking to a betterment for the winter, be expedited. 6 Opening as a general hospital in September, 1918, with a capacity of approximately 800 and with 400 sick, the activity of the hospital greatly increased and the number of sick rose during the fall and early winter of this year, reach- ing over 900. In February a decline began, continuing until May, 1919, when the number of sick fell to 513. 7 Much of this decline was due to the fact that better provisions were being made elsewhere for mental cases. After May, 1919, no more patients of this class were sent to this hospital, which was reorganized in that month for general medical and surgical cases only. Its activity now increased; and by June, about 1,000 medical and surgical cases were being treated. However, the final decline began at this point and continued until the closing of the hospital. On September 3, 1919, 8 when the sick had dropped below 700, its discontinuance was recommended to take effect Sep- tember 30. When the hospital closed on October 10 the remaining sick were sent by hospital train to General Hospital No. 41, Fox Hills, N. Y. 9 Statistical data, United States Army General Hospital No. 30 , Plattsburg Barracks, N. Y., from September , 1918, to October 10, 1919, inclusive. 0 SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. From command. From other sources. By trans- fer. Otherwise. 415 94 167 1 482 142 327 3 687 22 258 10 691 77 347 12 627 65 323 13 404 53 232 13 303 36 392 11 437 30 170 30 292 25 144 52 176 15 794 30 779 25 545 24 828 27 27 57 599 20 20 36 37 Completed cases. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. 2 3 2 5 7 1 p o o ._ 2 o % 8 g 5 Remaining Aggregate number of days lost from sickness. 1918. September October. . . November. December. 1919. January. . . February.. March April May June July August September October... 677 954 977 1,127 1,028 702 742 667 513 1,015 1,373 939 675 37 482 687 691 627 403 303 436 292 176 779 828 599 37 13,284 IS, 111 21,257 21, 127 16,528 8, 689 9,502 8,228 6, 555 13, 593 29, 363 20, 775 12,021 3,091 21 a Compiled from monthly returns and sick and wounded reports (Form 521 to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adju- tant General, on file, Statistica 'Division, Adjutant General’s Office (name of hospital). 588 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army General Hospital No. 30, Plattsburg Barracks, N. Y., from September, 1918, to October 10, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. 1918. September 04 50 20 134 October 30 50 20 100 November 23 54 20 97 December 11 54 20 85 1919. January 11 54 20 85 February 11 54 20 85 Year and month. Men. Women. Chil- dren. Total. 1919. March 11 54 20 85 April 11 48 16 75 May 11 48 16 75 June 25 60 16 101 July 25 58 14 97 August 26 57 12 95 September 26 56 13 95 PERSONNEL ON DUTY. Officers. Enlisted men . Year and month. Medical Corps. Sanitary Corps.' Miscella- neous (Q. M.C., etc.). Total. Medical Depart- ment. Miscella- neous (Q.M.C., etc.). Total. Nurses. Civilian em- ployees. 1918. September 31 5 4 40 249 76 325 56 4 October 36 4 4 44 348 70 418 54 4 N ov ember 45 6 4 55 370 87 457 45 2 December 45 9 6 60 571 182 753 40 2 1919. January 40 7 9 56 541 155 696 40 2 February 35 5 11 144 619 40 March. 32 5 17 54 463 136 599 36 April 30 6 18 442 112 37 May 24 5 13 42 355 104 459 35 45 54 6 4 55 320 397 74 July 5 u 70 409 38 447 in August 49 5 10 64 371 41 412 125 September 30 5 9 44 338 36 374 74 GENERAL HOSPITAL NO. 31, CARLISLE, PA. Carlisle Barracks was one of the oldest military posts in existence in the United States, having been established sometime prior to the Revolutionary War. It was garrisoned during the Revolution and at times was used as a prison for British prisoners. The barracks were built in 1777, chiefly by Hessian prisoners. They were occupied during the War of 1812. In 1S63 all but one or two buildings were burned by the Confederates on the night of July 1, just before the Battle of Gettysburg. Between 1865 and 1S70 the barracks were rebuilt and occupied as a Cavalry school. Subsequent to this time Indian prisoners were kept there, then later it became a school for Indian prisoners, and still later it became the Carlisle Indian School. On July 9, 1918, the Secretary of War requested the Secretary of the Interior to approve the turning back of Carlisle Barracks to the War Depart- ment, citing the need by the Army of an institution of this character for the rehabilitation and reeducation of sick and wounded, to which the Secretary of the Interior agreed on July 16. 10 Carlisle Barracks was situated on the outskirts of the town of Carlisle, in the beautiful Cumberland Valley, 19 miles west of Harrisburg, with which city there were train, trolley, and excellent road connections. The institu- tion, as transferred from the Department of the Interior, consisted of 30S acres of excellent farm land and 50 buildings. Farm No. 1. adjoining the campus, or main site, on the north and east, contained 110 acres. Farm No. 2, about three-fourths of a mile distant, contained 175 acres. The school section comprised 23 acres and 41 buildings, the latter consisting of barracks, quarters, administrative and school buildings, storehouses, power plant, etc. 11 OTHER GENERAL HOSPITALS. 589 Fig. 187. 590 MILITARY HOSPITALS IN THE UNITED STATES. A rapid survey of the buildings, which were old, was made by representa- tives of the Construction Division and the Surgeon General's Office, to deter- mine repairs and alterations necessary to restore them to properly care for the sick. It was estimated that $180,000 would be required to do this work and that 800 sick could be accommodated. 12 In the meantime, negotiations had been initiated with the Department of the Interior to effect the transfer of the real estate and a portion of the school equipment. The continuation of a lease of a 40-acre tract of land which was necessary for the operation of this property was also secured. Funds necessary for the conversion were requested on August 31 and were allotted on October 2. The major portion of this money was required for under the headings of carpentry, masonry and repair work, plumbing and heating, repairing, and fire protection. This work was completed in March, 1919. Some other miscellaneous improvements were found necessary, which increased the total cost of this project to $194,000 and produced a maximum capacity of 900 beds. On August 15, 1918, it was recommended that the designation, General Hospital No. 31, be given. This was approved in the following month. 13 Although the alteration work was not completed until March, 1919, some local sick were treated from the very beginning when the hospital was opened, in October, 1918. The capacity of the hospital reached 500 in February, 1919, and by this time about 380 sick were under treatment. In another month the capacity rose to 800 and the number of patients to 650. By the following August the maximum capacity of 900 was reached, though at that time there were 919 sick in the hospital. Throughout the period from August, 1919, to the end of the year the number of sick gradually diminished. 14 Statistical data, United States Army General Hospital No. 31, Carlisle, Pa., from September 21, 1918, to December, 1919, inclusive. a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command . From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. I Discharged, expi- ration of term. Transferred to in- sane asylums. O 73 £ c O , •s. 0 a 22 c3 - O e* Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. 7- 2 V3 O C5 191S. IS IS 13 1 2 2 23 79 67 71 2 15 0 316 40 20 37 33 4 236 50 3S 9 101 43 13 3S 951 1919. 38 70 SI 3 192 01 1 23 102 5 1, 4S3 25 55 31 S 69 549 40 1 7 10s 3SS 5 6, 91S 140 Mai ell 40 434 1S7 1, 054 SI 1 1 1 32s 642 16,639 30 201 195 1, 077 33 1 6 19 427 591 IS, 759 26 315 172 1, 104 29 S 17 300 750 19, 613 750 31 406 14 1, 201 149 3 s 16 137 sss 23, 7>1 27 39 3 19 16 375 1 43,504 10 376 13 611 19 1,019 643 10 7 4 13 340 2 11,107 11 342 37 852 7 1, 238 581 4 1 2 16 623 11 10,224 634 124 2, 360 137 3' 255 2,410 171 2 9 40 623 23; 556 23 623 35 '528 20 1 ' 206 752 25 1 1 17 25 384 1 14, 861 19 385 23 580 10 '998 633 13 7 6 12 327 11, 068 36 1919. 327 25 885 38 1,275 594 12 17 10 14 628 11,908 628 35 594 24 l' 281 538 13 10 278 19 423 423 34 533 16 1 ' 006 641 11 17 35 2 300 11,250 300 29 408 22 '759 257 2 137 20 22 320 1 9' 438 321 19 265 20 625 296 23 15 22 269 9', S04 269 18 315 27 629 305 5 10 1 10 22 276 8^ 532 July .. . . . 276 18 328 13 296 1 13 10 28 286 1 8, 486 287 28 444 17 776 358 3 9 6 26 374 9', 913 23 374 11 325 13 723 434 2 16 6 250 9,320 250 13 295 14 572 271 21 13 15 252 8,012 252 14 298 11 575 274 1 19 5 13 263 7,628 25 December 263 1 18 228 6 515 190 1 16 8 20 277 3 7,548 46 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. 1917. 24 37 40 101 25 30 32 87 26 30 27 83 July 26 30 27 83 25 28 24 77 23 25 22 70 1 18 9 28 1 18 9 28 1 17 7 25 1918. 1 17 7 25 1 32 14 47 March . .. 9 37 15 61 April. ....... 9 38 16 63 9 41 17 67 3 45 20 68 July 3 48 20 71 4 49 20 73 Year and month. Men. Women. Chil- dren. Total. 1918. September 4 50 22 76 October 4 50 22 76 N ovember 4 50 22 76 December 4 50 22 76 1919. January 4 50 22 76 February 4 50 22 76 March 4 50 22 76 April 4 50 22 76 May 4 50 22 76 June 4 50 22 76 July 4 50 22 76 August 4 50 22 76 September 4 50 22 76 October 6 50 22 78 November 6 30 20 56 December 6 30 20 56 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 45269 °— 23 40 626 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Base Hospital, Fort Bliss, Tex., from April, 1917, to December, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M.C., etc.). Total. 1917. 34 34 330 330 24 24 330 330 46 29 29 292 292 23 23 287 287 22 22 245 245 44 21 21 240 240 44 25 25 274 274 43 23 23 276 276 34 26 26 212 212 39 1918. 26 26 202 202 35 25 1 26 202 202 37 26 26 163 163 36 30 1 31 163 163 47 31 1 32 246 246 47 37 1 38 46 July. 38 2 40 275 275 49 35 2 37 270 270 43 33 4 1 38 263 263 47 31 5 1 37 258 258 45 32 1 38 268 268 42 30 6 1 37 250 250 42 1919. January 23 5 1 29 243 1 244 41 February 26 5 2 33 283 1 2S4 51 March 25 5 2 32 261 l 262 46 April 21 5 2 28 252 5 257 35 May 23 5 2 30 214 5 219 34 June 23 6 2 31 194 4 19S 34 July 24 8 2 34 1S4 3 1S7 32 August 21 6 2 29 185 3 188 30 September 20 3 2 25 177 3 ISO 32 16 1 17 162 3 165 37 18 2 20 162 3 165 33 December 24 2 26 159 3 162 30 BASE HOSPITAL, CAMP BOWIE, TEX.® The base hospital of Camp Bowie was located in Tarrant County, Tex., in the northeastern part of the State, 4£ miles from Fort Worth, a city of 110,000 population. The city of Dallas is east of Fort Worth, 28 miles by interurban railroad and 32 miles by automobile road. The hospital site was at the south- west corner of the camp and embraced 70 acres of slightly and gradually rolling land, which was not wooded but which had flat expanses throughout. The soil of that locality is of a clay-loam mixture overlying a limestone rock to a depth varying from a few inches to 4 or 5 feet, and there was very little high-flying dust about the hospital in dry weather. Bams, when they occur, are excessive, resulting in considerable extremely sticky mud, which soon disappears. Board and gravel walks, constructed several months after the organization of the hospital, eliminated the carrying of mud into the hospital buildings. The summers are exceptionally warm, but the humidity is not great; and. despite the heat of the day, the nights are cool as a result of a continuous a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Bowie, Texas,” by Maj. James C. Greenway, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s office, Washington, D. C. — Ed. OTHER BASE HOSPITALS. 627 breeze, ancl are conducive to restful sleep. The winters, as a ride, are not severe. The ‘‘northers,” however, which occur during the fall and winter, bring extreme cold, with verv abrupt changes, the temperature sometimes falling 70 or 80 degrees in a day. The gradation of spring into summer and fall into winter is not noticeable. At times the wind is strong, but the location of the hospital was such that the full force of the wind was not received. Several gravel and asphalt roads of good condition and leading to Fort Worth skirted the hospital. The hospital was organized on August 21, 1917, as an emergency hospital, and the first patient was admitted on the day following. Prior to the construction of the hospital proper, several small buildings, similiar to the ones subsecjuently used for the company mess pavilion, were utdized for hospital purposes, and tents were employed for the housing of the hospital corps men. During the construction of the hospital a small wooden building was used as an emergency hospital for construction employees. This contained a dispensary and a dressing station, but no ward. The buildings of the hospital were systematically arranged over an area of 70 acres. With the exception of six two-story convalescent wards, all buildings were of one-story frame construction, built on concrete footings. The ward build- ings were distributed according to a block scheme, there being six blocks. One of these blocks was isolated, and was used for the housing of contagious patients. All other ward buildings were connected by a system of covered corridor runways. The following scheme was adopted for designating the wards: The four principal rows of wards were designated “A,” “B,” “C,” and “D,” from north to south. The six wards in each row were numbered 1. 2, 3, etc., from east to west. The wards in the isolation section were numbered serially, from east to west, E— i being the neuropsychiatric ward. The F section comprised two-story ward-barrack buildings, situated in two rows of three buildings each. Ten of the wards of the main part of the hospital had porches inclosed by temporary siding, which was removable, and was fitted with windows at appropriate distances. The space thus provided afforded room for about 24 additional beds, should an emergency recprire additional bed space. This corridor was continuous with the porch at the rear of the ward and had two entrances. The ward known as D-l was fitted up as an office, with treatment rooms, waiting rooms, etc., for the venereal diseases section of the hospital; and it was here that the orthopedic clinic was held. The two sets of officers' quarters were at the extreme northeast portion of the hospital, and, like the remainder of the hospital, they were of frame con- struction. The nurses’ quarters were located to the southeast of the hospital grounds and were practically of the same plan and construction as the quarters for officers. In the early days of the hospital, before the warehouses were completed, supplies for the hospital and for the 36th Division were stored in warehouse No. 10, quartermaster depot. At that time no shelving was supplied, and different articles had to be issued from the boxes in which they were shipped. Five warehouses were completed in October, 1917. measuring 24 by 150 feet, on a portion of the hospital site. Two of these warehouses were shelved, and one was used as a storehouse for medical supplies of the hospital, the other for 628 MILITARY HOSPITALS IN THE UNITED STATES. medical supplies for the 36th Division. One half of a third warehouse was used to store the surplus stock and unserviceable property of the hospital, the other half was used by the camp medical supply depot. Another ware- house was turned over to the Red Cross, and the remaining one to the quarter- master. Two rooms, 8 by 14 by 11 feet, were built in the opposite ends of each warehouse. In one room of warehouse No. 1 was built a partition with a door and lock and the room, being shelved, served as the narcotic drug and liquor room. Three refrigerators were used in this warehouse for the storing of serums. When the base hospital was started, and while it was housed in tents, it was equipped with whatsoever could be borrowed from the field hospitals of the 36th Division. Most of the buildings, which subsequently constituted the base hospital, were received in an unfinished condition on September 24, 1917. At that time the medical supplies on hand were for a 548-bed hospital. The various wards, though unfinished, were equipped with these supplies to meet the demand of a beginning epidemic. There was no heating, water, lighting, or sewerage in connection with any building, and only an absolutely necessary equipment was installed from the Medical Department supplies. From time to time supplies were furnished on the basis of increased capacity, until an equipment was finally received for a hospital of 1,750 capacity. During December, 1917, the wards were ceiled and plumbing was installed in them. During October, November, and December, 1917, several epidemics occurred, causing approximately 1,800 patients to be continuously in the hos- pital. This necessitated equipping all buildings with medical supplies, whether they had been finished or unfinished, and included the warehouses, the laundry, and the chapel. It also necessitated the transferring of these various supplies from building to building, and it resulted in an unusual loss of breakable non- expendable property. Subsequently each ward was equipped according to the Wolfe unit plan. Two days before the hospital was to be occupied the kitchen and mess hall were destroyed by fire. The kitchen was then installed in what was subsequently used as a bathroom, and the mess hall in a room that later became a medical ward. The kitchen was equipped with two field ranges, on winch three meals a day were prepared for about 1,000 persons. Officers, nurses, enlisted men, and patients ate in the improvised mess hall; the patients and enlisted men messing at the same hour, but at separate tables, followed by the officers and nurses. These difficulties were soon overcome, however, and a large mess hall was opened for the convalescent patients in the center of the hospital grounds. Adjacent to this was a special diet kitchen, in charge of a dietitian, where every possible special diet could be prepared. The mess hall, which was one of the brightest spots in the hospital, could comfortably care for about 1,000 patients. The mess for the detachment , Medical Department, was separately located and had its own cooks; likewise, the nurses had a neatly arranged mess of their own. The offi- cers’ ward had its separate mess, supervised by a special dietitian; and a large mess hall for convalescent officers was located in the same building in which they were placed. No laundry was established in the hospital, all laundry work for the institu- tion being handled, at great expense and at much inconvenience, by outside OTHER BASE HOSPITALS. 629 laundries. From September 1 to December 31, 1917, a total of $5, 507. SI was expended on laundry work. Because of the delays in delivery and excessive charges, a six months contract was made with another concern. From January 1 to April 30, 1918, inclusive, the cost was $9,020.18. The stock room for laun- dry was installed in a central building where the soiled laundry was collected in a separate room and clean laundry was distributed to the wards from another. In this building was installed, for the purpose of sterilizing mattresses, blankets, etc., an American steam sterilizer and an electric sewing machine, a seamstress being hired to repair the torn linen and garments. The hospital received its water supply from Lake Worth, about 14 miles distant. The water was conveyed by gravity through 12-inch cast-iron water pipes into the Fort Worth pumping station, whence it passed through a filtration process into a reservoir, where it remained until settled. At the hospital 8 and 6 inch wrought and cast-iron pipe was used, the individual supply for each build- ing having a separate shut-off outside the building and one at the main. All sewage from the hospital buildings was carried off in 6-inch tile mains, branching into an 8-inch main sewer, which runs through the center of the hos- pital grounds, into the disposal plant, a modified Imhoff septic tank. After purification the sewage emptied into the west branch of the Trinity River. The ward latrines were situated between the wards, in double wards. Each was equipped with five vitreous china water-closets, one vitreous urinal, and one shower, with hot and cold water supply and a floor drain. All latrines had concrete floors. Each single ward had a separate lavatory and bath in either the south or the north end of the building. Each was equipped with one white enameled cast-iron bathtub, three white-enameled washbasins with hot and cold water sup- ply, and three water-closets with low flush tanks. The rubbish was burned in a number of incinerators located about the hospital grounds. Prior to the instal- lation of the sewer system, dishwater was evaporated over the incinerators, and the solid residue was then burned. The garbage was collected in large cans each day and sold by the quartermaster to stock raisers. Each ward was heated with two hot-air furnaces. Coal and wood were used as fuel. The electrical installation of the hospital was laid out excellently, from the converters to the main-line switches. Here there was evidence of contract rush and a disregard of National Code rules; but, in spite of this, the electrical effi- ciency was brought to the point where trouble calls averaged less than one per diem. A heavy-duty electrical potato peeler, a 3,000-watt electrical dry-bath cabinet, and a 1,200-watt baking apparatus for rheumatic ailments were installed. Many snap switches in the diet kitchen and a complete electrical outfit for the venereal clinic formed part of the electrical equipment. Six two-story ward and barrack buildings were electrically equipped, in which all wires were concealed and the ceiling lights were of the shallow-bowl canopy, pull-chain type. The entire electrical system of the hospital was pronounced over 90 per cent efficient. The post exchange was organized during the latter part of September, 1917, without capital, with a limited stock, and in temporary quarters. It was soon permanently located at the entrance to the patients’ mess building, where it gradually expanded in stock and the scope of its activities. A modern five- chair barber shop, baseball, tennis, and volley ball equipment, hat blocking, clothes pressing, a recreation room with billiard tables, were features of the 630 MILITARY HOSPITALS IK THE UNITED STATES. exchange. It finally reached a maximum of stock valued at $2,000, and the fixtures were valued at $1,700. A Young Men’s Christian Association was established in December, 1917, across the hall from the post exchange and in the same building. It occupied one room and offered a common reading, writing, and meeting place for patients and Medical Department men. Y arious kinds of instructive entertainments were given daily. In May, 1918, the association moved into the chapel, where newspapers, books, magazines, games (such as checkers, chess, and dominoes) , phonographic music, singers from the city, and other pleasures and comforts were provided. Because of the crowded condition, in consequence of the epidemics of the winter of 1917-18, Red Cross supplies, which had been kept in a warehouse pro- vided by the Government, had to be removed to and distributed from the base- ment of the chamber of commerce, Fort Worth. Later, a warehouse, centrally located, was provided and placed in charge of an associate field director. The Red Cross House for Convalescents was dedicated on May 18, 1918. The field director visited the hospital one to three times daily, and an associate director was stationed at the hospital to notify parents not only of the condition of patients from time to time, but when they were discharged from the hospital. In addition to the amusements provided by the Young Men’s Christian Association and the Red Cross, croquet sets, indoor baseball outfits, magazines, and books were available. The personnel had for their amusement baseball, tennis, handball, and basket ball. Statistical data, United States Army Base Hospital, Camp Bowie, Fort Worth, Tex., from August 22, 1917, to July 21, 1919, inclusive .° SICK AND WOUNDED. Year and month. Remaining from last month. From command. > Q. missio From soar d c3 ^ © ns. other ces. © © O 1917. 4 9 37 September 28 11 322 170 October 220 9 1,170 102 703 5, 071 2 1,459 2,529 2 191S. 599 1, 4S2 2 921 1,262 2 713 1,083 8 April 728 1,308 29 7 May 640 1,110 30 2 .1 urie 3S7 1,138 45 7 July 479 395 15 5 August 206 234 25 8 September 162 1,452 13 7 October 1,164 3,512 19 IS November 1,212 443 1 3 December 291 379 6 18 1919. January 219 417 423 10 February 449 585 400 9 March 652 422 656 2 April 647 342 1,000 6 May 750 219 741 10 J urie 232 221 6 7 July 128 120 1 3 s o © C3 © -O o o H 50 531 1,501 5, 776 3,990 2, 0S3 2, 185 1,804 2,072 1.7S2 1,577 894 473 1,634 4,713 1,659 694 1,069 1,443 1,732 1,995 1,720 466 250 Completed cases. Remaining. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals . Otherwise dis- posed of. Hospital. o3 22 2S 308 3 220 0 794 2 2 703 0 4, 273 40 1 1 2 1,456 3 191 2 132 599 1,121 19 17 921 1,175 20 2 19 256 713 776 16 5 2 277 72S 1,041 20 1 2 7 361 640 1,092 14 1 288 387 4 2 1 59 279 479 614 4 3 2 42 23 206 248 3 18 10 32 162 423 1 3 9 34 1,16? 3,315 110 2 1 3 70 1,212 1,283 47 10 2S 291 436 3 6 30 217 2 5S7 7 2 2 10 12 449 746 3 1 31 10 652 1,055 2 1 1 6 20 647 l , 209 2 1 1 17 15 750 1,233 1 3 3 240 s 232 7 234 97 9 126 169 1 76 4 Aggregate number of days lost from sickness. 205 3,610 12,564 913 3S, 069 31 17.992 24,243 21, 50S 21,370 10,290 16.843 10. 835 5,080 8, 956 41, 381 17, 562 10, 597 16, 525 20. 511 24. 474 19, 623 1 8. 156 4.760 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER BASE HOSPITALS. 631 Statistical data , United States Army Base Hospital, Camp Bowie, Fort Worth, Tex., from August 22, 1917, to July 21, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M. C., etc.;. Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1917. 10 10 143 143 September 28 2 1 31 139 139 October 36 2 1 39 142 142 8 36 2 1 39 299 299 53 December 54 2 2 58 303 303 87 1918. 63 2 2 67 303 303 89 66 2 1 69 306 306 March. .'. 68 2 1 71 359 20 379 85 April 76 2 1 79 361 20 381 94 May 64 2 1 67 552 20 572 94 June. 69 2 1 72 559 20 579 93 July 88 2 1 91 418 20 438 104 August 88 3 1 92 411 20 431 85 September 67 3 1 71 672 19 691 90 October 64 3 3 70 660 18 678 97 November 59 3 4 66 657 18 675 118 December 51 3 5 59 589 16 605 80 1919. January 44 3 5 52 530 16 546 78 February 42 3 4 49 412 15 427 76 March 43 3 3 49 392 13 405 58 April 39 3 3 45 380 13 393 58 May 39 2 2 43 275 4 279 58 June 17 2 2 21 275 4 279 23 July 17 2 2 21 63 63 10 BASE HOSPITAL, CAMP CODY, DEMING, N. MEX.a The base hospital was situated at the extreme western part of Camp Cody about 3^ miles to the northwest of Denting, N. Mex., a town of approximately 3,000 population. Denting, and the surrounding country for many miles to the east and west, lie in the Mimbres Valley, which at this place is about 30 miles wide and is flanked on either side by mountain ranges, all fully visible from the base hospital. The mountains, with the cloudless skies and wonderful sunsets, furnished a restful and serene outlook for the convalescent patients. The Mimbres Valley, level and unbroken, is practically a desert. To the eye of the casual observer, however, this arid character is partly concealed by the green of the soapweed, the yucca and the cactus. It is traversed from west to east by the Mimbres River, which, in the part of its course adjacent to Camp Cody, is a river in name only, its channel being cpiite dry except following a cloudburst or the rapid melting of the snows in the mountains. The water in the river, except at flood time, sinks and disappears in the sand at the head of the valley, only to reappear at the surface some miles beyond the Mexican border. This phenomenon is supposed to account for the high level of the underground water in the valley. The soil is sand, ofttimes mixed with an alluvium, which, under irrigation, is exceedingly fertile. During the period of high winds (from the latter part of October to May) violent sand and dust storms are common. It is from this characteristic of the a The statements of fact appearing herein are based on the “ History, Base Hospital, Camp Cody, N. Mex.,” by Lieut. Col. A. O. Davis, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. 632 MILITARY HOSPITALS IN THE UNITED STATES. camp that the 34th Division acquired its sobriquet of “The sand storm division.” Fortunately, the base hospital suffered less from the sand and dust than other parts of the camp by reason of its location to the windward side. The dust, much of which originated in the camp itself, was carried away from the hospital. The climate may be considered as agreeable and salubrious. The altitude of Deming is 4,215 feet. This combination of latitude and altitude, together with the cloudless sky in the middle of the day, favors an extreme diurnal range of temperature, which is especially noticeable in the fall and winter. In midsummer, however hot the day, the night is sufficiently cool for refreshing sleep. During the spring and summer seasons violent electrical storms occa- sionally occur. From September 1 , 1917, to September 1 , 1918, five soldiers were struck by lightning and two of them were killed. The roads about the hospital and camp were constructed of gravel, which packed almost to the consistency of macadam. The highways of the sur- rounding country were, for the most part, rather primitive, but by reason of the dry and sandy soil, were rather easily kept in fair condition. The com- plete absence of waterways, except for the so-called Mimbres liiver, has already been noted; but irrigation plants, the pumps of which were usually operated by wind, were numerous and made the surrounding tracts present the aspects of an oasis. Except for the absence of running streams, which rendered sewage disposal unusually difficult, the location of the hospital was almost ideal from a sanitary point of view. The base hospital had its beginning in 1916, growing out of the necessities of a camp occupied by a brigade engaged in the border service incident to the Mexican trouble of that time. With the cooperation of the town of Deming, there was constructed within its limits, on the west, a hospital building con- sisting of administration offices, an operating room, a patients’ kitchen and mess hall and eight wards, all built around a central court. The collection of buildings was partially steam heated, and was electrically lighted. Its normal capacity was 200 patients. This institution performed the functions of a camp hospital throughout the construction period of the camp. On August 25, 1917, the 34tli Division, consisting of 22,000 National Guard men from Iowa, Minnesota, Nebraska, and South Dakota, began mobilizing at Camp Cody, and in the course of events, on September 1, 1917, the camp hospital was officially designated as the base hospital. Coincident with the mobilization and estab- lishment of the 34th Division, the construction of a new, more extensive and complete hospital was in progress, but by reason of the remoteness from a large center, and the difficulties encountered in obtaining material and labor, the new hospital was not ready for occupancy until November 4, 1917. Even then the accommodations were far from being complete. The urgent necessities of the medical service, however, permitted no further waiting for a greater degree of completion. Beginning with 45 patients on September 1, by October the service had increased to 130, and to 566 by November 1. The capacity of the original camp hospital (now known as ‘old base ) was increased by about 140 beds by the use of seven hospital tents. In the meantime, four of the new wards had been casually occupied by convalescent patients and those awaiting discharge for physical disability. Finally, the administrative offices and all of the medical patients were moved to the new quarters, the surgical patients remaining in the “old base.” OTHER BASE HOSPITALS. 633 As finally completed, the new base hospital included 52 buildings. Facing toward the east, on the main north and south road, were three buildings, the receiving office and ward, the administration building, and the officers’ ward. Extending to the west from the receiving ward were wards 5, 6, 7, 8, 9, andlO; extending to the west from officers’ ward were wards 11, 12, 13, 14, 15 and 16. These two groups of wards, with the main building, surrounded a central court, in which was located in line with the administration building, and extending from it to the west, the X-ray and pathological laboratories, the operating pavilion, the post exchange, and the patients’ and enlisted men’s kitchen and mess hall. To the rear of each of the two rows of wards mentioned was an additional row of four wards; to the south were wards 1, 2, 3 and 4; and to the north were wards 17, 18, 19 and 20. All these wards and buildings were connected by covered walks, furnishing ready access from one to another. Additional buildings were grouped around this central body of buildings, stand- ing separate and distinct. Across from the main road, and facing the admin- istration buildings were the nurses’ quarters; to the southwest was the psychi- atric ward; to the west, the isolation wards, the medical property building, the morgue, the guardhouse, the garage, the quartermaster supply building, the enlisted men’s barracks; to the north, additional barracks (two story), the Red Cross Hall and Library; and, to the north and facing the main road, the pavilion for head surgery. At the time the camp hospital was organized as a base hospital, and until the new buildings were completed, the officers were quartered in tents. As the personnel increased, 2 hospital tents were pitched end to end, and occupied by 25 medical officers. The cold nights, the sand, and various other discomforts, rendered the tent quarters decidedly unsatisfactory for men just from civil life, but it was not recorded that anyone suffered from this mode of living. The new quarters were supplied with modern conveniences, one officer to each room. Enlargements of these accommodations were necessary. The nurses’ quarters were at first inadequate, but this inadequacy was rectified in time. The medical stores of the hospital were kept in a frame warehouse, situ- ated at the western edge of the hospital grounds. The office of the base hos- pital property officer was located at this warehouse. Property was arranged on the shelves according to the Manual for the Medical Department, which calls for the separating of medicines, stationery, miscellaneous, X-ray, laboratory, and additional articles. Surgical instruments, narcotics, poisons, and liquors, were kept under lock at all times. A refrigerator was used to store all biolog- ical and perishable articles. A clean and orderly warehouse was maintained. The family style of service in the officers’ mess and nurses’ mess was used at the patients’ mess — one service to eight patients. The food was properly cooked and the variety was the best possible under the conditions of the market. The mess was supervised by the mess officer and a sergeant first class. A daily inspection of the food served at the three meals was made by the mess officer, who tasted all food served. The kitchen personnel consisted of a sergeant in charge, five cooks, three cooks’ helpers, and the "kitchen police.” Patients who were able to do so marched to the mess hall from their respective wards, accompanied by an attendant. They entered the hall single file and stood at their places until seated by command. They were required to 634 MILITARY HOSPITALS IN THE UNITED STATES. remain at the table at least 20 minutes, but they were permitted to remain longer if they desired. The diet kitchen connected with this mess was in a separate room. The personnel connected with it consisted of 2 dietitians, 2 cooks, and 6 kitchen police. The food going out to the wards was served in tins or containers, each of which had a cover. The containers, tilled and ready for transportation to the wards, were placed in large trays containing hot water. The baking for the different messes was done by two bakers, at night, in the patients’ mess. The family style of service was employed in the detachment mess, as in the other messes, one service to eight men; and this mess was supervised by the mess officer and a sergeant first class, as in the patients’ mess. The kitchen personnel consisted of six cooks, two cooks’ helpers, and kitchen police. The men marched into the mess hall in single file, standing at their places until seated by command. In connection with these messes a training department was conducted at the “old base,” the mess of which was supervised by the mess officer and furnished with supplies as in the case of the others. The personnel of this kitchen consisted of tlu*ee cooks and four kitchen police. The hospital water supply was derived from a deep, drilled well, situated about 500 feet south of the hospital grounds, and ecpiipped with a turbine pump driven by a 50-horsepower electric motor. The capacity of the pump was 200 gallons per minute, filling a tank, located on a 50-foot tower built on high ground, and having a capacity of 200,000 gallons. Tins tank furnished the necessary pressure and afforded a direct supply of water to the hospital. There was no filter and no sterilization process; the bacteriological analysis of the water showed a very small count. This well was for the hospital use alone, but before it was completed the hospital received its water supply from wells that supplied the remainder of the camp. The sewer system, which was independent of the camp sewer system, consisted of a 10-inch main, 1 mile in length, running, with a drop of about 12 feet, to the Mimbres River. A large septic tank partially purified the sewage before it entered the river. The hospital buildings were connected with the 10-inch main by 6-incli laterals. The waste from the kitchen was disposed of by the reclamation service. The trash and other waste was placed in galvanized iron containers and burned at a dump, together with manure from the stable. Before the sewer system was constructed bathing facilities were furnished by means of shower baths in small buildings adjoining the wards, the waste water running out into ditches. Because of the low temperature in the morn- ings and late afternoons, and the lack of hot water, bathing was limited to the middle of the day. While somewhat uncomfortable, it was not shown that shower bathing under such circumstances was injurious to health. Subse- quently each ward had its own lavatory, with well-equipped tub and shower baths, and the other buildings had ample facilities of this kind. When the hospital buildings were first occupied the heating facilities were exceedingly primitive. A small sheet-iron stove, officially designated as “ wood No. 18,” was placed in each end of the ward. Being entirely inade- quate, these were soon replaced by large drum stoves (room heaters. No. IS OTHER BASE HOSPITALS. 635 and No. 20). These added to the difficulty in keeping the wards clean, but they served the purpose of keeping them warm. Steam heat was never installed. The hospital was electrically lighted from the beginning, being served by the Deming Electric Light Co. The service at first was not very satisfac- tory, but improved with time. The laundry work of the hospital was formerly done by outside laundries. In May, 19 IS, a full steam laundry equipment was donated by a resident of Silver City, N. Mex., for the use of the base hospital for the duration of war. He also gave his services as manager. After July 1, 1918, the laundry washed all the hospital linen and never missed delivering clean linen to each ward daily, except Sundays. In addition, large quantities of work were done for the camp quartermaster and the conservation and reclamation branch of the Quartermaster Corps, at a great saving to them. The clothes of the patients in the hospital were washed every day free of charge. Judging from the prices that would have been charged by an outside firm, the hospital laundry showed a saving of $4,260.44 for the first three months of its operation. During the period (prior to September 1, 1917) when the hospital was designated a camp hospital, and when it had seven wards, the hospital equip- ment was in proportion. One end of the ward was partitioned off as a store- room for both medical and quartermaster property. Practically the only medical stores held in stock were the bedding and patients’ clothing, for changes of laundry, and a supply of stationery. The wards were fairly well equipped, and the surgical department had just such instruments and appliances as were necessary for handling incoming cases. Pending the construction of the new base hospital, ward tents were erected, greatly taxing the limited equipment on hand. Some of the necessary drugs and medicines were practically unobtainable. Later, as the new hospital was completed, and the work of moving began, the hospital equipment became altogether inadequate. October, November, and December, 1917, were un- doubtedly the hardest in the history of the hospital. Patients not seriously ill brought then’ own cots and blankets. Drugs and general medical supplies could not be furnished in the large quantities required. Very few modern appliances were in use, and it was necessary to introduce many methods in order to obtain the desired results without the requisite surgical appliances and modern equipment. But with the beginning of the year 1918 condi- tions began to improve, and ultimately the base hospital at Camp Cody became modern and efficient in its equipment in every department and in all details. On October 17, 1917, the post exchange was started on credit extended by Deming firms. New features were added from time to time, until the exchange embraced a store department, three barber shops, a tailor shop, pool hall, recreation room, and laundry at the new base hospital, and a general store, pool room, and barber shop at the “old base.” In all the departments about 30 men were on duty. An average of 50 cents a day was paid them. The average monthly business of the exchange was about $17,000, with a profit of about $1,700. The exchange was free from debt, but did not declare a dividend, although from time to time a sum was set aside and used for the benefit of the hospital, as allowed by exchange regulations. 636 MILITARY HOSPITALS IN THE UNITED STATES. The Young Men’s Christian Association building was completed and ready for occupancy October 1, 1918. It had an auditorium, 110 by 45 feet, and a social room, 36 by 36 feet. It was painted steel gray and trimmed in light green, the colors offering a striking contrast to the groups of unpainted barracks in the northeast area of the hospital grounds, near which the building was situated. The equipment for the daily entertainment of the men consisted chiefly of checkers and chess boards, pianos, victrolas, and a moving-picture machine. During the emergency of the influenza epidemic the building was turned into a hospital ward, the secretaries giving their assistance in the care of the patients. After the epidemic subsided, weekly programs covering athletics, social, educational, and religious activities were given, which did much toward keeping up the morale of the men. At regular times mass services were conducted by the priest, and Sunday services were conducted by the chaplains in the auditorium. The American Red Cross building, constructed and furnished at a cost of $25,000, was a pleasing variation to the hospital architecture. It was a two- story structure, built in the form of a cross. The main part of the lower floor was occupied by an auditorium, with a stage, where various entertainments were given for convalescent patients and their friends. Here the patients, the men, and officers might read, write, or play games and feel perfectly at home. The hospital branch of the American Library Association was installed here, and there was a special reading room with professional literature for the medical officers attached to the hospital. Another valuable feature of the institution, especially appreciated because of the comparative isolation of Deming, was the arrangement for the temporary housing of the relatives of the dangerously sick who came from far away. Twelve rooms were available for this purpose. The Red Cross built a nurses’ house adjacent to their quarters, which could be used for a lounging and rest room or for dancing. A weekly dance given by the nurses served to break the monotony of their routine duties, remote from even a small city. This building, furnished, cost $12,000. Opposite the administration building the Red Cross built, at a cost of $2,500, a pass and information bureau, in which a part of the administrative work of the hospital was conducted. All these buildings with their equipment were turned over to the Govern- ment and were directly under the control of the commanding officer of the hospital. In addition to the recreation activities provided by the Red Cross and the Young Men’s Christian Association, other sports were fostered and supervised by an athletic officer, appointed for the purpose, who had charge of the athletic training of the men. From time to time boxing and wrestling tournaments were held. A swimming pool was built by the hospital corps men with the assistance of the Red Cross. The pool, which was of reinforced concrete, was 90 feet long, 40 feet wide, and 9 feet deep at the lower end. A constant change of water took place, and, in addition, the water was disinfected with chloride of lime. All persons were obliged to take a soap and shower bath before entering the pool. There were five cement and one dirt tennis courts at the hospital, so man- aged that everyone had opportunity to play. OTHER BASE HOSPITALS. 637 A baseball and football field was located to the extreme east of the grounds. The boxing and wrestling bouts were held in a regulation 16-foot ring, which was well made and so placed that about a thousand spectators could enjoy the sport. Statistical data, United States Army Base Hospital, Camp Cody, Deming, N. Mex., from September, 1917 , to April 10 , 1919 , inclusive .“ SICIC AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. ■ From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term . Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- ' fer. Otherwise. Hospital. Quarters. Hospital. Quarters. 1917. 22 312 38 372 192 2 6 39 133 2,423 133 19 827 73 1 , 052 479 2 43 9 20 499 8,321 499 2,708 9 3,216 1,826 10 169 9 1,197 28,646 1,197 2,264 26 3,487 2. 164 53 253 1 2 26 988 31,976 1918. 938 1,198 20 2,206 1,033 44 147 40 937 29.893 937 863 19 1,819 '785 35 117 9 46 827 25, 111 827 672 16 1,515 618 18 142 2 24 711 23,859 711 581 1,292 615 29 92 4 19 533 12,464 533 606 6 1, 145 551 5 59 1 6 13 510 11,563 510 1,137 11 1, 658 1,045 15 39 3 5 9 542 23,990 542 591 12 1, 145 579 7 11 20 10 518 16,427 518 620 32 1,170 660 13 25 28 437 20, 141 437 294 13 744 318 1 45 1 3d 343 10,871 343 2,578 72 2,993 792 52 12 61 2,076 25,943 2,076 901 13 2,990 1,944 194 9 14 49 780 35, 786 780 218 24 1,022 755 13 23 9 23 199 13,082 1919. 199 184 16 399 207 1 22 2 14 153 5,405 153 192 1 3 349 218 2 9 8 112 3,772 112 135 16 263 151 5 18 46 4 39 1,865 39 6 1 46 26 18 2 279 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1917. 25 2 27 153 153 32 2 34 153 153 13 38 2 40 267 267 22 66 3 1 70 294 294 32 1918. 83 2 85 358 358 78 81 3 84 358 358 92 March 84 2 86 341 20 361 92 April 77 3 80 478 20 498 91 May 71 2 73 523 20 543 90 J une 68 2 70 519 20 539 95 .1 uly 60 5 377 19 396 101 69 5 74 369 18 387 100 September 53 6 3 62 351 18 369 89 October 57 8 3 68 373 IS 391 80 November 61 5 1 67 395 17 412 103 December 37 4 3 44 393 16 409 102 1919. January 32 2 2 36 357 7 364 96 February 31 2 2 35 221 7 228 31 9 1 10 110 7 117 6 April 5 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 638 MILITARY HOSPITALS IN THE UNITED STATES. BASE HOSPITAL. CAMP CUSTER, MICH.a The base hospital of Camp Custer was favorably located in the county of Kalamazoo, in the State of Michigan, and approximately 7 miles from the civic center of Battle Creek, Mich. The country is rolling, with scattered wooded tracts. The soil is loam and fine gravel and sand, the latter predominat- ing. The site is located on the medial moraine of glacial drift. There is almost no mud, but much wind which stirs up a good deal of the sand, making con- siderable dust. The winters are quite severe for about three months of each year, the temperature not infrequently dropping as low as 20° below zero. The prevailing winds are from the southwest. Spring often begins early, but the frequent relapses of winter, and often cold, rainy days, with occasional mild days interspersed, necessitate some fire for comfort until June. Through- out the spring and well into summer hot sultry days may alternate with chilly and windy ones. The autumns have many beautiful days, but there may be several weeks of rainy chilly weather. The summer days are warm; the nights are generally cool. The hospital was on a hill directly overlooking Eagle Lake, and was subjected to moderately high winds in winter and spring. The roads were of earth, gravel, and cinders. A concrete road extended from just beyond the hospital receiving ward to the camp. The hospital was opened for patients on September 5, 1917, a tent being used near the temporary headquarters of the camp. On September 17, two partially completed ward buildings of the new hospital were available ; and the base hospital, its detachment, Medical Department, and 24 patients, were moved into these wards. Cases of contagious diseases were temporarily cared for in tents erected contiguous to the ward buildings. As rapidly as new build- ings were completed they were occupied, for the patients arrived as fast as adequate space for their reception was obtainable. The fimetion of this hospital was to treat all cases arising at Camp Custer, and medical, surgical, and venereal cases from overseas. Hie training of per- sonnel for further duty at home and overseas was a part of the function of the hospital before the armistice. The hospital wards, 38 in number, conformed to the standard designs for a northern climate. During 1918 the following construction was completed: Additional nurses’ quarters and 4 dormitories, 10 two-story ward-barracks, a refrigerating plant, a kitchen and mess hall for the enlisted men; 2 barracks and two additions to the general mess. At the end of the year there were in course of construction an addition to the administration building, the laboratory, the operating pavilion, a garage, nine new wards, a prison ward, and an umbrella corridor connecting the nurses’ quarters and the main hospital. A Red Cross house for convalescents and a Toung Men s Christian Association hut were also added. Officers, enlisted men, and nurses were quartered in the regulation buildings provided for the purpose. The crowded conditions which obtained in the earlier days were overcome by the construction of additional quarters during 1918. a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Custer, Mich.,” by Lieut. Col. Ernest E. Irons, M. C., U. S. A., while on duty as a member of the stafl of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C —Ed. OTHER BASE HOSPITALS. 639 The storehouses were completed promptly, hut great difficulty was encoun- tered because of the lack of shelving at first, and only a minimum amount of shelving was obtained. The storehouses were the last buildings to be equipped with steam heat. The hospital kitchen was not ready for occupancy at first; consequently, the cooking for both enlisted men and commissioned personnel was done in the open on a field range, underneath a tent fly. Later, the cooking for both classes was done in one kitchen; still later, the portion of the main kitchen designed for a diet kitchen was used in which to cook for the officers’ mess; and the detach- ment mess was separated from the patients’ mess. Subsequently, the officers’ mess was moved to the officers’ quarters. The following criticisms were made of the construction and equipment of the patients’ kitchen: The floor was not impermeable; on the contrary, it was made of green 6-inch lumber which shrank and warped after short use. It was impossible to keep it clean. The wing off the kitchen, shown in the original plans as a bakery, was never built at this hospital, although it was built at other camps and used as a kitchen storeroom. The storage space in the patients’ kitchen at this hospital was inadequate from the beginning. The laundry building was equipped with a drying room, a steam disin- fector, and a few laundry baskets. The incomplete equipment of the hospital laundry was met by daily service by the camp laundry. It was necessary, however, to send nurses’ uniforms which required ironing to Kalamazoo. A double check was kept on all linen and an inventory taken each week. The hospital water supply was received from the water system installed in Camp Custer. The water was piped across Kalamazoo River from deep wells in Marshall sandstone. This is a water-bearing stratum 30 or more feet in thickness, situated below a layer of sand and fine gravel varying in thickness from 30 to 50 feet. The average depth of these walls was approximately 110 feet. The water rose in them to within a few feet of the surface, so that elec- trically driven centrifugal pumps were successfully used. The water was of high quality, but the pipes were fouled during the crossing of the river and the laying of the mains, and liquid chlorine prophylaxis under laboratory control was employed at first. The sewerage system of the hospital was water borne and passed through sedimentation tanks into the Kalamazoo River, which received also the sewage from Battle Creek, Kalamazoo, and Augusta. A garbage house 8 by 20 feet, with cement floor and screened windows, was constructed in the rear of the kitchen. To this house garbage was brought from each ward and mess, weighed by an inspector, sorted over, and weights and contents noted. This report was then typewritten and sent to the desk of the mess officer, the dietitian, and the commanding officer. Undue waste from any ward or mess was noted and comment made locally, or at officers’ call. By thus fixing individual responsibility the daily waste of edible food was reduced to as low as 0.17 ounce per ration per day. The waste in the detach- ment mess was as low as 0.06 ounce per person. The garbage, except that from the contagious-disease wards, was hauled away in cans and turned over to a contractor. Sputum cups and articles containing discharges of a similar nature were collected in a pail, lined with newspaper, and burned in the furnace, as 640 MILITARY HOSPITALS IN THE UNITED STATES. were the infected dressings. Garbage from isolation wards was separated and burned. Lavatories and baths were connected with the sewer, all fixtures being: separately trapped and provided with cast-iron soil piping, which connected with the trunk sewer. The heating plant consisted of 10 shell boilers 150 horsepower each. The buildings were all steam heated by a one-pipe low-pressure system with no returns. The system was adequate to give ample heat throughout the hospital, with the exception of the new nurses’ quarters and the two-story barracks. The inadequacy of the system in this respect was said to be due to the fact that there was no return system. Without exception the original hospital buildings were provided with more radiation than was essential. The hospital was lighted throughout by electricity, commercially obtained, the system proving satisfactory. The initial equipment was incomplete as regards instruments, dental apparatus, and ward equipment. Since it was possible to treat patients and administer to their needs by the use of emergency equipment purchased locally, all patients were cared for satisfactorily. Sufficient equipment was eventually obtained. On September 20, 1917, the base hospital exchange was started on Har- monia Road, in the east end warehouse, with a lot of goods, costing S100. The exchange proper was opened in building 1836 on October 1, 1917. The exchange prospered, the business transacted being satisfactory as to both profits and patronage. It was a distinct asset to the hospital and filled a real want in satisfying the needs of soldiers, patients, and their relatives. During the early winter of 1917 ward 20 of the base hospital was opened for recreational purposes and was in charge of a private detailed for the purpose. On December 26 a secretary of the Young Men’s Christian Association assumed charge. The work was carried on in this ward until January 24, 1918, when it was necessary to move to the base-hospital exchange, on account of the crowded condition of the hospital. Subsequently a new Young Men’s Christian Associa- tion building was opened. It proved extremely valuable and was much used. The Red Cross house for convalescents was opened in April. 1918. Through the cooperation of the Red Cross and Knights of Columbus, Edison and Victor graphaphones were placed in nearly all wards. Sunday afternoon entertainments were given in the wards under the auspices of the Young Men’s Christian Association and the Knights of Columbus and by visiting groups of interested entertainers. Afternoon band concerts in the patients’ mess hall were frequently given, and the Young Men’s Christian Association furnished at least three evening entertainments a week, in addi- tion to their Sunday evening religious concert and service. Quoits, checkers, chess, and other games were distributed; and in favorable seasons the enlisted men played baseball. An orchestra was organized in the early days of the hospital and proved so successful as to warrant official recognition and encouragement. Assistance was given it from post exchange funds, instruments were purchased, and time off was allowed the members for practice. A band of 26 instruments was developed. OTHER BASE HOSPITALS, 641 The Daily Bulletin, a single sheet, mimeographed daily paper, was issued, with some intervals, from August 5, 1918. Its object was to keep the patients and the personnel informed as to official news, announcements of the Red Cross, Young Men’s Christian Association, and Knights of Columbus, to improve the morale, and to stimulate an esprit de corps. Statistical data, United States Army Base Hospital, Camp Custer, Battle Creek, Mich., from Septem- ber, 1917, to March, 1919, inclusive. a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. From command. From other sources. Returned to duty. Died. By trans- fer. Otherwise. 1917. September 0 16 156 1 173 80 4 October 80 420 39 1 540 270 2 November 263 574 15 4 856 493 2 December 347 843 12 7 1,209 679 3 1918. January 379 1.782 49 2 2.212 1.083 10 February 944 1.378 59 7 2.38S 1.345 19 March 83C 1 . 229 56 11 2. 126 1.304 21 April 729 1.524 60 3 2,316 1.281 35 May 806 1.323 23 4 2,156 1.153 24 June 671 1. 132 13 1C 1,826 940 6 July 647 1,232 32 4 1.915 910 6 August 665 1,083 4 8 1, <58 1. 186 5 391 3, 114 9 3,514 929 8 2,487 7,781 10, 268 7,926 661 U581 847 3 2,431 1.830 19 531 1, 157 92 1,780 1. 120 8 1919. 612 1. 196 734 2, 543 1.777 10 645 463 1,823 1,017 772 616 189 1,577 922 Completed cases. o T3 ^ g o ■s. o 1 103 115 187 51 l 1691 281' 194! 301 1481 48| 23 20 15 12 o Remaining. Aggregate number of days lost from sickness. ’Z) V) 73 2 O -2 o -2 © M4 p4 P4 o § o w Of s 5 79 i 900 9 3 262 l 5.499 41 12 347 11,862 38 374 5 12, 995 43 55 944 24,210 46 2 821 9 25.343 133 19 725 4 22,531 132 15 796 10 24.296 130 8 666 5 24, 896 140 23 640 7 22,302 122 10 659 4 20.225 106 10 388 3 16, 407 29 10 2.483 4 IS, 130 40 60 1.569 12 10.864 8. 651 36 513 18 2.876 1.457 24 605 8 16, 824 386 7 708 7 16,345 239 11 767 5 20.347 172 23 618 13,205 CHILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Y^ear and month. Men. Women. Chil- dren. Total. 1917. 1918. September 0 0 7 11 18 October 0 0 0 13 13 November 1 4 0 5 0 14 14 December 4 4 0 8 3 137 1 141 0 13 13 1918. 0 10 01 January 4 4 8 February 4 4 8 1919. March. .'. 4 4 8 0 15 April 4 4 8 0 21 0 21 May 0 8 0 8 0 31 31 June 7 11 0 IS “ Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 45269 °— 23 - 41 642 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Base Hospital, Camp Custer, Battle Creek, Mich., from September, 1917, to March, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Civilian em- ployees. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M. C., etc.). Total. 1917. 46 2 1 49 132 132 46 2 1 49 132 132 11 69 2 1 72 268 268 48 69 2 1 72 268 268 48 1 1918. 3 1 69 411 17 428 67 February 67 3 1 71 409 17 426 105 1 March 80 2 2 84 398 20 418 105 1 April 79 2 2 83 503 20 523 105 1 May 82 2 2 86 570 19 589 144 1 68 2 1 71 553 19 .Tilly... 83 2 1 86 519 18 167 84 3 1 88 511 18 529 173 September 66 3 i 70 466 17 483 138 1 107 4 2 113 845 860 191 100 4 2 106 708 17 725 212 73 2 80 688 17 705 206 1919. 5 2 74 651 24 117 71 3 80 28 6S1 103 March.. I 59 8 3 70 428 27 455 95 BASE HOSPITAL, CAMP DEVENS, MASS.a The hospital was located in Middlesex County, Mass., 14 miles from Fitch- burg and 24 miles from Ayer. The country is rolling, and wooded with second- growth trees, mostly hardwood of small size. The soil, for the most part, is gravelly, hut shows the variety common to glacial drift. There was no high-fly- ing dust about the hospital in dry weather, nor sticky, easily carried mud after rains. The climate is characteristic of New England, moderately cold in winter, moderately warm in summer, with frequent changes and considerable sunshine. The hospital site was not exposed to excessive wind. The roads about the base hospital were well kept. The main highways were of the best construction under State control; the county roads were of gravel or dirt. The Nashua River bordered the hospital grounds on the west, at a distance of a quarter of a mile. This stream was polluted by sewage from towns above. There was some low-lving land on the border of the stream, and there were several small ponds within half a mile of the hospital. The base hospital was organized the last week in August. 1917. and the first building was occupied August 10, 1917. The hospital treated all cases arising at Camp Devens, and medical, sur- gical, and venereal cases from overseas. A building, located near the center of the cantonment, was maintained by the insurance company as a first-aid station and infirmary for construction employees. It had six beds. Serious cases were sent to Boston. The buildings constituting the base hospital were distributed in the form of a Ian, radiating from the administration building toward the northwest. a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Devens, Mass.,” by Maj. W. B. Lancaster, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. OTHER BASE HOSPITALS. 643 There were three rows of medical wards, one row of isolation wards, and a psychiatric group toward the left of the administration building, and three rows of surgical wards to the right, with the administration building, the post exchange, and the main kitchen between the medical and surgical groups. The enlisted men’s barracks, the storehouses, garage, shops, and heating plant were to the northwest of the surgical group. Twelve two-story wards were added on the east of the surgical wards. Other construction was added from time to time, in various parts of the hospital. At the beginning, officers as well as enlisted men, were quartered in buildings which were subsequently used as the men’s barracks and the storehouses. The building primarily intended for the officers’ quarters was converted into a building for head surgery, necessitating the construction of a new building for officers’ quarters. Additional quarters were constructed as the commis- sioned personnel increased in number. The nurses’ quarters were inadequate at first, but additional quarters were provided later. The enlisted men of the detachment were quartered in eight barracks. The cooking for the patients was done in a central kitchen, which, with an auxiliary diet kitchen, had a capacity for 1,500 or more. An additional dining room was built, so that it would not be necessary, as in the beginning, to have first and second tables. The kitchen, however, was too small, having been designed for a much smaller mess. There was a kitchen and mess for the hospital detachment, Medical Department, in a building adjoining their bar- racks, which had a capacity of about 200, but at which 300 or 400 were fed under satisfactory conditions. The nurses maintained a separate kitchen and mess. This also was over- crowded at first because the number of nurses on duty was considerably larger than either the nurses’ quarters or the nurses’ kitchen and mess were planned to accommodate. The officers’ ward had a separate kitchen and mess, with a capacity con- siderably larger than the requirements of the sick officers demanded; so, for many months, all officers of the hospital were fed at a mess maintained in the officers’ ward. Subsequently a new wing was added to the officers’ quarters with a larger kitchen and a seating capacity of 120. The messes for the patients, the hospital detachment, and the nurses were maintained on the Government ration, but the enlisted men’s mess received a liberal addition from the hospital fund and the post exchange, bringing it up nearly to the ration for the patients. The building intended for the hospital laundry was not used for this pur- pose because it was not equipped with laundry machinery. All the laundry for the hospital was done outside the camp by firms in cities 30 or 40 miles distant. The laundry was collected in a central building in the camp from which it was distributed. This arrangement was very unsatisfactory. There were four storehouses, one of which was used for the hospital medical supply, the other three for the camp medical supply. They were buildings similar in dimensions to the wards and barracks, but were arranged with shelves inside and each had a wide platform outside, running the full length, for con- venience in loading and unloading. Shower and tub baths were connected with each ward. There were several shower baths, but no tubs, in each of the enlisted men’s latrines. The 644 MILITARY HOSPITALS IK THE UNITED STATES. water for the shower baths in these latrines was heated during the winter by steam from the heating plant. High-pressure steam was connected later with these lavatories. The officers’ quarters were equipped with shower baths and tubs, and the nurses’ quarters with tubs hut no shower baths. A central boiler house, located at the lowest part of the hospital area, had a capacity of 14 or more boilers. The steam was conducted by overhead piping, well insulated, to all parts of the hospital, with the exception of the 12 two- story wards, for which a separate heating plant was constructed. The system provided for conveying the steam from the boilers to the radiators, and the water of condensation was allowed to escape through exhaust pipes which emptied upon the surface of the ground, just without the buildings. The heating system worked well and proved entirely adequate even during an unusually severe winter. The consumption of coal was as high as 85 tons a day in winter and about 5 tons a day in summer. The building for surgical operations had an independent heating unit, installed to provide heat for warming the building and for sterilizing materials before the central plant was constructed, ft also pro- vided against a possible breakdown in the central heating arrangements. This auxiliary plant proved very satisfactory. Without it the surgical service would have been seriously handicapped during the early months of its existence. The water supply of the base hospital was identical with that of the camp. It was derived from a group of wells in a favorable location northeast of the camp. Owing to the possibility of surface water finding its way into some of the wells, chlorination was adopted as a precautionary measure. The hospital had a complete gravity system of sewerage. There were water closets in all the wards, and three latrines adjacent to the men's barracks. Pit latrines were temporarily established at various points on the hospital area for the use of the construction employees and also, in the days before the sewerage system was completed, for the use of the officers and men of the hospital. There was a filtration system near the river for the purification of sewage before its final outlet into the river. Garbage from the various kitchens and wards was divided into edible and inedible waste, and was weighed so as to keep track of the waste from each ward and kitchen. The garbage was collected daily and transported to a central station where all the garbage of the camp was handled by a contractor. Manure from the stables was hauled away daily and loaded upon a car at the railroad siding. The hospital was lighted by electricity obtained from the general camp supply, which, in turn, was derived from a hydroelectric station on the Con- necticut River, about 75 miles distant. The supply was steady and adequate. The current was 60-cycle, alternating 110-220 volt, to which it was stepped down by means of transformers placed where the high tension lines entered the hospital grounds. Lighting was accomplished by standard watt volt mazda lamps, with a few larger lamps where extra light was required. In the library the recreation rooms and the ophthalmic department, special units of larger power, properly shaded, were installed. During October, 1918, a building was erected by the American Red Cross Society for the conduct of occupational therapy for convalescent patients. In December the first group of reconstruction aides, 14 in number, arrived. Prog- ress was made in the work, especially among those confined to bed. but lack of teaching personnel hindered the full development of this branch of the work. OTHER BASE HOSPITALS. 645 In August, 1917, the post exchange was opened. Owing to the large number of workmen who patronized it during the construction period a fund was rapidly accumulated and the exchange placed on a staple basis. The Young Men’s Christian Association was located opposite the enlisted men’s barracks, and was connected with the wards by a covered corridor. This building was used by both the enlisted men and the patients. Basketball and other indoor sports were carried on during the winter; an hour, twice a week, being reserved for the officers. Entertainments of some sort, such as moving pictures, addresses, concerts, or dramatic entertainments, were given there nearly every evening. On Sundays religious services were held, by the chaplain or some visiting clergyman, in this building. The Red Cross building adjoined the part of the hospital where convales- cent wards were, and was intended for the use of patients of the hospital. The Red Cross aided the hospital in many ways. A representative called biweekly on the commanding officer to afford financial or other assistance. The patients were visited in the ward and were assisted with their corre- spondence, the Red Cross representative serving as a medium of communication between patients and their homes. Baseball and tennis games afforded the principal forms of amusement. The American Library Association furnished the material and equipment with which to convert the chapel into a library for the use of the enlisted men and the patients. A librarian was placed in charge and 3,000 volumes and a large number of periodicals were filed. The library association also supplied games, puzzles, etc., for the patients. Statistical data, United States Army Base Hospital, Camp Devens, Ayer, Mass., from September, 1917, to July, 1919, inclusive. 11 SICK AND WOUNDED. Y ear and month . Remaining from last month. i From command. 1 > missio From SOUI 2 s2 (£> & ns. other rces. s o Total to be accounted for. 1917. September 58 162 260 480 October 368 9 58 533 968 November 351 1,192 41 5 1,589 December 446 .2,112 3 19 2, 580 1918. January 617 2,030 1 13 2, 661 February 838 1,660 4 13 2,515 March 852 2, 623 10 28 3, 513 April 1,015 2, 335 25 39 3,414 May 1,001 1,789 7 29 2 , S26 June 1,075 1,654 10 39 2,778 July 1,171 1,468 7 21 2,667 August 985 2,059 10 66 3, 120 September 1,245 10, 951 3 119 12,318 October 4,180 2 , 200 1 20 6,401 November 1,720 1,460 2 12 3,194 December 859 1, 164 300 14 2, 337 1919. January 83S 1, 165 499 13 2, 515 February 913 840 253 10 2,016 March 678 658 530 5 1,871 April 787 1,136 225 16 2,164 May 945 461 232 17 1,655 June 615 301 2 13 931 July 266 395 10 671 Completed cases. Remaining. Aggregate number of days lost from sickness. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. o 1 if II £° Otherwise dis- posed of. Hospital. Quarters. Hospital. Quarters. 104 1 3 3 1 368 971 610 3 3 1 351 5,479 1,122 4 9 1 3 4 446 12,136 1,928 4 13 1 17 617 20' 109 1,769 9 33 12 838 21, 570 1,615 10 21 1 1 15 852 23, 579 2,202 15 44 215 22 1,015 24, 347 1,987 31 IS 344 33 1,001 26' 828 1,259 17 20 433 22 1 , 075 25, 238 1,318 13 33 229 14 1, 171 23,943 1,324 8 25 302 23 '985 25' 255 1,607 11 34 199 24 1,245 30' 538 6,924 652 15 427 120 4' 180 92' 538 1,994 135 15 2, 483 54 l' 720 50, 603 1,597 23 10 7 667 38 '859 26, 961 1,363 19 10 87 20 838 25' 076 1,520 7 5 61 9 913 24, 235 1,282 6 6 37 7 678 13^ 876 1,004 9 8 57 6 787 is; 163 1,111 14 3 78 13 945 21 , 676 '949 3 3 71 14 615 24', 084 516 2 129 18 266 13', 492 427 1 7 39 23 174 5,733 ° Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 646 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Base Hospital, Camp Hevens, Ayer, Mass., from September. 1917 , to July, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1917. 1918. September. . 2 2 2 _ _ October 5 46 51 1 November 4 53 57 1 26 December 8 57 1 10 11 1918. 1919. January 9 68 77 1 10 February 0 83 89 February 10 March 4 131 135 March. 11 April 4 134 138 April 11 May 4 134 138 1 June 4 146 150 1 31 July 4 154 158 July o 10 10 August e 164 170 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M.C., etc.). Total. 1917. September 48 48 249 249 October 48 48 257 257 November 50 4 1 282 282 52 December 70 3 1 74 392 392 51 1918. January 75 3 1 79 377 17 394 February 71 6 l 78 545 17 562 March 72 3 2 77 433 17 450 119 April 75 2 2 79 422 17 439 160 May 70 2 2 74 428 17 445 134 June 74 3 2 79 472 17 4S9 124 July 85 5 1 91 540 22 562 135 August 66 4 1 71 6S3 IS 701 128 September 146 6 3 155 940 19 959 126 October 86 4 3 93 924 17 941 507 November 88 4 3 95 916 18 934 241 December 70 9 3 S2 617 18 635 160 1919. January 70 7 3 SO 590 17 607 120 February 63 7 3 73 556 16 572 112 March 52 5 4 61 519 17 536 109 April 58 5 5 6S 500 17 517 93 May 47 6 6 59 410 2 412 S9 June 35 5 5 45 259 2 261 62 July 22 3 2 27 170 170 31 BASE HOSPITAL, CAMP DIX, N. J.u Camp Dix, together with the base hospital, which it included, was located at Wrightstowm, N. J., 21 miles southeast of Trenton, N. J., and 31 miles north- east of Philadelphia, Pa. The site of the camp is slightly rolling, surrounded by farming country, with some woodland to the east. The soil is sand, mixed with clay, with strata of loam. There is no high- flying dust in dry weather. The soil is white and muddy after about two days of rain, but dries up in three or four days. The mud formed is not sticky. o The statements of fact appearing herein are based on the “ History, Base Hospital, Camp Dix, N. J., " by Maj . Andrew F. McBride, M. C., U. S. A., while on duty as a member of the staff of that hospital. Thematerialusedbyhim in the com- pilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon Ceneral’s Office, Washington, D. C. — Ei. OTHER BASE HOSPITALS. 647 The climate is moderate. It is warmer in winter than that of either Philadelphia or Yew York, with less snow and rain than falls in these cities. The s umm ers are pleasant. The prevailing wind during spring and summer is from the west; during the remainder of the year, from the southeast. The hospital was not exposed to high winds. The roads in the hospital grounds were of concrete; but previous to June, 1918, there were no roads, and great difficulty was experienced during the part of the winter of 191S in bringing supplies into the hospital, as no motor vehicles could enter the grounds. Roads in the surrormding neighborhood were of dirt, with the exception of one service road to Trenton and one to Philadelphia. All roads were in very bad condition. There were no streams of any size in the immediate neighborhood. The sanitation of Wrightstown, N. J., the nearest village, was very bad, until the town was closed to soldiers by a camp order, in the spring of 191S. A sewer system was installed subsequently, macadamized roads were laid, and concrete sidewalks built. The condition of the town then became satisfactory. The medical activities of this camp began with the arrival, on August 27, 1917, of Ambulance Company and Field Hospital Yo. 22, together with several casual medical officers, all from Fort Oglethorpe, Ga. At the time of their arrival a hospital for the care of sick civilians was in operation in one of the temporary buildings. This hospital continued to care for civilians and later for soldiers until a temporary field hospital was established in another camp building. It functioned as a hospital until October 22, 1917, when the base hospital was opened. 648 MILITARY HOSPITALS IN THE UNITED STATES. The base hospital plan, as issued by the Surgeon General’s Office, was followed exactly: the character of the site permitted this arrangement. On October 29 the first patients were received, and the patients at the tem- porary hospital, then numbering 249, were transferred to the base hospital. At that time the north and south wings and central section were still under construction; there was no steam heat; there were no connecting corridors; and all cooking was done in the main mess kitchen and in the kitchen of the officers’ ward. The original plans showed 26 rooms in the officers’ quarters. As early as September, 1917, the commanding officer began sending requests for larger officers’ quarters. These were persistently refused for several months. Addi- tional quarters were finally authorized, construction was commenced in March, 1918, and the quarters completed the latter part of April. They were not sufficient, however, and a number of officers still had to be quartered in the officers ’ ward. At times these two buildings were not sufficient to accommodate all officers, and one hospital ward was used for the purpose. The original nurses’ quarters were not sufficiently large, and two Avards were used until the new nurses’ quarters were completed, in May, 1918. The original nurses’ quarters Avere then occupied by the nurses’ training school, and the graduate nurses were housed in the five nurses’ dormitories erected between March and August, 1918. The original plans shoAved six barracks. Two additional barracks Avere built, but one of the original buildings was converted into a mess hall. Each of these barracks held 74 men, but by instructions from the Surgeon General ’s Office, this capacity was reduced to 60, making a housing capacity of 420 men. The authorized strength of a detachment for this hospital was 650; the barracks, therefore, were entirely inadequate. The surplus men were housed in tents, in warm weather, and in the two-story barracks in cold weather, when these were not required for patients. The large hospital kitchen Avas completed October 28, 1917; and from that time until February 15, 1918, all the food for patients, enlisted men, and nurses was prepared here. This mess, which was designed to cook for 1,000, frequently had to serve 2,500, and hardly proved equal to the task. Conditions were improved by adding a large number of steam cookers and roasters. The en- listed men’s mess was opened on February 15, 1918, but was large enough to accommodate only the remainder of the detachment continuing to be served in the main hospital mess. An additional mess was authorized in the spring of 1918, but was not completed until August. The arrangement was very poor, as the mess Avas composed of two buildings connected by a narrow corridor, only one building having a kitchen. The nurses’ mess was opened February 1. 1918. Four storehouses Avere erected according to the original plans, and they proved sufficiently large for the use of the base hospital alone; but Avhen the division and camp supplies Avere moved into them they were decidedly crowded. Additional storehouses were constructed later. In the hospital proper, the t-Avo central rows of Avards had bath and closets in the wards. The tAvo end rows had bath and closets between wards, making four lavatories for each toav of eight wards. The lavatories and baths were OTHER BASE HOSPITALS. 649 connected with the sewer by ordinary trap. Latrines for enlisted men’s barracks were outside of the building. The hospital was heated by means of stoves until December 12, 1917, when a low-pressure steam heating system was installed. No return system for water of condensation was authorized or installed originally, and this made heating very expensive, as much as 75 tons of coal being used in a day. A return system was finally authorized about the middle of the winter. When it was installed the ground had to be thawed by means of burning fires over it. The expense of installation at this time was at least eightfold what it would have cost when the original plant was installed. The hospital, like the camp, was lighted by electricity, purchased from the Public Service Corporation of New Jersey. The hospital water supply, which was identical with that of the camp, was pumped from the south branch of the north fork of Rancocas Creek, 4 miles distant, and was treated by chlorination. The color of the water was very high, and the high carbon dioxid content made it worthless for use in high- pressure boilers, as the boilers were eaten out very rapidly and the hot-wate r supply was continually red with the iron rust. An artesian well was sunk beside the power plant to supply water for the boilers. The sewerage system was the same as for the rest of the camp, except that on account of a ridge between the hospital and the septic tank, it was necessary to pump the sewage to the tank. Kitchen waste and garbage were removed by the quartermaster to a central disposal plant. The laundry work of the hospital was originally done by a private laundry company of Philadelphia; later, it was done in a more satisfactory manner by the quartermaster, in the camp. In the early days of the organization of the hospital there was no shortage of beds, bedding, or drugs. There was a decided shortage of mess equipment and surgical instruments, however, but they later became adequate and satisfactory. When the construction of the hospital was begun the contractor was requested to complete the commanding officer’s quarters at once, with the exception of the inside finish of the walls and floors. This was done, and the building was used as a post exchange during the construction period. The profit on sales to the workmen employed was sufficient to form a good fund for starting a hospital mess when the hospital was opened. About October 15, 1917, the permanent exchange building was occupied. It proved to be satisfactory, except that it was too small. In emergencies, when necessary articles of equipment and supplies could not be obtained within a reasonable time, they were purchased with exchange funds. The Young Men 's Christian Association building was completed in Septem- ber, 1918. The construction of this building had been proposed and authorized by the Surgeon General’s Office and by the Young Men’s Christian Association authorities a year before; but its immediate construction was delayed through the opposition of the Red Cross representatives at the camp, their contention being that the Red Cross should handle all the work. This opposition was 650 MILITARY HOSPITALS IN THE UNITED STATES. finally overcome, after the work of the Young Men’s Christian Association whose representatives entered the field ahead of the Red Cross, was seriously interfered with for months. Two Young Men ’s Christian Association repre- sentatives were assigned to the hospital and were doing excellent work from the time of its opening. Owing to the strong objection on the part of the local representatives of the Red Cross to having the Young Men’s Christian Associa- tion encroach upon its field of looking after all that pertained to the patients, a hospital order was issued forbidding all patients to enter the Young Men’s Christian Association building. This left the building free for the use of mem- bers of the detachment. There were two Red Cross buildings, a large one for the patients and a small recreation building for the nurses. The work of this organization com- prised chiefly the writing of letters for patients, giving entertainments for convalescents, and obtaining minor supplies for the hospital, when they could not he obtained immediately by requisition. Various games anti drills were participated in by convalescent patients. Phonographs and records were placed in wards where it seemed desirable to have them. Statistical data, United States Army Base Hospital, Camp Dix, Wrightstown, N. J.,from October, 1917, to June, 1919, inclusive SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command . From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term . Transferred to in- sane asylums. o 'cS t o c, 2 o Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. L C2 Hospital. | 1917. 10 249 8 267 104 2 2 7 152 2 093 152 13 61 351 577 220 4 12 2 83 256 5 ’ 323 256 3*7 50 559 898 421 3 42 123 1 306 2 10.341 31 1918. 308 44 104 1,015 1,471 3 3 223 3 683 1 16.750 684 55 63 1,082 1 , 884 805 10 371 2 690 1 18 925 9 691 91 1,842 2, 6S9 1,677 12 20 256 724 724 81 74 1,945 2,824 1.374 13 21 1 1.057 30. 103 1 , 057 41 35 2,589 3,722 l . 975 8 39 373 8 1,319 40.S38 1,319 41 1,851 3,216 9 83 314 3 1.230 1,230 36 20 2,563 3,849 1.816 12 108 8 237 48 453 1,668 24 10 2,625 4,327 2,642 3 131 3 111 1 1,436 40, 893 1,436 211 14 6,282 7, 943 3,222 489 97 634 0 3,496 3,496 120 4 1,914 5,. 534 357 63 6 195 2 1,352 67.373 1,352 41 55 1,208 2,656 1 . 496 14 66 35 1.045 24.277 1,045 24 309 1,183 2,561 1 . 184 12 27 32 4 1,302 30.313 1919. January 1,302 37 3 2,459 3, SOI 2.23S 20 15 2 i 28 6 1,491 31. 657 1,491 32 12 1 . 816 3,351 1, 791 10 1 53 6 1.485 42.S47 1.485 46 31 1,835 3,39 7 1, 716 6 6 125 1.534 1, 534 23 54 989 2.600 1.315 2 2 194 s 1.074 38. 408 May 1,074 28 26? 9513 2,317 968 4 6 173 17 1, 149 34. 179 June 1,149 20 5 S9S 2,072 1,141 0 2S 15 176 16 691 52.01S o Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file. Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General's Office (name of hospital). OTHER BASE HOSPITALS. 651 Statistical data, United States Army Base Hospital, Camp Dix, Wriglitstown, N. J., from October, 1917, to June, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q, M.C., etc.). Total. 1917. 45 5 1 51 186 186 59 1 1 61 186 186 68 71 216 216 2 1918. C9 4 1 74 330 330 48 i 1 78 340 340 95 March. 94 2 1 97 352 17 369 97 April 1C6 i 2 1C9 360 17 377 131 95 1 2 98 431 431 133 87 2 1 90 451 451 124 July 82 3 1 86 607 607 134 85 3 1 89 590 590 120 104 3 3 110 650 650 158 89 4 3 96 650 344 76 3 5 84 546 546 272 December G4 4 5 73 532 45 577 197 1919. January 72 7 5 84 602 43 645 170 February C9 6 6 81 592 16 CC8 144 March 82 6 5 93 544 58 6C2 142 April 72 6 7 85 516 55 571 158 May C3 6 11 80 517 38 555 168 June 57 6 7 70 399 25 424 125 BASE HOSPITAL, CAMP DODGE, IOWA.« Camp Dodge was located on, and extended for about 3 miles along, the western slope of a picturesque ridge, situated just west of the Des Moines River valley. Islands of hard-wood trees, scattered here and there on both the east and west ridges, as well as along the reaches of the near-by Beaver Creek, added to the general picturesque appearance of the location. At the extreme western extremity of the cantonment, the base hospital was constructed. From here to Des Moines was a distance of 20 miles. The composition of the soil at Camp Dodge left much to be desired, considered from the viewpoint of comfort. It is composed of a thick, heavy, black loam, with a substratum of gravel. During wet weather, the lower levels of the area become tenacious in quality, and difficult to negotiate. During dry periods, however, the denuded soil was readily metamorphosed into an impalpable dust, which, whipped by the pre- vailing strong winds of the valley, became veritable dust storms that occasioned concern. The hospital was surrounded by well-kept concrete roads; but aside from these cantonment roads, the usual dirt country roads were to be found. South of the hospital, and immediately adjacent to it, was the village of Herrold, the sanitary condition of which was under the control of the division sanitary inspector. The function of the base hospital was to treat all cases arising in the camp and medical, surgical, and venereal cases from overseas. ® Thestatements of fact appearing herein are based on the “History, Base Hospital, Camp Dodge, Iowa,” by Lieut. Col. J. R. Shook, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. 652 MILITARY HOSPITALS IN THE UNITED STATES. When the hospital was organized, August 28, 1917, the division commander (88th Division) gave the use of two of the Government-constructed two-story cantonment barracks. One of these buildings was used for barracks for officers and for the administrative offices of the hospital; the other was used for wards. This ward building was rapidly filled, and a third two-story barracks building was added. Patients were admitted so rapidly at this time that a division of the buildings into special wards became necessary; and within a few days more buildings were added, until 10 two-story barrack buildings were being used exclusively as wards. The officers’ quarters were moved out of the barracks, the officers then being quartered in regular officers’ quarters. These 11 build- ings were used until the latter part of October, 1917. The cantonment contractor furnished an emergency hospital for the employees. It consisted of a well-equipped hospital tent, under the charge of civilian surgeons. At a later date it was moved into a brick building, and remained under the charge of civilian physicians and surgeons. On October 28, 1917, the patients were moved from the temporary to the permanent base hospital. At that time 19 wards were completed. Additional wards were equipped and occupied as need arose. When the base hospital was opened the officers were quartered in three officers’ barracks, each building having a capacity of 31 officers. These build- ings had independent heating plants and outside latrines. During the winter of 1917, the officers suffered much inconvenience from the cold and from insufficient bathing facilities on account of the inadequacy of these independent heating plants. Later, a new building for officers’ quarters was constructed, and opened in January, 1918. These quarters consisted of a main building 160 feet long, and three wings, the outside two of which contained rooms for officers, the central wing containing the assembly hall, dining room, kitchen, and toilets. This building was heated from the central heating plant, was well lighted, and was very comfortable. It contained 48 rooms and accommodated about 100 officers. The care of the building and the administration of the mess were in charge of a house committee, made up of three field officers from the base hospital organization. The members of the Nurse Corps were quartered in a building of their own, attached to the hospital proper b} T closed corridors. This building contained bedrooms, a mess hall, and kitchen, and, up to January, 191S, proved ample. As the hospital grew in size, and more nurses became necessary, they were placed in the officers’ barracks just vacated. In April. 1918, there was a rapid increase in the number of patients, necessitating a rapid and large increase in the Nurse Corps on duty in the hospital. This, in addition to a fire in the nurses’ quarters, made it immediately imperative that new and large quarters be pro- vided. A building was erected, a replica of the new officers’ quarters. This was soon fdled, and additions were made to it. The original nurses’ quarters were rebuilt after the fire, but even this did not provide for the 225 nurses on duty, so that it became necessary to reopen the old officers’ barracks. The enlisted personnel occupied three barracks on the west side of the hospital. As the detachment increased in size it became necessary to house the men in solaria, in vacant wards, in the chapel, and in every available space. OTHER BASE HOSPITALS. 653 Early in March, 1918, the situation became so acute that five new barracks were erected. These barracks were ready for occupancy on April 5. Added to the original three, they gave adequate accommodations for the 660 enlisted men to which the hospital was entitled. The kitchen building for the enlisted personnel consisted of a regular standardized structure, 24 feet wide by 156 feet long, with the storerooms at the east end and the kitchen at the other. It was situated as near the center of the hospital as construction permitted, and was connected with the mess hall and wards by closed corridors. The main kitchen equipment consisted of two 12-foot ranges; two steam roasters, with a capacity of 125 pounds of boned meat; two steam vegetable cookers, with a capacity of 4 bushels of prepared vegetables; two 40-gallon steam cookers for soup, etc., two 20-gallon and one 40-gallon steam coffee urns; one vegetable peeler with a capacity of 5 bushels per hour; one electric meat cutter, with a capacity of 150 pounds of boned meat per hour; and the usual auxiliary kitchen outfit for a kitchen preparing meals for about 1,800 patients. The liquid, and special, therapeutic diets were prepared in the diet kitchen situated just off the main kitchen. This building was 24 by 24 feet. The general mess hall consisted, for a time, of a single room, 156 by 24 feet, with two rows of combination bench tables running the entire length of the room. Later this mess hall was enlarged by the addition of three wings, 24 by 35 feet, running at right angles to and opening directly into the main hall at each end and in the middle, making a seating capacity of 620. The kitchen for the commissioned patients, which was well equipped, was attached to the officers’ ward. Its administration was entirely separate from that of the general mess, and was operated with its own funds. The mess hall opened directly from the assembly room of the officers’ ward and seated approxi- mately 100 persons. The tables were provided by the Medical Department; the table linen was furnished from the officers’ hospital fund. The hospital storehouse consisted of a standardized building, 24 by 150 feet. It had a cement floor throughout its entire length, and was partitioned into five rooms. These rooms were divided into a medical property department and a quartermaster department. It also contained the hospital carpenter shop. It was well lighted and steam heated. The building originally built as the hospital laundry was wholly inadequate in size and construction for the purposes for which it was intended. It was never ecpiipped, and consequently the hospital had to depend upon the laundries of Des Moines. The laundry was used as a linen room, where soiled linen was taken by the ward men, and exchanged, piece by piece, for clean linen. There was installed in this building a large autoclave for the sterilization of infected linen and for the sterilization of the clothing of patients coming into the hospital with infectious and contagious diseases. The hospital chapel was ready for use about September 1 , 1917. Owing to the great distance of the chapel from the center of activities of the hospital, it was never used for divine services. It served as temporary barracks for enlisted personnel for a number of months. The hospital water supply was from open and tubular wells, loca-ted on the Des Moines River bottoms, situated approximately 1,000 feet west of the 654 MILITARY HOSPITALS IN THE TOUTED STATES. river, and directly east of the cantonment. The water was filtered through a 15-foot bed of sand and gravel, then chlorinated and pumped to a million- gallon concrete reservoir, situated on a high ridge running parallel to the eastern boundary of the cantonment. From this reservoir it was distributed, by gravity, to the whole camp, including the base hospital. Practically all the toilets of the hospital were placed in the latrines between each two wards. They consisted of flush stools and enameled bowl urinals, with open plumbing, and were modern in all respects. The sewerage system was connected with the general camp system, which discharged, by gravity, into the Des Moines River 3 miles below Camp Dodge and 8 miles above the city of Des Moines. Kitchen wastes were collected by civilians in Government-owned trucks, under charge of a Quartermaster Corps noncommissioned officer. They were then carried to the railroad and removed from the cantonment by a contractor. Garbage from the infectious disease messes was carried in a like manner to the incinerator, and burned. Manure from the picket lines was conveyed to a dump and burned. The various wards and buildings of the hospital were heated by a vacuum- return system from a central heating plant, consisting of fourteen 150-horse- power boilers. The heating of the individual buildings was controlled by automatic gates. The system proved very successful. The hospital was lighted by electricity throughout. The current was a part of the general camp system, and was obtained from the Des Moines Electric Co. The first equipment of the hospital consisted of the standard field hospital equipment. Later, Gold Medal cots, with a field mattress, two blankets, and two sheets each, were issued. One pair of pajamas was given to each patient. On September 12, 1917, Medical Department supplies began to be issued, and as these increased the field hospital equipment was gradually removed. The hospital eventually became fully equipped for the care of about 2,000 patients. When the hospital was first opened the enlisted men and the ambulatory patients patronized a contractor s canteen two blocks from the hospital. This suggested the need of a hospital exchange, and one was established, being opened for business in one of the barracks, September 25, 1917. Trade was good from the start, and rapidly increased. In October larger quarters were obtained, making it possible to carry a larger variety of goods. When the new base hospital was finished the latter part of October, the exchange moved into an independent wing, 24 feet wide by 75 long, in the center of the hospital. A still greater variety of goods was then carried, including various uniform accessories. Three barber chairs were operated. Later, when the hospital had increased to about 1,000 patients, business increased to such a scale that it became necessary to enlarge the exchange. It was then completely reno- vated, an office was fitted out for the exchange officer, new counters were pur- chased, a temperance bar was installed, modern office equipment was bought, and a modern sanitary barber shop was installed. Sales increased from about $400 a week to $2,000, and the personnel from 2 to 17. Dividends to the extent of several thousand dollars were paid the hospital fund. OTHER BASE HOSPITALS. 655 The spirit of the Young Men’s Christian Association seemed to be to fill every demand made upon it. Stationery was distributed free in cpiantitv sufficient to write 850 letters per day. Stamps to the value of from $25 to $40 were sold daily, and enough money orders were sold monthly to average more than $12,000. Some months as many as 300 telegrams were sent for patients. Educational classes were held in all subjects for which there was a demand. Athletic equipment for baseball, indoor baseball, tennis, volley ball, and soccer were furnished. Nearly 200 testaments were given to patients each month, and about 1,000 pieces of religious literature were distributed in the same length of time. The Young Men’s Christian Association attendants spoke personally to not less than 1,000 persons in the wards daily, inquiring of them their needs, and supplying for them the obtainable comforts. Great quantities of supplies and equipment were furnished by the Red Cross, in several emergencies, and every service was rendered by them that would aid as a contributory to the rehabilitation of the patients. For a time the work of the bureau of communications and other activities, operated by the Red Cross, were seriously handicapped for lack of room and other facilities, but these difficulties were overcome with the completion of the Red Cross house. This was connected with the hospital by closed corridors, and served as a place of amusement and diversion for convalescent patients. The nurses’ recreation building, constructed by the Red Cross, with assembly room, library, kitchenette, shower baths, glass-inclosed porch, and other comforts and conveniences, added much to the welfare of the nurses on duty in the hospital. Numerous forms of carefully planned recreation for patients were available in the hospital. No matter how sick the soldier or what form his malady as- sumed, amusement was provided for him. Books, scrap books, magazines, in quantities, sent in as gifts, served to interest and amuse the patients. Con- certs by the detachment band and the regimental bands were given several times a week. Visiting entertainers also contributed to cheer the patients. In addition to all this, the Young Men’s Christian Association, Knights of Columbus, Red Cross, Lutheran Brotherhood, and B ’nai B Tith Club for Jews contributed to their share of entertainment and amusement. The base hospital was designated a camp hospital on July 5, 1919. Statistical data, United States Array Base Hospital, Camp Dodge, Iowa, from September, 1917, to July, 1919, inclusive .“ SICK AND WOUNDED. Year and month. £ c a tcS 3 p* Admissions. Total to bo accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. © © Vj O Q Discharged, oxpi- ration of term . Transferred to in- sane asylums. Transferred to othor hospitals. Otherwise dis- posed of. By trans- fer. j Otherwise. Hospital. Quarters. Hospital. o § & 1917. September 97 779 831 365 2 3 511 4, 7S5 October 511 53? 1,045 738 1 301 11,009 November 301 1, 195 69 1,000 2 14,282 December 559 R537 90 2, 186 726 H is 2 1 610 81oj 17, 755 “ Compiled from monthly returns and sick and wounded reports (Form .52) to the Office of the Surgeon G eneral, on file, Medical Records Section. Adjutant General's Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 656 MILITAKY HOSPITALS IN THE UNITED STATES, Statistical data, United States Army Base Hospital, Camp Dodge, Iovm, from September, 1917, to July, 1919, inclusive — Continued. SICK AND WOUNDED— Continued. Year and month. Remaining from last month. Admissions. Totaltobeaccounted for. From command. From other sources. By trans- fer. Otherwise. 815 2,611 53 3,479 1,156 2, 024 82 12 3,274 1,029 3,086 123 18 4, 256 1,542 2,893 150 13 4, 59S 1,820 2,370 141 28 4,359 1,568 1,785 114 39 3,506 1,445 2,358 52 44 3,899 1,562 1,762 20 27 3,371 1,402 2,026 29 37 3,494 1,833 9,694 3 96 11,626 1,909 1,542 12 3,463 1,092 1,514 730 13 3,349 1,044 1,838 1,214 13 4,109 1,346 1,078 6S2 11 3,117 1,312 82C 1,128 13 3,273 1,145 566 770 21 2,502 557 438 765 1C 1,770 507 696 1 17 1,221 320 360 5 6S5 Completed cases. o o tlj ^ II w g n 3 2 « £ 8 Remaining. Aggregate number of days lost from sickness. 1918. January. . . February.. March April May June; July August September October . . . November. December. 1919, January. . . February.. March April May June July 666 646 1,630 1,624 1,209 713 434 20 18 42 108 57 16 18 18 13 705 43 20 46 39 78 162 4 3 4 4' 225 88 120 25 126 504 586 941 856 722 599 808 648 552 39 8,383 441,822 41 1,494 13 2,019 1,346 411,061 1,312 1,156 1,029 1,542 1,818 1,568 1,445 1.562 1.402 1,833 1,909 1.092 1,044 71 105 37 164 224 340 45 10 16 -I 4 1 145'. 557 . 507 . 320 . 29,496 28,430 44, 294 62,567 56, 383 46,176 38,904 33; 840 30,240 141,289 67,005 32,483 30,635’. 22,063 . 20,960 . 17,993 . 10, 10S . 11,312 . 5,453 . CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1917. 1918. 105 105 June 14 14 July 14 14 1918. September 3 3 May 14 14 PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M.C., etc.). Total. Nurses. 1917. 41 2 2 225 225 41 2 2 225 225 IS 2 1 320 320 2 1 320 320 63 1918. 61 2 1 64 354 354 72 69 2 1 72 449 9 458 no 79 2 81 441 17 125 102 2 104 17 191 110 1 111 643 IS 661 239 106 1 107 632 IS 650 242 July .... 97 3 1 101 6S6 22 70S 265 100 3 1 104 659 21 680 233 86 4 1 91 626 20 646 207 101 4 1 106 623 23 646 324 110 3 1 114 690 22 712 376 94 3 2 99 673 19 692 341 1919. 71 4 2 1,127 19 1,146 120 72 S2 * 812 19 Sol 164 69 12 17 157 13 74 504 17 521 156 40 12 317 3 320 87 39 4 48 227 227 65 OTHER BASE HOSPITALS. 657 BASE HOSPITAL, CAMP DONIPHAN, FORT SILL, OKLA.<* The military reservation of Fort Sill comprised 67,713 acres. Upon a small portion of it had been constructed, prior to the World War, a permanent post for Field Artillery troops. The garrison buildings included a post hospital commensurate in size to the adecpiate care of the sick of the command during peace time. As was the case at Fort Riley, an abundance of space was avail- able at Fort Sill, when war was declared, upon which to construct a camp for a division of the National Guard; but there was this difference between the conditions at the two places: the permanent post of Fort Sill was to continue in use, and its buildings were not available for hospital uses; consequently, plans had to be formulated for the provision of a complete temporary base hospital as an integral part of the camp. Camp Doniphan was situated to the southwest of the "new post” of Fort Sill, 5 miles from Lawton, and about 90 miles from Oklahoma City. To the north of the “new post,” which formed the northeast corner of Camp Doniphan, the site for the base hospital was chosen. The terrain is rolling. To the west of where the hospital was situated there is a series of hills, several hundred feet high and bare of foliage of any kind. On the east and north is a small river bed, which is dry practically throughout the year, though its banks are wooded for several yards on either side, giving the semblance of an oasis in the desertlike region. These trees afforded the hospital a scant but nevertheless appreciable degree of protection against the cold winds of winter. Since the "oasis” was the only shaded spot for miles around, it afforded ample protection from the intensely hot rays of the sun in summer, and its comfort was sought and welcomed. The soil is loam. The atmosphere is extremely dry throughout the year and is heavily laden with fine dust. It was, consequently, wholly impossible to keep the hospital constantly clean in the sense of the term as usually under- stood in civil hospitals. During the year 1917-18, there was very little rain, and the dust storms were frequent and trying. It was inevitable that during these high winds particles of prairie dust should penetrate everywhere. The dust problem at the hospital was greatly relieved, though not entirely eliminated, by oiling the dirt roads in the vicinity and around the hospital. Rains, as a rule, are abortive, the parched earth receiving but a drop or two; but when rain in sufficient amount falls, it is taken up by the soil with great difficulty, and in consequence much sticky and tenacious mud results. Numerous puddles also appear and stay until the water has finally evaporated. The summers are intensely hot and long. During the summer the daily temperature ranges from 90 to 130° F. in the sun, more often over 100°, but for the most part the nights are bearable. The winters are short but severe, the changes in tem- perature being frequently excessive and sudden; and cold, icy, penetrating winds suddenly appear within a moment’s notice, laden Avith dust to spoil a mild and pleasant day. The temperature falls and zero weather and loAver is not uncommon. Snow, however, is rare, and Avhen it does fall disappears very a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Doniphan, Okla.,” by Capt. Louis H. Nahum, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, AA'ashington, D. C. — Ed. 45269°— 23 42 658 MILITARY HOSPITALS IN THE UNITED STATES. quickly. Aside from the changing spells, the weather continues pleasant into December, and becomes mild in February. The days of the springs and falls are very warm, but the nights are cool and livable. d he hospital roads were made of compressed dirt. They were well kept and were oiled. In the hospital neighborhood the roads were all of dirt, but were smooth. The camp road, 1 mile away, was of gravel construction at first, then of concrete. The road leading to Lawton, the neighboring town, was of dirt construction, bumpy and very uneven; a poor thoroughfare for travel, especially that of an ambulance laden with sick. Though there were two railroads to Fort Sill — the Chicago, Rock Island & Pacific Railroad, and the St. Louis & San Francisco Railroad — both were branch lines; they were badly ballasted and poorly equipped; and were sub- jected to frequent and prolonged transportation delays. The base hospital was organized on September 1, 1917. At this time, however, the wards of the hospital were not ready; so, to care for the sick of the division, it was necessary to employ the facilities and wards of the post hospital, where, for a time, the patients of the post and camp were handled together in the same wards. The commissioned and enlisted personnel of both the base and the post hospitals also united, working side by side, without regard to the origin of the case. This was a very fortunate, even if clumsy, arrangement, for the enlisted personnel of the base hospital were green; and had, for the most part, never seen the inside of a hospital, nor the proper handling of a ward and its patients; whereas the enlisted personnel of the post hospital had at least an average of three months’ experience. It can thus be seen how important a factor this combination was in the training of the personnel in the proper performance of then - required duties. The property also was in part pooled in the common interest. As the size of the command increased, the facilities of the post hospital became inadequate to meet the needs, and 10 new temporary wards were built around the old hospital to accommodate the excess in the number of the sick. The construction of the base hospital meanwhile was progressing very slowly. Delay upon delay occurred that could be directly attributed to insufficient building supplies. At one time in October construction came to a standstill because of the lack of concrete for the foundations of the buildings. Somewhat later, construction stopped because most of the laborers were removed to complete buildings for the school of fire, the need for which became urgent. And still later, although many of the wards were completed externally, the absence of a sewerage system and a water supply made them totally uninhabitable. Owing to the pressing need of these buildings, temporary cesspools were installed for some of the wards, pending a special appropriation by the War Department for the introduction of a water supply and a sewerage system. It appears that the plans first issued had provisions neither for water and sewage disposal nor for bathing facilities. On November 17, 1917, the buildings were 95 per cent completed, with the exception of a sewerage system. The installation of the sewerage system was begun about December 1, 1917. In the latter part of October, 1917, the full strength of the division, 27,000 men, had been attained. The number of sick was increasing daily, and the facilities of the old post hospital, including the 10 new wards, were entirely OTHER BASE HOSPITALS. 659 inadequate to meet the needs. On November 17, there were 40 cases of pneu- monia at the hospital, and the cases of meningitis and measles were on the increase. It therefore became urgently necessary to occupy the new base hospital buildings, about a mile away from the post hospital, regardless of the lack of proper sanitation. So, on November 26, the transfer of all the medical cases was begun. As the wards of the base hospital were completed they were at once occupied by patients who had been transferred from the post hospital. This gradual transfer, continuing during the months of December, 1917, and January, 1918, created the complex situation where part of the base hospital patients were at the post hospital and part at the base. Owing to this anomalous situation two officers of the day were required, as well as a constant ambulance service between the new and old hospital, for the admission of surgical cases to the old place and the transfer of patients thence to the new hospital. The operating room, at the base hospital, was one of the last to be completed. The original plans did not provide for the installation of steam heat, or for a proper finish to the walls, to permit their scrubbing and cleansing between operations. Until these improvements were provided most of the major operations were performed in the operating room of the post hospital, which had been constructed and equipped for such work. The very last part of the hospital to move from its temporary ward at the old post was the genito- urinary section. This moved into a series of tents within the convalescent camp in March, 191S. The officers’ quarters consisted of a long one-story building the size of a ward, and contained 22 rooms. This was manifestly too small for the personnel and a building, across the way, intended as an officers’ ward, was at once con- verted into officers’ quarters. About April 1 , 1918, three wings were added to the building originally intended for officers’ quarters, which increased the capacity to 62 rooms, and provided a mess hall and assembly room. This addition was altogether sufficient for the purpose. The nurses’ quarters con- sisted of a long one-story building with three wings. The wings at each end contained sleeping rooms, the middle one a mess hall and kitchen. It was totally inadequate for housing all the nurses, and a dozen tents were placed directly behind the home for the additional nurses. Finally, another similar home was completed across the way from the first- one. This solved the prob- lem of the nurses’ home. The enlisted men were quartered in five one-story barracks similar in size and construction to an ordinary ward. There were separate rooms for the noncommissioned officers. There were four storehouses, the dimensions of which were about 30 by 120 feet. Two of these were shelved. Until April, 1918, the laundry was sent to Enid, Okla., 150 miles away. This meant that it took from 10 to 15 days for its return to the hospital. Under such conditions it was inevitable that changes of hospital linen could not be made as frequently as desired unless several times over the supply of linen normally needed for this size hospital could be had in stock. Inas- much as there was not this supply of linen, some unjust criticism was made against the hospital for conditions of which it was innocent. The water supply of the hospital, in common with that of Camp Doniphan and the city of Lawton, was obtained from Lawtonka Lake, a body of water 660 MILITABY HOSPITALS IN THE UNITED STATES. that was situated about 8 miles distant. The source was dependent entirely upon local rainfalls; and since these were infrequent, the amount available, during the years 1917-18, was precariously small. The situation was rendered doubly acute by the accretions to the populations of both Fort Sill and Lawton, and early practices of conservation had to be instituted. These included the prohibition of the watering of lawns, the limitation of the number of baths one might take, and every other known method to cause conservation. In these efforts at conservation the physical characteristics of the water materially assisted: suspended in it were more than appreciable quantities of clay, algae, and protozoa. It frequently required a degree of real fortitude to quaff a glass of water within which there could readily be discerned Crustacea darting about in a world of their own. Then, too, there emanated from the water a fishy odor, which, though only objectionable when the water was cold, became positively repulsive when an attempt was made to use it in a hot tub within a small, closed room. Many ineffectual efforts were made to render the water palatable, or even acceptable, by the use of copper sulphate and chlorine; but it was not until after a filtration plant had been installed, during the early part of the year 1919, that it was effected. It has been related that the installation of a water supply in the hos- pital was much delayed. In the beginning, though the wards had their full quota of patients, the water necessary for bathing them had, perforce, to be carried in buckets into many of them. It was not until December, 1917, that a cold-water tap had been installed within the wards. But even then running cold water only was available, and to elevate the temperature of it to a point where it could be used for sponge baths it was necessary to heat it in pails placed on the tops of the ward heating stoves. In the isolation wards, this state of affairs existed until so late as January, 191S. The installation of boilers in the wards was begun in January and was completed the end of the following month. It was then only, when hot and cold running water was available in the wards, that conditions began to approximate those which are accepted for granted in civil hospitals. The necessity for them made it desirable to occupy some of the wards be- fore the sewerage system was installed. Cesspools, therefore, were constructed for the quarters and some of the wards. From these pools the water was removed by water wagons on alternate days. Later, a complete sewerage system was installed which emptied into a large, main sewer that discharged into a small creek at a point over a mile from the hospital grounds. There were two types of wards as regards toilets. In one type a common bathhouse opened off a corridor that connected two wards. Tiffs bathhouse contained five toilets and one urinal on one side, five basins, a bath, and a shower on the other side. There were also single wards, such as the isolation ward, in which one of the front rooms was a bathroom, containing a urinal, two toilets, two wash basins, a shower, and bathtub. Unfortunately, the plumbing in the isolation wards was so constructed that only one toilet room was at first installed. To prevent spread of contagion, only one kind of communicable disease could be housed in each building. This, happily, was changed, and the wards later contained three different rooms with toilets. Until the plumbing was all completed the hospital was in a sad plight. Baths were not taken as frequently as was desired; for a OTHER BASE HOSPITALS. 661 bathtub the officers were obliged to employ a small agate pail into which it was impossible to get even the foot comfortably, and to heat water for bathing pur- poses on the small heating stoves in each room. In the isolation wards, espe- cially, the lack of plumbing was a hardship, for here the absence of hot running water was tantamount to saying that there was no proper sanitation. The garbage was sold to a neighboring contractor. It was distributed in different cans according to the nature of the garbage. The contractors then came, removed the cans, and left an equal number of cleaned, dry cans. The heating of the hospital underwent its own special evolution. No gen- eral heating system was installed. Large stoves were used, at first, to warm the wards, three of them being used for each ward. They were not successful, they consumed large quantities of fuel and gave comparatively little heat. The only part of the ward that was warm was that in the immediate vicinity of the stoves; the separate rooms were not warm at all. Finally two large range heaters per ward were substituted for them, and separate stoves were provided for the detached rooms. In this way the wards were kept tolerably warm. Besides a greater distribution of heat the range heaters had another advantage; water could more readily be heated over them, and this facilitated the meager bathing facilities before the boilers were installed. The hospital was lighted by electricity which was obtained from the neigh- boring town of Lawton. It was, generally speaking, quite successful. On stormy nights the power was interrupted, but such an occurrence was extremely rare. Although the lighting was the very first utility to be installed, the meningitis ward was, for a considerable period in December, 1917, and January, 1918, without electricity, owing to a faulty construction. This was a great hindrance in the proper treatment of such cases, as many required treatment, night as well as day. Lanterns and candles, although inadequate for this pur- pose, had to be employed until proper lighting was supplied. The reason why it was not installed as soon as required was that the contractor could not over- come his layman fear of meningitis and for a long time evaded every opportunity to enter the ward. However, it should be said that, in spite of these conditions, proper treatment was never delayed because of such hindrances as poor lights, a fact that was borne out by the low local mortality rate. There was a paucity of facilities for recreation at the hospital. For the pa- tients, such games as cards, checkers, etc., were furnished by the various welfare organizations. The chapel was refitted by the Young Men’s Christian Associa- tion and was used by it for a recreation room, in which was installed a phono- graph, game tables, facilities for writing, etc. On July 24, 1918, the War Department authorized the abandonment of the camp. 662 MILITARY HOSPITALS IN THE UNITED STATES, Statistical data, United States Army Base Hospital, Camp Doniphan, Okla., from October, 1917, to June, 1918, inclusive .“ SICK AND WOUNDED. Y ear and month. 1917. October N ovember. . December. . 1918. January February. . . March April May J une last Admissions. O from inth. 'd a C3 From other sources. o o V Remaining m< O O 0 o £ By trans- fer. Otherwise. & o o 15 744 279 36 1,322 1,637 652 70 2,226 2,948 1,265 1,534 9 2,808 913 1,434 7 2. 354 1,017 1,834 22 2, 873 710 1,320 14 2, 044 352 11 675 1,038 217 6 396 619 Completed cases. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term . Transferred to in- sane asylums. 423 4 7 1 730 23 22 1,291 32 17 1,325 50 23 965 36 32 1,721 17 34 1,292 21 47 3 502 3 1.56 1 252 4 62 45 205 5 337 6 488 9 298 6 371 2C 313 18 146 13 102 23 Aggregate number of Remaining. days lost from sickness. ■3 « © 3 © g C3 <5 H 5 277 2 7, 395 28 650 2 1,264 34 1,259 6 31,690 15 921 1 25, 893 60 1,010 7 22. 245 225 703 7 24. 114 228 351 i 16. 647 191 212 5 10. 175 100 176 4, 845 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. W omen. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1917. 1 1 3 1918. 9 2 1 12 1 3 4 8 February 12 1 13 1 2 1 4 March 31 9 40 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps.' Miscel- laneous (Q. M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1917. 35 2 1 38 149 149 41 2 1 44 329 329 46 2 1 49 344 344 11 1918. 56 2 1 59 353 3.53 66 57 2 1 60 453 4.53 81 60 4 1 44S 44S 78 April 63 2 1 66 432 20 452 78 May 51 2 1 54 42S 20 44S 74 June 50 1 1 52 31S 20 338 21 a Compiled from monthly returns and sick and wounded reports ( F orm 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). CHAPTER XXX. BASE HOSPITALS, CAMPS EUSTIS, VA., FREMONT, CALIF., GORDON, GA., GREENE, N. C., HANCOCK, GA., A. A. HUMPHREYS, VA., JACK- SON, S. C., JOS. E. JOHNSTON, FLA., KEARNY, CALIF., AND LEE, VA. BASE HOSPITAL, CAMP EUSTIS, VA.a The base hospital at Camp Eustis, Lee Hall, Warwick County, Va., was opened September 16, 1918, before the completion of the buildings. The work of construction, and the presence of the workmen in the buildings; the giving up of the time of certain officers to the examination of recruits; the lack of adequate personnel in officers, nurses, and enlisted men; and the rapid increase in admis- sions were difficulties incident to the development of a new institution. Certain deficiencies in the work resulted, but these were limited to records and investiga- tions, not essential to the welfare of the patients. The original bccl capacity was 500, but early in October it was found necessary to provide more space for patients. The convalescent barracks, or the hospital annex, as it was called, was then opened. The annex consisted of a block of buildings used to house the troops in training in camp. All con- valescent and minor cases were treated here. Medical officers from the base hospital were in charge, but the nursing and clerical work connected with the operation of the annex had to be taken care of by enlisted men of the Coast Artillery Corps, who had had no previous training in the duties of the Medical Department. The base hospital exchange was opened October 8. It was well patronized by the personnel on duty at the hospital, as well as by the patients, and at the end of the year showed a net value of over $4,000. The function of this hospital was to treat all cases arising in camp. a The statements of fact appealing herein are based on the “ History, Base Hospital, Camp Eustis, Va.,” by Maj. P. C. Riley, M. C., U. S. A., while on duty as a member of the stall of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. 663 664 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Base Hospital, Camp Eustis, Lee Hall, Va., from September 16 1918, to March 9, 1919, inclusive , a SICK AND WOUNDED. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. Nurses. 1918. September 14 4 3 21 17 9 26 31 October 22 4 1 27 408 12 420 6S November 27 4 1 32 459 12 471 60 December 39 4 1 44 429 12 441 70 1919. January 19 5 3 27 336 9 345 55 February 17 5 3 25 310 9 319 34 March 29 4 2 35 201 5 206 24 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section' Adjutant's General’s Office; and monthly statistical returns made to the Office of The Ad- jutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). BASE HOSPITAL, CAMP FREMONT, CALIF. ' The base hospital. Camp Fremont, was situated in San Mateo County. Calif., 2 miles from Palo Alto. The surrounding country is flat and wooded. The soil is loam, forming little dust and a moderate amount of sticky mud after rain. The climate is mild. The temperature in winter ranges from 50° to 70°, and there is no snow, except on the mountains, 30 miles away. In summer the temperature ranges from 65° to 95° F., and occasionally there is some fog, but very little wind. The prevailing winds are from the south. The roads in and around the base hospital were of oiled gravel, and were well kept. The only stream near the area is San Francisco Creek, half a mile away, which is dry all summer. The sanitary status of the hospital neighborhood was satisfactory. On July 6, 1917, the hospital at Camp Fremont was estab- lished. It occupied a small building which was erected as a regimental in- firmary, and was totally inadequate for the sick of the command; so the a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Fremont, Calif., by Col. E. B. Frick, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. OTHER BASE HOSPITALS. 665 infectious and venereal patients were quartered in tents adjacent to the hos- pital. All important cases, both surgical and medical, were transferred to the Letterman General Hospital, Presidio of San Francisco. On November 13, 1917, the base hospital was organized. Its function was to treat all cases arising in camp; and medical, surgical, and venereal cases from overseas. The hospital was constructed on the standard plan. The first part of it completed was occupied January 4, 1918; gradual occupation followed. Officers were quartered in a separate building of 22 rooms. This building had, in addition, 2 baths, 4 lavatories, and 4 toilets. The sleeping rooms were small, each accommodating one officer; and, as the commissioned personnel increased, it became necessary to pitch tents for additional officers. Nurses were quartered in 24 single rooms and in 2 dormitories, each of which contained 12 beds. There were 2 baths, 6 washstands, and 6 toilets for the nurses. It became necessary, as was the case with the officers, to pitch tents to accommodate the increase in the number of nurses. The barracks for the enlisted men consisted of 4 buildings, each containing 40 beds, 4 noncommissioned officers’ rooms, a recreation room, and a mess hall. There were 2 bathhouses, each containing 8 baths and 8 toilets. Later it became necessary to pitch 21 extra tents to accommodate the overflow of men. When the base hospital was first occupied, the patients, the detachment Medical Department, and officers all messed in the main mess hall. Later the detachment messed in its own barracks, the patients in the main mess hall, and the officers in a mess maintained temporarily in tents. The hospital storehouse consisted of two buildings, 25 by 150 feet; they had no electric lights, no running water, no toilet, and no sewer connections. Because of lack of machinery the hospital laundry was not operated. The work was done outside, by contract. This arrangement was satisfactory, but expensive. The hospital chapel was used early in January, 1918, for religious services. The chaplain maintained an office in the chapel where he could be consulted by members of the detachment. The building was furnished through con- tributions and gifts. The initial hospital equipment consisted of approximately one-tenth of a 500-bed base hospital, according to the Wolfe unit. By April 30, 1918, the hospital was equipped to care for 1,500 patients, but was lacking in some things, such as surgical instruments, for all services. The laboratory equipment was not sufficient to meet all necessities. On the whole, however, the work ran smoothly under all conditions. On September 13, 1918, at 3 a. m., fire broke out in the building of the receiving office, and the whole building rapidly burned to the ground, nearly everything, including patients’ clothing, being lost. This building was never rebuilt, and barracks No. 1 was used at first as a receiving office, and later ward B was altered and answered very satisfactorily for that purpose. The origin of the water supply was Alemada and Contra Costa Counties, from which it was piped across San Francisco Bay. Prophylactic treatment of this water supply was by filtration. The entire hospital sewage was dis- 666 MILITARY HOSPITALS IN THE UNITED STATES. posed of by a sewer main which passed through the hospital grounds, emptying by gravity into San Francisco Bay. The unusable part of the kitchen waste and other forms of hospital garbage were incinerated ; the usable part was sold to hog raisers. In separate wards the baths, toilets, and latrines were rooms directly connected with the ward. In double wards the baths, toilets, and latrines were in small separate buildings between the wards, accessible through short halls. They emptied into the main sewer which passed through the hospital grounds. The hospital was heated by means of coal stoves, of which there were about 500. This seemed to be a wasteful and inefficient method, and inferior to a central heating plant. The wards were each equipped with two large coal furnaces (Lexington No. 25). These furnaces had metal jackets, which inter- fered with conduction and radiation of heat, and were, in fact, designed for furnace heating rather than room stoves. Nearly all the heat rose and passed out of the top of the stove, and if the ward ventilators were open, passed through them out of the ward. The stoves occupied, in each ward, the space of four beds, meaning, of course, a great expense in waste bed space; and it was extremely difficult to regulate the temperature of the wards with the stove heating. Hot water was supplied from separate small coal-burning water heaters, one for each ward. The hospital was lighted by electricity. The system was successful, except that porch lights were on the same switch as the lights in the corridors of wards. This gave rise to waste, as the lights in the corridors and porches could not be turned off separately. On January S, 1918, the post exchange was opened for business, without funds. The business increased, until by April 30, 1918, the total amounted to more than $10,000. At that time there was on deposit with the Palo Alto Bank a balance of $4,235.37. The Bed Cross, Young Men’s Christian Association, and Knights of Colum- bus were all represented at the hospital. The usual amusements were furnished by the Bed Cross, the Young Men's Christian Association, and the Knights of Columbus. Dances were held frequently at the Red Cross building. An open-air theater, planned and constructed by the Ladies’ Garden and Hospital Committee of Menlo Park, was an important factor in the life of the hospital. Moving pictures, vaudeville, and other performances were given here. Baseball, tennis, basket balk volley ball, and other games were encouraged. OTHER BASE HOSPITALS, 667 Statistical data, United States Army Base Hospital, Camp Fremont, Palo Alto, Calif., from January, 1918, to March 31, 1919, inclusive SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed eases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals . Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. Hospital. Quarters. 1318. 43 41 468 11 563 275 3 6 3 276 G 276 29 623 928 431 1 1 3 492 9 070 March.. " 432 25 1,140 1 1,658 884 2 33 8 16 712 19, 521 712 65 1,380 0 2, 157 1,517 5 25 13 592 22 471 592 69 1,300 1,961 L 111 9 23 5 10 803 20 982 803 55 1,238 2, 096 1,256 9 6 59 21 745 23 ! 890 745 27 882 937 3 78 4 632 20 487 632 21 1 , 378 2,039 993 16 6 56 11 954 22 967 954 35 1, 147 2, 136 891 5 6S 25 5 1,142 30 294 1,412 229 2,692 4,063 2,930 141 23 105 21 843 44 373 843 112 224 1,179 881 11 19 9 24 235 14 702 235 77 177 4S9 286 3 30 11 179 6,292 1919. 179 85 513 777 257 2 25 4S s 49 3S8 9,742 388 118 339 845 97 1 34 1 253 12 78 366 lO^SSS 386 90 161 617 82 173 259 3S CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. "Women. Chil- dren. Total. 1918. 1918. 5 5 November 10 13 23 7 7 December 10 11 21 July 8 3 11 6 12 1919. 13 9 22 January 14 11 25 Otcober 13 10 23 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1918. 21 1 1 23 Ill Ill 11 February 21 1 1 23 123 123 29 March.. " 37 1 2 40 122 9 131 44 April 35 1 2 38 152 9 161 66 May 40 3 2 45 273 15 288 90 June 39 3 1 43 311 15 326 99 July 42 2 1 45 363 17 380 106 August 60 3 1 64 376 16 392 79 September 49 4 1 54 364 16 3S0 S3 October 59 3 3 65 366 15 381 105 November 56 4 2 62 386 15 401 147 December 45 4 3 52 377 15 392 SO 1919. January 35 6 4 45 339 14 3S3 36 February 28 4 3 35 353 12 385 50 March 13 3 3 19 60 12 72 55 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 668 MILITARY HOSPITALS IN THE UNITED STATES. BASE HOSPITAL, CAMP GORDON, GA.« The base hospital was located in the northeast corner of Camp Gordon, about a half mile from Chamblee Station, De Kalb County, Ga., and about 14 miles, by rail, from Atlanta. The topography of the surrounding country is rolling to hilly. Where the camp was located is quietly rolling and fairly well wooded, with small growth of oak, hickory, and short-leaf pine. The camp lay within the drainage area of the Chattahoochee River, which is approximately 10 miles to the west. The soil of this section is derived primarily from a granite gneiss which breaks down to a reddish sandy material with a comparatively small percentage of finely divided substance which forms dust or mud. In the top soil that has been long exposed, practically all the reddish clay has been washed out, leaving a comparatively coarse sandy soil. Where the top soil has been eroded away and the subsoil or original decomposed material is exposed, mud forms rather readily. A portion of the soil is derived from a hornblend gneiss which yields a more finely divided red soil and which forms mud very easily. In dry weather a comparatively slight current of air will float the fine particles. Practically the entire hospital area was graded, exposing the subsoil, which made condi- tions worse than they would have been otherwise. The climate is characterized by long summers and short winters. The summers are marked by periods of oppressive heat, although the temperature seldom reached a maximum of 100° F. The winters are generally mild and open, with periods of damp, penetrating cold, during which the temperature seems lower than is shown by the thermometer. The winter of 1917-18 was of unusual severity, characterized by a freeze, with snow and sleet of several weeks’ duration. The precipitation is ample for the successful production of all crops common to this region, the mean being 49.47 inches. There is a nor- mal growing season of 225 days. The average date of the last killing frost in the spring is March 23, and of the first in the fall, November 3. The mean temperature for winter is 44°; spring, 61°; summer, 76.4°; and fall, 62.1°. The roads in the immediate vicinity of the hospital were decidedly inferior in quality to others in the camp. The main thoroughfare in front of the hos- pital was bedded with crushed stone and surfaced with soil, but not otherwise improved. The other roads in the hospital area were graded but not surfaced, and were, therefore, exceeding^ dusty during the dry season. All roads, with the exception of the main road mentioned, were difficult to travel after a few hours of rain, and were impassable with continued rains, or with intermittent showers and very much traffic. The natural drainage of the hospital section was excellent. Two small streams, thoroughly ditched, transversed the grounds. The sanitary status was excellent, save in the matter of the great prevalence of dust and mud in dry and wet seasons, respectively. Mild affections of the upper air passages were naturally prevalent at all times. a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Gordon, Ga.,” by Lieut. Col. S. J. Young, M. C. ,TJ. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. OTHER BASE HOSPITALS. 669 The hospital was officially opened September 7, 1917. Its function was to treat all cases arising in Camp Gordon, and medical, surgical, and venereal cases from overseas. Buildings in block “0,” designed for barracks, were used for temporary quarters. The first hospital for the camp was installed on a limited scale — a small infirmary, in fact — in a building which subsequently became military police headquarters. Previous to the official opening of the hospital and the transfer of personnel with patients, the equipment was that of Field Hospital No. 25. Four buildings of barracks type, with two small administration buildings and two officers’ quarters, were utilized. The hospital with the field hospital equipment in the buildings described constituted the camp hos- pital, until it was designated the base hospital, September 7, 1917. Such of the equipment in block ‘‘O” as belonged to the base hospital, with records, personnel, etc., were transferred to the permanent location on October 2, 1917. Very few of the buildings were complete at that time. The examination of recruits, which had been part of the duties of the hospital per- sonnel in block “ 0 ,” was continued there for several weeks. The incompleted wards were used for the purpose of examining the incoming draft and also for the housing of patients. From day to day the capacity was increased as wards were either finished or made suitable for the reception of patients. Not for several weeks were the buildings of the first unit completed in the full meaning of the word; in fact, all the winter the steam fitters were found daily engaged putting up and taking down pipe, placing new connections and taking out others. The runways were at no time clear of plumbers and plumbing material from October 2, 1917, to May 31, 1918. The plan and distribution of buildings was the same as in other canton- ments, with perhaps slight variations. All buildings were constructed of wood, and were ceiled with beaver board. The original capa'city of 500 was soon increased to 1,000; the maximum capacity attained was 4,167. When the base hospital was opened the officers were quartered in the building to be used as nurses’ quarters. On November 15 the nursing staff began to arrive, and the officers moved into their own quarters, which were then sufficiently near completion to be occupied. It was found, however, that these quarters were not adequate, and the overflow was quartered in rooms in the eye, ear, nose, and throat building, in the sick officers’ building, and in other parts of the hospital in which equipment had not been installed. This over- flow state of affairs applied also to nurses. Five separate messes were maintained in the hospital: an officers’ mess in the officers’ quarters ; a sick officers’ mess in the building set apart for their ward; a nurses’ mess in the nurses’ quarters; a general or patients’ mess in the main mess hall; and the enlisted men’s mess in the barracks provided for the detachment of the Medical Department. At first the storehouse capacity of the hospital was ample for ordinary needs, but as the size of the institution increased, the storehouse became inade- quate. Four buildings, with floor space aggregating 14,500 square feet, were occupied by the hospital supply officer and the camp supply officer jointly. 670 MILITARY HOSPITALS IN THE UNITED STATES. The hospital at no time operated its own laundry. From September 7, 1917, when the base hospital was opened, to May 4, 1918, the work was done by private laundry concerns in Atlanta. On May 4, 1918, arrangements were made for all laundry work to be done in the camp. The chapel was completed and ready for use about November 20, 1917. It filled a very useful place in the life of patients, enlisted personnel, and officers of the hospital. Religious services, entertainments for patients, and lectures for officers and enlisted men were held here. The hospital water supply was part of that of Camp Gordon, obtained by contract from the city of Atlanta. The source of supply is the Chattahoochee River, which has its origin in north Georgia. The city ’s storage plant consists of two large reservoirs, coagulating basins, and pressure filters. The water was furnished to the camp through an 18-inch main. The character of the water was satisfactory from the chemical and bacteriological standpoint, except that at times when an overflow was placed on the filters, B. coll were found. At times, when the camp was filled, the pressure was inadequate for fire-fighting purposes, doubtless due to wastage of water in the camp. The bursting of mains, which were made of wood wrapped with wire, was responsible for lack of a water supply in several instances. The danger of shortage of water was later overcome by the installation of intermediate storage reservoirs in the camp. A complete and adequate system of sewerage was provided for the hospital. The mains connected with those of the camp and ended in a septic tank. The entire hospital was fully equipped with toilets of modern type. Latrines were not tolerated, except when required for the employees of const ruction companies, and then only under the closest supervision of the hospital sanitary officer. In the first unit of wards constructed some of the “ double wards” had joint toilet rooms. In the later construction each ward had its own urinal, toilet, and bath. It was generally conceded that the double-ward arrangement was un- satisfactory, sanitary conditions and discipline being more difficult to maintain than in single wards. The garbage of the hospital Avas disposed of through the garbage transfer station. Garbage was sorted in the kitchens, wards, and elsewhere in the hospital, thereby entailing no extra labor in the selecting of garbage. Sufficient cans, adequately covered, Avere placed at each mess to take care of the sorted garbage. The wagons and trucks collected the garbage daily, and more often as occasion arose. Paper, pasteboard, pieces of AA'ood, cans, fabrics, etc., were separated from all other garbage and taken to the incinerator. At the transfer station the sorting Avas carried further, and anything of value, such as hog feed, bones, tin cans, bottles, etc., Acas salvaged, and disposed of by contract. A central heating plant, consisting at first of a series of 10 batteries of Ioav- pressure boilers and one high-pressure boiler, supplied the heat for the hospital. The heating system was inadequate. During the severe winter of 1917-1S, there were times Avhen the patients would have endured great suffering from poorly heated buildings had there not been an ample supply of blankets. The expense of repair incident to freezing and the bursting of pipes was almost in- estimable. Because of the lack of steam, the Avards having steam tables were OTHER BASE HOSPITALS. 671 •without their use many days when they were very essential. For the same reason, sterilizers in the operating room were useless at times, and frequently when most needed. A further handicap was the difficulty with which coal was delivered to the steam plant. A railroad spur should have been laid for the delivery of coal, but this was not done. For a greater part of the cold season, when the quantity of coal used was the greatest, the roads were practically impassable, trucks could not be used, and mule teams had to be resorted to, working day and night to keep sufficient fuel on hand. Additions to the heating plant were made in the autumn and winter of 1918; and by December these additions were 90 per cent complete, greatly reducing the difficulties of heating the hospital buildings. Current for the electric lights was obtained from the Georgia Light & Power Co., of Atlanta. The grounds and buildings were Avell provided with suitable lights, and the electrical equipment for other purposes was adequate. The only disadvantage experienced in this connection was lack of provision for an electrician to be on hand at all hours. On many occasions such services were urgently and promptly needed, but could be obtained only after waiting in- definitely for the arrival of an electrician from the utilities branch of the Quarter- master Department. In the early days the equipment was practically that of a field hospital. Temporary quarters were being occupied; there were no water or sewerage connections; and the buildings were not suitable for the installation of equip- ment of a permanent nature. Later, the equipment was satisfactory in the main. There was a shortage of sphygmomanometers, and a few instruments were badly needed for the eye, ear, nose, and throat department. The messing arrangements of the convalescent wards were inadequate, a kitchen and mess hall being badly needed. The post exchange was opened January 13, 1918, with a stock, the value of which was $1 ,374.75. Sales for the first day were $110. Dividends for the first month were $95.56; in February they were $800.73, and in March, $1,103.96. There was no Young Men’s Christian Association building on the hospital reservation at first, but two “Y” men were on duty in the hospital practically all the time, and in an adjoining block the “Y” building was open to the men of the hospital detachment. The Red Cross erected a commodious building adjoining the hospital grounds for the use of patients during the day and for entertainments in the evenings. Valuable assistance was rendered the hospital in the matter of correspondence with relatives of sick soldiers, and in many other ways. Several rooms were so equipped that relatives visiting the patients might remain over night. The activities of the various clubs, societies, etc., in the city of Atlanta were very beneficial to the patients in the hospital. Many of the wards were adopted by these organizations, whose representatives made at least one visit a week to the patients, bringing flowers, reading matter, etc., for the men. A recreation room under the auspices of a Red Cross Chapter was fitted up in the exchange building, and here ambulatory patients were allowed to congregate at certain hours. Practically all of the wards were supplied with phonographs and a goodly number of records. 672 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Base Hospital, Camp Gordon, Atlanta, Ga., from December, 1917, to June, 1918, inclusive. 0 - SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums . Transferred to other hospitals . Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. c/5 3 3 Hospital. v5 q 1917. 430 1,967 56 3 2, 456 621 17 7 392 643 775 1 18, 174 1918. January 776 1,391 77 5 2,249 380 63 12 347 768 679 21 910 February 679 1,202 91 8 1,980 370 20 11 305 441 830 3 e ?7 > 45v5 March.. I 833 l’ 804 132 6 2, 775 691 9 7 238 727 1 099 4 31 743 April 1,103 2, 564 114 i 3, 782 1,099 39 5 1 533 761 1,341 3 36* 694 1,344 3, 186 71 4^ 601 1,266 69 39 1 624 1 069 1 531 2 J urie 1,533 2, 250 52 3^ 835 1,349 23 35 4 310 776 1,336 2 35, 666 188 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1917. December 85 2 87 235 235 49 1918. January 83 2 1 86 316 18 334 52 February 73 2 1 76 338 IS 356 79 March 77 2 1 80 320 IS 338 7S April 70 2 1 73 333 IS 351 113 May 70 2 1 73 35S IS 376 161 June 66 2 1 69 449 IS 467 158 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s 0 ffice; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). BASE HOSPITAL, CAMP GREENE, CHARLOTTE, N. C.° The base hospital, Camp Greene, was located in Mecklenburg County, 4J miles from Charlotte, N. C. The surrounding country is rolling and wooded. The soil is red clay, which gives rise to very little high-flying dust in dry weather, but a great deal of red, sticky mud after rain. The climate in summer is moderately warm, with very hot days occa- sionally. The autumn is cool and exhilerating. The winter of 1917— IS was very severe and cold, which was unusual for this location. The roads in and about the hospital were of cinders and dirt. The streams in the immediate vicinity were small brooks. The sanitary status of the hospital neighborhood was good. “ The statements of fact appearing herein are based on the “History, Base Hospital, Camp Greene, N. C.” by Lieut. Col. George A. Penn, M. C., U. S. A., while on duty as a member of the stall of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. OTHER BASE HOSPITALS. 673 The base hospital was organized September IS, 1917, its function being to treat cases arising in the camp as well as medical, surgical, and venereal cases from overseas. The base hospital was occupied September 18, 1917, when four wards were completed and patients admitted thereto. The hospital was originally erected on the standard pavilion plan. Later, six two-story barracks buildings and a ward which was used for clinical lectures and as offices for the chiefs of service, were constructed. The hospital water supply was identical with the general camp supply, and was obtained from the Catawba River, and treated by mechanical filtration by gravity through a sand-sulphate-aluminum coagulant. Comfortable quarters were provided for officers and nurses, and the barracks for enlisted men were satisfactory. The general mess was conveniently situated and centrally located with reference to the wards, with which it was connected by covered boardwalks. The officers’ mess was conducted in the officers’ quarters, and, likewise, the nurses had their separate mess. Five warehouses were provided for supplies for the medical supply officer, the dispensary, and the quartermaster of the hospital. The hospital had to depend entirely upon a laundry in Charlotte. The service was very unsatisfactory. The hospital was fairly well equipped in the early days of its existence, and fully equipped eventually. A complete sewerage system was installed in the hospital. There were no latrines. Water-closets and shower baths were placed in separate rooms in the wards. All garbage was delivered to a dumping platform where it was removed by farmers. Manure was disposed of in the same manner. Shower baths were placed in the wards in separate rooms with the water-closets. The hospital was heated during the winter of 1917-TS by means of very inferior trash stoves. These were replaced later by a general assortment of various coal stores and so-called individual ward furnaces, which were operated by men from the detachment on duty in the wards. This method of heating was very unsuccessful and unsatisfactory, and there was a continual danger of setting fire to the wooden structures. Furthermore, during the very severe weather of the winter of 1917-18 great difficulty was experienced in procuring sufficient fuel because of the almost impassable condition of the roads. The hospital was lighted by electricity, the system being successful in the main. Early in November, 1917, the chapel was ready for use for religious purposes. A post exchange was established soon after the hospital opened, and proved a great convenience to the patients. The Young Men’s Christian Association constructed a building for the use of the personnel and patients. It was well patronized and proved a source of much entertainment. Until July 1 , 1918, no Red Cross building had been erected. Red Cross workers, however, were very active from the time of the organization of the hospital and proved a source of great help. 45269°— 23 13 674 MILITARY HOSPITALS IX THE EXITED STATES. Statistical data, United States Army Base Hospital, Camp Greene, Charlotte, N. C'., from September, 1917 , to March 8, 1919, inclusive .“ SICK AND WOUNDED. Y ear and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, ev pi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. . © Hospital. | 1917. September 191 191 4S 143 1 157 October 143 657 800 508 4 1 287 287 869 1.156 465 i 60 630 15 629 630 2,077 2. 7071. 509 111 1,072 22 726 1918. January 1,072 2,163 3,235 1,801 98 14 1 6 1.312 38 434 February 1,312 1,532 2,844 1,598 34 9 i 6 1, 196 38 897 March.." 1,196 1,836 3,032 1,869 13 20 1,130 38 241 April 1 130 1,296 2. 426 1 605 31 30 2 29 111 May ' 739 1,494 800 13 32 13 1 635 21 624 June 635 637 2 1,274 788 1 17 2 461 16' 324 July 461 381 2 814 473 0 10 1 360 13.3S9 August 360 54 1 707 1,122 519 2 66 1 2 30 502 13. 719 501 46 1,252 1,799 820 7 8 3 14 912 19.794 October 912 123 424 2,767 4, 256 2, 756 4 4 9 1,221 2 48 796 145 1,223 34 '696 1,953 1 . 353 28 6 13 11 .542 '542 47 34 599 1,222 775 7 1 11 423 15) 192 1919. January 423 31 133 290 877 516 12 41 303 11,869 10 303 20 188 249 760 380 4 31 112 233 9 000 8 March.." 233 9 34 14 290 171 1 114 4 2,0S1 CIVILIAN POPULATION WITH THE COMMAND. Year and month. 1917. October November December 1918. January February March..'. April May June Men. 150 160 500 650 600 625 675 450 25 Women. Chil- dren. Total. 150 160 500 650 600 625 675 450 25 Year and month. Men. Women. Chil- dren. 1918. July 31 9 9 6 9 1 8 1919. 9 9 March..'. 4 Total. 31 9 9 6 9 9 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1917. September 28 2S 132 132 October 28 2S 132 132 November 42 42 263 263 4S December 42 42 439 439 1918. January 57 1 5S 428 13 441 67 February 67 1 68 424 13 437 S3 March . 1 426 20 446 So April 87 1 SS 621 20 641 120 May 71 2 73 425 IS 443 June 69 2 71 416 IS 434 101 July 74 2 2 78 3S5 IS 403 99 August 59 3 1 63 378 16 394 S6 September 58 3 1 62 36S IS 386 84 October 66 4 1 71 453 IS 471 94 November 64 4 1 69 453 15 46S 95 December 49 4 2 OO 410 19 429 92 1919. January 34 4 2 40 406 16 422 60 February 27 3 1 31 305 14 319 35 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section. Adjutant General’s Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER BASE HOSPITALS. 675 BASE HOSPITAL, CAMP HANCOCK, AUGUSTA, GA.« Camp Hancock was located in Richmond County, Ga., adjacent to the city of Augusta. Augusta is a city of about 50,000 inhabitants, is largely devoted to agricultural business — principally cotton — and to cotton manufacture on a large scale. It is located on the Savannah River, which forms the boundary between the States of Georgia and South Carolina; and is about 135 miles from the city of Savannah, situated at the mouth of the Savannah River. The camp was located west of the city, which it bordered for a distance of three-quarters of a mile. The base hospital reservation was at the extreme eastern end of the camp, and part of this reservation actually lay within city limits. City street-car lines passed the hospital at a distance of about two blocks from the entrance to the hospital area. The country in this region is rolling, partly wooded, and partly under cultivation. The hill upon which the camp was located is about 400 feet above sea level, and this represents the average height of the hills in this vicinity. From this hill there was a view in all directions over the surrounding country, the horizon to the east and south being at least 50 miles distant from the camp. The soil of these hills is of sand to a depth of about 8 or 10 feet, and below is a subsoil of red clay varying in thickness from 4 to 20 feet. Below this again is sand, of a fine quality, light in color, and very closely resembling the sand of the seashore. The top layer of the soil is sand a bit coarser than ordinary sea sand but closely resembling it. This sand is quite heavy and, except during high winds, does not blow to any extent, but it washes away badly during heavy rains; and because of this it is difficult to maintain roads and levels. The red clay is admixed with sand, and it packs very well. It is used extensively in the region for the construction of roads, being practically the only material avail- able, as there is no rock or gravel to be found in the region. In the valleys there is a mixture of loam with the sand, and as these are well watered during freshets and after heavy rains they are extremely fertile. Vegetation on top of the hills reminds the observer of the seacoast, with the same scrubby wild pea. The climate is mild and fairly equable. Summers are hot, the thermometer often reaching 100° F. for many days at a time, and during July and August there are frequent and violent thunderstorms. Hot weather begins about the 1st of June and continues well into September, sometimes well into October. Actual winter weather begins usually about Christmas and lasts six or seven weeks. During that time the winter may be fairly violent, with low tempera- tures and sleet storms. There is, however, no great precipitation of snow, and if snow falls it melts very quickly. There are a good many days with low temperature and high winds. During the winter of 1917-18 the thermometer once reached 5° above zero in the early morning. The weather in spring and autumn is delightful. October, November, and most of December are very much like early October in New England, with much sunshine and few gray days. Often it is possible to gather roses on Christmas Day. Again from the 1st of February until the last of April the climate is delightful. Spring advances a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Hancock, Ga.,” by Lieut. Col. F. T. Barrett, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General's Office, Washington, D. C. — Ed. 676 MILITARY HOSPITALS IN THE UNITED STATES. slowly but steadily; there is much sunshine; and there are very few days when the temperature is too high for comfort. The roads in the entire region were rather unsatisfactory, there being no rock for the formation of a roadbed and no suitable gravel for the top (dressing. From necessity roads were constructed from the red clay which formed the sub- soil. Properly mixed with sand this formed a hard, smooth surface, but it washed away easily during rainstorms and was easily torn up and the surface rendered uneven by heavy traffic. The roads, however, were fairly easily repaired by the use of road scrapers, the addition of more clay, and some rolling. In the valleys between the hills there is comparatively little swampy land, and, owing to the nature of the soil, this can be drained easily. The camp was therefore, com- paratively free from mosquitoes. No date can be set for the organization of the base hospital, for this was a gradual proceeding, occupying several weeks. The first medical officer to report for duty arrived August 14, 1917. At that time the hospital site had not been selected, but some of the neighboring buildings were under construc- tion. Practically the only persons in the Military Establishment present at that time were the constructing quartermaster with his staff, and one battalion of the Georgia National Guard. During the next few days several medical officers arrived, and on August 18, 1917, the commanding officer of the base hospital reported for duty. In conjunction with the constructing quarter- master, his first duty was the selection of the hospital site. Building of the hospital was begun about September 9, 1917, and progressed rapidly. Such rapid progress was made on certain of the buildings that it was possible to admit the first patient on October 14, 1917. The National Guard regiment from Pennsylvania had been arriving since the last days of August to form the 28th Division, which was to train at Camp Hancock. This division had as part of its sanitary train four field hospitals, and these were set up and used for the accomodation of the sick of the division during the interval preceding the opening of the base hospital. There was no great amount of sickness during this period and no epidemics appeared, so that the field hospitals were well able to care for the sick of the camp. It was not necessary, therefore, to engage temporary quarters or to use local hospitals except for acute surgical cases. The university hospital connected with the medical department of the University of Georgia, at Augusta, opened its doors to the surgical department of the base hospital, and acute surgical cases arising in the camp were operated upon and cared for there. Even after the opening of the base hospital it was not possible to care for acute surgical cases until the middle of January, 191S; apparatus and equipment had not been received, and the heating plant for the operating pavilion was not complete until that time. Upon its completion there was no formal opening of the hospital, and improvements and additions were constantly made even so late as August, 191S. The buildings constituting the base hospital were of the type adopted for all National Guard camps. The original orders for the construction of the hospital did not include lining or ceiling the buildings, nor any sewerage and plumbing system. It was not until January, 1918, that the constructing quartermaster began to line and ceil the buildings with heavy beaver board— a much-needed addition because of the very cold weather then being experi- OTHER BASE HOSPITALS. 677 enced. Those who spent the month of January, 1918, at Camp Hancock are not likely to forget then- experiences there. Plumbing had not been installed in the hospital; there was no sewerage system; the hospital was heated only by stoves ; and there was no lining to walls nor were there ceilings to hold what heat the stoves gave. There was no hot-water supply, all water being brought in from the grounds and heated by stoves. Added to these handicaps, the weather was exceptionally cold and severe. The work of ceiling and lining the buildings was completed during January, so that after that tune life was much more comfortable. About this time also the installation of the plumbing and sewerage systems was begun. At first, the city water mains were brought into the hospital grounds, and fire plugs were located for the protection of the buildings against fire. These mains were tapped at various places in the grounds so that there was provision for water for use in the wards. There was at first no sewerage system, and latrines were placed about the hospital grounds, allowing one for about every four wards. These latrines were of the usual open-air type, and in winter weather were far from comfortable, especially for patients. Though at times crowded, the quarters throughout the hospital were satisfactory. Six barracks of the standard one-story type were constructed for enlisted men. These were about 160 feet long and 24 feet wide, with four rooms at one end for the noncommissioned officers, and a small common sitting room at the other end. Each barrack accommodated about 50 men. The bar- racks were very comfortable except for the fact that beaver board for ceiling and lining was not installed until w r ell into cold weather, when troops, patients, and all who were housed in the hospital buildings w r ere very comfortable. The original building for the officers was long and narrow and was divided into 24 rooms, each room being about 9 by 10 feet, with one window. No bath- rooms were provided until the plumbing for the hospital was installed. A latrine was constructed about 60 feet from the end of the building, and the only bathing facilities obtainable at the time were a galvanized-iron bucket, and a faucet in the yard. The building was heated by small stoves, one 6-inch "cannon” stove for each room. Each stove had its separate galvanized-iron smokestack, and the resulting appearance of the long row of these stacks was weird. In the early spring of 1918 three large additions w T ere made to this building, converting it into an E -shaped structure. The two outer wings were for bedrooms, all of the same shape and size as those described above. The center wing contained a good-sized assembly room, a dining room, and a kitchen adequate for the needs of these quarters. The barracks for nurses were almost exactly like those for the officers, pre- senting the same difficulties. A nurses’ recreation house was built and equipped by the Red Cross. A society of young ladies of Augusta raised a sum of money by a series of entertainments during the winter of 1917-18, and fitted up the sitting room in each of the barracks with furnishings, curtains for the windows, and other comforts. Before the plumbing system was installed the men of the Augusta fire department allowed the men of the detachment the use of their shower baths, a privilege which was deeply appreciated. 678 MILITARY HOSPITALS 1 1ST THE UNITED STATES. Because the cooks and their assistants were more or less inexperienced, the kitchen of the hospital was perhaps the most difficult department to establish and maintain. There were five messes at the base hospital — the main mess for convalescent patients, including a diet kitchen for the feeding of ward patients; the enlisted men’s mess; the sick officers’ mess;. the medical officers’ mess; and the nurses’ mess. The three last named required the least care and attention; they were relatively small and their management much more simple. The patients’ mess required the greatest effort and caused the most trouble, as it was the largest, and a variety of needs had to be catered to. The original equip- ment in this mess consisted of a battery of four-burner gas stoves with fair- sized ovens under each. Aside from these and a somewhat too small refrig- erator, there was practically no equipment, except the usual pots and pans. For some reason this hospital did not receive as much equipment as did some other base hospitals, and it was a struggle to get along with the inadequate equipment for feeding patients. In March, 1918, a small hospital fund having accumulated, permission was requested to expend part of it in the purchase of additional kitchen equipment, such as steam kettles, dish washers, potato parers, etc., but word was received that the Construction Division would install these. Installation began in August, 1918. The original equipment included wheel carriages with hot-water trays for food containers, but these trays were too shallow and did not serve during cold weather to keep the food hot. Indeed, the serving of hot food to ward patients was one of the greatest problems of the winter. Most food had to be reheated on the gas stoves in the ward diet kitchens, and even then it is probable that the food served to many patients was not sufficiently hot to be palatable. Hot kettles were improvised by putting small pails into larger ones containing hot water. This helped improve the situation, but the preparation and service of food was far from satisfactory. During the winter of 1917-18 difficulty was experienced also because of low gas pressure, due to fuel shortage. Because of this fuel shortage many house- holders in the city depended upon gas for keeping their houses warm, and the supply was limited and the consumption excessive. A dietitian was added to the staff of the hospital about Christmas, 1917, and her efforts greatly increased the comfort of patients as regards their diet. Supplies were abundant at all times. In the enlisted men’s mess much the same trouble was experienced. The kitchen was at the end of the gas main and pressure was often lower there than anywhere else, and on many of the coldest days it was impossible to serve warm food. Breakfast was likely to be the best meal, as it was served before the city people were up and using gas. The storehouses of the hospital were among the first buildings finished. There were four of them, each about 150 feet long and 25 feet wide. One was assigned to the hospital quartermaster for his use, and the camp medical supply officer and the hospital property officer occupied the other three. Until the later construction of nine two-story ward barracks, these warehouses were sufficient to meet the needs of the hospital, but at least one more could have been used to great advantage. A building was originally constructed as a laundry, but no machinery was installed. Laundry work was done by a steam laundry in the city of OTHER BASE HOSPITALS. 679 Augusta, the arrangement proving very satisfactory. Suitable steam laundry facilities were greatly needed. A chapel was one of the original buildings of the hospital, but it was not used in the early months; it had no furnishings and there was no ceiling. Owing to the proximity of a Young Men’s Christian Association building in camp, available for religious purposes, and to the fact that several of the city’s churches were only a short distance away, there was no great demand for the use of this building. During January, 1918, there was an epidemic of German measles, and the hospital was filled to overflowing. During that time the chapel was fitted up for a ward. Later, it was turned over to the representa- tive of the Young Men’s Christian Association, who fitted it up for the detach- ment of the hospital and provided it with writing tables and games. Fortunately, owing to the proximity of the city of Augusta, it was possible to bring gas mains to the hospital for a supply of fuel gas. At first there was only a limited supply of gas stoves, but gradually these accumulated so that before cold weather set in there was at least one installed in the diet kitchen of every ward. These served the dual purpose of warming food for patients, brought over from the mess, and for heating water for the care of patients, and was almost the only approach to the usual comforts obtainable during the severe weather. From the first the hospital was heated by stoves and furnaces. These were in great variety of sizes and shapes, but the “cannon ” type predominated, sizes ranging from grates of 7 to 18 inches in diameter. For the wards hot-air fur- naces were provided. Each ward had two of these, of a type ordinarily used for heating small houses. They were mounted at either end of each ward, and above each was placed a large deflector plate in the hope that the hot air would be deflected downward. The scheme was a disappointment, however, as the heat continued to rise and the lower portion of the rooms remained cold. One could stand beside a heater in full operation and yet get no warmth from it. Removal of the outer case of these heaters improved the warmth of the wards, and this measure was adopted. There was a total of 300 “heaters” and stoves set up throughout the hospital, and the labor required to carry fuel to and from these can well be imagined. There was also considerable difficulty from the soiling of the wards by ashes and from the fact that patients persisted in using the stoves as receptacles for all manner of refuse. The hospital was benefited by its proximity to the city in the matter of lighting, insuring electric lighting from the start. The supply was constant and satisfactory. Power came from a dam on the Savannah River about 12 miles above the city. The various equipments for fire protection were completed, during the summer of 1918, with the installation of a fire house and a high-powered auto- mobile fire engine of the latest type. In addition, chemical fire engines, a siren whistle, several 40-gallon chemical fire entinguishers mounted on wheels, with a 100-foot hose attached, were installed in several parts of the hospital. There was also a night watchman system for fire protection, with 4 watchmen’s clocks and 64 stations. These stations had to be rung up at least once an hour during the night, and were so arranged that a watchman should visit all parts of the hospital at least once an hour. The initial number of hand extinguishers 680 MILITARY HOSPITALS IN THE UNITED STATES. and fire buckets was considerably increased, and an automatic fire-alarm system was added to the equipment. For its water supply the hospital was connected with the Augusta water system. The arrangement was satisfactory, and the supply never failed. When the plumbing was installed there was water, both hot and cold, in every ward and in all kitchens and bathrooms of the hospital. Each ward had a bathroom in which there were two hand basins, a bathtub, a shower bath, a dental sink, urinal, and toilets. There was also a slop sink in a room designated the “service room” and the diet kitchen had a satisfactory kitchen sink. Each ward had its own hot-water heater installed in a small lean-to outside, and there was an abundance of hot water. The sewerage system of the hospital was connected with the sewer mains of the city of Augusta, thus providing for the disposition of all sewage. There were no toilet facilities until the plumbing was installed in February, 1918. The disposal of garbage was accomplished by digging a pit about 16 feet deep, which took it through the layer of red clay which forms the subsoil in this region, and from 12 to 14 feet in diameter. It was filled up to about 10 feet from the bottom with a cribwork of logs. On top of this cribwork was placed a layer of logs laid close together, and upon these about 4 feet of broken brick, upon which a fire was built and garbage disposed of. A hopper was constructed at one side to take care of the sullage water contained in the garbage. Upon being poured into the hopper this water ran down over the heated bricks into the pit and what was not evaporated ran off into the sands. This incinerator proved very satisfactory and easily took care of all the hospital garbage until some months later when arrangements were made with a contractor to purchase and remove the garbage. Still later a reclamation service, established under the camp quartermaster, assumed the duty of caring for this detail. The equipment of the base hospital gradually developed from an amount which would be considered extremely scant by a well-established city hospital, to that which would compare favorably with any hospital in the country in this respect. Bed linen was one of the shortages when the hospital was first established. Oniy about 2,400 sheets were available at first, and for several weeks after the hospital opened, obviously an insufficient quantity for a hospital of 800 beds. Office fixtures were lacking in the early days of the hospital, and in many of the administrative offices and in the office of the ward surgeons it was necessary to construct tables from scrap lumber left by the contractors and from packing boxes in which medical supplies had been delivered. Much of the necessary shelving was at first constructed from these same scrap materials. For a long time there were no tongue depressors and it was a common sight in many of the wards, and particularly in the nose and throat ward . to see conva- lescent patients whittling them out of box wood. They were then sterilized and distributed throughout the hospital. A great deal of ingenuity was shown by ward surgeons and wardmasters in improvising chairs and tables. In the nose and thoat clinic several very clever tables were devised with bottle and towel racks which were so useful and practical that they were later copied in better material, properly finished. During the early spring of 1918 the American Bed Cross constructed a large house for convalescent patients. This was a very elaborate building and consisted of a large auditorium with stage. The stage and auditorium could OTHER BASE HOSPITALS. 681 be converted in the day time into a large reading and game room. There was also a small kitchen and on the second floor in two of the wings were several bed- rooms which were used by the staff of the Red Cross house and for the accommo- dation of the relatives of sick patients. The Red Cross house was presided over by a Red Cross worker, and a member of the Army Nurse Corps was on duty there as matron. The American Library Association placed many books upon the shelves of this house and assigned a trained librarian for their proper care and distribution to the convalescent patients throughout the hospital. L T nder the direction of the representative of the Red Cross, entertainments for con- valescent patients were arranged, and uncjuestionably the house was of great benefit to the patients and materially assisted in hastening the convalescence of many by giving them a much-needed change of environment from the hos- pital wards. Early in the autumn of 1917 a Young Men’s Christian Association worker was on duty at the hospital, working untiringly among both patients and the men of the detachment. In the spring of 1918 he took charge of the chapel, as mentioned above. After January, 1919, there was a steady decrease in numbers both in the camp and at the hospital. On January 21, the Surgeon General designated this hospital for the care of severely gassed patients whose homes were east of the Mississippi River. About 50 cases were received and carefully studied, particu- larly with regard to physical signs and the radiographic findings. On February 25 orders were received that the camp and hospital were to be demobilized at once, all gassed patients to be sent to the general hospital at Biltmore, N. C. On March 26, 1919, the base hospital was officially' closed, and the buildings turned over to the Public Health Service. Statistical data, United States Army Base Hospital, Camp Hancock, Augusta, Ga., from October, 1917, to March 28, 1919, inclusive. a SICK AND WOUNDED. Year and month. Remaining from last month. From command. > Q. missio From SOUI d PQ ns. other ces. © g © ,d O 1917. 495 84 November 500 764 14 3 535 888 27 1918. 1,491 22 845 1, 263 14 March.. . 842 '850 8 April 664 968 60 17 May 698 69 1 696 June 757 1,257 July 959 36 1,241 August 980 59 10 1,551 September 1,265 46 31 3, 035 October 2,314 256 330 5, 216 November 2, 2S7 70 23 1,607 December 2,109 66 23 980 1919. January 1,044 137 19 1,041 February 856 79 12 286 March 370 17 1 117 Total to bo accounted for. Completed cases. Remaining. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. Hospital. Quarters. 579 77 1 1 500 1,281 717 4 17 2 6 1,450 699 1 59 1 5 685 2, 19S 968 5 23 347 10 845 2, 122 1, 146 18 10 102 4 842 1,700 957 11 40 19 9 664 1.709 930 7 47 6 1 21 698 1,464 641 4 3 44 2, 079 969 3 60 26 62 959 2, 236 1,137 4 36 27 980 2, 600 1,206 9 46 4 20 50 1,265 4, 377 1,679 17 53 265 49 2, 314 8, 116 5, 295 474 20 2 38 2 , 287 3,987 1,704 86 22 13 2 , 109 3, 178 2,014 39 26 21 34 l, 044 2,241 1,219 70 26 IS 52 1,233 745 6 58 24 30 370 505 227 2 23 241 12 Aggregate number of days lost from sickness. p< o 4,044 14, 888 19, 806 24, 236 19, 051 22, 937 20, 889 20, 209 26, 669 27, 295 35, 213 43, 684 95, 804 62, 347 51,425 33, 852' 17,456 6,482 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office; and monthly statistical returns made to the Office of The Adju- tant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 682 MILITARY HOSPITALS IN' THE UNITED STATES. Statistical data, United States Army Base Hospital, Camp Hancock, Augnsta, Ga., from October, 1917 , to March 28, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Y ear and month. Men. Women. Chil- dren. Total. Y ear and month. Men. Women. Chil- dren. Total. 1918. 1918. 1 1 7 7 February 1 1 1 1 9 9 April 1 1 7 7 1919. June 8 8 January - July 7 7 6 6 1 i September 6 6 PERSONNEL ON DUTY. Officers. Enlisted men. Y ear and month Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. Nurses. October 1917. 40 2 1 43 274 274 39 2 1 42 279 279 1 45 2 1 48 276 276 30 1918. 46 2 1 49 285 285 48 2 1 51 392 17 409 54 2 1 57 311 17 32 s April 74 1 2 77 522 17 539 90 60 1 1 62 303 17 320 93 61 2 1 64 400 17 417 109 July 55 3 1 59 62 400 18 418 102 58 3 1 18 91 67 3 1 71 512 18 530 542 98 68 5 1 74 523 19 107 66 4 1 71 534 19 553 113 77 4 1 82 534 IS 101 1919. 66 5 2 73 799 16 738 129 52 4 2 642 13 655 116 8 4 12 52 52 BASE HOSPITAL, CAMP A. A. HUMPHREYS, VA.« Camp A. A. Humphreys was situated in Fairfax County, Ya. The nearest town was Alexandria, Va., 1 2 miles distant, with a population of about 15,000; Washington, D. C., was about 18 miles away. The camp occupied Belvoir Peninsula, which is rolling and wooded, and about 3 miles long and one-half to 2 miles wide. On the east is Dogue Bay; on the west, Accotink Bay. The point of the peninsula is in the Potomac River, about 20 miles from Washington. On the east side, the shore is heavily wooded and rises abruptly for 100 feet to a comparatively level plateau. On the west, the rise from Accotink Bay is more gradual, and level ground is not reached for half a mile. The plateau runs north and south, and makes possible the boast that Camp Humphreys had the longest parade ground in the United States. The point of the peninsula, from the Potomac north for about a a The statements of fact appearing herein are based on the “History, Base Hospital, Camp A. A. Humphreys, Va.,” by Maj. J. M. Greer, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. OTHER BASE HOSPITALS. 683 mile, is Aery rolling, with an abrupt rise to the south end of the parade grounds. On the edge of the plateau, a half-mile east of the shore of Accotink Bay, and separated from the southwest corner of the parade ground by a quarter mile of timber, was the base hospital. Its situation was ideal: half a mile east, across the parade ground, was the headquarters and the civic center of the camp, and thus the hospital was conveniently near for ease of access, yet sufficiently distant to escape the noise and bustle of camp life. The soil is clay, with occasional outcroppings of gravel. While the soil forms mud when mixed with water, it is not distressingly tenacious. The neighborhood of the parade ground became very dusty in summer, but the base hospital did not suffer from dust, nor was it visited by disagreeable winds. The pine, oak, hickory, chestnut, elm, cedar, and sycamore trees were carefully preserved, and served the purpose of both beautifying and protecting. Even in winter, when the deciduous trees had been stripped, there was enough pine and holly to rest the eye. The roads about the hospital were not ideal. On the east side there was a clay road, fine in dry weather, but rather muddy in rainy weather. On the west side an attempt was made to make a cinder road, but coal dust was used, with a result that may be left to the imagination. However, the site was so excellently drained that the character of the road structure was not a serious consideration. The history of the base hospital begins with the original hospital, at the very point of the peninsula, on the shore of the Potomac. The site, though comparatively low — not more than 25 feet above tide water — was naturally well drained. From April 28, 1918, to September 13, 1918, this was where the hospital was located. This original hospital, or camp hospital as it was then called, took the name of Belvoir. The only building available was a rough, wooden, one-story barracks, formerly occupied by soldiers in training. It was partitioned into five rooms, three of which were used as wards, one as an emergency operating room, and the fifth as the administration office. Con- ditions were very trying. A real base hospital was promised; therefore no expensive improvements were attempted at Belvoir. The water supply, from a deep well, pumped to the latrines and kitchens, was excellent when the pump worked; but the water was not piped to any of the barracks, and the hospital supply had to be carried in buckets to kitchen or latrine. On more than one occasion the pump failed to work, and the water was transported in cans by truck from the main camp. From this small beginning of five rooms on April 28, 1918, the hospital grew steadily. On May 29, an order was issued by the War Department changing its name from camp hospital to base hos- pital, Camp A. A. Humphreys. By the following September, 27 buildings were required to house patients, the medical detachment, medical officers, and equipment. There was finally a bed capacity of 350, which included about 50 beds in tents placed about the grounds and used for contagious cases and isolation purposes. On September 13, 1918, the surgical ward and operating room equipment were moved to the new hospital. As rapidly thereafter as equipment could be installed the remaining wards were moved. Last of all, the administrative offices were moved. By September 20, everything was running smootldy, and plans for a formal opening were discussed. At tins 684 MILITARY HOSPITALS IN THE UNITED STATES. time, however, the hospital was far from complete, either in buildings or in equipment. The original plans called for 45 wards, arranged in sections, the various wards in each section opening into a common corridor, each of the corridors being connected with a main central corridor. At the time of occu- pation only three sections were completed. From September, 1918, to the beginning of 1919, progress toward completion was provokingly slow. Labor shortage, the influenza epidemic, and the armistice combined to delay construc- tion. The original plans included an additional building for officers’ quarters and an additional one for nurses. These buildings never materialized, leaving both officers and nurses rather uncomfortably crowded. Officers were quartered in two buildings. The staff officers’ quarters, for the accommodation of the commanding officer, a registrar, and the chiefs of the medical and surgical services, were roomy, fitted with toilet and bath, and were conveniently located opposite the administration building. Large quarters, with kitchen and mess hall opposite the officers’ ward, housed the rest of the com- missioned officers. The original plans called for an additional building; but as this was never erected, the officers had to “double up,” two occupying a room large enough for only one. The detachment, Medical Department, was quartered in three large two-story barracks on the east side of the hospital. A fourth building, intended for the detachment mess hall, was converted into a recreation room for the enlisted men. These quarters were steam heated and fitted with baths and toilets. There were three messes in the hospital. A general mess, the largest, was fitted with every necessary appliance. This served the enlisted men of the detachment, as well as the convalescent patients. The large, any mess hall, adjacent to the kitchen, was so arranged that each table of 20 men was pre- sided over by a noncommissioned officer whose duty it was to see to the con- servation of food and to insure proper conduct at the table. Each presid- ing noncommissioned officer was responsible to the mess sergeant. Food for patients on light and liquid diet was prepared in the diet kitchen under the direct supervision of the dietitian. The nurses had their own kitchen and mess in their quarters. The commissioned officers and officer patients had a common mess in the officers’ ward. There were two large one-story warehouses situated about a quarter of a mile from the base hospital. Each building was divided into two by a brick fire wall 2 feet in thickness. The buildings were of such dimensions (400 feet long and 50 feet wide) that it was possible to carry a three months’ supply of medical property for the base hospital as well as for the field organizations. The warehouses were heated from the hospital heating plant. The hospital chapel was never used for religious purposes. During the influenza epidemic the building was used for the overflow from the mortuary; otherwise the chapel was not utilized. Religious services were held in the detachment mess hall, in the nurses’ mess hall, and in various other places, including the Red Cross recreation building. All laundry work was done by the Alexandria Laundry (Inc.) under con- tract. The arrangement was quite satisfactory except during the influenza epidemic, when the laundry plant was overtaxed. OTHER BASE HOSPITALS. 685 The hospital water supply was from the camp supply, the source of which was Accotink Creek at a point about 3 miles from camp. From the creek it was carried by wood pipes to a filtration and chlorination plant at Accotink, and from there to a centrally located steel supply tank with a capacity of 300,000 gallons, thence to every building hi the cantonment. The water was excellent in quality. The hospital sewerage system was, likewise, a part of the camp sewerage system. Every ward, and the officers’, nurses’, and detachment quarters were well equipped with the most modern type of tub and shower baths, lavatories, urinals, and closets. The base hospital had the most complete, as well as the largest, steam heating system in camp. The buildings were all heated by direct radiation, the steam for which was supplied by a central boiler plant. The central boiler plant consisted of 150-horsepower return tubular boilers, brick set, vacuum pumps, boiler feed pumps, feed water heater, and such other accessories as were necessary for a complete installation. It was operated by the personnel of the utilities detachment, consisting of 1 officer and 37 enlisted men. The boilers operated at a steam pressure of about 100 pounds, which was reduced by valves, to about 60 pounds before the steam entered the mam lines to the hospital buildings. This permitted a supply of steam at this pres- sure within the buildings for cooking and sterilizing purposes, and a further reduction to about 5 pounds pressure provided steam at a suitable pressure for heating purposes. At the return end of each radiator and steam cod was installed an automatic return trap of the fluid disk type. This trap pre- vented the loss of steam into the return lines, and permitted the free passage of air and water of condensation into the return line, and out of the heating system. It was intended to install a complete return line system to convey tins water back to the boiler plant, where it could be fed back to the boilers. Due to the shortage of pipe this was not done, and the water wasted to the sewer at the most convenient point. It is evident that there was an enormous waste of water and heat: large quantities of make-up water were necessary at the boiler plant, the temperature of this fresh water had to be increased, when otherwise this would have been unnecessary, and scale-forming elements had to be removed in large quantities. The waste of fuel and the injury to the boiler plant can hardly be estimated. The pumping plant for the camp was not designed to handle this additional load thus placed upon it. In the event of the necessity of shutting down the pumping plant, it would have been necessary to shut down the heating plant also. The light and power system of this camp consisted of a system of dis- tribution lines, 3-phase, 60-cycle, 2,300-volt primary and 220-110-volt 3-wire secondary extending to all parts of the camp. The system was divided into four circuits, No. 2 being the circuit that supplied the base hospital. Electric current was purchased from the Alexandria County Lighting Co., which had a transmission line supplying the camp exclusively. In the early days the hospital equipment was very meager. Beds, linen, blankets, and like supplies were sufficient. But the water supply, as noted above, was very inconvenient; the only means of sterilization was a kerosene stove; and the almost impassable condition of the roads in April, May, and 686 MILITARY HOSPITALS IN THE UNITED STATES. June, 1918, made new supplies very uncertain. This condition steadily im- proved, until by September 20, when the new hospital was taken over, everything was running smoothly. During the influenza epidemic the property office was fairly "swamped.” While, eventually, the hospital became well equipped, especially for ordinary purposes, there were times when need arose for instru- ments not procurable through military channels, or which, if obtainable, would have been too long on the way; these were supplied by the officers on duty. On May 27, 1918, the hospital exchange was started by purchasing out- right, on credit, the stock of the exchange of the 51st Engineers. By the end of June, after a little over a month, the exchange had assets, over and above liabilities, of $1,825.19. After that date the average gross business per month was $6,000. At Belvoir the Young Men’s Christian Association proved a very efficient organization in spite of the difficulties of transportation. At the base hospital there was no Young Men’s Christian Association building, the detachment mess hall being used as a recreation room, under the supervision of the asso- ciation. A plentiful supply of magazines, home papers from practically every State in the Union, a pianola, and material for other recreations were available. The completion of the Red Cross recreation building was delayed because of the scarcity of labor and materials. Two associate directors of the Red Cross were stationed at the hospital, their chief duties being to visit the pa- tients daily, and to aid, as far as possible, in making them comfortable and cheerful. By furnishing stationery and reading matter, by communicating with the relatives and friends of the sick, by shopping for the patients, and in many other ways, valuable assistance was rendered. In February, 1919, the base hospital reverted to the status of camp hospital. Statistical data, United States Army Base Hospital, Camp A. A. Humphreys, Va., from June, 1918, to February 1919, inclusive a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. <§ 73 OT o j 1918. 209 563 30 802 325 1 2 227 9 23S 6.125 238 750 35 9 1,032 402 3 s 378 4 237 7,642 237 698 78 5 1,018 455 3 2 252 s 298 7.226 298 1,002 197 1,502 378 32 10 440 12 612 IS 11.582 41 October 630 1.915 383 28 2.956 1, 114 405 5 828 22 4 31.379 798 682 801 13 4 1,500 '586 21 8 299 9 13.863 96 577 559 15 11 1,162 618 23 IT 154 10 343 14.722 1919. January 343 566 4 16 929 550 14 3 39 40 279 4 9.910 52 February 283 375 1 13 672 409 5 2 13 22 220 1 7.095 26 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office; and monthly statistical returns made to the Office of The Ad- jutant General, on file statistical Division, Adjutant General’s Office (name of hospital ). OTHER BASE HOSPITALS. 687 Statistical data, United States Army Base Hospital, Camp A. A. Humphreys, Va., from June, 1918, to February, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 191S. 26 2 2 30 272 287 July 25 5 1 31 262 15 277 30 4 1 35 253 14 267 33 5 2 40 338 14 352 October 39 3 7 44 393 14 407 68 November 32 4 2 38 383 13 396 99 December 23 2 2 27 425 13 438 73 1919. January 27 1 2 30 310 12 322 63 February 27 1 2 30 306 10 316 39 BASE HOSPITAL, CAMP JACKSON, COLUMBIA, S. O The base hospital at Camp Jackson was situated in the midst of the “sand hill” country of Richland County, S. C., 7 miles east of Columbia, the State capital. It covered an area of 80 acres at the highest point of the reservation, 500 feet above the sea level, and on the summit of a hill which was scantily covered by dwarf oaks and a few long-leaf pines. The hospital area was free from running or standing water. The soil of the locality is sandy, with a substratum of clay. Here are the sand dunes which mark the western-most limit reached by the ocean, at the junction of the Piedmont Plateau and the alluvial plain stretching 120 miles to the coast. The hospital area was practically denuded of every living green thing; the resulting bare stretch of sand, which was very glary in the sun, rapidly absorbed the heaviest rainfalls, and the fine dry sand was readily blown about by the winds, at times amounting to sand storms. The climate of this section of South Carolina is ordinarily dry. The average winter temperature is 47°. The winter of 1917-18 was the coldest in 32 years, the temperature dropping, at one time, to 6° F. above zero. The mean daily range is 23°. The average summer temperature is 79°, with cool nights. Gently blowing breezes, mostly from the southwest, are almost constant, and seldom attain a greater velocity than 7.4 miles per hour. The roads in and leading to the base hospital grounds were made of sand- clay, similar in character to the standard highways of South Carolina. In dry weather these roads were good, though very dusty; but in wet weather, or when there had been a frost, they were unsatisfactory because of the deep ruts which rapidly formed, requiring prompt attention. The last week in November, 1918, marked the beginning of the construction of a concrete road around the hospital area, a sorely needed improvement. Until June 1, 1918, there were no roads through the hospital grounds, and the delivery of supplies was greatly ham- pered. Autos and wagons sank into the loosely packed sand, frequently a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Jackson, S. C.,’’ by Lieut. Col. S. R. Roberts, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. 688 MILITARY HOSPITALS IN THE UNITED STATES. becoming stalled. Abuse of motors, waste of gasoline, and delay in delivery of goods resulted. The hill on which the hospital was located sloped gently down to the low- lands about a quarter of a mile distant. The lowlands were swampy, were covered by a heavy growth of vegetation, and had sluggishly running streams and pools of standing water, which furnished ideal breeding places for mos- quitoes, both Culicidse and Anopheles. The immediate neighborhood of the hospital was occupied by poor, small farmers, both white and negro, whose homes, buildings, and surroundings generally were badly kept and insanitary. Within a few miles, however, were many fine farms with modern homes and buildings, containing every sanitary convenience, and occupied by intelligent, clean-living, well-to-do farmers. Prior to the occupancy of the base hospital the least seriously sick were cared for in field hospital "A,” while those more dangerously ill or requiring major operations, were treated in the Baptist Hospital in Columbia by members of the base hospital staff. Preceding the formal opening of the hospital proper, a part of the hospital detachment occupied the detachment barracks. The wards were occupied by patients October 22, 1917, before heating or plumbing facilities had been completely installed. The two central sections were heated from the central plant December, 1917; the last part to be so heated was the contagious section, which was not until late January, 191S. The hospital was constantly growing, new buildings being added weekly. Much of this delay in construction was due to faulty management and lack of intelligent honest supervision. The greater portion of the hospital was of the single-story pavilion type, each ward occupying a separate pavilion, and accommodating 32 patients. A later addition, of 9S0-bed capacity, was of two-story construction, each build- ing housing SO patients. This was intended primarily for ambulant and con- valescent patients still needing hospital care. All these buildings were con- nected by covered, screened board walks. In addition, there was a convales- cent camp for those no longer ill, yet not able to do duty, and for those awaiting discharge on surgeon’s certificate of disability. This last group was housed in board shacks, each accommodating eight men. The officers’ quarters were inadequate from the first, and no mess hall was provided them. From the opening of the hospital until the middle of April, 1918, the medical officers were required to eat in the sick officers’ mess, under crowded conditions. Some duty officers were lodged, at first, in the officers' ward quarters. The original nurses’ quarters, like the officers’ quarters, were too small. The erection of a second building still proved inadequate, and four additional dormitories were constructed. In addition, the Red Cross built a recreation hall for nurses, near the Red Cross building. The detachment barracks were built to accommodate 5S men each. The eight buildings for this purpose were steam heated, lighted by electricity, and had bathhouses and toilets just outside. The mess was in a separate building. The buildings proved inadequate, and during the summer of 191S some of the enlisted men occupied ward barracks. OTHER BASE HOSPITALS. 689 The main kitchen was equipped with all the modern appliances for the preparation of food by means of high-pressure steam, such as vegetable steamers, boilers, soup kettles, roasting ovens, and tea and coffee urns. A dish-washing machine was part of the equipment. There was a diet kitchen for the prepara- tion of special diets. The mess hall was used for ambulatory patients only, bed patients being served in their wards from this mess, the food being sent to wards in food carriers which were heated by hot water, and the food served individually on trays. These food carriers were found, in actual practice, to fail in their purpose of keeping the food hot. The division of sick officers had its own kitchen and mess halls, the latter being so arranged that convalescents from different communicable diseases could be fed separately. The kitchen and mess halls were separate from the living quarters. The detachment, Medical Department, was quartered in two buildings, each of which had a kitchen and mess hall, supervised by a mess officer. The mess hall in one building accommodated 300 and in the second 200, and there were 1,050 to be served. The mess halls were entirely too small and their equip- ment totally inadequate. The mess for nurses was in the nurses’ home, and was supervised by a mess officer. The cafeteria plan was employed, and proved very satisfactory. The staff officers’ mess was in the wing with the staff officers’ quarters. The expense of the mess was defrayed by the officers participating. It was in charge of a mess officer and a dietitian. Lavatories and baths were of two types: those in immediate connection with individual wards, and those common to two wards. The latter arrange- ment was unsatisfactory. The necessity for the isolation of various types of communicable disease, and the desirability of a separation of races, rendered such an arrangement unsatisfactory. Lavatories and baths were connected with the main cantonment sewer. The base hospital was heated from a central heating plant the equipment of which consisted of one return tubular, high-pressure boiler (the pressure being from 70 to 90 pounds), and 15 cast-iron sectional low-pressure boilers, with a maximum pressure of 12 pounds. This system was faulty in its incep- tion, installation and operation: the feed water was cold; the condensation from the heating system was wasted, there being no return. The sectional boilers operated at a pressure of 12 pounds or less with a draft suitable for boilers of the return tubular type. To supply heat to the buildings farthest removed from the plant, fires were forced to the absolute limit, so that the breachings to the stack were made red hot, with a consequent loss of heat up the stack. This deserved unquestionable condemnation. During the summer of 1918, this heating system was so altered as to eliminate its faults. Water for the camp supply was taken from the Congaree River at Columbia, pumped first into the sedimentation basin, then through rapid sand filters, with the use of alum as a coagulant, and later through a 16-inch main to a reservoir of a capacity of a million and a half gallons. From this reservoir the hospital water supply was pumped to a 30,000-gallon tank on Jones Hill, from which it flowed, by gravity, to the hospital buildings adjoining. The hot water was supplied from the central heating plant. 45269°— 23 44 690 MILITARY HOSPITALS IN THE UNITED STATES. The hospital area had a gravity flow sewerage system. The sewage was treated by means of a specially designed Imhoff septic tank. All hospital buildings, except the convalescent camp, were connected to this sewerage system. The water-closets, urinals, utensil hoppers, shower and tub baths, were grouped in compartments at one end of the ward, and were generally clean, efficient, and inoffensive. Garbage from the kitchen was separated into four classes: (a) Bones, fats, and grease; (b) other kitchen waste (drained); (c) tin cans; and id) paper, rope, twine, and bottles. The hospital kitchen waste was disposed of as follows: Each kitchen was provided with eight garbage cans for handling the material. The waste classed as (a) and ( b ) was disposed of by a contractor, who removed it each day, using it as food for animals and for by-products. The waste classed as (c) and ( d ) was incinerated at the camp. Other waste, such as soiled dressings, sputum cups, etc., as well as tea leaves, coffee grounds, and other combustible material, was disposed of in a small incinerator near the reservoir. While no animals were stabled around the hospital, the droppings from the animals used by the contractors accumulated at various points on the hos- pital grounds, proving, with the advent of warm weather, ideal breeding places for myriads of flies. These fly-breeding spots were eliminated in time. When the hospital was turned over to the Medical Department by the contractors, many minor faults of installation were found in the lighting system, but these were all corrected. Extensions were made as needed, and the light- ing system eventually became satisfactory. The lines, however, were heavily loaded, owing to the large number of new buildings, and to the fact that the hospital area was supplied from the same circuit as the camp laundry, where the use of current was heavy. The building designed for the purpose of a hospital laundry was never utilized in this manner, but was used for a detachment mess, because of the need of quarters. The hospital laundry was sent weekly to the camp laundry, and on its return was stored in a warehouse of the base hospital, until reissued to the wards. The patients’ wearing apparel, shirts, underwear, socks, and handkerchiefs, were sent daily to the camp laundry as individual bundles. These bundles were returned, clean, in 24 hours, and were given to the patients upon their discharge from the hospital. The hospital chapel was first occupied by the Young Men’s Christian Association, February 1, 1918, in lieu of a building of their own, and under their auspices entertainments and religious services were conducted there. The chaplain, who arrived February 18, alternated services, morning and evening, with the representative of the Young Men’s Christian Association. At times services were held by representatives of Baptist, Lutheran, Episcopal, Methodist, and Catholic churches. In May, 1918, this building was made the detachment supply office, a new chapel being erected, in a better location. The base hospital treated all cases arising in Camp Jackson, and medical, surgical, and venereal diseases from overseas. When the hospital was opened to receive patients (Oct. 22, 1917), the only medical supplies on hand were parts of the first Wolfe unit received. This was completed in about three weeks, and was later increased to accom- modate a capacity of 1,000 beds. In a short time epidemics began to appear, and the arrival of the necessary supplies to take care of the rapidly increasing OTHER BASE HOSPITALS. 691 number of patients was very slow. This was due, principally, to the freight congestion on all railroads. On June 1, 1918, the capacity of the hospital was 2,398 beds, and the medical supplies on hand or requisitioned were sufficient to meet the needs. The base hospital post exchange was started in October, 1917, on credit. After the declaration of the dividend in May, 1918, the exchange was worth approximately $6,000. The Young Men’s Christian Association used the chapel until May 12, 1918, when its own building was ready for occupancy. The Red Cross had a building for supplies and offices, and another for an office, a cafeteria, recreation, and for the accommodation of relatives visiting patients. It also erected a nurses’ recreation house. The society was helpful to soldiers in many directions. In addition to the recreations furnished by the Young Men’s Christian Association and the Red Cross, there was an elaborate set of bowling alleys, conveniently situated, and operated without charge, by the hospital. There was also an extensive athletic field with a baseball diamond, tennis courts, a ru nnin g track, and a boxing arena. Reading matter was provided for the entire personnel, a special library being arranged for the tuberculosis patients. Music was furnished by civilian singers, the camp band, and phonographs. Games were generally provided, and a moving-picture machine was installed. In July, 1919, the base hospital reverted to the status of camp hospital. Statistical data, United States Army Base Hospital, Camp Jackson, Columbia, S. C., from October, 1917, to July 16, 1919, inclusive .“ SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to bo accounted for. Completed eases. Remaining. Aggregate number of days lost from sickness. d c3 O g o £ From other sources. >> "3 d o d © d H 3 © £ d © s 'S o . ©id © 5 d © © Q ft • © 2 d^ fcJ0° 5 o 81s — 1 ~ Q a o 3 'did g >> « 3 ^ o a 3 o co "c3 d w © o tA x 8 a — 2 o d o ©d 'g 8 o ^ A +» O a <3 . >■ ^ © 1 © ,g O 3 *P< o M © c3 3 > p © © P3 'd 2 >- © — tL-X c3 "3 8 © © x S © £ © © jjf 3 W 3 o g tZ ci & © 5 S ci w c -1 o c/5 73 r -j ft £ o cLT, V. © 9^ c -1 o or? f § © '" H 3 • &|S B © Cl. missions. From other sources. By trans- fer. Otherwise. 1917. i 0 21 6 269 137 267 1,286 9 1918. January. ......... 696 2,010 ii 964 1,552 March,. I.... 987 1, 754 i9 856 May.... ..... 637 2,326 1,234 1,636 1,089 1,714 1, 174 2 , 435 l\ 101 5 , 206 October.......... S' 346 3,688 November l' 138 1,566 17 December '887 1,611 428 1919. January 1,163 1,407 965 28 February 1,283 538 525 197 March. 1,169 5S3 4S7 137 April 1, 149 661 509 72 May 805 808 524 62 June. 760 732 3 35 Completed eases. 1 03 2 '3 O EH Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. 1 1 21 13 2 412 139 3 3 1,562 844 7 2,717 1,721 25 1 6 2, 516 1,508 20 1 2,760 1,881 22 1 2,313 1,437 18 1 1 10 9 2,953 1,704 13 2 10 2,870 1,712 7 2 1 9 45 5 2, 803 1, 575 10 11 1 30 2 3,609 2,359 11 47 22 69 6,307 2, 7S2 53 64 1 12 49 7, 034 3,804 61 2 1,247 28 2,721 1,709 23 69 7 19 7 2, 926 1,625 17 49 11 19 39 3,566 2,117 19 26 3 36 82 2, 543 1,069 5 9 4 60 221 2, 376 1,030 6 13 96 82 2, 391 1,396 5 16 5 104 60 2 , 199 1,243 5 20 10 112 49 1,530 885 3 7 143 26 Remaining. Aggregate number of days lost from sickness. 6 267 696 18 3,056 6,095 961 987 856 837 1,234 1,089 1, 171 1,101 3,346 1,138 887 1,166 23,308 26,434 29, 977 26, 638 32, 571 35, 265 32, 02S 36, 327 46,446 64, 820 28, 557 28, 255 1,283 1,169 1, 149 805 760 466 39, 687 34, 416 34,683 27, S26 26,269 18,648 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1917. September. 31 1 32 196 196 October... 31 1 32 196 196 Noyember 42 1 43 315 December 42 1 43 315 315 27 a Compiled from monthly returns, and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section^Adjutant General's Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 732 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Base Hospital, Camp Meade, Md., from September, 1917, to June, 1919, inclusive — Continued. PERSONNEL ON DUTY— Continued. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps." Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M.C., etc.). Total. Nurses. 1918. January 65 2 2 69 372 17 3S9 72 February 71 2 2 75 390 17 407 92 March 86 4 2 92 453 19 472 104 April 96 2 2 100 470 20 490 106 May 99 2 2 103 473 20 49.3 144 June 93 2 3 9S 479 IS 497 134 July 79 3 2 84 461 19 480 145 August 75 4 1 80 49S 20 518 137 September 71 4 1 76 729 17 746 1.54 October 89 5 1 95 721 17 73S 221 November 85 6 2 93 690 20 710 214 December 70 5 1 76 636 18 654 111 1919. January 58 6 1 65 629 16 645 104 February 61 S 5 74 630 14 644 109 March 62 8 8 78 584 13 597 117 April 51 8 9 68 52S 11 539 110 May 37 8 10 00 444 7 451 102 June 33 8 9 50 395 G 401 05 BASE HOSPITAL, CAMP PIKE, ARK.“ The base hospital at Camp Pike was located at the northern end of the cantonment 8.79 miles from the city of Little Rock, Ark. The terrain of the region possesses a rolling wooded surface with a sandy loam soil. During the dry season there is much high-flying dust; and after rain, mud of sticky consistency is present. The spring and fall months are delightful in character, the days being clear and brilliant, with moderate breezes. The summer months, especially August and September, are very hot and dry, the thermometer in the sun frequently registering as high as 110° F. Room temperature during this season averages between 80° and 90°. The winter months are for the most part clear and moderately cold, with frequent cold rains and mist and rarely snow. During the spring and early summer months there are electrical storms of great severity. The roads about the base hospital were of sand and gravel, with an oil binder; and though the hospital site was much exposed to wind, being the highest point in camp, there was little dust because of the improved condition of the roads and drill fields, the latter having been oiled. The wooded surroundings also helped in preventing what dust there was from reaching the hospital buildings. The sanitary condition of the hospital neighborhood was good. It was improved by a system of drainage which handled the sudden and heavy rain- fall adequately. The base hospital was organized on September 27, 1917. L T ntil that time, from about August 11, 1917, Regimental Infirmary No. 1 was used for base hospital purposes. During the construction period, employees of the con- a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Pike, Ark.”, by Col. L. A. Fuller, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compila- tion of the history comprised official reports from the various divisions of the hospital. The history is on file in the His- torical Division, Surgeon General’s Office, Washington, D. C. — Ed. OTHER BASE HOSPITALS. 733 tractors who were sick or injured were treated in the same building. A few accident cases were sent to the hospital at Fort Logan II. Roots. The first occupation and opening of the hospital may be dated on September 27, 1917. The plan and the distribution of the hospital buildings followed the standard plan of the War Department. Officers’ quarters originally consisted of three buildings. These proved inadequate and necessitated the assignment of officers to various parts of the hospital for sleeping quarters, at times. Later, by the addition of wings, the officers’ quarters were made entirely adequate. Originally the nurses were assigned two buildings, and for a while it was necessary to furnish them with a ward, for use as a dormitory. Four additional buildings were constructed for nurses’ quarters, which, with the original build- ings, furnished adequate housing facilities for the nurses. There never was adequate dormitory space for the detachment, Medical Department, in spite of the additional construction of two barracks. The situation was ameliorated by the use of two vacant two-story wards, but as the hospital population grew these wards had to be given up, and tents were utilized. Upon the opening of the hospital, officers, nurses, and the enlisted personnel were all messed in the general mess. No provisions had been made for a mess hall for officers until the erection of a separate wing on one of the sets of officers’ quarters had been effected. Later, a new mess hall was authorized in connec- tion with the additional quarters constructed. The new mess hall had a capac- ity for seating at least 150. For a while the nurses’ mess was operated in the first nurses’ quarters to be constructed. The mess hall was very small, and the cafeteria plan of feeding had to be adopted to obviate having three or four sittings. A new mess hall was about to be constructed when the armistice was signed, which placed a halt on all construction work. As with the officers and the nurses, the mess hall for the patients proved inadequate in size. The general kitchen and the diet kitchen were enlarged and remodeled, and the general mess hall was considerably enlarged. The equipment for the general mess was made more modem, and many additions were made to it. Thereafter no difficulty was experienced in its operation. The mess for the officer patients, located in the officers’ ward, satisfactorily answered all purposes. The mess for the detachment, Medical Department, was situated in one of the group of barrack buildings provided for the enlisted personnel. At first, entirely inadequate, it was made satisfactory by the enlargement of the kitchen, and the conversion of an adjoining barracks into a mess hall. There were four storehouses, two with shelves and two without, in the medical supply depot. They were steam heated, electric lighted, and protected by heavy iron-wire mesh over windows. The supply officer had his office in building No. 1. It was necessary to turn over one of these buildings to the quartermaster of the base hospital for his supplies. The remaining three buildings constituted the medical supply depot for Camp Pike, and in them were stored all medical, dental, and veterinary supplies for the camp and for the base hospital. The steam railroad from Little Rock to the base hospital ran by these storehouses and was convenient for loading and unloading supplies. 734 MILITARY HOSPITALS IN THE UNITED STATES. A laundry building was erected, but it was not equipped. It was used principally for the disinfection of clothing, bedding, etc., by means of a steam sterilizer. The laundry of the hospital was done in Little Rock. The chapel was opened the latter part of November. It was put in use at once for religious services. It was also used in the evenings for the instruc- tion of officers and noncommissioned officers, and to some extent for the instruction of nurses. The hospital water supply was the same as that used in tne city of Little Rock, Ark., and in the cantonment. The water was pumped from the Arkansas River and was chlorinated. A water-carriage system for the removal of the sewage was in use in con- nection with the general system of the cantonment. The sewage from the whole cantonment was treated in a septic tank. The various latrines, toilets, showers, and sinks were connected with a vitrified clay pipe sewer forming part of the general system. It was necessary at times to use latrines, which were systematically tilled in and abandoned as soon as their use could be discontinued. A small amount of hospital garbage and waste was incinerated. Kitchen garbage was removed by the contractor for the cantonment. Manure from the hospital farm was carted away. Originally the hospital was heated by a central low-pressure steam plant. During the first winter the heat radiation was very unsatisfactory; the boiler capacity was none too large; scale and other substances choked the disk or seat, causing the return pipes and even the radiators to fill with water of condensa- tion, at times giving rise during the coldest weather to freezing of the contents and a consequent bursting of the equipment. These defects were remedied by the provision of more boiler space and a high-pressure system. The steam and hot-water pipes were carried above ground on A frames of wood, and all the pipes were insulated. The hospital was lighted by an electric current furnished by the Little Rock Railway & Electric Co., of Little Rock, a 13,000-volt line running to the substation at the corner of Twelfth and South Boulevard in the canton- ment, and thence a 2,300-volt line to the base hospital, a 110 to 220 volt distri- bution being made to the hospital buildings. The equipment of the hospital in the early days of its organization was that of a unit of 500 beds complete. This equipment steadily increased in nearly every particular and ultimately became adequate for the official bed capacity of 2,220 beds. The post exchange was established on September 20, 1917, supplies being obtained on credit. The exchange was at first a branch of the division exchange. Afterwards, for some months, it led an independent existence. About January 15, 191S, it again became a branch of the division exchange. From the start the exchange had a prosperous existence. The surplus accumulated amounted to more than $28,973.75, and monthly sales eventually averaged $14,000. The Young Men’s Christian Association, popularly known as Base Hospital Y, continued in service throughout the existence of the hospital, except during the influenza epidemic, when it was closed and turned over to the base hospital authorities for use as barracks for additional enlisted men. The 1 secretaries OTHER BASE HOSPITALS. 735 performed many duties in addition to that of furnishing amusement to the soldier. Among these duties were letter writing, educational work, and the supervision of athletic contests. During the influenza epidemic the staff vol- unteered their services to the commanding officer of the hospital, and they were of great help in meeting relatives of sick soldiers, acting as guides, performing religious services for the dying or those seriously ill, and in locating chaplains of any faith as requested by the individual soldier. Three Red Cross buildings were eventually in active use. The first one constructed was situated near the railroad tracks at the base hospital and was called the rest cottage. It was designed to serve the relatives and friends of sick soldiers and functioned admirably in this respect. The second building, known as the “ convalescent house,” served the convalescent soldiers. It furnished reading material, the base hospital library being situated there, and also housed various entertainments for the soldiers in hospital. The third was a clubhouse for nurses, furnishing a social center for them. Programs arranged by the Red Cross and the Young Men’s Christian Asso- ciation furnished almost nightly entertainment for all. The enlisted personnel of the base hospital maintained baseball and football teams and a field was supplied for their use. There was a tennis court for officers, which was very popular. Statistical data, United States Army Base Hospital, Camp Pike, Little Rock, Ark., from September, 1917 , to June, 1919, inclusive . a SICK AND WOUNDED. Year and month. 1 Remaininer from last 1 Admissions. Total to be accounted for . Completed cases. Remaining. Aggregate number of days lost from sickness. C c O £ c £ From other sources. >> 0 T3 a> P t- a> & T3 a> 5 0 . 5b £ <3 O 5 'd a? s 0 'o* • O' q ^ P 03 0 £■§ • -4 s— c Q Si — d II § I S O OT T5 C~ 2 0 ■ 2-5 < n r° 0 aj-d QJ $ 0 t_. OJ Xi O c £ ctober 710 2,331 3 3,044 959 1,745 '884 2, 629 1 , 713 December '446 714 43 9 1,212 587 1919. January 471 661 112 1 1,245 691 February 394 353 109 856 460 March 229 423 342 994 598 April 290 694 9 9 1,002 693 May 283 584 4 10 SSI 658 June 188 168 1 11 36S 154 Completed cases. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. Remaining. days lost from sickness. Hospital. © c oi 2 132 412 4 3 442 10,938 8 9 1 1 1,230 11 27,375 133 49 7 4 1 S6 943 16 32,118 322 13 1 2 217 1,096 3.112 320 11 4 1 1,024 30', 0S0 200 12 39 1 7 341 82 S 11 27,946 209 10 52 2 2 299 804 28, 079 8 29 1 1 163 680 4 22, 621 213 1 20 13 158 635 21,527 6 35 28 166 90S 3 22,051 43 7 21 370 1,513 8 37, 283 12 18 12 619 '70S 2 34.761 247 14 14 312 1,734 11 29j3S9 159 41 4 13 412 '446 32j 652 2S0 4 1 9 140 467 4 14.573 235 8 1 9 142 391 3 13.706 144 160 227 o Sj 776 101 1 9S 289 1 9.046 2 6 18 283 9,469 3 17 1SS 8,686 1 76 14 123 4.612 Aggregate CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. 1917. September 15 15 October 15 15 November 25 25 December 25 25 1918. January 20 20 February 20 20 March. .'. 32 32 April 60 2 62 May 38 3S June 20 13 33 July 4 11 15 August 4 11 15 Year and month. Men. Women. Chil- dren. Total. 191S. 8 11 19 4 19 23 1919. 4 19 4 11 15 3 11 14 3 s u 3 6 9 1 5 6 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adju- tant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER BASE HOSPITALS. 753 Statistical data, United States Army Base Hospital, Camp Shelby, Hattiesburg, Miss., from September, 1917 , to June, 1919, inclusive — -Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Civilian em- ployees. Medical Corps. Sanitary Corps. Miscella- neous. (Q.M.C., etc.). Total. Medical Depart- ment. Miscella- neous. (Q. M. C., etc.). Total. 1917. 52 2 1 55 127 127 3 3 October 50 4 1 55 138 138 32 1 40 7 1 48 216 216 64 1 December 45 6 1 52 219 219 70 2 1918. January 50 3 1 54 216 216 71 February 58 3 1 62 216 216 88 March 73 4 1 78 293 293 91 April 85 3 1 89 493 20 513 132 Mav 97 2 1 100 491 20 511 117 June 89 3 1 93 492 20 512 119 July 84 4 1 89 489 20 509 130 August 79 3 1 83 483 20 503 131 September 73 3 1 77 474 20 494 149 October 87 3 1 91 481 19 500 145 November 73 3 1 77 473 18 491 120 December 62 5 3 70 478 20 498 125 1919. January 47 5 3 55 470 17 487 106 February 42 4 3 49 344 17 361 65 March... 35 4 3 42 286 13 299 48 April 27 3 2 32 260 12 272 49 May 23 3 2 28 229 7 236 46 June 17 2 4 23 126 1 127 20 BASE HOSPITAL, CAMP SHERIDAN, ALA.a The base hospital of Camp Sheridan was located in Montgomery County, Ala., about 5 miles northeast of the city of Montgomery. The terrain of this region is a slightly rolling open country. It is well watered, and is recognized as good farming land. The soil is a sandy loam, cover- ing a deep clay substratum, and there are areas of gravel along the banks of an adjacent creek just to the northeast of the hospital site. In hot, dry weather there is a great deal of dust but, inasmuch as the hospital was situated 2 miles from the military camp, off the line of autobuses, and beside a road that was traveled mainly by vehicles in business association with the institution, the hospital did not suffer seriously from clouds of dust such as occasionally visited the camp. Rams in this region are very heavy, sometimes torrential in character, but the fields do not become very muddy, and the water is absorbed or carried off so rapidly that walking over the ground is possible within a few hours after. The climate might well be considered ideal for a military post. The United States Weather Bureau has compiled the statistics of meteorological conditions for the past 45 years, between 1872 and 1916, and these show that the average mean temperature for the spring months (March, April, and May) is 65.6° F. ; for the summer months, 80.8°; for autumn, 65.8°; and for the winter months, a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Sheridan, Ala.,” by Maj. Henry O. Reik, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s 0 ffice, Washington, D. C. — Ed. 45269°— 23 48 754 MILITARY HOSPITALS IN THE UNITED STATES. 49.5°; which makes the average annual temperature 65.5° F. During the year 1916, the latest for which published figures are available, the extremes of temperature were as follows: Highest, 99° on May 27; lowest, 21° on February 3. There was no snow that year and the same held true for the winter follow- ing. The rainfall, however, amounted to a total of 46 inches, with 5.73 inches as the greatest fall within 24 hours; that occurring July 6 and 7. Sunshine existed in 63 per cent of the possible number of hours. In the course of the year there were 62 thunderstorms, 30 of these occurring during the months of June and July, while October and November were the only months entirely free of this phenomenon. High winds are unusual, the average velocity for the year 1917-18 being 6.6 miles per hour; only once during the year did the extreme velocity exceed 36 miles. In the spring and summer months the pre- vailing winds are west to southwest, and in the fall and winter months north- west to north. The roads in and about the hospital reservation were excellent, being con- structed of a sand-clay base with a gravel-t-op dressing. The buildings occupied the high ground to the east of Lomax Creek, a tribu- tary of the Alabama River, while to the eastward spread out a rolling plateau for a distance of 4 miles, to the Tallapoosa River, this region being intersected by many small branches and creeks flowing northward into one or the other of the above-named rivers. The main road from the city, or the camp, crossed Lomax Creek by a concrete bridge, 75 feet long, with an arch 30 feet above the water. The stream at this point was some 30 feet wide and quite shallow, not exceeding 3 feet deep in its central pools. On each side of the creek there was a strip of wooded swamp which was properly drained and prepared against mosquito development. The outflowing water from the hospital's septic-tank sewage plant emptied into the creek just below this bridge. There were no near-by farmhouses, none within a mile and a half to the west, south, or east, and those to the northeast were upon land that necessarily drained into the streams flowing away from the hospital district. The base hospital was organized by the commanding officer reporting for duty August 15, 1917, in compliance with Special Orders, No. 176 (par. 10S), W. D., July 13, 1917. On August 21 the general plan of grounds for the base hospital were staked out, and the work of grading same started on August 25. There were present for duty in the beginning the commanding officer, a supply officer, one sergeant, first class, Medical Department, and three sergeants, Med- ical Department. Quartermaster’s warehouse No. 6 was, by permission of the camp quarter- master, first occupied as an office for the base hospital and for a medical supply depot. On September 13, 1917, the infirmary of the 74th Brigade was turned over to the base hospital for temporary quarters and on October 9 removal was made to the present hospital; the administration building, one structure for officers’ quarters and six hospital wards being then sufficiently advanced for occupancy. The construction of the hospital had been sufficiently advanced by October 9, 1917, to permit the use of the administration buildings and six wards. From this date the organization of the institution may be said to have begun. Con- struction was subsequently pushed, and within a comparatively short time OTHER BASE HOSPITALS. 755 all of the buildings originally planned for had been completed. As constructed, the hospital groups covered an area of 40 acres. Its pavilions, arranged on the standard plan for base hospital, ran east and west, which limited the ex- posure of their walls to the sun’s rays practically to the southern side. There were 25 wards originally constructed; but, to increase the capacity of the hos- pital, six two-story ward barracks were provided during the early part of 1918. In the same year an extension was made to the laboratory building, almost doubling its capacity; and a head surgery building was erected, with special clinic rooms for ophthalmology, otolaryngology, and dentistry. The ward additions made a total authorized bed capacity of 1,310. The officers’ and nurses’ quarters were frame buildings of the simplest form of construction — buildings 25 by 100 feet, with a central hall running lengthwise, and the small rooms (10 by 10 feet) opening off either side. Near the center, one room was fitted with toilet facilities and one for bathing pur- poses. The enlisted men occupied barracks constructed in much the same manner save that they were in the form of a dormitory instead of having separate rooms. There were three large kitchens and mess halls. The largest, situated nearly in the center of the hospital quadrangle, was for the patients and the enlisted personnel. The others were for the officers and the nurses in their respective quarters. All were well equipped with the essential apparatus. Five warehouse buildings were used for the storage and issue of supplies; one was the camp medical supply depot, one the hospital medical supply depot, one the hospital quartermaster’s supply station, and two were general store- houses, one of these being used in part as a carpenter shop. A separate building at the south end of the grounds was provided for a laundry, but it was not equipped for work, and it was used solely as a sorting room, all the linen being sent to the city laundries. In the early days of the organization there was, quite naturally, consider- able delay in securing satisfactory equipment, and the work had to be done under many difficulties. The surgical department suffered perhaps more from this than did the medical. The operating pavilion was not started until after most of the wards had been completed, and even then there was a long delay in procuring the necessary furniture and supplies and, especially, in installing the steam sterilizers. Pending that, all of the surgical work was performed in the city; all surgical cases being transported to St. Margaret’s Hospital, where every facility was placed at the disposal of the Army surgeons. Ultimately, the equipment of the hospital was almost perfect, and the most complicated and technical surgical procedures could have been under- taken 'with the same assurance of success as would attend similar operations in civil hospitals. At first some of the surgeons had to rely upon instruments of their own, fortunately brought along, but this condition rapidly became corrected by requisition. The water supply for both the hospital and the camp was obtained from the general supply of Montgomery City through the medium of a special pipe line. The origin of this water was a series of artesian wells, and it was so pure that neither filtration nor any form of sedimentation was necessary. 756 MILITARY HOSPITALS IK THE UKITED STATES. In the early days of the hospital regulation Army latrines were used, but these were all disposed of, and all wards and nearly all the other buildings were equipped with water-closets connecting with underground sewer pipes that con- veyed the sewage to a large septic tank located on the bank of the creek about 100 yards to the west of the hospital. No animals being kept at the hospital, manure disposal was not a prob- lem. Kitchen waste and general garbage were destroyed in open-air in- cinerators. Each of the officers’ quarters, nurses’ quarters, and ward buildings was supplied with a lavatory and bathroom, provided with hot and cold water, the heating being done by a stove installed in a shed outside each building. It was unfortunate that no central heating plant was established. In the wards a large soft-coal burning furnace was located in the central part of the room. In quarters and in the smaller buildings reliance was placed upon small egg-shaped stoves, also burning soft coal. Naturally, the heating was imperfect and irregular, an inordinate amount of service attention was required, great waste was a necessary evil, and fire risk was beyond exaggeration. January 18, 19 IS, fire broke out in the officers’ quarters at 5 p. m., causing an estimated loss of $1,000, beside the heavy personal losses of those resident in that building. February 11, 1918, fire in ward 41, at 11.45 a. m., caused an estimated loss of $750. An efficient volunteer fire department, and the fact that both fires occurred during the daytime, were all that prevented serious catastrophes. The lighting of the hospital was by electricity furnished from the Mont- gomery Electric Light & Power Co. The service was both efficient and cheap. In fact, the rate, 54 cents a kilowatt hour, was considered exception- ally low. Montgomery enjoyed this rate by virtue of the fact that the electricity could be made by water power from the Alabama River. In consequence, the lighting of the hospital buildings, corridors, and grounds was very satisfactory. The chaplain of the old 2nd Ohio was attached for special duty to the base hospital on November 8, 1917. The following Sunday, November 11, religious services were held. As the little building designated “the chapel ’ was so distantly related to the main part of the hospital, it was decided to use one of the rooms in the receiving ward, which was much more convenient, as the place of worship. The hospital post exchange opened September 5, 1917, in an unused camp mess hall. When the new hospital was opened a special exchange building was provided, and here, in addition to the store, a barber shop, tailoring shop, and the post office were established. The exchange was well patronized and considerable profit was derived from it, which was periodically invested to the benefit of the enlisted men of the hospital. There was no Young Men’s Christian Association building at the hospital, but representatives of the organization provided entertainment for the patients and personnel, making use of the patients’ mess hall and Red Cross convalescent building. The American Red Cross constructed a handsome building for its activities and a recreation building for the nurses. OTHER BASE HOSPITALS. Y5 7 During the early weeks of the base hospital’s existence no, or at best but sporadic, attempts were made to furnish diversion and amusement for the sick and injured. The hospital itself was far from being completed and the energies of everyone were bent in that direction. In November the 1st and 7th Ohio Regiments were absorbed by the 147th Infantry, leaving their bands unattached. One of these bands was secured by the hospital and detailed there by order of the division commander. This was the band of the former 1st Ohio Infantry, Cin- cinnati. The members, being quartered in one of the old barracks, entered into their new duties with enthusiasm and in a short time converted the band from a marching body into a concert organization. Concerts were given daily in the quadrangle between the operating pavilion and the patients’ mess hall. Later, when the weather became cooler, the concerts were held Tuesday evenings in the temporary chapel. Soon the townspeople began to show an interest and the concerts were augmented by vocal and instrumental solo selections, to which the faculty of the Women’s College lent no little aid. On Sunday afternoons at 2 o’clock the band held open-air concerts in front of the hospital. Statistical data, United States Army Base Hospital, Camp Sheridan, Montgomery, Ala., from August, 1917, to May 15, 1919, inclusive, a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for . Completed cases. Remaining. Aggregate number of days lost from sickness. T5 a o3 a a o o a o £ From other sources. "3 O © a a © P$ © s ^3 o . aa t- ft a a .a o c/3 S © © © ft ft • * ft © £ ^ © © o ££> a c3 o ft £ C/3 03 •— < u< A a sn "©^ C/3 © 03 © a § a w S o 'd ft £ g © ^ © 1° *3 O ©'d C/3 © © ^ o a o3 • t- s- © 1 © £ o *3 ’ft C/3 o H C/3 © Hi a c3 ’ft C/3 o w C/3 © Ui 03 a O* 1917. August i 1 i 1 101 105 207 96 1 106 4 1,284 187 October 110 518 65 2 695 363 2 l 1 325 3 6 , 466 87 328 826 25 2 1,181 810 2 6 3 360 12, 230 December 360 806 16 1 1,183 835 3 9 2 334 10; 439 1918. 334 1,728 33 1 2,096 1,410 13 673 17, 129 February 673 847 1 1,521 978 14 7 i 12 509 15, 331 March.. I 509 863 8 3 1,383 870 7 3 6 497 18, 147 April 497 2, 021 6 6 2,530 2,002 7 2 5 514 20, 577 May 514 777 3 3 1,297 827 3 10 2 13, 677 June 700 7 7 1, 169 590 3 12 6 558 15, 202 July 558 507 10 7 1,082 508 4 22 15 533 15' 722 August 533 1,120 19 19 1,691 754 3 6 1 4 18 905 23' 474 September 905 1,240 30 17 2,192 962 4 lJ 1 4 104 1, 103 28, 294 October 1,103 4,732 88 5, 923 4,655 146 5 2 2 49 1 064 60, 100 November 1,064 690 12 6 1,772 1, 130 26 10 46 560 23,921 December 560 623 78 4 1,265 729 9 6 2 1 3 41 474 16,633 1919. January 474 489 115 18 1,096 776 4 1 6 15 287 12 966 February 287 212 127 5 631 389 1 4 9 11 217 March 217 53 16 352 189 7 117 31 2 001 April 5 10 1 1 17 14 1 2 May 2 2 2 2 8 1 1 3 47 3 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 758 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Base Hospital, Camp Sheridan, Montgomery, Ala., from August, 1917, to May 15, 1919, inclusive — Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1917. September 40 2 2 44 127 127 October 32 2 1 35 129 129 November 28 2 1 31 287 287 December 28 3 1 32 284 284 26 1918. January 35 4 1 40 275 275 February 39 4 1 44 323 15 338 62 March 38 5 1 44 325 16 341 91 April 40 4 2 46 347 16 363 92 May 41 5 1 47 318 16 334 92 June 36 3 1 40 336 15 351 88 July 34 1 1 36 464 14 478 100 August 30 1 1 32 424 16 440 76 September 23 3 1 27 429 13 442 85 October 31 3 1 35 426 13 439 88 November 33 3 1 37 435 12 447 89 December 32 6 1 39 477 12 489 77 1919. January 30 6 1 37 591 12 603 72 February 23 6 1 30 421 9 430 66 March 6 5 11 36 36 18 April 5 5 10 37 37 6 May 4 2 6 20 20 6 BASE HOSPITAL, CAMP SHERMAN, CHILLICOTHE, OHIO.« The hospital group was about 3 miles from the center of the town of Chillicothe (15,000 inhabitants, 1915), Ross County, Ohio, and 54 miles from Columbus, the capital of the State. The choice of a site upon which to build Camp Sherman, and with it the base hospital group, was influenced by the fact that it is an historic military spot. In this region, then a part of the old Northwest Territory, a detention camp was established for British prisoners of the War of 1S12; and it is an interesting commentary on that fact that some of their descendants assisted in the erection of the buildings and in preparing the grounds of the hospital. Moreover, a portion of the camp site was occupied in the early days by an old Indian stockade, used for camping and war purposes by the aborigines. The Scioto Valley, in which the base hospital was situated, although not far from the Kentucky line, is usually quite cold in winter; the thermometer in January and February often reaches zero, Fahrenheit, or below it, and there is generally plenty of snow during these months. The summers are sometimes quite hot. The hospital buildings were erected facing the Frankfort Pike, between it and the low range of hills that encircle the flat valley plateau on which the camp proper was built. There are scattered groups of trees along the highways and on the hills. a The statements of fact appearing herein are based o n the “ History, Base Hospital, Camp Sherman, Ohio,” by Lieut. Col. Casey A. W ood, M. C., U. S. A. , while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. OTHER BASE HOSPITALS. 759 The soil (cultivated farm land) is a sandy gravel covered by a layer of gumbo clay of varying thickness. Water-smoothed, small-sized gravel, con- taining very few bowlders and admirably adapted for road building, can almost everywhere be found at a depth of from 3 to 10 feet. The principal objection, from a hospital standpoint, to the site as a cantonment hospital was tills upper- soil deposit of clay, commonly known as gumbo. After rains this stratum is readily converted into an adherent mixture that is easily carried into the hospital buildings, and which, in spite of steel scrapers and other devices, is almost impossible to remove from the footwear. In continued dry weather also the clay forms a fine, impalpable dust which rises in clouds from the dirt roads and filters through the screens of neighboring windows. There are no disagreeable prevailing winds. At first there were few concrete or asphalted roads or streets in or near the hospital. This defect was slowly remedied, however, until in the spring of 191S cindered walks and roads were built all over the site of the hospital The water supply, from artesian wells, was demonstrated to be remarkably clear and bacteria free, but impregnated with iron and lime salts, hence cjuite hard and pleasant to drink, although far from ideal for washing purposes or Fig. 197.— View of Base Hospital, Camp Shennan, CMllicotlie, Ohio. for use in the boilers of the heating plant and laundry, owing to the deposition in them of ferrocalcitic salts. The water supply of the whole camp was obtained from one large dug well and five drilled wells located in the northeastern por- tion of the cantonment property, near the Scioto River. All of these wells secured their supply from an excellent water-bearing gravel stratum at depths varying from 80 to 90 feet from the surface. The dug well was 20 feet in diameter and about 70 feet deep and was cased with steel piling supported by a wood templet or centering. The top of the well was curbed with brick and concrete and provided with a tight wooden cover. Two of the drilled wells were 6 inches and three of them 8 inches in diameter. They were located about 250 feet apart. The water from the wells was pumped by means of motor-driven centrifugal pumps. Four of these pumps were located in the main pumping station and were of sufficient capacity to furnish 750 gallons per minute each against a head of 250 feet. The small centrifugal pumps had a capacity of 400 gallons per minute and pumped the water into a suction well of 25,000 gallons capacity near the pumping station, the suction lines for the main pumps being connected with this well. 760 MILITARY HOSPITALS IN THE UNITED STATES. The water was pumped directly through the distribution system to four 100,000-gallon storage tanks located on a hill northwest of the cantonment. These tanks were constructed of redwood on concrete foundations and were about 220 feet above the water in the wells. There were also two 25,000-gallon tanks located on the hill above the hospital group at the same elevation as the main storage tanks. This additional water supply not only helped, from the ordinary consumption point of view, but it meant more protection in case of lire. The distribution system was made up largely of wood pipe from 6 to 14 inches in size, and extended throughout the cantonment. Hydrants were provided at frequent intervals, and small service pipes were connected with the various lavatories and kitchens. As an additional sanitary precaution a liquid chlorine disinfection device was provided at the pumping station to disinfect the water supply in case of emergency. The main sewerage system of Camp Sherman, of which the hospital system formed a part, consisted of two trunk sewers from 8 to 24 inches in size, one of which was located on each side of the cantonment, discharging into an outfall sewer 30 inches in size. This sewer in turn joined a treatment plant, located along the Baltimore & Ohio Railroad, to an outlet in the main channel of the Scioto River, a small stream that skirted the east boundary of the camp at a point near the outlet of the most northerly sewer for the town of Cliillicothe. Connected with the main trunk sewers was a large number of 6-inch lateral sewers extending to the various lavatories and kitchens throughout the canton- ment. Manholes, located at frequent intervals, were constructed of concrete with wood covers. The sewage was disposed of in two concrete tanks 50 by 150 feet in plan and having a capacity of 500,000 gallons. The effluent from these tanks was treated with liquid chlorine disinfectant solution. This device was located in a separate house adjacent to the tanks and automatically fed into the tank effluent in proportion to the rate of flow through the tanks. The urinals and closets were of the latest and best types of permanent construction; they emptied into the sewerage system just mentioned. Hospital construction at Camp Sherman may be divided into two periods: first, that of camp construction in general, and second, that of readiness for the reception of patients. During the former period the so-called emergency hospital was very useful and served especially the Bentley organization, and was commonly known as the Bentley Hospital. It was, however, inaugurated and controlled bv the Aetna Insurance Co., which had charge of all the insurance of the Bentley employees. This small building was placed at the entrance of the camp, and prominent signs posted all over the cantonment gave instructions to rush all injured men to it. There were generally but a few patients in this small hospital, but it acted as an emergency hospital for the Cliillicothe hospital mainly, and, later, the embryo base hospital. On June 20, 1917, the first contingent of troops (to guard construction work) appeared, when Company D, of the Ohio Engineers, from Cleveland, pitched them tents on the grounds. Shortly after, the commanding officer of the base hospital was selected, and his staff began to arrive at Cliillicothe. At that time the organization consisted of a small group of officers in barracks B-33. The commanding officers’ offices, officers’ mess, and the enlisted men’s mess OTHER BASE HOSPITALS. 761 were all in barracks A-34. With one or two exceptions the officers of the staff slept and had their quarters in barracks B-33. By the end of November, 1917, the staff numbered about 65. The single operating room of the future base hospital was for the time the kitchen of barracks A-34, the second story of the building being given up to ward space. The small number of patients, between 20 and 30, were more than amply provided as to ward masters, nurses, and orderlies by the assign- ment of an ambulance company of 100 men, recruited from Northwestern University and Evanston, 111., and at that time stationed at Fort Sheridan, 111. Tliis fine body of men, with the patients and personnel of the hospital itself, were transferred to the permanent buildings of the base hospital group on the 17th of September, 1917. This portion of the enlisted equipment, with the ex- ception of some half dozen men, subsequently was detached from the hospital service to various other organizations, but especially to the aviation section of the Signal Corps. In addition to these, 21 enlisted men of the Medical Depart- ment of the Regular Army were assigned to the base hospital, of whom 15 were still on the same duty on November 20, 1917. At last the commanding officer decided that the wards of the base hospital were sufficiently finished to permit of their partial use in receiving bedridden patients, so on September 17, 1917, the equipment of the primitive hospital was conveyed by ambulances and automobile lorries to what were later known as wards 9 and 10 of the permanent base hospital, the services being divided into medical and surgical. At the same time the staff officers moved to regular officers’ quarters. In this connection it is to be noted that the original plans of the base hospital provided for two such buildings, one on each side of the house allotted to the commanding officer. However, it was discovered that the site assigned on the plan for the second building was the middle of the high road or pike and so it was not constructed in that locality and not until the following year. In consequence, late arrivals had to be quartered in the officers’ ward and elsewhere. For the 1,000-bed hospital there were buildings for administration, receiving ward, officers’ quarters, officers’ ward, nurses’ quarters, operating room, X-ray and research laboratory, 32 single wards, 4 isolation wards, kitchen, mess hall, exchange, powerhouse and heating plant, laundry, commissary stores, repair shop, 6 barracks with 2 lavatories, a chapel, mortuary, fire-engine house, garage, and guard house. All of these buildings (65 in number) were built of frame construction. The ward buildings, administration, officers’ and nurses’ quarters, and ex- change had porches. At first there was little privacy and but little chance of improvement, even in permanent officers’ quarters. Before a fortnight had elapsed, however, a remarkable change had taken place in them as well as in all the hospital build- ings. In the early days only wards 9 and 10 were occupied, by all classes of patients, there being at that time no general infectious cases. The dispensary was settled in ward 10. There was, at first, an irregular supply of water, doubt- ful and insufficient lighting, and no heat, except from a scant supply of coal-oil stoves, a few electric heaters, and one or two electric lamps. It was also quite a common occurrence to have the electric light fail during the mess hour or at 762 MILITARY HOSPITALS IN THE UNITED STATES. some other critical period, when those officers who possessed candles became quite popular with their fellows. However, these were only incidents in the game, “all in the day’s work,” and nobody complained either then or after- wards, because it was realized that everyone was doing the best he could and that it was his privilege as well as his duty to help others by being as cheerful and as hopeful as possible. Gradually the necessary equipment was furnished, which, supplemented by private efforts and the loans and purchases of members of the staff, produced a really effective hospital. The number of patients in the permanent hospital on September 17, 1917, was 17; on November 30, 1917, they numbered 811; while on March 31, 1918, the base hospital was caring for 910 patients in all lines of medicine and surgery. The maximum number of patients was 9,736 in October, 1918. This rapid increase in the number of patients was mainly due to transfers from the regi- mental infirmaries. Additional wards were opened and equipped as the exi- gencies of the service demanded, although the equipment was quite scarce and often insufficient, because Government supplies came in slowly. However, in a few weeks the whole 16 wards of the inner hospital group, and finally many of the outer group, were called into requisition, partly because of the natural increase due to the arrival of the draft, partly because of epidemics, such as tonsillitis, cerebrospinal meningitis, pneumonia, and venereal diseases — the latter especially among the colored troops from Oklahoma. Following the modified plan of the base-hospital group, ground was broken for the head surgery hospital at Camp Sherman on September 28, 1917. Per- haps as good an idea as can be formed of the almost marvelous fashion in which the construction and erection of buildings in this camp were carried on is obtain- able from the fact that this special building, with its four operating rooms and their surroundings of special chambers for special work, was practically roughed in and completed in its essentials within a space of 10 days. Although, owing to the difficulties of heating and lighting, it was not utilized until the end of October, yet there was soon established a large and flourishing eye, ear, nose and throat clinic. The reason the laboratories, wards, and operating rooms of the hospital at Camp Sherman were earlier and better equipped than most of the cantonment hospitals lies in the fact that the commanding general, wearying of the continued and persistent excuses which all the medical officers were, of necessity, obliged to offer in explanation of a lack of the implements and appliances needed for their service, and of the constant apologies they were obliged to make not only to the general himself but to visitors and friends, decided upon a radical step. One day he called together the commissioned officers of the base hospital, the chiefs of services and their assistants, and, after telling them that he expected a change in this state of affairs, ordered them to buy at once such instruments and other equipment as would convert the defective hospital into one of the first class. As a result of this order, there were obtained from Columbus, Cincinnati, and other neighboring towns numerous medical and surgical supplies, including a large amount of drugs and other requisites. Four surgical operating rooms received several coats of white enamel paint, numerous pine examination booths were colored a dead black, a few floors were oiled and some of them OTHER BASE HOSPITALS. 763 covered with linoleum of various hues, and windows were decorated with curtains. Unattractive floors were stained, and every necessary appliance that could be had was added to the previous scanty equipment. This emer- gency equipment undoubtedly enabled the medico-military officials of the head surgery building of the base hospital and, to some extent, the heads of other services, to do much effective work that would have been impossible or fur- ther postponed until the necessarily tardy arrival of the Government outfit. Hospital storehouses were four in number. Three were for medical supplies and one for quartermaster supplies. The buildings were 150 feet long and 24 feet wide, with heat and light. Medical supplies for the canton- ment hospital and the organizations of the division, as well as the veterinary and dental supplies for the division, were all kept in these buildings. Hospital linen was washed at Washington Court House, Ohio, until November 6, 1917, when the camp laundry took over the work; but it was not entirely satisfactory. The chapel at Camp Sherman base hospital was used for religious purposes; just as frequently, however, it was put to such secular uses as lectures, con- ferences, and instruction classes of various kinds. Here the clinical society of the hospital first met. Kitchen wastes were divided into four classes, sorted and sold to con- tractors. They consisted of (a) bones and fats; ( b ) other kitchen garbage; (c) cans, bottles, coffee grounds, etc.; (> d p o P © © Ph © s 'B .o . aa a 03 rd s © © © A * a © £ © o d o3 O ft* ■ A 1-4 A .tjj p £ © >, t- CO aJ * © gl EH o 'd’p* 2 S co o> CO •B O ©P w © 5 o fc ft P o d -t - 3 © A © co © rd o *03 'Hh CO o H © f- C3 O' u CO o H -M 03 d 3 2,105 320 ..... 6 54 1,368 4.5,385 1,368 1,203 2,571 1 , 570 28 19 169 " 7S5 36. 838 December 7 7S 5 7 695 508 1,988 1,291 30 2 59 606 23.434 1919. January 606 S23 1,581 315 3,325 1,585 14 31 611 1,084 34.211 February 1,0S4 879 444 2, 9S4 1, 14S 12 39 37 1,194 34. 167 March... 1 , 194 1,093 335 456 3 7 07S 1364 21 59 52 425 1, 157 27. 104 April l' 157 858 866 155 279 2, 457 1, 134 6 41 104 314 S5S 20 , 790 May 1, 155 333 253 2 599 1 193 10 37 331 972 2>. 2.58 972 576 177 294 2*019 932 3 36 95 230 723 17,456 July 723 396 S6 35 1,240 493 1 19 660 67 $.519 ® Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General ’s Office, and monthly, statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER BASE HOSPITALS, 775 Statistical data, United States Army Base Hospital, Camp Upton, N. Y., from September, 1917, to July 18, 1919, inclusive — Continued. CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1917. 191 S. 68 22 31 121 September 10 21 31 68 25 38 131 30 30 32 14 6 52 30 30 28 28 1918. January 45 9 6 60 1919. 87 12 8 107 82 82 90 10 6 106 82 82 115 37 10 162 March. .1 103 103 85 12 8 105 April 103 103 97 25 10 132 May 99 99 18 17 35 99 99 10 21 31 July 49 49 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M. C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q. M. C., etc.). Total. 1917. 41 1 42 146 146 66 1 67 196 196 84 1 85 214 214 i6 92 2 94 325 325 46 1918. January 90 2 92 339 339 February 90 1 91 333 333 96 March 89 1 90 436 17 453 101 113 1 114 519 17 144 May 92 1 93 624 17 641 150 88 1 89 730 17 747 128 July 96 1 1 9S 676 IS 694 152 August 83 2 1 86 597 19 616 140 September 10.5 2 3 no S43 19 862 158 < 'ctober 102 3 2 107 854 IS 872 267 November 99 2 1 102 786 IS SOI 327 December 73 7 2 82 891 16 907 225 1919. January 78 8 2 ss 587 14 601 161 February 72 5 4 SI 589 12 601 138 March 77 8 5 90 640 11 651 132 April 71 6 6 S3 600 7 607 137 May 54 7 7 68 824 2 826 128 June 47 5 8 60 445 1 446 86 July 36 2 4 42 214 3 217 57 BASE HOSPITAL, CAMP WADSWORTH, SPARTANBURG, S. Cfi On the outskirts of Spartanburg, and at a point 19 miles due east of Camp Sevier, the site for Camp Wadsworth was chosen. The physical characteris- tics of the place were much the same as they were at Camp Sevier, for a descrip- tion of which the reader is referred to the historical sketch of the base hospital at Camp Sevier. The portion of the camp which was selected for the site of the base hospital was at its southwest corner. This site was adjacent to the National Highway from Spartanburg, but was farthest removed from the railroads. a Tlie statements of fact appearing herein are based on the “History, Base Hospital, Camp Wadsworth, S. C.,” by Maj. W. Bamdollar, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — £ 'i. 776 MILITARY HOSPITALS IN THE UNITED STATES. Prior to the construction of the hospital, sick of the division, mobilized at Camp Wadsworth, were hospitalized in the field hospitals attached to the division, and the necessary operative surgery was performed in the civil hospitals at Spartanburg by the personnel which had been provided for the base hospital. On September 1, 1917, the officers’ quarters of the base hospital were com- pleted and occupied. On October 8, 1917, the first ward of the hospital group was ready for occupancy. On this date, the base hospital was formally or- ganized and the completed ward was put to use in the care of patients. There- after, so rapidly as the wards were constructed they were utilized, the last one being made available on December 18, 1917. The officers’ quarters when first used had neither water supply nor toilet facilities, and were inadequate for the personnel. Subsequent additions were made and the requisite utilities were supplied. The original nurses’ quarters were, likewise, inadequate; there were accommodations for but 83 nurses. An additional set of nurses’ quarters was provided in which there were 36 bed- rooms, each sufficiently large to accommodate two nurses in an emergency. The mess hall of the original set of nurses’ quarters was used as a dormitory, after the later set of quarters in which there was a larger mess hall had been made available. Six barracks were provided for the enlisted men, Medical Department. The normal capacity of each of these barracks was 40 men. At one time in the history of the hospital there were 400 enlisted men of the Medical Depart- ment, and it was necessary to place 55 of them in each barrack and to house the remainder in the building which had been provided for a laundry. When the two-story ward-barracks were erected, sufficient space in them was taken to provide dormitories for the excess number of enlisted men. At the base hospital six separate messes were conducted. These were the general mess for the enlisted patients, a mess for the isolation wards, an officer patients’ mess, a mess for the detachment Medical Department, a nurses’ mess, and a medical officers’ mess. The general mess was at first inadequate to properly feed the large number of patients in hospital. As at other base hospitals, both increased space and equipment were provided, so that, with the use of the cafeteria style of feeding, it was ultimately possible to prepare food for and to feed, within a reasonably short period of time, 1,500 patients. The medical supply depot, situated on the grounds of the base hospital, consisted of four warehouses, 155 by 25 feet, with two small rooms, 8 by 12 feet, in each building, one at each end. Only one of the buildings was provided with sufficient shelving. There was no shelving in the other buildings. The hospital laundry was handled at the supply depot, where it was exchanged daily for soiled linen from the various departments of the hospital. It was called for and delivered to the agent of the Asheville Laundry Co., who, in turn, delivered it to the express company at Spartanburg, for shipment to Asheville, N. C., where it was laundered and then returned. This process required an average of five days, but it was not possible to get the work done at a place nearer than Asheville. The hospital chapel was first used for religious purposes April 7, 191S. It was thereafter used regularly each week for both the Protestant and Catholic OTHER BASE HOSPITALS. 777 services. It was also used as a hospital library, and frequently as a recreational and amusement hall, and proved to be very popular and helpful to the men of the detachment, and to the patients in the hospital. The water supply of the base hospital was a part of the camp’s water supply which was obtained from Spartanburg. There were two sources for the city’s supply of water, namely, Scully Creek and Lamson Falls. From these moun- tain streams the water was piped to a covered reservoir, H miles from the city, whence it was distributed. The quantity of the water was adequate, and its quality was so good as to require no methods of purification. No sewerage system was originally provided for the hospital. In its absence, pit latrines were used for the disposal of excreta, and surface drainage removed water from the baths. On February 5, 1918, a sewerage system was opened. Connected with the sewerage system there were two septic tanks, one for the main group of hospital buildings and the other for the isolation wards. Until the sewerage system was installed all liquid wastes from the kitchens were evaporated in Guthrie incinerators. Thereafter it was discharged into the sewerage system. Solid garbage was removed by civilian labor. No heating facilities were at first provided for the hospital. After the advent of freezing weather in the fall of 1917, small sheet-iron, wood-burning stoves were installed in the buildings. These stoves proved very unsatis- factory and they were replaced by cast-iron stoves, two for each ward. These cast-iron stoves in time were found to be ineffective and were replaced by an equal number of hot-air furnaces. At the time of the installation of the hot- air furnaces facilities for regulating the ventilation of the wards — to conserve the heat — and beaver-board lining for ceilings and walls were provided. Fol- lowing these improvements the temperature of the wards was more regularly maintained at a comfortable degree. The hospital, in common with the buildings of the camp, was electrically lighted. Current for the lighting system was obtained from a public utility company of Spartanburg. The service was uniformly good. The exchange of the hospital was opened October 8, 1917. Local mer- chants readily extended sufficient credit to permit a small beginning with such things as cigars, cigarettes, and candies. In the spring of 1918 the value of the stock increased to approximately $10,000. A restaurant was opened for a period of about two months and though a splendid paying feature, was closed for lack of sufficient space. A seven-chair barber shop was conducted and there was a shoe and a tailor shop connected with the exchange. The Red Cross conducted a “hospital service” department after February IS, 1918. In May, 1918, their convalescent house was completed and opened. Facilities for the recreation of both patients and personnel at the hospital were provided by the Red Cross and the American Library Association. The base hospital at Camp Wadsworth was designated “General Hospital No. 42” on March IS, 1919. On March 24 it was formally opened as a general hospital for the purpose of treating patients suffering from tuberculosis whose homes were in the southeastern portion of the United States. MILITARY HOSPITALS IN THE UNITED STATES. 778 The authorized bed capacity of the hospital was reduced from 1,630 to 1,000, and as this size institution it continued to function until October 1, 1919, when it was formally closed and abandoned. Statistical data, United Stales Army Base Hospital, Camp Wadsworth, Spartanburg, S. C., from October 8, 1917, to October 1, 1919, inclusive & SICK AND WOUNDED. Year and month. Remaining from last ! d d From command. missions. From other sources. By trans- fer. Otherwise. 1917. October 338 129 6 277 838 142 December 824 903 104 11 1918. J anuary 792 957 94 6 February 821 911 42 11 March 734 1,213 57 7 April 793 1,629 48 May 830 1,525 12 11 June 931 1,788 3 14 July 1 026 1. 153 6 r.oia 2, 342 1 September i 1 II 1, 520 1 October i 231 3,153 9 November i 459 1, 553 49 11 December 925 385 39 8 1919. January 324 240 145 10 February 203 147 316 7 March 421 92 597 3 April 911 23 140 5 May 666 17 4.33 8 June 782 26 301 12 July 573 21 129 g August 362 26 64 21 September 210 5 12 4 October 1 Completed cases. 473; 195 1,257 421 1,8421,012 1, 849 986 1,7851,010 2, Oil si, 185 2, 47 Oil, 590 2,378ll, 392 2,736 1,631 2,1851,061 3,3612, 168 2, 662 1,378 4, 393 2,829 3, 072 2, 003 1, 357 971 719 673 1,121 1,079 1,124 1,121 731 473 231 1 . 472 210 156 186 232 370 146 72 22 Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. 1 3 2 18 15 21 3 25 6 1 27 10 1 4 3 2 14 1 6 4 10 4 ' 'i 6 7 i 79 12 82 38 21 26 2 5 14 1 1 3 5 10 1 11 9 13 9 2 18 39 22 59 8 19 48 3 13 61 3 1 13 23 37 177 62 97 126 99 129 1 Remaining. 275 824 789 817 733 793 830 929 1,024 1,00 s 1,135 1,231 1,459 925 323 203 429 911 666 782 573 360 210 1 Aggregate number of days lost from sickness. 3,951 11,922 23,386 23,253 19,357 22, 54'" 27, 276 25, 579 29. 437 26,349 29,522 26,672 43, 578 26, 165, 16, 8711 74 113 62 60 144 96 14 1 54 7, 732 19 s,36s: 9 36, 440 27, 078 23, 634 20, 062 13, 596 j 45 7, 44.5 4,065! 1 4 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women . Chil- dren. Total. 1918. 1919. June 2 3 5 3 6 9 July 2 4 6 3 10 August 2 4 6 3 10 September 3 10 13 3 9 12 October 3 20 23 4 12 16 November 3 20 23 33 3S December 3 16 19 4 14 IS September 4 14 IS 1919. 2 2 January 3 7 10 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office; and monthly statistical returns made to the Office of The Adju- tant General, on file, Statistical Division, Adjutant General's Office (name of hospital). b From March 24 to end of period considered, this hospital was General Hospital No. 42. OTHER BASE HOSPITALS. 779 Statistical data, United States Army Base Hospital. Camp Wadsworth, Spartanburg, S. C., from October S, 1917, to October 1, 1919, inclusive — Continued. PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. Nurses. 1917. 31 2 2 35 124 10 134 10 49 2 1 52 418 11 429 48 52 2 1 383 11 394 66 1918. 53 2 1 56 387 15 15 402 66 February 55 2 1 58 375 390 79 March 63 3 1 67 399 19 418 78 April 79 3 1 83 401 19 420 115 74 3 1 78 420 19 439 119 72 2 1 556 19 105 July 73 2 6 81 67 589 19 608 112 57 3 7 598 668 18 616 106 53 4 6 63 20 688 128 October 53 5 6 64 20 607 134 59 5 C 70 586 22 608 113 December 57 6 8 71 648 27 675 99 1919. 36 6 8 50 492 21 513 54 34 6 6 46 393 19 4;2 501 38 60 36 7 3 46 463 38 39 6 3 48 467 36 503 83 May 40 6 6 52 461 437 6 79 44 8 6 58 1 438 80 July 37 7 9 53 404 404 78 29 5 9 43 277 277 74 8 5 6 19 76 76 57 8 5 6 19 BASE HOSPITAL, CAMP WHEELER, MACON, GA“ Camp Wheeler was situated in Bibb County, Ga., approximately 5 miles to the southeast of Macon, the county seat. The base hospital was located on the western side of the camp on high ground that had excellent natural drainage in all sections. Much of the ground within the hospital inclosure had been fertilized, plowed, and made into truck gardens. The soil was cpiite sandy, and though readily pulverized in dry weather, giving rise to easily carried dust, it did not form tenacious mud after rains. The climate of this region is fairly equable. The summers are quite hot, but the winters are not rigorous. There is very little snow. The surroundings of the hospital were satisfactory from a sanitary view- point. To the west of the hospital area there was a large swamp, but this was drained and its menace as a malarial breeding place was thus removed. On September 1, 1917, the first National Guard troops of the division began arriving. The Florida Field Hospital, which was one of the units of the divi- sion, was utilized to establish a camp hospital. This organization used its own tentage and supplies and for additional material drew on the supplies which had arrived for the base hospital. At this time work on the buildings for the base hospital had not been begun. Work on the base hospital (a 500- bed unit), was begun about September 10, and was rapidly pushed. By October 30 it had been about half completed, with perhaps 10 buildings that a The statements of fact appearing herein are based on the “History, Base Hospital, Camp Wheeler, Ga.,” by Lieut. Col. J. II. Stearns, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on filein the Historical Division, Surgeon General's Office, Washington, D. C. — Ed. 780 MILITARY HOSPITALS IN THE UNITED STATES. could have been occupied. The camp hospital was expanded by the addition of more tentage and was continued in use until October, 1917, when eight single wards of the base hospital were opened for patients. The plan of the base hospital followed the standard plans furnished by the War Department for base hospitals of National Guard camps. For the original number of officers on duty at the hospital, the quarters constructed for them were adequate, but when this personnel was increased no additional quarters were provided and the excess number of officers were housed in convalescent ward barracks or in tents. For the nurses several build- ings were constructed as quarters. There were two one-story buildings, type E, and one single building. For the student nurses a ward barrack was used for quarters. For the enlisted men there were 2 single barracks with a capacity of 50 men each and 2 ward barracks. These facilities were inadequate for the maximum number of enlisted men on duty at the hospital and it was necessary to use 60 pyramidal tents to house the excess number. All the duty personnel and all the ambulatory patients were fed in the general mess. The cafeteria system was used for feeding the ambulatory patients and enlisted personnel, and the entire operation of the mess was very satisfactory. Three small buildings were used for the storage of both the supplies for the base hospital and the supplies for the division in training in the camp. This space was inadequate at all times. A laundry building was constructed, but as no equipment was supplied for it the laundry work was done by a commercial company in the city of Macon. All of the buildings of the hospital were heated by means of stoves. During 1918, small water heaters were installed in penthouses adjacent to the wards for the purpose of heating hot water for baths. For heating the tents which were used to quarter a portion of the detachment, Medical Department, Sibley stoves were used. The base hospital, in common with the camp, was lighted by electricit}-, which was obtained from Macon. The service, because the current was subject to frequent interruptions, was not entirely satisfactory. The water supply of the hospital was a part of the camp supply, which in turn was obtained from Macon. The source of the supply was Ocmulgee River, and since the water was contaminated it was treated by sand filtra- tion and chlorination. When it was determined, during the year of 1917-18, that certain of the base hospitals at National Guard camps should have a sewerage system, one was provided at the base hospital at Camp Wheeler. After its installation, which was effected about March 1 , 191S, it was connected with the main sewer of the city of Macon. Prior to the installation of the sewerage system, pit latrines had to be used and they were very unsatisfactory. Guthrie incinerators were used for the disposal of liquid wastes before the sewerage system had been installed, and at that time garbage was collected by a civilian, under contract, and removed by him. During 191S the garbage was collected and properly disposed of by the conservation and reclamation department of the camp. On September 12, 1917, a post exchange was opened, its stock having been obtained on credit. It was operated very satisfactorily, for at the end of the OTHER BASE HOSPITALS. 781 year 1917, after paying dividends amounting to over $3,000, there was a cash balance on hand of about $6,500. Both the Young Men’s Christian Association and the American National Red Cross constructed buildings for the entertainment and recreation of those at the hospital. In the Young Men’s Christian Association building, intended primarily for the duty personnel of the hospital, various entertainments were given, including moving pictures. On Sundays religious services were held. In the Red Cross building, likewise, entertainments were given. In this building there was a limited number of rooms which were available for the friends and relatives of the seriously ill patients in the hospital. Before either of these annexes to the hospital had been provided, one of the barracks for the enlisted men had been converted into a recreation room. This room was very well etpiipped with furniture; a library was provided as well as various means of indoor entertainment. Outdoor games such as baseball, football, basket ball, etc., were conducted in season, for both patients and duty personnel. Statistical data. United States Army Base Hospital, Camp Wheeler, Macon, Ga. , from September, 1917, to March 10, 1919, inclusive a SICK AND WOUNDED. Admissions. Year and month. 1917. September October... November. December. 2 734 944 2 1,302 3, 8.55 3,206 1918. January February. . . March April May June July August September . October November.. December. . 1, 1.57 925 731 680 736 727 868 734 890 492 1,096 601 3, .540 1,788 1,242 2,386 1,045 1, 104 1, 176 1,727 1,300 2, 714 1,558 382 1919. January February... March 437 256 316 124 119 5 From other sources. By trans- fer. Otherwise. 91 2 Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. Hospital. Quarters. Hospital. Quarters. 2 2 1.304 566 1 3 734 7,990 4, 5S9 3, 526 105 14 944 38, 613 4, 150 2, 668 87 4 222 12 1, 157 37, 438 4, 697^3, 510 5 183 29 925 34, 738 2, 713 1,849 21 6 90 16 731 24, 089 1,973 1,254 15 1 3 20 680 22' 839 3, 066 12, 288 28 14 736 28, 412 1,781 1,031 12 1 i 9 727 23, 616 1.922 1.012 13 17 12 868 23, 128 2,044 1,250 9 1 5 734 26,913 2,461 l, 523 22 2 1 4 19 890 21, 362 2, 190 l' 634 19 10 27 8 492 19' 823 3', 208 2 , 002 70 15 16 9 1, 096 24. 824.. . 2 , 654 1,955 83 6 4 5 '601 24^ 382 9S3 '530 8 3 3 2 437 14, 476 693 361 2 2 12 316 12, 074 440 305 1 5 7 3 119 4,933 124 84 1 39 '508 CIVILIAN POPULATION WITH THE COMMAND. Y ear and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1917. 3 3 1918. 20 8 28 3 3 50 10 60 46 9 55 September 4 11 15 October 41 15 56 1918. November 20 15 3 3 6 December 46 9 55 February 3 3 6 March. /. 3 3 6 1919. April 3 3 6 38 19 57 May 12 8 20 February 6 13 19 June 12 8 20 6 e 15 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adju- tant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 782 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Base Hospital, Camp Wheeler, Macon, Ga., from September, 1917 , to March 10, 1919, inclusive — Continued. PERSONNEL ON DUTY. Y ear and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1917. 22 22 127 127 40 40 123 123 10 57 57 280 280 87 62 62 2S0 280 77 1918. January 63 63 276 13 289 75 69 69 283 13 296 80 78 1 79 277 20 297 79 April 74 1 75 284 20 304 84 May 61 2 1 64 285 21 306 104 June 56 2 1 59 289 20 309 101 July 69 2 1 72 374 21 395 99 August 65 2 1 68 357 21 378 92 September 59 4 1 64 5S2 20 602 105 October 57 5 1 63 502 20 522 107 November 58 3 1 62 501 17 518 116 December 58 3 1 62 461 14 475 106 1919. January 33 2 1 36 414 14 428 104 February 19 2 1 22 259 10 269 34 1 1 9 1 1 Table 22. « — Consolidated statistical data ( sick and wounded, and strength of personnel) at United States Army camp hospitals A OTHER BASE HOSPITALS. 783 •saa -iiojduia nBifTAp jaqio •siaqio-ii pus sapiy •sasjn^r •(•0J9 ‘ H ’ft) snoanBXjaostjv; •jnani -jjEdaa; iBorpajt •(•o?3 ‘-H -ft) snoauenaosi JA •SdjOQ AjEJIIIEg •sdjoo (EOipaK CWHMC ■pap?a :4 s^nai^d jo jaqnmu i[mnoni umunmpi »o co oo ^ o Tf c c - O' — < ~t< »o O 00 Cl HNHf» iO H©Tf O ft — ft ft -ft -f ft ft c co -ft -ft ci d -ft o- i—i co co r- Ol P— o ft X h ft N ot» h o r^* d •paj^ail shaped jo jaqnmn Afq^uoui nmnnxcj^ oj Oi oo co io c P; co cocoocoo coh ^3 oiiorto ooico-^tG ft ft r^- x ft ft 05 ft — ft ft d ci ft — — • t— co x x ft ft co ci r— x x — ci — ft co — ci ci co ft co i'- r^ftd i-i h i-T d*' o' t-T a o o ft •jo p9sodsrp asrjueqxo COTt^t^di N”t©OCOOO c:-t-0 — CO CO ft ft — Oi — ft — 1-0 ft f'- X CO C 'O ft — ro — ft P— ~Xj co r^- CO -ft 00 Cl H 1.0 — r- O COftftft'Xi t'ClX'S-ClCOftOCl ft C1XC5 COrt cTi-T tjT ho'h n o' co ua'i-T cT co Admissions. •IB}ox — CO 05 it TT CO CO Ol N ft05t^dxc0ftft05 05ft N-C1X ft © X O ft N IONOOH — — 1 X 05 ft ft i—fti-HCOCOCOCOftftCOftOOfti-HftCOft ft — Cl UO ft CO 0-1 CO 1—1 CNC1X Tf 05 1— 1 to XiOtONCO^LOCOCi-iCI — ft ft -^Cl t-T cTi-T o' ci'od'cTi-Tt^' oT t-To'cT co' o' t-TcT co' •aspsuaq^o O C<1 Cl CfliOXNCl — X CO r- XCIOlOXXOcOCNOH ONftiONO r- p- -ft ci ci c- -f Nftdid- iLCftp- — 1 co co ft ft ft ci lo ci x ft — -h r- ft fti -ft ft ci d ft ft d --4 r — i co ft t-T o' HH rt" N t-T r-T CO r-T •puBimnoo raoi^ 7 878 88 2-17 20 53 2, 058 65 99 265 1, 174 6, 691 1,454 570 2, 977 CO iQ ft H Cl -f CC d i.O O it 1 c-^coccici MCOCOCOONddX X Cl X Cl r- h o d i-4 i> x ft ft ci •'*' ^ TlT Period operated. To- November, 1917... December, 1919. . . Anril. 1917 March, 1919 August, 1919 December, 1919... do November, 1918.. . September, 1917... December, 1919. . . do March, 1919 December, 1919 do do Sentember. 1917.. . Doeombcr, 1919. . . do do September, 1918. . . January, 1919 January, 1918 December, 1917 Docombor, 1919. . . .do May, 1919 December, 1918. . . December, 1919. . . do do do do March, 1919 From — August, 1917 April, 1917 do August, 1918 July, 1919 August, 1919 May, 1917 April, 1918 April, 1917 do April, 1919 June, 1917 April, 1917 August, 1919 July, 1919 Julv.1917 April, 1917 April, 1919 July, 1918 May, 1918 April, 1917 July, 1917 June, 1917 July, 1919 do March, 1919 November, 1917... February, 1918 March, 1919 July, 1919 March, 1919 April, 1919 October, 1918 Ph r* ■ ^ Or— Ilf a - 2 a ^.2 ^ W3 =: — c G =5 .52 «— A o C.=, v- £ © ° o’&p © M C E .Gt ft © Op §■— sill aid s 0 'S C a c^ u -* hs O r- 3 © ta h ?? & 3 S^-2'3 '5^3- 'd 2 'EL 2 d^ 1 S' -1 OT 3 © * - 3 o 3ft.G-— " ‘ >,& ft O w w_o X_ i c3 ^ *= -a - o CO © a £«'g ngufi f go © oM - ~s A; £ ~ci5 SO I d'z d cJft 0.2 p,aaa aaaa c3 a d cs ouoo ’ P i* s >H X ^ © ft 0 li=| © ©— i- r^ft © © ^ <-Q >> c3 <- cq -T-T^ — ^ c3 c3 ft •- -P =Z ® p,ft© „ St * c3 O ~> a c3 o 6 . go >>®2 a 3 'l ® tcM ft 2 .fgft s 5Q g 3 o.O <-> — 2 & J =2 2 3-3*. ft ft Oft* | saa^sas^! c3cd,PaJc3o3^< oohooo c •■52 C3 © - - — • • _ > ^ >- ! 3 ^ >,© II I ° -2X0° . <3 Oi>— i a-^ j>> ft 2 3 © g-sgg ft © ^ O Table 22. — Consolidated statistical data ( sick and wounded, and strength of personnel) at United States Army camp hospitals — Continued. 784 MILITARY HOSPITALS III THE UNITED STATES. Average monthly number of personnel on duty. *S99 -iCojdnia ubijiato Jaq40 *sj83[joa5l pue sapiy - •sasm^ 00 05 CO L~ — co to CM tO co C5 CO' P- CM o ft-. Enlisted. ■(•oia ‘'W ■‘b) snoan^^aosij^ CM — COHH O r- "f L- *4119111 -preda(i i^oipaH CM 05 o> oo co 05 CO CO to 00 CO -*p — to OO rH CO CO CO OO 05 CM — 55 o ® e$ S CO L- O CM Officers. •(•018 W '0) sno9n^n 80S TK — CO CM — 1 CM CM •sdioo Aie}iueg CM CM CM •"'t* 00 CM CM • •sdrog jnoipapi CM CO -H CM CM CM *0 CO CO O ^ CM 05 C5 NOOCM — X •pejeoji sjuaijod jo jaqmnu Axqjnoru umunuiH ^rHCOlMCOCOOSCOt^COrHCOH H CM r,f^MC5(MN«OlO©CMlO'^f f*r^C5 oocor^io r^oi^HCM cm oo-m^ — ico t^o i— I y-t •— i Tfi CM i— ( ft t— CM •pei'Baii s^napnd jo jaqumu Ajqjuom umnrrxex'i — ^C'ir^CMC5oot^05'^*oo5io co— C500'f't*C5 — r^r^o— i ci n ^ uc ci lc o 01000*000 — — T^OOCMcOiCO ft ^ NC5COO - CON’fLOcC - OC — — COO COCOCO CM COOCMCM— — CO 00 CO' — CO^OO — 05 — r^CMiO OD r-T — s —'cm'’ i-T Dispositions. •jo pasodsrp osuuaqjo COCMP'.OOOOOOO^OlCMCOiOCO OC'— CO O CO. 00 — CO-criOOC-f^CCCMCMCOCOOt- — CM — rf — CMCOCMiOr-OOCMCO CMCO 05COMCNNC5COC1^CC5C -fCO 00 — CM — CM— — CM Tt< OI CO Tf to — — O *0 — »0 c5 CM 00 s CM*' CO* — ' CO* •paw COCO— • — HLO .co — to CM • Tjt . OcOCOC5CMt>-050tOC005 — — — O-^i • CM . • CO — CO — • • —COCO T}< — CO — — •Ajnp oj paumjaa — r^io — ocococococMC 505 t^ cooi oosr^ooMt^N — ca — loc-'too-c: CMCMOOCOOO — COT^C5tOTj*COtO to — — 00O5CMIOCM — ^ 'J* C5 O 4 — OCMCO 000*0 05 CO-OOON Tf t-- t^05TjtcOtOCMftcOCMCO«OOcO OC CO CM — — CO CM — — rt<— — to CM CM — — — — ! < •m°x CCOO^OMONO-CMOMO 00 C? OStOCOtOcOr^tOcOCM — OCMCCMXNO co ^ ft o cm to co oo 'O* o cm o 06 to oo *o — CMr^cMcc^ccocr^cMcocco CO CO CM — — CO to CO C — G5 OCM05CMOCOtOCOC005C*0 0 CO CM cm*'—'—' — ' co'co’— 'r-T r-T co~ — ' co" cm" ft cm* - go" co" co" cm" co" co"cm" •9smj9ii4o 00 05 — 05 • O CO — N I.C N 05 COCO CO 00 L O — .00 — 05 O — — X — t'- CM 05 •CO-’^TfCOtOt^.CMOO 05 05 COCOCO’ti • 05 -r ■ t-CC CC P- 005 00 • 05 — — — CM — — CO ft . 05 • t'— CO CO 00 -O' • CM • CM • CO — ' — ' •pummnoo raoj^j I00t'0--CNC'C10CO- ICO tm^cO — C00505CMcoc'C05COCM — XC5~-' x 05 >o — 05 — co cm cm x 05 — —05 t.o — — — oi rj* x cm oi co 05 — cm cm 00 CO -t-OXOOO tooo to— Ct^i.C*fO[^CM — COCC — — CM r-T cm" cm" — ' —T — " -ft — ' — ' tcT ft" cm" — " — " Period operated. To- December, 1919. . . do do. May, 1917 May, 1919 December, 1919. . . January, 1918 May, 1917 December, 1919. . . do October, 1919 December, 1919. . . April, 1918 October, 1918 December, 1919. . . do March, 1919 December, 1919. . . do October, 1919 December, 1919. . . January, 1919 May, 1919 September, 1918 — December, 1917. . . April, 1919 January, 1919 December, 1919. . . Juno, 1917 December, 1919. . . do June, 1918 From — December, 1918. . . August, 1919 do April, 1917 March, 1919 July, 1919 April, 1917 do do July, 1919 October, 1918 September, 1918.. . do April, 1918 December, 1917. . . July, 1919 June, 1918 March, 1918 April, 1917 July, 1919 do September, 1918.. August, 1917 April, 1917 June, 1917 July, 1918 April, 1917 July, 1919 April, 1917 April, 1919 July, 1919 August, 1917 grO-g X O 2 0) I .J © O'* t>ft otTJ § § * a o u t-H —3 ft O ftftftO sas§ c3 c3 c3 ft OUOhl 6 to o rt’S-O c3 oc a C3 O- ss- ftOT a S'* c3 e3 o is \ w ^ «o > G © ft ft Or^ :> ft ft 2o 5 -2 tc’fE _r ® 3*r5z;.‘ ft O _ tw e c.o"- ^ © ° c £ rf '5)2 ce o 0,3 -CL ft &CQ ,© 52 ;pj> > © ; js C — ;e oa^ c, &U . ©- ,® © ^ ^ -d, , ftrtC.^^j-cSfc* '"cj rt ~ ^ ^ c > ) O c3 d u t. ©'CH©^ ojO ©sgg°|j £ a - - c 5 -*a =s ~ 7 A □ Sd'SVcas >A" o £ i_ , E* ll'i |U g| fe-| 1| all Pu ft P5 •§ gg go caxft ^ ft — > ft c- eft ft ft | eft S 3 ft ^ SBSi^ESSEu^oSStt: e8o8eaOe8c8.S?e8 r O°Oc8 O ,e ft OOOftOOMOftSPHOOft*^ z - SECTION YII. OTHER EMBARKATION AND DEBARKATION HOSPITALS. CHAPTER XXXIII. PORT OF HOBOKEN, N. J.° EMBARKATION HOSPITAL NO. 1. In describing the general situation at the two principal ports, mention was made of the fact that the first hospital to be made available for Army use at New York was St. Mary’s Hospital, Hoboken. This civil hospital occu- pied a lm ost, an entire city block, which was formed by the intersection of Fourth Street, Willow Avenue, Third and Clinton Streets. There were a main building and two annexes. The main building had five stories, a base- ment, and a roof garden; one of the annexes, originally constructed for isolation purposes, had three floors and a basement, and the other annex had three floors and a basement. This second annex, at the north end of the main building, had been used in part as a laundry, the equipment for which was on the first floor. The bed capacity of the hospital was 650. In June, 1917, arrangements were made with the management of St. Mary’s Hospital to admit the sick of the Army at the rate of $2 per day. This charge included all services except professional. Medical officers and enlisted men were assigned to the hospital to provide for the professional care of the patients. The dual control of St. Mary’s Hospital continued until July 1, 1918, when it was leased by the Government and placed entirely under military control as Embarkation Hospital No. 1. The organization of the hospital as a military institution necessitated furnishing more officers and enlisted men and the replacement of the civilian nurses by members of the Army Nurse Corps. The female nurses were quartered at the hospital. In the building assigned to them for quarters the general mess was operated. From here to the variously located wards the food was conveyed by means of covered food trucks. The enhsted men were quartered principally at 412 Washington Street, Hoboken. When the number of the personnel reached its maximum, at the height of activities, there was an inadequacy of space at the building on Washington Street and the excess number of men were housed in the Stevens Home, which was at that time a ward of the hospital. During the summer of 1918 several private houses were offered for use in the care of convalescing soldiers. The offers of these private dwellings were accepted and the buildings were made convalescent wards of the hospital. a The statements of fact appearing herein are based on the “History, Embarkation Hospital No. 1, Hoboken, N. J.,” by Lieut. Col. T. C. Quick, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital- The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. 45269°— 23 50 785 786 MILITARY HOSPITALS IN THE UNITED STATES. With the advent of the winter of 1918-19, however, their use as adjuvant portions of the hospital was discontinued. These homes were situated at Mendham, Lewellyn Park, and Berwoodsville, N. J. When the armistice was signed the commanding officer of the hospital was notified that Embarkation Hospital No. 1 would be utilized, to an extent for debarking sick and wounded. Shortly thereafter patients from overseas were received. Successive groups of these patients were admitted to the hospital for classification and evacuation to hospitals in the interior of the United States. The welfare activities of Embarkation Hospital No. 1 were supervised by a field director of the Red Cross. He, with a number of subordinates, managed the distribution of tobacco and other articles of comfort to the patients. The chaplain of the hospital acted in the additional capacity of morale officer, and, due to his efforts, much entertainment was afforded the patients. Embarkation Hospital No. 1 was discontinued in October, 1919. Statistical data, United States Army Embarkation Hospital No. 1, Hoboken, N. J.,from July, 1918, to October, 1919, inclusive a SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. 'd 0 « 3 o a 0 M fa From other sources. >> -t-s 3 TJ O 'd CD a •d © A 'd 5 • •dk 1 s-i M * % 5 'd © CD 3 ft 02 3 . ej © © !§ O ~-'c. S CO t- o ©~ so © C " 1 © ©•d £ c © co 0 a ■ +* © PQ © f © £ o ’E, co c w h © 5> I CO 1918. July 237 16 615 9 877 200 2 2 266 3 403 i 7,014 31 404 18 714 2 1. 138 394 4 3 1 288 1 445 o' 61 September 447 59 1,236 2 1,744 12 1 390 784 2 17, 372 30 786 46 1, 137 14 1,983 932 102 1 3 332 605 8 16, 105 125 November 613 19 303 935 10 1 176 190 3 7. 471 128 December 193 68 219 7 487 257 7 1 61 158 3 4, 21 S 185 1919. January 161 192 294 6 653 276 27 5 91 247 7,904 113 February 254 324 248 6 832 228 15 12 230 340 l[ 308 March.. I 347 514 221 2 1,084 241 23 8 2 473 4 325 s 8 . 451 159 April 333 397 148 2 sso 189 14 320 1 342 122 May 349 313 147 2 811 179 9 7 364 1 248 3 34 June 251 421 136 6 814 204 11 7 235 353 4 11.300 183 July 357 602 178 4 1, 141 179 14 14 1 585 345 3 10, 392 167 August 348 2 32 180 3 793 169 9 384 2 206 8 7. SOS 27 September 214 79 128 421 171 3 21 1 136 82 7 3, 762 141 October 89 4 5 2 100 26 2 1 71 27S CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. 1918. July 5 6 11 9 August 4 5 September 9 5 14 October 16 7 23 22 22 November 11 11 December u it 1919. January 9 10 19 Year and month. Men. Women. Chil- dren. Total. 1919. 12 27 18 IS 36 12 12 12 12 12 12 July 11 u 35 12 47 35 12 47 IS 6 24 ° Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER EMBARKATION AND DEBARKATION HOSPITALS. 787 Statistical data , United States Army Embarkation Hospital No. 1, Hoboken, N. J from July, 1918, to October, 1919, inclusive — Continued. PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. Nurses. 1918. 18 1 19 175 19 194 64 27 1 28 198 19 217 63 29 1 30 215 17 232 72 October 29 1 30 222 17 239 80 29 1 1 31 218 218 88 28 2 1 31 233 233 80 1919. January 34 1 1 36 264 19 2S3 80 February 28 1 0 29 240 240 79 73 March 30 1 31 250 250 April 31 1 32 275 275 79 May 30 3 33 276 276 78 June 29 34 278 278 77 34 39 269 269 78 77 33 3 1 37 269 269 22 3 1 26 233 233 55 EMBARKATION HOSPITAL NO. 2, SECAUCUS, N. J.a In July, 1918, arrangements were effected whereby partial use could be made of the Hudson County institutions located on Laurel Hill, overlooking the Secaucus Station of the Erie Railroad. Secaucus is situated in the low- lands to the west of Jersey City, about midway between the hills bordering the western part of the city and the Hackensack River, and is about 4 \ miles from the docks of Hoboken. The hospital buildings were of brick but were not fireproof. There was a fire-hose system on each floor of the building used by the Army, and the fire risk was not considered to be grave. The roads about the hospital were either macadam or Belgian block; and the road to Jersey City was Belgian block for a part of the way, the remainder being asphalt and macadam. This hospital was used as a communicable-disease hospital and to it were sent all patients suffering from communicable diseases which developed on transports or in the other military hospitals of the port of embarkation, as well as "contacts” requiring hospitalization. The method of administering the hospital was similar to that which obtained during the early period of the use of St. Mary’s Hospital. Shelter, subsistence, medical supplies, and nursing were furnished by Hudson County for the sum of $2 for each patient per day. The Medical Department supplied medical attendance, administrative officers, and enlisted men who acted in the capacity of orderlies. The food furnished by the Hudson County authorities was purchased from the Quartermaster Corps to the extent of the total com- muted value of the rations of the enlisted men at the hospital. i The statements of fact appearing herein are based on the “History, Embarkation Hospital No. 2, Secaucus, N. J.,” by Capt W. J. Monaghan, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. 788 MILITARY HOSPITALS IN THE UNITED STATES. In January, 1919, further need for this hospital ceased, and on February 8, 1919, its military use was discontinued. The patients remaining in hospital on February 8 were transferred to Debarkation Hospital No. 1, and the per- sonnel were distributed to the various hospitals still operating at the port of embarkation. Statistical data, United States Army Embarkation Hospital No. 2, Secaucus, N. J., from July 1, 1918, to February 20, 1919, inclusive SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. ; Quarters. Hospital. CQ 1918. July 112 2 157 271 60 1 9 200 1 4, 718 6 201 8 143 352 166 1 1 6 178 4^ S78 3 178 8 395 581 309 3 21 247 1 8, 973 248 13 366 627 398 23 52 1.54 24 154 1 208 363 172 5 186 5, 008 186 6 299 491 1 235 1919. 235 6 435 676 168 3 131 374 9,424 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. July 6 18 24 3 26 29 August 9 14 23 3 33 36 September 6 24 30 3 24 27 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Medical Corps. Sanitary Corps.' Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C, etc.). Total. 1918. July 12 12 4S 48 August i 12 12 September 11 1 12 76 October 12 1 13 73 73 November 14 1 74 74 December 16 1 17 74 74 1919. January 20 1 21 S4 84 February 1 1 0 “ Compiledfrom monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon. General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). OTHER EMBARKATION AND DEBARKATION HOSPITALS. 789 EMBARKATION HOSPITAL NO. 3, HOFFMAN ISLAND, NEW YORK HARBOR.® Embarkation Hospital No. 3 was located on Hoffman Island, a low-lving artificially made body of land, situated in New York Harbor, in that part com- monly referred to as the Lower Bay. Accessible only by boat, this island made an admirable location for a hospital for the treatment of venereal diseases. Both the island and the hospital were the property of the State of New York, and, prior to their accession by the War Department, had been used as a place of detention by the quarantine officer of New York. The buildings were old and the plumbing, heating, and lighting facilities were inadequate, but during the early period of embarkation the Medical Department looked with much favor upon the acquisition of these buildings, since it meant a relief from the serious situation regarding the bed capacity of the embarkation hospitals. First used in December, 1917, it was known as the Army Hospital, Hoff- man Island. Under this name it continued until July, 191S, when it became Embarkation Hospital No. 3. The hospital, throughout its existence, was operated much the same as other military hospitals, with the exception that the State of New York pro- vided the food and medical supplies, at the rate of $2 per diem per patient. The Medical Department supplied personnel for the administration of the hospital and the professional care of the patients. The Army subsisted the enlisted personnel on duty at the hospital. In December, 1918, other and more satisfactory arrangements were made by the Medical Department for the treatment of genitourinary diseases, and Embarkation Hospital No. 3 was abandoned on January 1, 1919. The patients then in hospital were transferred to one of the other hospitals at the port. Statistical data, United States Army Embarkation Hospital No. 3, Hoffman Island, N. Y., from July, 1918, to December, 1918, inclusive J SICK AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases . Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. In hospital. In quar- ters. 1918. 393 10 185 588 356 8 224 6,911 10 224 10 325 194 15 348 2 8,660 8 350 7 392 749 255 1 5 12 475 1 13,975 2 476 17 129 622 285 5 3 328 1 12,106 45 329 13 73 415 217 37 161 7' 706 28 161 4 14 179 121 54 4 2 , 397 a The statements of fact appearing herein are based on the “History, Embarkation nospital No. 3, Hoffman Island, N. Y.,”by Maj. L. A. Walker, M.C.,U.S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. b Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Sections, Adjutant General’s Office; and monthly statistical returns made to the Office of the Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 790 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Embarkation Hospital No. 3, Hoffman Island, N. Y.,frorn July, 1918, to December, 1918, inclusive — Continued. PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment Miscel- laneous (Q.M.C., etc.). Total. 1918. 87 87 14 1 15 80 80 September 1G 1 17 73 73 October 16 16 November 19 19 86 S6 9 9 35 35 EMBARKATION HOSPITAL NO. 4, NEW YORK CITY.a The hospital of the New York Polyclinic Medical School and Hospital was leased by the Government on October 20, 1918. The hospital was located at 345 West Fiftieth Street, New York City, 3 miles from the center of activities of the port of embarkation, three blocks from Pier 90 at Fiftieth Street and Hudson River, and one-half block from the electric car lines on Eighth and Ninth Avenues. The building was an 11-story, fireproof structure of steel and concrete, and contained a basement, a cellar, and a subcellar. It had been designed for use as a hospital, and had been completed in 1912. Its ground area was 100 feet square and its gross floor space was 110,000 square feet. Within it there were 94 private rooms and wards, 4 operating rooms, and a number of rooms which had been used for clinical and didactic purposes, and which were readily convertible into wards. These rooms and wards gave a bed capacity of approximately 450. The building contained a kitchen of sufficient capacity to feed 800 persons at one meal; a bakery adequate to prepare all the bread needed for the hospital; a laundry equipped to meet all needs; and a heating plant that not only heated the building in which it was located but five dwellings adjoining the hospital. All stairways were of steel and concrete construction, and they were equipped with fire doors. There were three large elevators ample in size to accommodate stretcher cases. The institution was lighted by both gas and electricity; and, to guard against a temporary failure of the city water supply, had reserve tanks for water on its roof. From October 20, 1918, the day it was taken over for Medical Department use, until December 18, the building was cleaned, and preparations were made for the reception of patients. During much of this period of time the main hospital building was used as quarters for nurses who were being mobilized for duty overseas. There were a few patients in hospitals representing members of the command, nurses from overseas, etc.; but on December 19, 1918, the hospital was formally opened by the admission of 176 patients from overseas. ° The statements of fact appearing herein are based on the “History, Embarkation Hospital No. 4, New York City,” by Lieut. Col. .1. L. Robinson, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. OTHER EMBARKATION AND DEBARKATION HOSPITALS. 791 Thereafter, the hospital, though designated an embarkation hospital, functioned principally as a debarkation hospital. On August 15, 1919, the hospital was abandoned. Statistical data, United States Army Embarkation Hospital No. 4, New York City, N. Y., from November 4, 1918 , to August 15 , 1919 , inclusive .« SICK AND WOUNDED. i> last Admissions. Year and month. from rnth. 'd d c3 From other sources . Remaining m< O o a o H By trans- fer. Otherwise. 1918. November 4 1 6 199 1919. 196 14 3 177 34 17 7 378 134 14 9 197 48 29 38 367 May 134 16 45 311 153 25 27 246 184 22 5 293 22 1 Total to be accounted for. Completed cases. Remaining. Aggregate number ol days lost from sickness. Returned to duty. Died. Discharged for dis- ability. Deserted. Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. Hospital. Quarters. Hospital. Quarters. 4 1 2 1 2 11 206 8 2 196 2,514! 390 14 1 341 33 1 3,852 12 436 21 1 2S0 129 5 3 890 28 354 31 3 272 47 1 1 751 21 482 29 318 1 134 3 029 59 506 40 1 311 1 153 2 985 19 451 11 1 184 1,967 504 63 6 413 22 7,373 23 23 229 1 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 18 20 38 1919. March 20 24 44 20 20 40 April 20 24 44 19 28 47 1919. 20 32 52 18 17 35 July 28 27 20 20 40 August 25 29 54 PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1918. 19 1 20 121 121 December 30 1 31 141 5 146 1919. 29 1 30 171 7 178 29 1 30 161 10 171 25 4 1 30 162 9 171 32 5 1 38 174 8 182 29 6 1 36 173 8 181 June 31 5 1 37 172 4 176 28 6 1 35 174 174 28 6 1 35 167 167 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file. Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office'(name of hospital). b Sick and wounded figures above do not include patients invalided to the United States from Europe and held in hospital for a few days only while awaiting transfer to other hospitals. (Letter from The Adjutant General to com- manding generals, ports of embarkation, on disposition of medical records for patients invalided to the United States. A. G. O., file “E. E.” Misc. Div.) 792 MILITARY HOSPITALS 1ST THE UNITED STATES. DEBARKATION HOSPITAL NO. 1, ELLIS ISLAND, N. Y.a Ellis Island comprises three parts known as island No. 1, No. 2, and No. 3, respectively. The group lies midway between Brooklyn and Jersey City, prac- tically at the head of the New York Bay, and about 1J miles from New York City. Two of the islands are artificial, and the buildings upon them have been erected on piling. The buildings on Ellis Island had been used by the Bureau of Immigration, principally, but partly by the United States Public Health Service. On February 21, 1918, the Secretary of Labor, in a letter to the Secretary of War, agreed to the partial use of the buildings by the Medical Department of the Army and designated portions of the group that were available. At that time there were 109 patients on the island, representing immigrants and enlisted men of the United States Navy. The hospital, with its patients, was turned over to the Army on March 8, 1918, and the commanding officer of Pig. 198. — Airplane view of Debarkation Hospital No. 1, Ellis Island, New York. Debarkation Hospital No. 1 assumed charge, relieving the Public Health Service from all responsibility for the care of both patients and property. The following use was made of the portions of Ellis Island transferred to Army control: Island No. 1 was used primarily as quarters for the enlisted men on duty at the hospital, and for 260 patients; island No. 2, used as the adminis- trative center, contained wards for 2S0 patients of a surgical character; and island No. 3 was used for 500 patients, in separate wards, located in buildings of one or two stories each. The officers on duty at the hospital were quartered in the buildings of island No. 3, while the nurses were quartered on the third floor of the building on island No. 2. The buildings occupied practically all the space on the islets, and there was no possibility for expansion. Connecting the buildings, one with another, were covered ways. “The statements of fact appearing herein are based on the “ History, Debarkation Hospital No. 1, Ellis Island, N. Y.,” by Maj . C. R. Haig, M. C., TJ. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. OTHER EMBARKATION AND DEBARKATION HOSPITALS. 793 On each island there was a kitchen which was used for the preparation of food for patients, as well as the duty personnel. The officers had a dining room on island No. 3, the nurses’ mess hall was on island No. 2, and the mess hall of the detachment, Medical Department, was on island No. 1. Each group thus had a dining hall in close proximity to its respective quarters. The equipment of the kitchens was mainly that transferred by the Public Health Service. All departments of the hospital were directly connected with the public waterworks of Jersey City. The water, as supplied, was found to be consist- ently of excellent quality and of a low bacterial count. All the buildings contained modern plumbing. The sewage emptied imme- diately into the surrounding body of water. For the disposal of garbage, brick incinerators had been constructed on island No. 1. These incinerators satisfactorily disposed of all solid wastes not discharged into the sewerage system. Each building was comfortably heated by steam that was supplied from the heating plant operated by the Immigration Service. The lighting of the hospital was by electricity, likewise supplied by the Immigration Service from a power plant on the island. The form of current furnished was 220 volt, direct. The lighting system was only fairly satisfactory. When the hospital was transferred to the Medical Department there was sufficient equipment for 500 patients. This equipment was increased to make it adequate for the care of 1,000 patients. On March 23, 1918, a hospital exchange was started without capital. Sub- sequently, in addition to its retail department, it conducted a three-chair barber shop, a tailor shop, and a laundry. During the summer months of 191S the Red Cross maintained a large tent on island No. 3. Here during the hot days the patients gathered for entertain- ment or to visit with their friends. At night there were performances of various sorts for the benefit of the patients. In the fall of 1918 the construction of a large fireproof building was begun on island No. 2. This building was com- pleted and ready for use on Christmas day following. There was no separate building provided by the Young Men’s Christian Association, but space was given this organization in the building on island No. 1, where a well-equipped library and reading and writing room were estab- lished. There were also musical instruments, pool tables, etc., for the use of members of the detachment as well as the patients. A moving picture apparatus supplied ample evening entertainment. Since the hospital buildings occupied practically all the available space on the islets, there was little possibility for outdoor recreation. During the sum- mer months the only means of recreation were swimming, boxing, and other forms of outdoor contests which could be carried on in the very limited space. This hospital was closed on June 30, 1919, in compliance with a request of the Secretary of Labor, addressed to the Secretary of War on April 1, 1919. 794 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Debarkation Hospital No. 1, Ellis Island, N. Y, from August, 1918, to June 30, 1919, inclusive fi SICIC AND WOUNDED. Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted. Discha rged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. w © 3 Hospital. Quarters. 1918. 272 37 33 342 33 3 293 3 7 3 1 375 39 10 71 96 177 42 4 73 2 56 1 088 29 56 101 116 273 128 6 1 83 2, 173 42 55 46 64 1 166 43 6 5 48 64 1 674 10 64 52 127 3 246 40 10 14 127 53 2 2,684 8 1919. 55 56 99 6 216 58 4 1 60 3 S9 1 2,095 34 90 70 677 1 838 67 5 1 278 487 8. 173 14 487 72 468 1,027 101 9 649 1 267 12.268 61 267 32 470 '769 64 6 393 306 8 829 12 306 25 195 526 97 16 1 264 147 1 7, 205 14 148 5 10 1 164 23 11 1 10 119 1,501 3 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 1919. 2 18 20 January 2 15 17 2 18 20 February 2 21 23 2 19 21 March. 9 21 23 2 15 17 April 2 21 23 2 15 17 May 2 21 23 June 2 18 20 PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps.' Miscel- laneous (Q. M.C., etc.). Total. Medical Departs ment. Miscel- laneous (Q. M. C., etc.). Total. 1918. August 29 2 1 32 297 11 30S 50 September 29 2 1 32 363 10 373 64 October 29 2 1 32 350 10 360 79 N ovember 34 2 1 37 360 360 44 December 37 3 2 42 378 23 401 76 1919. January 34 3 2 39 392 31 423 64 February 33 3 1 37 374 37 411 63 March 29 3 1 33 363 31 394 73 April 27 3 1 31 316 22 33S 69 May 23 3 1 27 2S2 17 299 62 June 8 2 1 11 53 17 70 “ Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). h Sick and wounded figures above do not include patients invalided to the United States from Europe and held in hospital for a few days only while awaiting transfer to other hospitals. (Letter from The Adjutant General to com- manding generals, ports of embarkation, on disposition of medical records for patients invalided to the United States. A. G. O., file “E.E.” Misc. Div.) OTHER EMBARKATION AND DEBARKATION HOSPITALS. 795 DEBARKATION HOSPITAL NO. 2 (GENERAL HOSPITAL NO. 41), FOX HILLS, STATEN ISLAND, N. Y. Early in the war it was the plan of the Surgeon General to begin the pro- vision of the debarkation hospital facilities at the port of New York in order that, when the time came, facilities would be available at that port for the reception and temporary treatment of the returned overseas sick and wounded. 1 Several properties in the vicinity of New York City were considered. Two tracts on Staten Island, the Mathews site and the Fox Hills site, were chosen as being more suitable than any others. They were both carefully inspected and the latter was selected for the site of the debarkation hospital. The site was high and rolling and comprised 158 acres situated at Rosebank, near the quarantine dock on the northeastern portion of the island opposite The Narrows. It was 15 minutes by motor from St. George Ferry and approached by good macadam roads. 2 On November 8, 1917, the Surgeon General recommended the leasing of the various properties constituting the site. 3 This was approved by the Secre- tary of War on the 10th of that month, 3 and on the 15th the Quartermaster General was requested to execute the leases as approved. 4 Although the site was hilly and, therefore, rather difficult and somewhat expensive for temporary construction, it was approved by those concerned and the leases were pro- ceeded with The total yearly rental to the various lessors was $18,656. 3 Four of the lessors tendered their properties at SI per year; the remainder were commercial leases. By December 18, 1917, most of the leases had been secured. Meanwhile, further study was given to the planning of the hospital and the general question of the handling of debarking sick, and, as a result, preliminary plans were prepared for a hospital larger than any hitherto constructed for the War Department in the United States. 2 Special attention was given to the requirements of the receiving building. It was so planned as to permit the physical examination and the necessary record work incident to the admis- sion of large numbers; and a portion of it was planned to facilitate the discharge of patients en route to the general hospitals of the interior. In conjunction with and attached to it, to unify operation, the laundry, disinfecting, and dry- cleaning buildings were arranged. The latter, a new departure in Army hos- pital construction, was planned to afford a much-needed utility. In general, the plans of the hospital were the same as for the base hospitals in the canton- ments, but the kitchens and mess halls were larger, thus giving the hospital greater expansion possibilities than there were in the other hospitals. 6 These preliminary plans were sent to the Quartermaster General in December, 1917, with request for construction. 7 The preliminary construction work began in January, 1918, when a spur track was built from the Staten Island Rapid Transit Railroad. This facili- tated the construction of the hospital which was to follow and which was carried on as rapidly as weather and other conditions permitted. As originally planned and constructed, the capacity of the hospital was 1,912 beds for sick and accom- modations for 40 commissioned officers, 180 nurses, and 440 enlisted personnel. In all, there were approximately 70 buildings . 6 1<'ro. 190. — Debarkation Hospital No. 2 (General Hospital No. 41), Fox Hills, Staten Island, N. Y. OTHER EMBARKATION AND DEBARKATION HOSPITALS. 797 A portion of the hospital was completed for occupancy in the early summer of 1918, and by midsummer the hospital, except for certain additions requested, was entirely com- plete. Six one-story wards and 2 two-story wards were added in the fall of 191S; 6 wards, already constructed, were altered for the treat- ment of psychiatric cases, and an automatic fire-alarm system was installed. 8 The total cost was $2,600,000. This hospital was one of four where, due to the scarcity of lumber and shipping facili- ties, large quantities of insulite, a substitute for lumber, were used in its stead in the erec- tion of buildings. Late in 1918 over $50,000 was spent in the application of stucco and paint over the insulite of which many of the buildings were constructed. 8 On March 14, 1918, the hospital was des- ignated “ United States Army General Hos- pital No. 10/’ 9 and on May 10, 1918, it was designated “Base Hospital, Fox Hills, Staten Island,” and placed under the commanding general of the Port of Embarkation, Hoboken, N. J. 10 It was opened in June, 1918, and was designated “United States Army Debarkation Hospital No. 2,” 11 but it was not until Octo- ber, 1918, that any considerable number of overseas sick and wounded was handled there. Starting with about 50 patients in October, the number reached 229 before the end of the month. 12 By the end of November the num- ber had reached 1,500. 12 From November, 1918, until March, 1919 (at which time it was taken from the port and made General Hos- pital No. 41), 13 the number of sick in hospital varied from 400 to 1,S00. 13 The number was never the same two weeks in succes- sion, due to the sudden and frequent arriv- als of large numbers from France or to the rapid evacuation of large numbers to the various general hospitals throughout the United States. Within the week of Jan- uary 4 to 10, 1919, the high and low points varied over 1,200. 13 Fig. 200. — Debarkation Hospital No. 2 798 MILITARY HOSPITALS IN THE UNITED STATES. Statistical data, United States Army Debarkation Hospital No. 2, Fox Hills, Staten Island, N. Y. , from July, 1918, to February, 1919, inclusive a SICK AND WOUNDED. & Year and month. Remaining from last month. Admissions. Total to be accounted for. Completed cases. Remaining. Aggregate number of days lost from sickness. From command. 1 From other sources. Returned to duty. Died. Discharged for dis- ability. Deserted . Discharged, expi- ration of term. Transferred to in- sane asylums. Transferred to other hospitals. Otherwise dis- posed of. By trans- fer. Otherwise. Hospital. Quarters. 'a c Quarters. 1918. 10 28 1 39 23 1 311 2 16 36 1 53 36 3 14 613 2 14 68 1 83 52 1 2 28 391 4 28 140 60 1 229 184 2 38 2,452 36 38 32 34 1 105 38 7 19 2 39 888 2 39 70 147 1 257 39 6 112 100 3,186 18 1919. 100 99 345 5 549 84 7 108 350 4,232 11 350 91 223 2 666 80 10 6 414 llj G90 22 CIVILIAN POPULATION WITH THE COMMAND. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1918. 3 3 1919. January 13 13 13 13 February 15 15 13 13 13 13 13 13 PERSONNEL ON DUTY. Officers. Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q. M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M. C., etc.). Total. Nurses. 1918. July 29 3 2 34 413 31 444 54 August 40 4 2 46 40S 37 445 55 September 37 4 0 41 431 60 491 67 October 29 3 4 36 430 63 493 69 November 44 3 4 51 482 S4 566 S6 December 49 6 2 57 536 187 723 S9 1919. January 50 7 2 59 528 165 693 64 February 38 6 1 45 514 3S 552 65 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division Adjutant General’s Office (name of hospital). b Sick and wounded figures above do not include patients invalided to the United States from Europe and held in hospital fora few days only while awaiting transfer to other hospitals. (Letter from The Adjutant General to commanding generals, ports of embarkation, on disposition of medical records for patients invalided to the United States. A. G. 0 ., file “ E.E.” Misc. Div.) OTHER EMBARKATION AND DEBARKATION HOSPITALS. 799 DEBARKATION HOSPITAL NO. 4 (GENERAL HOSPITAL NO. 39) LONG BEACH, LONG ISLAND, N. Y. Debarkation Hospital No. 4 consisted of the Nassau Hotel and several adjoining buildings of minor consequence, situated at Long Beach, Long Island, 25 miles from New York City. The Hotel Nassau was a 7-story fire- proof building with a 2-story annex, and it contained 400 rooms above the first floor. The building had been erected directly on the beach, facing the ocean, and was 300 feet long and 140 feet wide. In addition to being fireproof, it was well supplied with fire extinguishers and fire lines with outlets on each floor. If was reached by the Long Island Railroad, the station being five blocks from the hotel. 14 The ground floor contained the mechanical department, including the heat- ing, lighting, power plant, laundry, paint shop, storerooms, kitchen, bakery, servants’ dining rooms, grill room, barber shop, etc. 14 The main floor, sur- Fig. 201. — Debarkation Hospital No. 4, Dong Beach, Long Island, N. Y. rounded by a large covered veranda, contained the main lobby, reception cor- ridor, ballroom, main dining room, several large private dining rooms, offices, etc. 14 The remaining were the sleeping floors containing, with the exception of the sixth, 50 bedrooms each. 14 On the sixth floor there were 104 rooms, 4 dormitories, and outdoor sleeping facilities. 14 In the two-storv annex there were additional sleeping rooms. 14 This hotel had been inspected by an officer from the Surgeon General’s Office in the fall of 1917, with a view to its use as a general hospital. Negotiations concerning its rental or purchase consumed much time throughout the fall of 1917. The first offer demanded $150,000 rental per year, the purchase of the furniture and equipment at $210,000, the necessary renovation and alteration at $71,500, and an additional $25,000 to restore the property after War Department occupancy had ceased. 15 It was decided not to lease this property, but to look elsewhere for hospital facilities, as the above stipulations could not be met by the War Department. 800 MILITARY HOSPITALS IN THE UNITED STATES. On December 4, 1917, the president of the Nassau Hotel Co. made another offer to lease the hotel to the Government for $150,000 and the purchase of the equipment at $100,000 to $140,000, or the sale of it to the Government for $1,150, 000. 18 Neither of these propositions was acceptable to the War De- partment and again negotiations failed. Until the spring of 1918 it had been the intention to use this hotel, should it be acquired, for general hospital purposes, but by the spring of 1918 the neces- sity for increasing the number of beds in the port of New York becoming more acute, and with negotiations still unsettled, it was decided, should it be possible to secure it, to use the Nassau Hotel as a debarkation hospital for that port. Accordingly, on May 22, the Surgeon General, for the first time recommended the leasing of this property at not to exceed $125,000 a year. As a result of the surveys made prior to this date, it was reported to have a capacity of 1,300 beds. 18 It was not contemplated to purchase the equipment at this time. The lease was approved on June 12, 18 preliminary arrangements were made to take possession after September 5, and the rental figure was agreed upon at $105,000 a year. 17 Arrangements having been finally completed, the hotel was taken over in September, 1918, and on the 19th of that month was designated ‘‘Debarkation Hospital No. 4” and assigned to the jurisdiction of the commanding general of the Port of Embarkation, Hoboken. 18 On August 14 a complete survey had been made of the hotel with a view to determining what alterations would be required for its use as a hospital. Based upon the plans prepared, the Surgeon General recommended the expendi- ture of $25, 000. 19 Renovation and construction work began soon after Septem- ber 25, 1918, when those to be in charge of this work arrived. The work done consisted particularly of repairs to the heating plant, the installation of new radiation on the seventh floor to render it habitable in winter for the personnel on duty at the hospital, the installation of a diet kitchen on each floor, some plumbing alterations and installations throughout the building, the erection of necessary partitions, some painting, and the installation of additional kitchen equipment. 20 The work was practically completed in December of 1918 and cost $24,889. The hospital was not put to use during the period of renovation. Condi- tions at the port of New York in respect to bed space in debarkation hospitals, which previously appeared to be inadequate, now, in December, 191S, proved to be well taken care of. Consequently, when it became available, it was not required for debarking sick. The Surgeon General then recommended that it be designated as a general hospital and placed directly under the control of the War Department, and on December 9, 1918, it became General Hospital No. 39. 21 As General Hospital No. 39 it was opened in January, 1919, with a capacity of 500 beds, and a small number of sick was immediately sent there. 22 By March the number of sick constantly in the hospital had increased to 500. 22 In the meantime, however, February, 1919, the general bed situation in general and base hospitals in the United States was becoming less acute. The Surgeon General’s policy for some time had been to use the base hospitals in cantonments as well as the general hospitals for the care of the overseas sick. While there were many sick yet to be returned from France, the date upon which the peak load would be reached had been predicted and had just been reached. On OTHER EMBARKATION AND DEBARKATION HOSPITALS. 801 February 19, 1919, the Surgeon General, under the terms of the lease, recom- mended cancellation of all leases and the abandonment of the hospital, 23 much as it was desired to operate it for the sick through the coming su mm er season. Patients and personnel Mere to be removed by April 1. It was contemplated to remove all property and to deliver the buildings to the lessor on April 30. This recommendation was approved and carried out. The sick, meanwhile, having been reduced to a small number by successive stages, were transferred, prior to the removal of Government property and the surrender of the buildings. 24 Statistical data, United States Army Debarkation Hospital No. 4, Nassau Hotel, Long Beach, N. I".. from October, 191S, to March, 1919, inclusive .<* SICK AND WOUNDED. Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 191S. 1919. 16 23 January 24 31 24 6 30 February 23 10 33 24 6 30 March 21 11 32 21 26 April 20 4 24 PERSONNEL ON DUTY. Officers. | Enlisted men. Year and month. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. Nurses. 191S. September 7 3 1 11 79 1 SO 11 3 1 15 79 3 S2 November 19 3 1 23 SI 3 S4 December 24 3 1 37 310 14 324 46 1919. January 30 6 1 37 310 14 324 46 February 26 6 4 36 313 16 329 44 March 9 4 2 15 109 13 122 44 April 4 1 5 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office: and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). 45269° — 23 51 802 MILITARY HOSPITALS IN THE UNITED STATES. DEBARKATION HOSPITAL NO. 5, GRAND CENTRAL PALACE, NEW YORK CITY.* On September 16, 1918, the building formerly known as the Grand Central Palace was designated “Debarkation Hospital No. 5 ,” by General Orders, No. Ill, Headquarters, Port of Embarkation, Hoboken, N. J. A lease bearing the date September 1, 1918, had been executed by the Government on September 3, at a time when the floors of the building were still in use by tenants. The build- ing was of the loft type of architecture and was considered highly adaptable to hospital purposes. It was located in New York City and covered the entire block from Forty-sixth to Forty-seventh Street on Lexington Avenue, and extended west to Depew Place, a private right of way of the New York Central Railroad. On the east and west the building was 200 feet in height and on the north and south sides it was 272 feet high. It was within one block of the Grand Central Terminal, 1 mile distant from the Pennsylvania Railroad Terminal, and was within easy access of all the docks of Manhattan. The structure was classed as a 12-story fireproof building; its walls were made of steel and light-faced brick, trimmed with terra cotta; and all of its floors except the first three were of cement. The first, second and third floors were of fireproof wooden construction. The total floor area of the building was 600,000 square feet. On September 18, 1918, the constructing quartermaster forwarded to the Construction Division, War Department, a $215,000 estimate, covering the alterations deemed necessary to convert the building to hospital purposes Revised plans were received September 20, 1918, but it was not until October 3 that actual work on alteration was begun. The building, being in good general condition and readily adaptable to the purpose intended, obviated any structural changes. The revised plans, however, called for partitions, plumb- ing, and other fixtures. Numerous baths and showers were installed, the work conforming in a large measure, in finish and construction, to that of the base hospitals in cantonments. The existing building was disturbed as little as possible. The many partitions referred to were required to divide the floors into wards, toilet sections, cafeterias, a post exchange, gymnasium, assembly room, a theater, closets, kitchen, and storeroom departments, in addition to the various offices and recreation rooms. These partitions were made of semifireproof plaster board and extended to a height of about 7 feet, being topped by a 2 by 6 inch rider, though in some instances they extended from the floor to the ceiling. All the wards were well ventilated and heated and had abundant light on two sides. In each of the east wards there was a floor space of over 10.000 square feet, while in each of the smaller or west wards there was a floor area of about 8,000 square feet. A large recreation room was located between two of the main wards on each floor and was so placed as to give a view of the eastern part of the city and the East River. Each floor used for wards had two quiet rooms, two toilet and service sections, as well as a cafeteria dining room. Offices, living rooms, and closets were conveniently and amply provided. The toilet sections comprised a ward toilet section with 6 closet bowls, 1 urinal, a The statements of fact appearing herein are based on the “ History, Debarkation Hospital No. 5, New York City,” by Capt. J. D. Caldwell, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General’s Office, Washington, D. C. — Ed. OTHER EMBARKATION AND DEBARKATION HOSPITALS. 803 DEBARKATION HOSPITAL NO. 5 GRAND CENTRAL PALACE NEW YORK CITY Fig. 202. 804 MILITARY HOSPITALS IN THE UNITED STATES. 1 double lavatory, a shower, and tub bath; a utility room with flushing hopper; a nurses’ toilet room with 2 closet bowls; an officers’ toilet with 1 bowl. The typical ward floor had 370 beds, and the bed capacity of the entire hospital was 3,500. The twelfth floor differed from the typical floor plan in that it was somewhat smaller. There was less light because of restricted window space and because of the obstruction caused by the overhanging roof. The eleventh floor also differed from the typical ward floor in that it was subdivided into smaller wards, there being 1 0 in all, varying in capacity from 2 to 25 beds. On this floor were diet kitchen, living rooms, offices, and conveniently located compartments. In the center were located the dispensary and the pharmacists’ room. The dispensary was large and commodious, was well supplied with the needs of the hospital, and was always well kept. The surgical section, X-ray, dental, ear, nose and tnroat, eye, genitouri- nary, dressing departments with four sterilizers, two separate pairs of operating rooms (between each of which there was a sterilizing and wash-up room), the morgue, autopsy rooms, three wards, the laundry, the Carrel-Dakin room, and the surgeon’s office were all located on the third floor. The first or main floor was one of the most important in the building. Here were located the receiving and evacuating rooms, the kitchen, and the kitchen storerooms, the Red Cross offices, officers’ lavatory, the nurses’ locker room and lounge, and the chaplain’s office. The basement, on the east, was at the level of Lexington Avenue. Many offices were located here, which included the quartermaster department, and in addition there were the sterilizer, the ice plant, telephone exchange, carpen- ter’s room, guardhouse, and the street level for the elevators. The Lafayette House, at 112 East Fifty-Ninth Street , formerly the German Club, was operated as an auxiliary to this hospital and was used as an officers’ ward. This building was equipped by the American Red Cross and was operated by them, except that the control and treatment of the patients was maintained by the hospital. The building was adequate for the care of convalescent officers but had no equipment for the care of the seriously sick or injured. In December, 1918, the Bible Teachers’ Training School, a block away from the hospital, was leased for nurses’ quarters. The principal difference between this hospital and Debarkation Hospital No. 3 was that in the Grand Central Palace building it was necessary to establish a floor unit arrangement. The Greenhut building had but 6 stories, all of which intercommunicated by means of 12 elevators and 6 stairways, thus permitting ambulant sick and personnel to come to meals at the central mess hall without overtaxing the elevators or producing a great amount of noise on the stairways. The Grand Central Palace had 12 stories and but 9 elevators and 4 stairways. Since it was essential that noise be kept at a minimum the constant use of the stairways by large numbers was precluded. If the mess hall had been estab- lished on the lirst floor the second floor only could be excluded from the numbers that would have had to use the elevators, since it could be expected that only those on the floor above the mess hall would utilize the stairway when coming to meals. To have reduced the number using the elevators, by establishing the mess hall on the sixth floor, so as to require those from the fifth and seventh OTHER EMBARKATION AND DEBARKATION HOSPITALS. 805 floors to use the stairways, would have necessitated establishing the cooking facilities on the same floor, to which there were too many practical obstacles. The kitchen was installed on the first floor. It extended from the service storage end of the building to the service elevators which connected with the floors above. Service and mess rooms were then provided each floor, adjoining the service elevators. Each serving room was equipped to receive food from the main kitchen, to serve it from steam tables to the patients’ mess or the cafe- KITCHEN EQUIPMENT- 9 Sauce pan rack. to Gas ranges io Fish boxes ti Salamanders ii Work sink Stock kellies iz. Vegetable tables ts Vegetable boilers 13 Work table ia Vegetable steamers 14 Cooks table tb Coffee urns is Cooks table sink is. Dish washing machine i6 botchers bench t7 Vegetable peeler 17 butchers block ts Hood IS Meat chopper t9 Pot sink J9 Mixer -MESS-EQUIPMENT- 50 Cafeteria counter S6 Refrigerator 3i Tray slide 37 Glass washing sink 32. Steam table 3B Dish washing machine 35 Tablethanging shelf over>39 Tray table 34 Counter 6 shelves 40 Tables benches 55 Refrigerator 4. Coffee urn Q ip. 2C 30 40. J CA LE.. • General ■ kitchen • -Typical- patients- ME55- - Debarkation - hotpitial-n 0 - 5 Grand central palace, /wYorkaty. Fig. 203. teria counter, to mane up the trays for the bed patients, and to wash and store necessary dishes and utensils. The initial installation of the floor unit was more expensive; it cost more to operate it; and it occupied more space than the centralization of these activi- ties necessitated, such as was the case at the Greenliut Building. It operated with entire satisfaction. 806 MILITARY HOSPITALS IN’ THE UNITED STATES. The American National Red Cross was placed in charge of the general information bureau which concerned patients as well as visitors. The location of the hospital in the heart of New York, as well as the fact that the building had a reputation of being a former show place, attracted many visitors. The Red Cross completely equipped many recreation rooms in the hospital and pro- vided personnel for them. To carry on its work the Red Cross was organized into the following departments: A home service, a department for entertain- ment and outside recreation, an educational department, a social service depart- ment, the information bureau for questions of compensation and war-risk insurance, and an information bureau concerning recreation work and voca- tional education. The American Library Association operated in conjunction with the Red Cross and supplied an immense number of daily newspapers, books, and much reading matter for the patients. On June 2, 1919, the last patient was received, and on June 16 the last patient was evacuated. The work of removing medical supplies had already started and the property was rapidly being removed when, on June 30, 1919, the hospital was officially closed and the work of dismantling and restoring the building to its original status was begun. Statistical data, United States Army Debarkation Hospital No. 5, Grand Central Palace, New York City, from December, 1918, to June 30, 1919, inclusive. a SICK AND WOUNDED. i> Year and month. Men. Women. Chil- dren. Total. Year and month. Men. Women. Chil- dren. Total. 1919. January 8 8 1919. April 53 February 33 33 53 53 85 March. /. IS 39 10 45 a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General's Office; and monthly statistical returns made to the Office of the Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital). b Sick and wounded figures above do not include patients invalided to the United States from Europe and held in hospital for a few days only while awaiting transfer to other hospitals. (Letter from The Adjutant General to com- manding generals, ports of embarkation, on disposition of medicalrecords for patients invalided to the United States. A. G. O., file “E. E.” Mise. Div.) OTHER EMBARKATION” AND DEBARKATION HOSPITALS. 807 Statistical data, United States Army Debarkation Hospital No. .5, Grand Central Palace, New York City, from December , 1918, to June 30, 1919, inclusive — -Continued. PERSONNEL ON DUTY. Year and month. Officers. Enlisted men. Nurses. Medical Corps. Sanitary Corps. Miscel- laneous (Q.M.C., etc.). Total. Medical Depart- ment. Miscel- laneous (Q.M.C., etc.). Total. 1918. December 59 7 2 68 478 478 1919. January 69 s 2 79 602 8 610 122 February 69 8 2 79 640 41 681 176 March 74 10 2 86 749 40 789 187 April 78 10 2 90 740 32 772 185 May 58 10 2 70 684 32 716 1S6 June 7 6 1 14 144 23 167 81 BASE HOSPITAL, CAMP MERRITT, N. J.