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Chapter 14

Table of Contents

Chapter 14

IN THE SHADOW OF WAR

Even as late as 1914, few in the United States expected to be drawn into an overseas conflict unless the territories acquired in the Spanish-American War were threatened. Furthermore, almost until the moment when the nation entered the struggle in April 1917, President Wilson believed that energetic preparations for war would make U.S. involvement in European hostilities more likely. Congress, uncertain first about whether to prepare for war and then about how to do so, refrained from voting a major increase in the size of the Army until raids by Pancho Villa into the United States led to the mobilization of all available regular and National Guard troops along the Mexican border in 1916 and a campaign within Mexico itself.1

Military officers realized that the United States might eventually become involved in a major war. But they were preoccupied with thoughts of a conflict that might take place after the war in Europe, especially if Germany failed to achieve a decisive victory and tried to recover stature by aggressive moves in the Americas, possibly taking advantage of the problems with Mexico, or if Japan attempted to take advantage of any weakening of the Western powers. Thus, although the Army was by no means idle in the years before the United States entered World War I, not even the nation's military leaders envisioned a need for great haste in preparing for war.2

The hostilities already under way in Europe did emphasize the concerns of those who had for decades wished to see the nation better prepared to meet the challenges of modern warfare. Their efforts moved into high gear early in 1916. The surgeon general, Maj. Gen. William C. Gorgas,3 was among those who testified before congressional committees as they worked to prepare the legislation that would become known as the National Defense Act of 1916 and to appropriate the money necessary for implementing it. Beginning his testimony in January 1916, he noted that the size of the Medical Department had not changed since 1908, even though the size of the Army had increased by 50 percent. The resultant ratio of less than 5 physicians to 1,000 men was, in his opinion, woefully inadequate. Only by calling up Medical Reserve Corps officers and hiring a few contract physicians could he provide peacetime medical attendance for the posts, hospitals, and depots within the United States and in the Caribbean and the Pacific and for the units serving along the border with Mexico. Gorgas believed that 7 physicians for 1,000 men was a bare minimum for peacetime and that 10 per 1,000 would be necessary to meet wartime needs. Should the Congress decide upon a peacetime Army of 140,000


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SURGEON GENERAL GORGAS

men, the Medical Department would have to be more than doubled in size, signing on 537 new medical officers to reach the required total of 980.4

Surgeon General Gorgas pointed out that abruptly doubling the size of the Medical Corps would bring into the service large numbers of untrained civilian doctors who were not prepared to do all that was required of a military surgeon. Managing a military hospital was so complex that it had "attained the rank of a distinct speciality." Many duties routinely assigned to the medical officer called for experience and training not available to civilians, and a considerable length of time would be necessary before physicians without military experience who were called up in wartime could function successfully as medical officers. Allowing Medical Reserve Corps officers to train with the National Guard and other branches of the government rather than with the Regular Army meant that some of them would initially be unable to function with complete effectiveness if called up in wartime. The demands upon experienced medical officers was great. The services of many of them would be denied to units in the field because they would be needed to train civilians. Gorgas was by this point resigned to the fact that the "real function" of the Medical Department had become "training whatever medical officers are required for whatever Army may be arranged for," but he seemed to find the French approach of using non-physicians to handle many administrative responsibilities appealing.5

Surgeon General Gorgas also testified that the larger the number of men called up to meet a major conflict, the greater the difficulties that would be involved in maintaining their health, especially during the first year of service, when volunteers traditionally suffered a higher rate of disease than regulars. If an army as large as 500,000 men should be called up to meet a critical emergency, he predicted that the Medical Department would have great difficulty in providing adequate care. The situation in early 1916 was only "somewhat better" than it had been at the beginning of the Spanish-American War.6

In his testimony Gorgas emphasized that supply would also be a problem if the nation were suddenly plunged into war. In January he had on hand supplies for 300,000 men-or 200,000 more than the existing strength of the Army-for only five to six months. He pointed out that he would have the greatest difficulty promptly supplying the army of two million that might be necessary to defeat a major military power. An inability to purchase abroad would further complicate the supply situation, since some items were


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not obtainable in the United States and, in the case of drugs, no effort was being made to develop substitutes. After Congress voted the Medical Department another $37,500 in March, the surgeon general testified that he now had enough in reserve to supply an additional 220,000 men beyond those already serving-in other words, a 320,000-man force.7

As passed in June 1916, the National Defense Act demonstrated the attitude prevailing among the nation's leaders. It called for a gradual increase in the Regular Army, not for a rapid mobilization of men and resources, to take place over a five-year period and to peak ultimately at a peacetime strength of 175,000, with an additional increase to 286,000 to be allowed in the event of war. Although passed against the backdrop of the Mexican border situation, this legislation remained basically, as historian John P. Finnegan has put it, "a decision that the United States would not arm immediately to meet the menaces of a world at war. [It was] a peacetime measure produced by wartime demands," and an "act . . . far more intelligible when looked upon as an implementation of the Army's peacetime demands than as a response to world war."8

The nation's military forces remained unprepared to meet the challenges they would face in the spring of 1917. Even so, the Medical Department was officially delighted with the National Defense Act of 1916. A medical officer who fought in World War I termed it "the most important piece of preparedness legislation ever passed before any of our wars." According to Surgeon General Gorgas' annual report of 1916, it placed the department "for the first time in its history, upon a satisfactory basis." To keep up with the gradual expansion of the Army, the new legislation called for gradually adding 1,107 medical officers to the department. It also created a Veterinary Corps as part of the department, authorized assigning 5 medical officers to work with the Red Cross' military relief department, and established a working relationship between the department and the Red Cross in matters of supply. Lt. Col. Edward L. Munson of the Medical Corps had reservations about the new legislation, however. He pointed out that although the new law established the ratio of 7 medical officers to every 1,000 men that Gorgas favored, the proportion was still less than the 10 to 1,000 the British considered necessary.9

The passage of the National Defense Act did not relieve individual Medical Corps officers and civilian physicians of their anxieties about the lack of attention being paid to the "sanitary plans" that must, according to Colonel Munson, be "a part of the general plan of the campaign." Dr. George F. Keenan warned in Southwestern Medicine that "we face a serious situation, an ease loving people, self pampered and prosperous. We possess the universal short sightedness of Americans about the possibility of conquest by invading powers. . . ." Dr. Charles H. Mayo of Rochester, Minnesota, agreed, noting in an article in the St. Paul Medical Journal that "our nation is becoming soft, dissipated and inefficient" with "from 25 to 50 per cent of our youth from 20 to 30 years of age . . . physically defective from preventable causes." Attacking what he regarded as the traditional neglect of medical preparedness, he maintained that "in recent times, through army officers and war boards, the great nations have prevented their medical officers from doing their full duty because, like that of law, the conduct of war has been estab-


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lished by precedent." In the Crimean, Boer, Civil, and Spanish-American Wars, Mayo concluded, "the real cause of failure was lack of medical preparedness." With the zest and optimism typical of his generation, however, he predicted that "two years of war with discipline and sacrifice will make us the greatest nation on earth."10

A rider attached to the Defense Appropriations Act of August 1916 increased Surgeon General Gorgas' ability to meet the great challenge that faced him when it created a Council of National Defense, and the six cabinet members and civilian advisors who were to coordinate defense preparations under this measure appointed Gorgas to the Council's committee on medicine. But because few predicted that the United States would enter the vast conflict in Europe, the Medical Department, like the Army itself, remained unprepared to handle the rapid expansion that wartime needs would dictate.11

The Surgeon General

When William Gorgas became surgeon general in January 1914 following Torney's unexpected death, less than eight months remained before the outbreak of what would be the most deadly war the world had ever known. He was a 63-year-old physician of illustrious credentials, remarkable accomplishments, and genial disposition, an officer apparently well qualified to meet the challenge facing the Medical Department. His successes in Cuba and the Panama Canal Zone were familiar to many (and possibly most) Americans and to the scientific world abroad as well. His achievements as a scientist were made all the more remarkable by the fact that his medical career had initially been undertaken as an expedient, a means of obtaining an Army commission when he was unable to obtain an appointment to West Point, possibly because he was the son of an officer who had resigned his commission to serve with the Confederate forces in the Civil War. The esteem in which he was held was both demonstrated and enhanced by his becoming the first surgeon general in the history of the Medical Department to be given the rank of major general.12

But Gorgas, according to a contemporary in the Medical Department, had little interest in administration. His wife later commented in her biography of her husband that "the new Surgeon-General had little opportunity, at this time, to give to his official labors. The call for his services in the field that he had made his own became insistent." The field that he had made his own was yellow fever, which, should the nation be required to defend its new tropical empire, might well be a matter of concern. In June 1916, after spending many weeks testifying about the department's needs before Congress while it prepared the budget for fiscal year 1917 and designed the National Defense Act, Gorgas accepted an invitation to spend several months visiting countries in South and Central America on behalf of the Rockefeller Foundation, a privately funded organization concerned with world health, to advise it on the formation of comprehensive plans for the struggle against yellow fever. There, while the Germans, French, and British killed one another by the hundreds of thousands at Verdun and along the banks of the Somme, he spent four months that were, according to his wife, "among the most delightful and enjoyable of his life." Everywhere acclaimed and awarded honorary degrees, he joined in the festivities, she noted, "with the zest of a schoolboy." By January 1917, three years


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after he became surgeon general, Gorgas was eager to retire to concentrate entirely on yellow fever, but his return to the United States coincided with Germany's resumption of unrestricted submarine warfare, and "the war for a time necessarily postponed" his departure from the Army. He remained at the head of the Medical Department until the end of the struggle.13

Medical Department Personnel

Although Gorgas' major interests were clearly scientific, the principal challenges he faced as surgeon general were administrative. The Surgeon General's Office would be responsible for directing the Medical Department during the inevitable turmoil that could follow entry into a major war, but it was still composed only of the surgeon general himself and six other officers, with a civilian staff of 146 working under them. Medical officers headed divisions for personnel, sanitation, supply, and the library and museum, while the Record, Correspondence, and Examining Division worked under the direct authority of the chief clerk.14

The shortage of trained, experienced personnel posed an especially formidable problem. Physicians specializing in either scientific or administrative fields were becoming increasingly important to the Army, and training in many of those specialties was scarce outside the military. Yet a total of barely more than 5,000 men and women, including 426 medical officers, were working in the entire Medical Department in 1914. The modest increase in the number of enlisted men and Medical Reserve Corps officers on active duty resulting from the conflict along the Mexican border brought the total serving in the department by 30 June 1916 to 5,792. The theoretical capacity of the field hospital had increased from 108 to 216 beds, and the Field Service Regulations of 1914 called for an increase in the size of the evacuation hospital from 324 to 423 beds; but, because of the shortage of personnel, medical support on this scale could be provided for only half the Regular Army. Any expansion of the Army would make it necessary to call up an additional 3,500 physicians, almost all untrained, for every additional 500,000 men. Thus, although plans for the management of medical care in the field continued to be refined, the question remained as to whether the Army would have enough physicians able to carry them out effectively if the United States were drawn into a major war.15

The first challenge resulting from the decision to triple the size of the Medical Corps was to make a career in the military service seem attractive to more than 1,100 medical graduates capable of passing the entrance examinations. Although the nation's dwindling number of civilian medical schools had improved in quality, they continued to graduate fewer physicians than before the turn of the century. The Journal of the American Medical Association joined Military Surgeon in trying to convince more of them of the advantages of an Army career. The increased salaries and benefits voted in 1908 made it possible for Military Surgeon to emphasize that the medical officer was paid well enough "to live like a gentleman in a community of gentlemen," with an income that was "adequate [and] assured" and increased with time. Furthermore, "proportionate to the whole number of physicians in the country, the number of medical officers of the Army who have achieved an enviable position in the profession, is greatly in excess of the average


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in civil life." The Journal noted that the Medical Corps physician was also "encouraged to specialize" and that the Army's laboratories, operating rooms, and post libraries were all equipped to assist the research-minded surgeon with his work. What effect the appeal had is difficult to judge, since the growing possibility of U.S. involvement in war may have also encouraged would-be applicants. In any event, while only 20 young physicians who had passed the initial examination reported for class at the Army Medical School in the fall of 1915, 65 did so a year later.16

The increase in the size of the Medical Corps exacerbated the problems of the Army Medical School's already inadequate facilities. Beginning in October 1916, two terms were scheduled for the academic year, with 115 young physicians qualifying for commissions as Medical Reserve Corps officers in order to enroll for one or the other of them. Of the 101 passing the final examinations in that school year, 98 won Regular Army commissions. The school had to prepare to accept a still larger enrollment, but the Medical Department had not yet succeeded in gaining acceptance of the idea of building a new medical school on the grounds of the Walter Reed General Hospital. With no time to waste, Surgeon General Gorgas found a former Department of Commerce building in the city twice as large as the facility then in use and had the school and laboratories moved into it in September 1916. Since even the new grounds were not large enough to permit establishing a camp and initiating field exercises, Gorgas continued to hope for something better in the way of accommodations.17

Even if the Medical Department was successful in filling all openings in the Medical Corps, in the event of full-scale war the Army would have to rely heavily on National Guard physicians, who numbered about 800 in 1916, and Medical Reserve Corps officers, roughly twice that number, and possibly on civilians without any exposure to the military. Military training was not required for members of the Medical Reserve Corps, and few reservists were likely to have attended the lectures on military medicine that civilian medical schools and societies were beginning to offer. Few Medical Reserve Corps officers undertook active duty, less than 100 in either 1914 or 1915, though this figure included those at the Army Medical School. In fiscal year 1916, when 1,903 were on the combined active and inactive reserve lists, only 146 requested active duty. The experiences of Medical Reserve Corps officers called up to care for troops during the crisis with Mexico in 1916 showed their lack of enthusiasm for more than the briefest of training, since some resigned rather than be subjected to a similar experience again. The National Defense Act dictated an end to the Medical Reserve Corps as of June 1917 and offered each Medical Reserve Corps officer a commission in the newly created Officers' Reserve Corps, a step that the surgeon general opposed vigorously but in vain.18

The untrained medical officer was deemed to be "worse than useless." As an article in Military Surgeon pointed out, an Army surgeon had to be able to "visualize the country from a map . . . to handle [medical] units [and] to coordinate their movements with those of other troops." He also had to learn to understand military orders and how to execute them. As a result, the correspondence course given through Fort Leavenworth and designed specifically for reserve officers who could not leave their civilian practices was greeted with enthusiasm. In January 1916 Surgeon


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General Gorgas informed the House Committee on Military Affairs that about 700 Medical Reserve Corps officers were taking the correspondence course.19

Still another method of training medical personnel was introduced not long after Gorgas became surgeon general, one intended for those who could afford to leave their practices briefly. Joint camps of instruction, apparently similar to Surgeon General Torney's medical camps, offered Medical Reserve Corps officers and their colleagues in the National Guard the opportunity to work with field hospitals and ambulance companies both from the Medical Department and from the Guard. In 1915 five such camps were established, each with its own field hospital and ambulance company. The Army set up the camps at centrally located sites that varied from year to year, to which reserve and Guard medical officers could come with a minimum of transportation expense to spend a week learning about medical problems in the military. At least one prominent member of the Medical Reserve Corps, Maj. Joseph C. Bloodgood of the Johns Hopkins Medical School, believed that his colleagues should be willing to pay for themselves "the small expenses incidental to this experience," which for reservists involved the uniforms they wore, transportation, and mess fees. In spite of Bloodgood's personal enthusiasm, joint camps of instruction for training Medical Reserve Corps officers initially aroused less enthusiasm than the correspondence course.20

Since the Medical Department was allowed to hire enough contract dentists to maintain a ratio of 1 to 1,000 men, no new legislation was necessary to increase the size of the Dental Corps. Because dentists were expected under normal circumstances to care for dependents, servants, and civilian employees as well as soldiers, in fiscal year 1915 the ratio of dentists to the total number of eligible patients in the Eastern Department, for example, was 1 to 2,300. Shortly after passage of the National Defense Act in June 1916, 40 dental surgeons and 50 contract dental surgeons were on duty with the Army. Their small number and the fact that their work did not require their presence near the front lines meant that military training for them was not a major problem for the department, even when as many as 43 dentists were serving in the Southern Department during the crisis with Mexico.21

Although the new law did not change the ratio of dentists to soldiers, it did modify the organization of the Dental Corps, abolishing the institution of the contract dental surgeon and decreeing that the applicant for a position as a dentist who met the Medical Department's standards be immediately commissioned a lieutenant. Examinations for professional competency were required for eligibility for each promotion thereafter. After eight years the dentist could be promoted to captain, and after twenty-four years he might be chosen as one of the 15 dental surgeons holding the rank of major.22

The size of the Army Nurse Corps, like that of the Dental Corps, seemed inevitably to lag behind the need. Three nurses from the Red Cross reserve had to be called in to assist the 9 members of the Army Nurse Corps sent to Vera Cruz when it was occupied by a joint Marine/Army force early in 1914, by which point many base and military department hospitals were urgently requesting more nurses. Transports sent to Europe to bring Americans back after war was declared there in the summer of 1914 needed nurses, and the shortage that this situation created forced the


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Medical Department again to hire contract nurses, in this instance for the Walter Reed General Hospital. The 1916 mobilization resulted in a serious shortage until Secretary of War Lindley M. Garrison lifted the ceiling of 150 nurses that he had imposed. Although eventually more than 300 additional nurses were added to the Nurse Corps, the increase did not come in time to avoid the necessity of calling in reserve Red Cross nurses; during the mobilization 184 of the 251 nurses in the Southern Department were from the reserve.23

To house nurses, new quarters had been completed at the Army-Navy Hospital in Hot Springs, Arkansas, and were either under way or almost complete at Letterman General Hospital in San Francisco and the hospital in Honolulu, all areas relatively unaffected by the Mexican situation. In June 1915, however, the quarters at the Fort Leavenworth hospital were still inadequate. At the Fort Sam Houston facility, upon which much of the strain fell, space had to be rented in 1916 to house the average of 42 nurses assigned to meet the needs of the newly mobilized forces there. The nurses quarters at the various base and camp hospitals near the border were, of necessity, "temporary structures," the surgeon general reported, but "comfortably furnished, and in the main, very satisfactory."24

Although serious complaints about female nurses were no longer heard, some in the Medical Department believed that the Army needed male nurses as well; however, no significant body of trained civilian male nurses existed. Furthermore, of the 900 male nurses in the United States, few were interested in serving in the Army, and not all of those who were interested could qualify for military service. In January 1915, therefore, 10 Hospital Corps privates were chosen to receive four months of training as nurses. A second 10-man class was organized the following November for a six-month program, but the surgeon general's annual report for 1917 does not reveal whether courses of this type were given thereafter.25

These 20 student nurses were but a few of the more than 4,000 enlisted men in the Medical Department during this period, most of whom were not of the caliber the surgeon general wanted for the Hospital Corps. Gorgas blamed "inferior inducements" for the poor quality, noting that the War Department had been ignoring his suggestions for improving the situation. Although as early as 1914 the threat of hostilities on the Mexican border rendered the secretary of war more responsive to pleas for an increase in the quantity and the quality of enlistees, except for the sergeants, the enlisted men caring for the sick and wounded continued to be, as one officer put it, "the riffraff of the Army." The quantity was as inadequate as the quality. Gorgas pointed out that while a ratio of 5 corpsmen to 100 soldiers was adequate in peacetime, twice as many would be needed in the event of war and that the department was already having great difficulty in interesting enough men in the corps to keep all authorized positions filled.26

In 1916 the National Defense Act ended the official life of the Hospital Corps, the Medical Department's first corps. All the department's enlisted men, including saddlers, farriers, and mechanics as well as former corps members, became part of the enlisted force. Privates first class were given extra pay to serve as dispensary assistants, nurses, or surgical assistants. Surgeon General Gorgas believed that since the extra pay would serve as an incentive, the red tape involved in obtaining the three better-paid specialties for those deemed


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worthy of them would have to be endured. Enlisted men new to the department still had to start at the bottom as privates and work their way, if they could, up to the highest position, master hospital sergeant, with its pay of $75 a month. The new law allowed the president to increase the number of the Medical Department's enlisted men by as many as he believed necessary in wartime, but it set the peacetime ratio at 5 percent of the total number of enlisted men in the entire Army.27

While causing the Hospital Corps to lose its identity, the National Defense Act gave the veterinarians an organization of their own within the Medical Department. The new law recognized the fact that one of the many new developments following the advent of scientific medicine was the appearance of the professional veterinarian, replacing the self-taught farrier and similar untrained figures who had traditionally cared for sick and injured animals. To be appointed to the new Veterinary Corps, a veterinarian had to be between twenty-one and twenty-seven years old and a graduate of an approved school of veterinary medicine. Veterinarians already in the Army could join the new corps upon passing the required physical and professional examinations, but many proved unable to do so. To receive rank, those accepted into the Veterinary Corps had to serve a two-year probationary period, during which they could be dismissed at any time. By April 1917 sixty-two veterinarians had received commissions as second lieutenants. After five years of service and the passage of the first of the exams they would have to take to progress through the ranks, they would become first lieutenants and after ten years of acceptable service, captains, moving from the category of assistant veterinarian to veterinarian. After another five years, they would become eligible for promotion to major. Two members of the corps were to be assigned to each cavalry regiment, one to every three artillery battalions and one to every mounted engineers battalion, while seventeen would inspect horses and mules. As veterinarians for the Quartermaster Corps, another seven were assigned to inspect meat. Reserve veterinarians, who also had to be graduates of approved institutions of veterinary medicine and pass professional and physical examinations, could also be appointed to care for Quartermaster Corps animals. While on active duty, the reserve veterinarian would be paid as a second lieutenant.28

The creation of the new corps and the solidifying of the position of the Army dentists could not mask the fact that, even after the passage of the National Defense Act, the Medical Department continued to face the same basic problem, the shortage of trained personnel. The increases in number, whether voted by Congress or, in the case of nurses and enlisted personnel, allowed by the secretary of war, were inadequate. A system to train the massive numbers of physicians that would be needed in the event of a major war had not been found.

National Guard Medical Personnel

Problems of both quality and quantity plagued the National Guard medical organization as it did the Medical Department. Although some Guard units heeded the congressional requirement that after 21 January 1910 "the organization . . . and discipline of the Organized Militia . . . be the same as that . . . for the Regular Army," this goal was completely realized only after December 1914, when the Division of Military Affairs issued a circular describing the


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desired form of organization in detail. As a result, for a time some Guard physicians were still chosen and promoted because of favoritism rather than competence. In addition, the size of the Guard medical establishment grew slowly. While the 869 medical officers serving as of 30 June 1914 represented an increase of 90 from the previous June, the 3,554 enlisted men who handled the duties of the hospital corpsman in 1914 could form only one more Hospital Corps detachment than had existed in 1913. By August 1916, when the number of guardsmen called to the Southern Department to meet the Mexican threat peaked at more than 110,000, the number of enlisted medical personnel was at full strength-19,000 men-and 59 field hospitals, 47 ambulance companies, and 267 sanitary detachments had been federalized. Failures of medical personnel to report with their units for federal service and resignations among those who did continued to cause shortages. Since some state units brought no enlisted medical personnel with them, men had to be transferred from the line to make up for the deficiency. Although the commissioned medical personnel on National Guard rolls at this point included 1,407 medical officers, 307 dentists, and 81 veterinarians, in addition to 53 militia reserve medical officers who had not been called into the federal service, the number of federalized medical officers fell 60 short of those needed.29

Until the entire Guard was federalized in 1916, most of the military experience of militia medical officers consisted of determining fitness for duty, but their ability to make objective decisions was compromised by the fact that the men with whom they were dealing were often friends, patients, and friends of patients. Moreover, many civilian and Guard physicians giving physical exams did not bother to familiarize themselves with the standards and might not even require those being examined to undress. One report maintained that a man with a glass eye had been accepted, and a Medical Corps officer reported that "frequently any one who is strong enough to walk can enlist" in the Guard. Those taken into the Guard in spite of their physical condition might have to be discharged shortly thereafter when it became obvious that they could not function successfully as soldiers.30

Nevertheless, Major Gilchrist, who was still detailed to the Division of Militia Affairs (shortly thereafter renamed the Militia Bureau), was encouraged by the progress that had been made by early 1915 toward solving the problems of the Guard's medical organization. He gave the credit for the improvement to the adoption of a uniform organization throughout the Guard, greater support from the states, correspondence courses for interested militia physicians, the elimination of officers whose interest in their responsibilities was minimal, the enrollment of younger doctors, and the use of inspector-instructors to spot deficiencies and bring about improvements.31

Five Medical Department surgeons had been made available to work as inspector-instructors with the National Guard east of the Mississippi, usually in areas with which they were familiar. They taught a correspondence course, added to it by personal instruction, and inspected camp sanitation. The great size of the areas to which they were assigned was a handicap, for an officer might be responsible for several states whose medical organizations differed. Instructors' problems were further aggravated by a shortage of textbooks and by the fact that they sometimes received little cooperation from state authorities,


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which rendered their work "very trying and extremely difficult."32

Uniformity in the operations of the various sanitary units of the National Guard became an important goal. Together with eleven Regular Army post surgeons designated to teach correspondence courses for militia surgeons in areas to which instructor-inspectors had not been sent, instructor-inspectors taught an identical and carefully planned course. Since personal instruction proved especially valuable, when the assignment of a post surgeon teaching such a course was changed, the effectiveness of the course was to a degree reduced. Nevertheless, more than 60 percent of the students taking the course completed it successfully in fiscal year 1916. As a result, a sixth medical officer was assigned to work as an inspector-instructor, and Surgeon General Gorgas concluded that still more officers should be assigned to that position. The National Defense Act requirement that all doctors appointed to or promoted within the Guard pass examinations before boards of Regular Army medical officers also contributed to creating uniformity, but when the units of Texas, New Mexico, and Arizona were federalized in May 1916, too few regular medical officers were available to man the examination boards.33

Unfit guardsmen might become the responsibility of the Medical Department because the law allowed men from states that had officially adopted federal standards to be mustered into federal service before undergoing federally administered physical exams. Because of inadequate state examinations, a total of 25 percent of the men in newly federalized units had to be discharged in 1916 as physically unable to do all the duties required of them. The new recruits called up to replace them proved to be no healthier, many ending up in hospitals not long after arriving at the recruit depots. The department's suggestion that a Regular Army medical officer examine all men before they were accepted into federal service was overtaken by events. When the Guard was called out and sent south toward the Mexican border, haste was the order of the day, Medical Corps officers were few, and Medical Reserve Corps officers who were called in to help were sometimes slow in arriving. On occasion, federal physical examinations were given first to Guard medical officers so that those who passed could assist in examining the rest.34

Both Guard and Regular Army physicians worked as many as sixteen hours a day conducting physicals and administering the required immunizations against typhoid and smallpox in each mobilization camp. In spite of pressure sometimes brought upon physicians at this point to overlook defects, Regular Army surgeons were never given permission to waive problems that would interfere in the performance of duty. Nevertheless, in the haste, men who were not qualified to serve sometimes slipped through.35

The quality of the medical enlisted men of the Guard also left something to be desired. Men "of high quality, . . . medical students of good education," might find the duties beneath their dignity, and others would have to improve markedly, Major Gilchrist believed, if they were to meet federal standards. Furthermore, noncommissioned officers, although often able pharmacists, were not necessarily competent to manage the work of others. Guard line officers contributed to the problem by their failure to appreciate the role the Medical Department wanted the corpsmen to play, too often regarding corpsmen as mere laborers available for


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digging trenches and latrines. Under such circumstances, the work of Medical Department sergeants as sanitary instructors for the militia proved so valuable that in fiscal year 1916 three more were named to join the twelve already assigned to this duty. Even so, the Medical Department noncommissioned officer and two privates who were sent to each mobilization camp to assist and train their Guard counterparts sometimes ended up doing both their own work and that of the men they were sent to train because so few guardsmen were willing to do the work of a hospital corpsman.36

Supply

The supply situation continued to cause the Medical Department less concern than the shortage of trained personnel, although Surgeon General Gorgas had on hand in December 1914 but half the four-year reserve recommended by the Dodge Commission. He blamed the deficiency at least in part upon the fact that much of the department's reserve had accompanied the force sent to Vera Cruz earlier that year. Rebuilding the reserves would not be easy. The rate at which the warring nations in Europe had been buying up medicines and equipment made it difficult for production to keep up with demand, and 80 percent of the surgical instruments used in the United States were of German manufacture. The surgeon general agreed with other members of the nine-member committee that Secretary of War Garrison had named to investigate potential problems in war production that private industry could handle the demand and that a government monopoly over the production of such items was neither needed nor wise.37

In April 1916 Surgeon General Gorgas showed no great anxiety over supply. The Medical Department had on hand the equipment for 20 evacuation hospitals, 3 base hospitals, 44 field hospitals, 41 ambulance companies, and 131 regimental infirmaries and a reserve of supplies that, Gorgas estimated, would last 250,000 to 300,000 men five to six months. He admitted early in 1916 that if an army of 2 million men were to be put into the field, providing adequate supplies of medicine would be extremely difficult. The problem would be exacerbated if control of the sea were lost, since he had made no preparations to make in the United States any items usually obtained abroad. By January 1917 he could no longer keep pace with the National Guard's requirements, and in February he noted that eight to twelve months would be required for the department to acquire and pack everything necessary to meet wartime demands.38

Although the volume of supplies and equipment held by the Medical Department left much to be desired-the reserve at its maximum was sufficient for a force only three times the size of the Army rather than four-its management was increasingly efficient. The unit system of supply initiated by Surgeon General O'Reilly had been adopted on a widespread basis so that everything needed by a Medical Department unit, be it a field hospital or a recruiting depot, was carefully recorded, stored together, and ready for use regardless of which department of the Army was responsible for procuring each individual item. Plans called for camp infirmaries to hold a reserve of supplies for regiments and to draw on a base medical depot for replenishment. Base depots, similar to those used in the Civil War, each manned by two medical officers and fifteen enlisted


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men, would in turn draw on the major depots in New York, St. Louis, and San Francisco. A reserve medical supply, described as "a movable depot," would move with each division, under the control of the division's chief surgeon, and be replenished as needed from base depots along the line of march. To further standardize medical supplies and to find ways in which to speed production and reduce costs, a committee was organized of representatives from the Army and Navy Medical Departments, from the Public Health Service, and from the Red Cross a few weeks before the United States entered the war.39

Standardization was but one of the problems involved in supplying motor ambulances, the only vehicles the Medical Department bought for itself. Design improvements were frequent, and no one type filled all needs, making standardization impractical at this early stage of the use of motor transportation. Surgeon General Gorgas did note the need for "a standard commercial chassis made by a reliable firm" so that spare parts would always be available and pointed out that the motorization of all hospital transportation would "increase its efficiency, and . . . economize in the maintaining of this department." A board that met to consider the question of ambulance design recommended buying 500 "standard ambulance bodies," but when the United States declared war in April 1917, motor ambulances were continuing to come from several sources.40

Quality was as much of a difficulty as design. A Keeton Motor Company ambulance shipped to Texas City, Texas, for example, in the spring of 1914, a time when the Medical Department had fewer than twenty motor ambulances, arrived with dead batteries. "The entire machine seemed to have been carelessly put together," the department informed the manufacturer. On a march to Houston it broke down the first day, when "the differential came loose and broke up." Incorrect instructions accompanied a Keeton vehicle sent to Fort Riley, Kansas, and the starter could not be located for some time; the discovery that pushing down the light button, which was twisted to control the light, activated the starter was accidental. Nevertheless, the department continued to buy ambulances, although when one old Keeton was condemned in the Philippines, two models from the White automobile company were bought to replace it. So impressed was Surgeon General Gorgas with motorized transport that in the spring of 1916 he even urged Congress to appropriate money for motorcycles, a few of which the department had been trying out in Mexico, to be used to carry Medical Department messages and field supplies.41

The true potential of the motor ambulance for meeting Medical Department needs, as well as the difficulties that vehicle might present, first became apparent in 1916 on both sides of the Mexican border. Initially, trucks and mule-drawn ambulances provided transportation for the sick and wounded within Mexico. When motor ambulances arrived, the harsh punishment to which they were subjected in Mexico, where roads were often nonexistent, demonstrated that the models from the General Motors Company were "cheaply constructed." The lack of shock absorbers led to much breakage of springs, and one of the two types provided by this firm had a body so high that it was easily overturned. The problems experienced with these vehicles were exacerbated by the fact that the only trained mechanics available were those sent in to service the expedition's planes.42


390

The difficulties experienced with motor ambulances along the border encouraged debate over the relative merits of this vehicle and the mule-drawn model. The ambulance company with mule-drawn vehicles had, according to one medical officer in 1916, "fully justified its organization and continued existence." Mules could cover terrain too rough for motor vehicles, but this advantage was at least partially negated by questions about the advisability of subjecting the wounded to the jolting caused by a ride over a surface too uneven for motor ambulances. The motor vehicle could go faster than its mule-drawn counterpart, did not have to stop to be fed, could carry a comparatively large number of patients within a given period, and was, European experience suggested, cheaper to operate. Furthermore, some of the ambulances used by the Army apparently had pneumatic tires to provide a less jarring ride for their passengers, and although a truck designed specifically for Army use had yet to be developed, some commercial models had proved to be very durable even under difficult conditions. Despite the fact that by the end of September 135 motor vehicles were in service in the Southern Department and many more were on their way, the motor ambulance company was still regarded as "experimental."43

The supply system established by the Medical Department was very effective, but the magnitude of World War I had not been anticipated in designing plans to meet wartime demands. Occasional difficulties with distribution were inevitable. National Guard physicians were generally ignorant about how to buy supplies in an emergency. The sites of mobilization camps were occasionally changed on short notice, delaying delivery and making for even greater difficulties if the requisitions had not been made in a timely fashion in the first place. The movement of supplies rapidly and in adequate amounts remained the major problem, principally because the Quartermaster Corps, hampered by demands for economy and the need to determine when, whether, and how to convert to motor transportation, was, like almost everyone else, uninspired by any sense of urgency.44

Hospitals and Laboratories

The fragile relationship with an unstable Mexico and attempts to prepare for the demands of a major war added to the difficulties traditionally experienced in managing the Army's hospitals and laboratories. Permanent hospitals, whether large or small, had rarely received the attention and the financing they needed, and the work of laboratories in the rest of the United States was curtailed in the interests of meeting the demands upon those near the Mexican border. Surgeon General Gorgas' continued efforts to obtain the money to improve and enlarge aging facilities often met with frustration, especially since the limit on money to be spent on construction undertaken without specific congressional authorization still applied. The hospitals at posts near the Mexican border were expanded to meet the needs of troops that gathered there, but in 1914 capacity did not keep up with demand at Forts Bliss and Sam Houston in Texas or at Fort Huachuca in Arizona. Since, in addition, female nurses were not always available for the posts in the Southwest and both medical officers and hospital attendants often lacked appropriate training, a Southern Department surgeon reported to Gorgas that the "care of the sick and the general


391

management of these hospitals . . . at times suffered severely."45

In 1914 the Army-Navy Hospital became an informal general hospital for the Southern Department and the 2d Division, stationed at the Mexican border. A ward for another fifty beds and a new barrack for sixty hospital corpsmen were built there in 1915, but the waiting list was long, and still more space was needed. The hospital at Fort Bayard remained restricted principally to the treatment of patients with tuberculosis, but its population, too, was slowly growing. Because the funds to complete all of the requisite construction there were difficult to obtain, a ward had to be set aside at Letterman General Hospital in San Francisco to accommodate tuberculosis patients. The existing buildings at Letterman, which served as the hospital for posts in the San Francisco area, were all of wood, and the danger of another disastrous fire was real. Surgeon General Gorgas ordered that all new construction there be of reinforced concrete, but because of the size of the hospital grounds, little expansion could be attempted.46

The overseas hospitals that might be needed in the event of a colonial war experienced their share of difficulties, many of which could also have been cured by granting more money to improve or enlarge the facilities. What had been a 12-bed post hospital in Honolulu, Hawaii, only a few years before had by 1916 become a 275- to 300-bed facility, serving both as a post hospital for nearby garrisons and as the general hospital for the entire Department of Hawaii and handling well over 2,000 patients a year. In the Philippines, where one quarter of the Army was stationed in 1914, the hospitals were inadequate in size and required repair. In the Canal Zone, now under a U.S. civilian government, the absence of military hospitals made it necessary for Army personnel and their families to use civilian facilities for all problems that could not be handled by a post dispensary. As a result, while an Army medical officer remained responsible for the overall management of Canal Zone hospitals and sometimes another Army physician might manage an individual facility, the care of the individual hospitalized military patient was not otherwise under the Army's control. Military dependents were charged for the entire cost of their hospitalization rather than merely for subsistence and medication.47

Although hospitals had always been important to the Army, the role of laboratories, constantly increasing with the growth of medical knowledge, grew still more rapidly under the stimulus of mobilizing large numbers of troops. The experience gained along the Mexican border provided insight into the vital part they would play if the United States were to become involved in a major war. At a time when venereal disease was regarded as a major threat to the Army's effectiveness, both actual and potential, the laboratory was needed to help in the diagnosis and to follow the progress of the treatment of both syphilis and gonorrhea as well as many other health threats. Routine tests, such as urinalyses and blood counts, were done in the small labs that existed in every hospital, while more complicated work, including testing drinking water for signs of bacteria and pollutants, was assigned to major facilities. The importance of the Army Medical School laboratory also grew during the mobilization, initially because it was responsible for making all vaccines. When the demands of the Mexican situation necessitated moving the Central Department's laboratory into the Southern De-


392

BASE HOSPITAL AT FORT SAM HOUSTON, TEXAS

partment, the Medical School was assigned the routine work normally done by the Central Department's main facility at Fort Leavenworth, Kansas.48

The burden of the 1916 mobilization fell most directly upon the Fort Sam Houston laboratory. Although the size of its staff was increased, additional laboratories had to be set up at El Paso, where the Fort Leavenworth unit was moved in August 1916, and at Nogales, Arizona, a month later. After medical officers discovered that the climate in Texas favored raising guinea pigs, many tests that required the use of these animals and were vital to the correct diagnosis of several diseases were run at the Fort Sam Houston laboratory. The facility also sent out guinea pigs to scientists at El Paso and Nogales. An epidemic, probably paratyphoid (a disease similar to but milder than typhoid), first diagnosed in units along the Mexican border in the early summer, struck the guinea pigs in December, threatening vital diagnostic work. The threat was brought under control by vaccinating breeding females, the chief victims of the disease, by isolating sick animals, and by disinfecting cages. Even after the epidemic was brought under control, the load that the Fort Sam Houston laboratory had to carry remained high, dictating the construction of a new building by early 1917.49

Training Along the Mexican Border

The involvement of U.S. forces in the turmoil within Mexico increased with time in the first years of Gorgas' service as surgeon general. As a result, Mexico and the Mexican border became, both literally and figuratively, training areas for the medical officers watching over the health of both U.S. soldiers and foreign nationals. When


393

FIELD HOSPITAL NO. 7 EN ROUTE TO MEXICO

Gorgas first assumed the duties of his office in January 1914, members of the Army Medical Department were already joining representatives of the Red Cross to care for 5,000 Mexican refugees, soldiers, and civilian camp followers who had crossed the border to escape rebel forces. Ten hospital corpsmen and two sergeants were sent to Fort Bliss, Texas, where the refugees were initially interned in a camp commanded by a medical officer, and four more corpsmen joined them there on a temporary basis. Finding the physicians among the refugees of little assistance in either caring for the sick and wounded or taking measures to prevent outbreaks of disease, the six medical officers sent to the fort promptly began immunizing against typhoid and smallpox, thus nipping incipient epidemics in the bud. Because Medical Department personnel insisted upon high standards of sanitation, the 21.8 per 1,000 death rate experienced by the refugees during their six-month internment, first at Fort Bliss and then at Fort Wingate, New Mexico, was blamed on the hardships they had endured, their debilitated condition when they crossed the border, and their poor morale.50

Army units were concentrated north of the border with Mexico throughout 1914 and 1915 in a state of watchfulness, the soldiers for hostile activity, the medical officers for signs of disease. Because the refugees continued to bring typhoid, typhus, smallpox, and influenza with them, constant vigilance was necessary to prevent the reappearance of typhoid and smallpox epidemics. Immunization against both was compulsory in the Regular Army and in federalized National Guard units as well, but medical officers were aware that vaccine did not always prevent disease and concluded that the effectiveness of the ty-


394

phoid vaccine began to weaken after no more than three years. The source of every typhoid case that did develop was routinely traced so that the reasons for any outbreak could be ascertained and steps taken to prevent further spread. Mosquito control kept malaria rates low, and sanitation reduced the threat of dysentery. At times, medical officers also cared for the casualties resulting from minor incursions by Mexicans into Texas and Arizona, including a few members of the factions contending for power within Mexico.51

Although medical officers could rely on sanitation and immunization to limit the threat of the old camp diseases, chiefly typhoid and dysentery, to manageable proportions, they could not be equally confident of their ability to devise a truly effective approach to the prevention of venereal disease. While the stoppage of pay for time lost because of self-inflicted health problems caused alcoholism rates to continue the steady decline that had started in 1907, the new regulation had not produced a comparable trend in venereal disease rates. Army studies offered Surgeon General Gorgas the small consolation that the VD rates in the civilian and military populations were similar, a conclusion that the high rejection rate of recruits because of VD seemed to support. One of the Army's most experienced bacteriologists concluded that syphilis alone was "a greater menace to the public health than any other single infectious disease, not even excepting tuberculosis."52

The thought of what was likely to happen to the venereal disease rate when soldiers were far from their families, were alone in a strange environment, and were more likely than ever to become the victims of diseased women, was alarming. Surgeon General Gorgas decided that the medical officer's lecture on the dangers of venereal disease at each post should be appropriately illustrated. Because he had received reports that soldiers might use the prophylactic treatment once-just to have their names on the record should they later discover they had contracted a venereal disease-but then fail to report subsequent sexual contacts, he also suspected that the rule calling for prophylaxis within six hours of exposure was being violated. He therefore urged that prophylactic packets, to be used promptly after sexual activity, be given rather than sold to individual soldiers as the men seemed reluctant to buy these items. In spite of the alarm about VD rates, the packet still did not contain condoms, although the recent introduction of vulcanized rubber made their manufacture both easier and cheaper. As late as 1918 an authority on syphilis noted that "the objections to the use of such a mechanical device are practical and moral" (apparently a common belief), since they were expensive and hard to locate when needed and appeared to make immorality safe.53

U.S. Army units first ventured across the border into Mexico at the end of April 1914, when they joined the marines who had just taken Vera Cruz. Since military action was by that time at an end, Army medical officers under Col. Henry P. Birmingham, the expedition's chief surgeon, could again add the health of civilians to their routine responsibilities. They took over the direction of local health authorities in all matters except quarantine from the Public Health Service physicians who had borne that burden during the Marine/Navy phase of the occupation. A Medical Reserve Corps lieutenant who lived in Mexico was made temporary superintendent of the civil hospitals, later to be replaced by a retired U.S. Army officer,


395

HENRY P. BIRMINGHAM

under whom he then served as assistant. To care for their military patients, Army physicians set up a 216-bed field hospital in a preparatory school, "the newest and most modern structure in the city," with modern plumbing and electric lights. The building was large enough to shelter a laboratory and quarters for hospital corpsmen, while the twelve nurses sent in by the Army Nurse Corps were housed in a nearby private building. Two medical officers and twenty-five enlisted men formed an ambulance company. Navy doctors worked under Colonel Birmingham in a separate facility they established for Marine patients, using supplies from the Army.54

The burden of the responsibility for civilian and military health was made particularly heavy by the condition of Vera Cruz, "one of the unhealthiest and most disease-ridden cities of the world," where yellow fever, malaria, smallpox, and dysentery were rampant and, according to Colonel Birmingham, the "more or less disorganized state" of the government had resulted in the neglect of sanitation. Army surgeons quickly set to work to immunize the civilian population against smallpox, vaccinating more than 41,000 in the period from 18 May to 30 June. U.S. troops were stationed on the outskirts of the city, where they could use city water and sewers while reducing their exposure to the city's hordes of insects and the diseases they bore. The floors and walls of the buildings occupied by soldiers were disinfected, and a daily dose of three grains of quinine was made mandatory for each man because of the danger of malaria. Experts from the Canal Zone, some of whom had trained under Gorgas, were called in to help improve the city's sanitation, using the techniques he had developed.55

Since city ordinances already in effect allowed authorities to control prostitutes in Vera Cruz, these women were restricted to specific areas, registered, inspected by a medical officer each week and, if diseased, confined in a charity hospital until pronounced cured. Only 25 percent of the registered prostitutes required hospitalization because of venereal disease, but 90 percent of a sampling of the "clandestines" who had escaped regulation were infected. Free prophylactics and educational materials in both Spanish and English were made available at several sites. Colonel Birmingham concluded that "all these measures proved amply effective" and that, as a result, what could have been "an inordinately high rate of venereal infection" was kept at what he regarded as a reasonable level under the circumstances, a noneffective rate for the period from late April through the fall of 1914 of 5.21 per 1,000.56


396

FIELD HOSPITAL AND ITS SURGICAL WARD


397

U.S. troops entered Mexico again in 1916, when the situation at the border reached a crisis point after a raid on 9 March by Pancho Villa upon the New Mexican community of Columbus. When Brig. Gen. John J. Pershing led a provisional division across the border, physical and psychological stress was added to the threat of disease. Although National Guard troops were federalized in response to the fear that the situation might get out of hand and many were sent to the border area, only regulars accompanied General Pershing's force in an unsuccessful attempt to run Villa down within Mexico. Medical officers learned at this time, as one of them put it, that "to work with real men and animals and equipment and machines over miles of territory" was "quite different from moving pegs on a map."57

General Pershing's punitive expedition was composed of two cavalry brigades and one infantry brigade, all regulars, initially numbering some 5,000 men. Units in the field operated in detachments of varying size stretched out over "an attenuated line of communication." Some of Pershing's officers considered the campaign the most grueling they had ever known. During its active stage, which ended in late June 1916, they chased Villa much as U.S. soldiers had chased the Apaches in the 1880s, when Leonard Wood was first making a name for himself. Like Wood, they discovered that the environment was as difficult an enemy as the Mexicans. The days were very hot, the nights very cold, and violent winds blasted both men and horses with abrasive dust. Pershing's men never went farther than 150 miles south of the border, but the stress they endured was great; horses and men were sometimes inadequately fed as they attempted to live off the land, and some animals died of sheer exhaustion. Physicians left behind with those too exhausted to continue became especially vulnerable to guerrilla attack. Surgeon General Gorgas noted, however, that although service in Mexico involved "a restriction of food, clothing, and shelter quite unparalleled in the history of the United States Army," medical supplies were "plentiful and of good quality" and shipped from the El Paso depot "with remarkable speed, facility, and accommodation. . . ."58

Since General Pershing's campaign was conducted by regiment-sized or smaller units, the medical service relied heavily on the regimental organization, backed up by one of the division's two field hospitals set up as a camp hospital and by one of the two ambulance companies from the advance base at Colonia Dublan. Each infantry regiment was usually accompanied by a mule-drawn ambulance, its infirmary, its share of equipment, and two medical officers, but cavalry regiments with Pershing in pursuit of Villa sometimes had to leave most of their supplies and their ambulances behind to move as rapidly as possible. The division surgeon believed that all ambulances should be motorized except those accompanying regiments in the field, which were needed to move patients from areas that motorized vehicles could not reach. Long marches proved so exhausting to Medical Department personnel that the division surgeon urged that transportation be provided for them in the future. Fortunately the health of the men was extremely good in spite of the hardships; the sick rate was under 2 percent. Casualties were light; in 11 encounters from March through May, 31 were wounded and 15 killed, and in the campaign's most disastrous engagement on 21 June, 11 were wounded and 33 killed.


398

ANIMAL-DRAWN AND MOTOR AMBULANCES


399

Thus regimental plans for evacuation and hospitalization were never really tested.59

When not engaged in the active pursuit of Mexican soldiers, General Pershing's troops fell prey to Mexican prostitutes who swarmed around the camp. The general finally had the prostitutes rounded up and placed in huts behind a formidable barbed wire fence with only one gate, by which he set a guard. For a fee, each soldier was allowed half an hour in the hut of his choice; when he lingered longer, a guard came to fetch him. To leave the compound, the soldier had to visit the prophylaxis station by the gate. The approach of legalizing and controlling prostitution proved to be moderately successful, despite its obvious drawbacks to moralists. The syphilis and gonorrhea rates of the men in Mexico remained low. Nevertheless, venereal disease caused the return of more men to the U.S. than any other health problem, since men with gonorrhea were not up to hard service and those undergoing treatment for syphilis were obviously even less so.60

Venereal disease, which afflicted 44 of every 1,000 men on the sick list in General Pershing's force, was but one of several ills encountered by the men in Mexico. "Intestinal disease," including diarrhea, dysentery, typhoid, and paratyphoid, all common diseases in northern Mexico, struck 243 of every 1,000 sick. Paratyphoid was a new threat to health that affected troops along both sides of the Mexican border. Although it had been so rare among U.S. soldiers that in 1914 Medical Department authorities decided not to use a mixed paratyphoid/typhoid vaccine, paratyphoid was identified in 93 cases among Pershing's men and suspected in many more. Malaria was found principally in a regiment that had camped for a lengthy period in a damp area. Disease rates in general were highest where the contact with Mexican civilians was greatest.61

Preventing disease among the men of the punitive expedition required eternal vigilance. Although vaccination against paratyphoid prevented its spread, keeping all immunizations current was difficult when soldiers were conducting what was essentially anti-guerrilla warfare. The chief surgeon with the expedition, Lt. Col. James D. Glennan, urged that no civilians be hired until they, too, had been immunized against smallpox, typhoid, and paratyphoid. Washing, boiling, and ironing clothing frequently and thoroughly was necessary to eliminate lice and prevent the spread of infection. An effort was also made at this time to discover how large a role the expedition's veterinarians could play in preventing human disease, but medical officers were not sure how much inspecting cattle and supervising their slaughter contributed to disease prevention in humans. The drive to keep disease rates low was successful in spite of the stress members of General Pershing's expedition endured, since the annual death rate from disease was less than 2 per 1,000 men, as compared with 3 per 1,000 from injury.62

The units serving across the border in Mexico formed but a fraction of the entire force called out in 1916 because of the Mexican situation. Although most of the regulars had been moved into the area, the length of the border and the wild country that lay on either side led President Wilson to conclude that the National Guard should also be called out. The Mexicans never attacked in force across the border, and since the entire National Guard was not needed, the Army took advantage of the situation to stage maneuvers, rotating Guard units from state camps to the border so that as many as possible were trained. By the fall


400

of 1916 a total of 42,000 regulars and 128,000 Guard troops had been involved, 60,000 of whom were totally without previous military experience.63

Some difficulties experienced by those guarding the health of these men developed well before the militia troops arrived in the Southern Department, among them supply problems resulting from state government red tape. Because some Guard units brought no ambulances with them, vehicles sometimes had to be hired to take patients from the camp to the hospital. The initial strangeness of Army routines to National Guard medical officers and the relative scarcity of Regular Army medical officers to guide them added to the confusion at mobilization camps. Surgeon General Gorgas sent each camp the equipment and supplies necessary to establish its own camp hospital so that field hospitals could be kept packed and ready to move. Some militia physicians, apparently unable to believe in the adequacy of the camp hospital because their equipment was scanty in comparison to that of civilian facilities, set up field hospitals for their sick and injured, though this move jeopardized the mobility that was the reason for the field hospital's existence.64

In the Southern Department, men still unfamiliar with military sanitation were gathered in camps to accommodate from 4,000 to 15,000 that were reminiscent of those seen during the Spanish-American War. To ensure against a repetition of the disaster of 1898, seven "general sanitary inspectors" were appointed to report to the adjutant general on the conditions they found while preparing camps for the arrival of the militia. Another sanitary inspector, who might be the district surgeon, one of the general inspectors, or even a medical officer, functioned exclusively as district inspector in each district. The regulations required that at least one sanitary inspector, who had to be a Regular Army medical officer, be assigned to each camp along the border. He reported problems that he noticed both to the commanding officer, who had the responsibility for seeing that the defects were remedied, and, through one of the general inspectors, to the surgeon general. The camp sanitary inspector was also to instruct "the untrained troops in the care of their camps and personal hygiene." Because of the shortage of Regular Army surgeons, the camp inspector also had to function as camp surgeon. Some older Guard line officers, convinced that age alone gave a superior understanding of sanitation, ignored the advice of younger sanitary inspectors and even assigned their own medical officers the role of camp surgeon. In some instances, this move could be justified by the fact that physical exams and the work of sanitary inspection sometimes overwhelmed the single Medical Corps officer detailed to each camp.65

Recognizing the importance of what he called "the human factor" to the maintenance of proper sanitary standards, Surgeon General Gorgas had no doubt that instructing these men about sanitation was crucially important. Each line officer and each enlisted man would have to be convinced of the need "for almost meticulous care in carrying out many rules which appear to them more or less unimportant," since, as one surgeon put it, they were not likely to "appreciate the necessity for sanitary precautions except in an academic way." General orders issued in July 1916 required hand washing after every use of the latrine and bathing at least twice a week. The surgeon general urged daily baths during the summer, a step made all the more advisable by the presence of typhus, a


401

louse-borne disease, among the Mexicans. Since the Mexican laborers working on the roads used by the U.S. forces were infested with vermin, caring for them was instructive for medical officers, who even devised an "inexpensive plant" that could delouse a man and his clothing every twenty minutes. They were also prepared, should typhus break out among the troops, to provide "a completely equipped bath and disinfecting train" to move its victims. In August a "systematic scheme of training," to be conducted at every camp "as far as circumstances . . . permitted," was started in the Southern Department, with the pupils to be enlisted men and junior officers, especially those in the militia and the Medical Reserve Corps.66

Like the camps, the hospitals set up to care for the men serving along the Mexican border formed a training ground, in this instance for medical personnel. They included 200-bed base facilities at El Paso and at San Antonio, Texas, where an early patient was a member of a new and hardy breed, a victim of an airplane crash who reportedly walked for two days from the site of the disaster to reach San Antonio. Patients more fortunate than the aviator arrived at San Antonio on a 160-bed hospital train of ten Pullman cars especially constructed for this purpose, staffed by Medical Department officers and enlisted men and seven members of the Nurse Corps. This train made occasional runs from San Antonio to the Army-Navy Hospital at Hot Springs, Arkansas, or to the West Coast. A temporary facility of 150 beds was built at Columbus, New Mexico, and temporary additions went up at San Antonio, where the total number of beds reached 750, and at El Paso, for a total of 900 beds. New base hospitals of 500 beds each were put up at Brownsville and Eagle Pass, Texas, and at Nogales, Arizona. Six smaller 100-350 bed facilities, presumably classified as camp hospitals, were constructed in Texas and one each in Arizona and New Mexico. By the end of October 1916, 4,600 hospital beds were available to the troops in the Southwest. Each hospital had an operating room with an X-ray machine and a sterilizer and a small laboratory, and all but three of these facilities was staffed by the Nurse Corps and usually by Medical Corps and Medical Reserve Corps officers and Medical Department enlisted, assisted by carefully chosen officers and men from the National Guard.67

Six "permanently organized field hospitals" and ambulance companies with motor transport as well as three provisional field hospitals and ambulance companies with mule-drawn vehicles had also served in the Southern Department by the end of fiscal year 1916, and state troops brought thirty-two more field hospitals with them. Field hospitals were "merely meagerly equipped shelters," where in wartime the sick and wounded could be held until sent back to a base hospital. Two field laboratories were also set up, ready to be moved wherever they might be needed to assist in diagnosis.68

Among the health problems threatening effectiveness in the Southern Department, venereal disease caused the most concern. In spite of instruction on the price that could be exacted by sexual incontinence, "the human factor" remained a major problem. Two Texas forts, Sam Houston and Bliss, eventually developed the highest VD rates of any Army post in the country. Near the border in the Brownsville area, the prostitutes, few in number, apparently did such a thriving business that all were soon infected with both venereal disease and pubic lice. In the course of a


402

year, courts-martial convicted seventeen of the soldiers in the Brownsville area for contracting venereal disease when they were not recorded as having used prophylaxis. Along the border at Nogales one surgeon attributed the low infection rate of his infantry regiment, where 5,401 prophylactic treatments were recorded in a year, to the absence of saloons in the area, "venery associated with drunkenness" being "a serious menace."69

Maj. Henry J. Nichols, now head of the El Paso laboratory, believed that the huge size of the National Guard camps tended to make access to prostitutes difficult, and the incidence of sexually transmitted ills among the Guard troops in his area was low, 44 per 1,000 men. This rate, roughly one-third of that of the regulars in the area, was attributed to either the "greater moral restraint" of the militia or the "failure of medical officers to detect and report many cases as required by orders."70

Apparently many officers assumed that their men inevitably needed the services of prostitutes, and the stories that the public heard about the drunkenness and debauchery of the camps, surrounded and engulfed by saloons and brothels, did not suggest that access to prostitutes was necessarily difficult. Mexican prostitutes were known to boast of serving 40 to 60 soldiers a day, and medical officers encountered one woman with syphilis who had had 120 customers in the two days preceding their discovery of her disease. Although some attempts were made to examine prostitutes regularly, no one in the United States adopted the approach General Pershing used to the problem in Mexico. Some officers reported that their problems with discipline diminished when they closed down the brothels and saloons frequented by their men.71

In 1916 another potential threat to health developed when cases of paratyphoid began to appear in significant numbers in National Guard troops, especially those in the area of Mission, Texas, although prompt action prevented any extensive spread. The affected regiments, principally New York State troops, were quarantined, victims sent to civilian hospitals, and carriers isolated, while the use of a triple vaccine was initiated to protect against typhoid and both A and B paratyphoid. In fiscal year 1917 the Army had 410 cases, of which 296 with 4 deaths were among the men of the federalized National Guard and 114 among regulars.72

With the new recruits called in during the Mexican crisis, measles also remained a significant problem, and complications, including pneumonia, empyema, and middle ear infections, continued to cause high death rates. The increase in the number of recruits in 1916 brought an increase in the number of cases of measles from 555 in 1915 to 1,247, with 9 deaths. An epidemic of pneumonia that erupted in November 1916 and lasted until April 1917 was blamed in part on measles, from which bronchial pneumonia often resulted, as well as on mumps and influenza. The outbreak, which was limited to Texas, Arizona, and New Mexico, resulted in 611 cases of lobar pneumonia with 103 deaths and 68 cases of bronchial pneumonia with 29 deaths. Surgeon General Gorgas believed that using serum had kept the death rate from climbing even higher.73

A study of regiments suffering the highest rates of disease along the Mexican border in 1916 led to testing the men of two southern units for hookworm. More than half the soldiers from Alabama tested positive, as did almost a third of those from Mississippi, but a Texas regiment had a 6-


403

percent rate. The investigation demonstrated that soldiers with hookworm were much more likely than those not harboring this parasite to contract measles and to have serious complications when they did. The men found to be infected were all treated before their units were demobilized, and Surgeon General Gorgas recommended that in the future all men from hookworm-infected areas be tested before they left the mobilization camp.74

Medical Department efforts to prevent nonsexually transmitted diseases among the soldiers along the border brought impressive results, for the sick rate remained below 2 percent. The contrast in the disease rates with that in the camps of the Spanish-American War showed the value of immunization and also suggested that much had already been learned about how to impress neophyte soldiers and their officers with the importance of camp sanitation and to indoctrinate them into its mysteries. Long marches also taught that greater care would have to be exercised in weeding out those who were unfit, many who seemed sound in camp proving not to be up to the "daily stresses of burden carrying" on a march.75

Virtual unanimity characterized appraisals of the value of the Mexican border experience. All seemed to agree with the National Guard physician who noted that "the maneuvers were uniformly most interesting and instructive for officers and men." The authors of the Medical Department's mammoth history of World War I noted that the mobilization had done more to inspire improvements in the supply situation than had the outbreak of the war in Europe and that the Army's "sanitary conscience" had been raised to a high point when the United States entered that conflict. One surgeon maintained that the Mexican border experience had shown a clear need for a considerable increase in the size of the medical reserve and that it suggested, as Colonel Munson had also theorized, that even 7 physicians for every 1,000 men would not be a high enough ratio should the United States become involved "in a war of the first magnitude." Because of his experiences in 1916, yet another Army surgeon concluded that an Army-wide policy on dealing with prostitution was necessary. Still others called for a systematization of the Army's approach to field sanitation, which should not be left up to "chance and individual caprice." Surgeon General Gorgas, too, considered the experience of the 1916 mobilization "invaluable." He concluded that it showed that "military medical administration," and specifically "the rendering and keeping of reports and records of sick and wounded and the handling of other essential papers," was still a weak point in the Medical Department's operations.76

The training maneuvers along the Mexican border in 1911 had involved the use of planes, whose pilots were assigned to the Signal Corps. A prototype of a plane designed to serve as an ambulance had been tried out in January 1910. Yet little was accomplished to create a medical service specifically for aviators before the United States entered World War I in April 1917. According to the Medical Department's history of World War I, "No division having to do with aviation existed in the Surgeon General's Office, but some thought had been given . . . to what should constitute the physical requirements for admissions to the aviation service." In 1912 the Medical Department had designed a physical examination for would-be pilots that strongly resembled the one given to all Army recruits, with


404

added emphasis on heart, eyes, and ears, and especially balance, but this effort apparently had not completely satisfied the head of the Aviation Section of the Signal Corps. The department's "partial study" of the physical standards for flyers set by major European nations in an effort to design a better examination proved fruitless, and "preparation for war by way of a Medical Aviation Service had gone no further than this when war came in 1914." The next test to be devised was based on existing requirements modified by information derived from physiology textbooks, but it proved so rigorous that few could pass it until it had been changed.77

By June 1916, when the National Defense Act assigned the responsibility for accepting or rejecting all candidates for the Aviation Section of the Signal Corps to a five-member board, two of whose members were to be medical officers, the quest for adequate physical standards for aviators was still under way. Although Lt. Col. Theodore C. Lyster of the Medical Corps and two Signal Corps officers were named in 1916 to a board to develop the physical standards to guide such decisions, their recommendations and the orders that the adjutant general based on them were not issued until May 1918, after the United States had entered the war. At this time, Colonel Lyster was required to add the Medical Department's "aviation work" to his other duties, thus becoming the first Army medical officer to be assigned specifically to examine candidates for the Aviation Section.78

Lessons Learned From Europe

The experience of the troops in the Southwest was not the only source of insight into the difficulties U.S. forces might encounter as participants in a major conflict, nor were physical standards set for pilots by the warring nations the only subject of interest to Americans in Europe. The Medical Department's history of World War I recorded that in 1917-1918 "our early arrangements . . . were influenced to a considerable extent by what we had learned before we entered the war, from the experience of our future allies and enemies." U.S. physicians, both civilian and military, Navy as well as Army, had long been interested in what the medical services of European armies were doing. Medical officers who happened to be in Europe at the time the conflict broke out were detailed to serve as observers with the various armies involved, and from time to time the War Department sent others over to join them. Six were sending back reports and observations in the late summer of 1916, when the surgeon general's annual report for the fiscal year was being prepared. The work of these officers, Gorgas noted, was "a matter of great assistance to the War Department and of particular advantage and satisfaction to the Medical Corps." Some American civilians, having worked with small groups from U.S. medical schools that assisted the medical services of one or another of the belligerent nations and having been "imbued with the spirit to serve in their professional capacities," wrote journal articles about what they saw. The Army Medical Department itself also collected pertinent articles from European journals and other publications concerning war surgery on the nervous system and published them for the enlightenment of U.S. physicians.79

Among the observations sent back by Medical Department representatives in Europe were those of Lt. Col. Frank R. Keefer, who emphasized the difficulty of


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maintaining proper hygiene and sanitation in the trenches, where the men were constantly wet and "tormented by a variety of insects," including lice. Lt. Col. William J. L. Lyster concluded that when American troops joined the war in Europe, they should take medical consultants with them, a member of each specialty "for each group of casualties," physicians who would study both the administrative problems of their specialty as practiced in a military context and the medical problems. An observer who worked with hospital units sent to Germany and Austria in 1916, having resigned his reserve commission to do so with the guarantee that it would be returned to him when he got back from Europe, urged greater attention to preparedness by the U.S. medical profession, both civilian and military. The Army Medical Department also learned that the French preferred light-bodied ambulances to heavier models because they were more maneuverable and easier to free from the mud when they had to leave the road to allow military traffic to get by. Based on reports he had received about the successful use of dogs to search for the wounded on the battlefield, Surgeon General Gorgas was convinced that the department should begin training animals for this purpose. And after months of service in the Balkans, Maj. Clyde S. Ford informed the readers of the New York Medical Journal that he was convinced that "no doubt . . . future changes in national frontiers will be effected more permanently by those who eat garlic than by those who do not."80

A major conclusion drawn by American observers was that the nation could not wait until it entered the war to take the necessary steps to form a backup system of base hospitals. As a result, the Army began working with the Red Cross' new Military Relief Division to create such a network, using the Army's 500-bed base hospital as a model. The National Defense Act allowed the president to detail up to five Medical Corps officers to work with the Red Cross as it prepared to assist the Army in the event of war. Under the guidance of Colonel Kean of the Medical Corps, the first director general of the Military Relief Division, the Red Cross adopted the approach suggested by Dr. George W. Crile of Cleveland, Ohio, who had operated an American hospital in France, turning to the staffs of large civilian hospitals to form the basis for the new organizations.81

By the time the United States entered the war, more than thirty such teams had been formed. In October 1916 Crile's unit from Cleveland's Lakeside Hospital was mobilized in Philadelphia so that the public could see what such a unit entailed and appreciate that it was not a hospital building but a hospital staff. The staffs of institutions too small to create full-sized hospitals could either form the basis upon which a larger unit could be built or serve as a camp hospital. The Red Cross provided the necessary equipment for all facilities, but Army authorities made decisions concerning the nature and quantity of the equipment. With the guidance of future surgeon general Major Patterson, the Red Cross also organized forty-five ambulance companies, but the judge advocate general ruled that they could not be called in to assist the Army unless war had begun or was imminent. As a result, none of the Red Cross units was mobilized for the Mexican crisis.82

Principally because of the experiences both of observers in Europe and of medical officers in the conflict with Mexico, the leaders of the U.S. Army Medical Department were aware before 1917 of the general na-


406

ture of the difficulties their organization might face if the nation were drawn into the European conflict. The National Defense Act of 1916 had created the framework upon which a wartime personnel expansion could be based. A system for the efficient handling of supplies was being devised, but a sufficient reserve had not yet been built up, and in the early months of 1917 the prospects for speedily enlarging it were not good. The men who would have to be called up if the United States entered the European war were not yet trained. Many months would be required for a thousand experienced medical officers to train 29,000 physicians in the intricacies of military medicine, sanitation, and military medical administration and for enlisted men already familiar with their Medical Department duties to assist Regular Army physicians in training an additional 260,000 or more new department recruits. Widespread unwillingness to believe that the United States would in fact be drawn into the war in Europe had caused Medical Department preparations for it, like those of the rest of the nation, to progress slowly. In March 1917, however, a sense of urgency was finally created with the resumption of unrestricted submarine warfare by Germany and the publication of a secret note suggesting that it would form a military alliance with Mexico if the United States joined the war on behalf of the Allies. On 6 April, still unprepared, the United States entered "the most formidable military contest of all time."83


NOTES

1. An excellent discussion of the prevalent attitudes toward preparations for war can be found in John P. Finnegan, Against the Specter of a Dragon.

2. Mahlon Ashford, "The Most Practicable Plan for the Organization, Training and Utilization of the Medical Officers of the Medical Reserve Corps of the United States Army and Navy and of the Medical Officers of the Officers' Reserve Corps of the United States Army in Peace and War," p. 126; Marvin A. Kriedberg and Merton G. Henry, History of Military Mobilization in the United States Army, 1775-1945, p. 189; James L. Abrahamson, America Arms for a New Century, pp. 92-100, 151, 162-76; War Department, [Annual] Report of the Surgeon General, U.S. Army, to the Secretary of War, 1916, pp. 20, 24, and 1917, pp. 121-22, 124 (hereafter cited as WD, ARofSG); James G. Harbord, The American Expeditionary Forces, p. 22.

3. Gorgas was appointed surgeon general with the rank of brigadier general on 16 January 1914 and was promoted to major general, the first surgeon general to attain this rank, on 4 March 1915. See James M. Phalen, Chiefs of the Medical Department, United States Army, pp. 91-92.

4. Hearings Before Committees on Military Affairs of United States Senate and House of Representatives, 64th Cong., 1st Sess., pp. 572-73, 578-80, 627, 689, 695-97, 719-20 (hereafter cited as Sen/HofReps MilAffs Cmte Hearings), in Record Group (RG) 287, National Archives and Records Administration (NARA), Washington, D.C.

5. Ibid., pp. 578, 627, 688 (remaining quotations), 695-97 (first quotation), 720-21, RG 287, NARA.

6. Ibid., pp. 578 (quotation), 697, RG 287, NARA; WD Bull 16, 22 Jun 1916, p. 40.

7. Sen/HofReps MilAffs Cmte Hearings, pp. 578, 583, 866-67, RG 287, NARA; WD, ARofSG, 1916, p. 233.

8. Finnegan, Against the Specter, p. 155.

9. Percy M. Ashburn, A History of the Medical Department of the United States Army, p. 256 (first quotation); WD, ARofSG, 1916, pp. 16 (second quotation), 194, and 1917, pp. 11, 118; Phalen, Chiefs, p. 92; Stanhope Bayne-Jones, The Evolution of Preventive Medicine in the United States Army, 1607-1939, p. 148; "Medical Preparedness and the Army," p. 575; Louis A. LaGarde, "Relation of the Civilian Physician to National Preparedness," p. 240; War Department, Surgeon General's Office, The Surgeon General's Office, p. 75 (hereafter cited as WD, SGO, SGO); "Current Comment," p. 1308; George F. Keenan, "Our Medico-military Responsibility," p. 13; Edward L. Munson, "The Training of Medical Reserve Officers," p. 714; WD Bull 16, 22 Jun 1916; William B. Banister, "The Medical Mechanism for War in the U.S.," p. 411; Paul F. Straub, Medical Service in the Campaign, p. 129. Munson was promoted to colonel on 15 May 1917.

10. Edward L. Munson, "Military Preparedness From the Medical Standpoint," p. 447 (first two quotations); Keenan, "Medico-military Responsibility," pp. 14 (third quotation), 17; Charles H. Mayo, "Medical Service in the United States Army," pp. 351-52 (remaining quotations); Hermann Hagedorn, Leonard Wood, 2:148, 169; Edward M. Coffman, The War To End All Wars, pp. 15-16.

11. Bayne-Jones, Preventive Medicine, pp, 148-49.

12. Phalen, Chiefs, pp. 88, 92; Ltr, William C. Gorgas to Mamie, 27 Aug 1913, Gorgas Family Papers, W. S. Hoole Special Collections Library, University of Alabama (UA), Tuscaloosa, Ala.; Marie D. Gorgas and Burton J. Hendrick, William Crawford Gorgas, pp. 302, 305; WD Bull 16, 22 Jun 1916, p. 9; John M. Gibson, Soldier in White, pp. 39-40, 212.

13. Quotations from Gorgas and Hendrick, Gorgas, pp. 296, 301, 304. See also ibid., pp. 302, 305; Beryl Williams and Samuel Epstein, William Crawford Gorgas, pp. 159-60; Hanson W. Baldwin, World War I, pp. 77-79; Franklin H. Martin, Major William Crawford Gorgas, M.C., U.S.A., pp. 55-56; Gibson, Soldier in White, pp. 231, 296, 299, 301-02, 304-05.

14. WD, SGO, SGO, pp. 126, 137, 218, 246; Robert S. Henry, The Armed Forces Institute of Pathology, pp. 150, 157; War Department, [Annual] Report of the Secretary of War, 1917, 1:138 (hereafter cited as WD, ARofSW, date); Preliminary Inventory of RG 112, pp. 30-32, NARA.

15. WD, ARofSG, 1914, pp. 13, 154, 1915, p. 157, 1916, p. 194, and 1917, p. 122; WD, SGO, SGO, p. 75; Elbert E. Persons, "Special Article," pp. 406-07; Banister, "Medical Mechanism," p. 413; Weston P. Chamberlain, "Care of Troops on the Mexican Bor-


408

der," pp. 1576-77; Mahlon Ashford, "Most Practicable Plan," p. 125; Field Service Regulations, 1914, p. 206; Reuben B. Miller, "The New Manual for the Medical Department," pp. 309-10, 314; Paul F. Straub, "Medical Service in the Campaign," p. 695; Sen/HofReps MilAffs Cmte Hearings, pp. 624, 629, 695-97, RG 287, NARA.

16. Initial quotations from "Is the Medical Corps of the Army Worth While," pp. 660-61; final quotation from "Current Comment," p. 1308. See also Banister, "Medical Mechanism," p. 418; William G. Rothstein, American Physicians in the Nineteenth Century, pp. 287, 294; WD, ARofSG, 1909, p. 126, 1916, p. 194, and 1917, p. 291; Sen/HofReps MilAffs Cmte Hearings, pp. 612-22, RG 287, NARA.

17. WD, ARofSG, 1914, p. 149, 1916, p. 220, and 1917, pp. 298-99, 310; "Current Comment," p. 1308.

18. WD Bull 16, 22 Jun 1916, p. 40; Keenan, "Medico-military Responsibility," p. 13; WD, ARofSG, 1914, p. 154, 1915, pp. 157-58, 1916, p. 195, and 1917, p. 292; WD, SGO, SGO, pp. 82-83; LaGarde, "Relation," pp. 241-42.

19. Harold Hays, "The Camp of Instruction for Officers of the Medical Reserve Corps, U.S. Army," p. 263 (first quotation); William O. Owen, "Relation of the Army Medical Corps and the Medical Reserve Corps to the Medical Corps of the Organized Militia," p. 555 (second quotation); S. H. Wadhams, "Military Preparedness From the Medical Standpoint," p. 448; M. A. W. Shockley, "The Correspondence Course for Officers of the Medical Reserve Corps," pp. 64, 67; Sen/HofReps MilAffs Cmte Hearings, p. 581, RG 287, NARA.

20. Joseph C. Bloodgood, "The Tobyhanna Camp," pp. 118, 122 (quotation); Hays, "Camp," p. 263; WD, ARofSG, 1915, p. 170; S. C. Stanton, "The Sparta Encampment," p. 115; "Camps of Instruction for Medical Officers," p. 722.

21.WD, ARofSG, 1915, pp. 81-82, 159, 1916, p. 195, and 1917, p. 122.

22. Ibid., 1915, pp. 81-82, 1916, pp. 16, 195, and 1917, p. 122; Chamberlain, "Care of Troops," pp. 1574, 1577; WD Bull 16, 22 Jun 1916, pp. 12-13.

23. WD, ARofSG, 1914, pp. 159-60, 1915, pp. 160-61, 1916, pp. 19, 197, and 1917, pp. 22-23, 123, 226-27; Chamberlain, "Care of Troops," p. 1577.

24. WD, ARofSG, 1914, pp. 131, 160, 1915, p. 161, and 1917, p. 153, 296 (quotations).

25. Ibid., 1915, p. 82, 1916, p. 149, and 1917, p. 123; "What About the Sanitary Private?," pp. 326-27.

26. WD, ARofSG, 1914, pp. 156-57 (second quotation), 158 (first quotation), 1915, pp. 12, 160, and 1917, p. 119; Sen/HofReps MilAffs Cmte Hearings, pp. 627-28, RG 287, NARA.

27. WD, ARofSG, 1916, p. 197; WD Bull 16, 22 Jun 1916, pp. 10-11; WD, SGO, SGO, pp. 76-77.

28. WD Bull 16, 22 Jun 1916, pp. 9, 18-20; WD, ARofSG, 1916, p. 16; WD, SGO, SGO, p. 78; Cassedy, Medicine in America, p. 69.

29. Div of Militia Affs Cir 18, 23 Dec 1914, p. 1 (quotation); WD, ARofSG, 1914, p. 173, 1915, pp. 168-69, 1916, p. 206, and 1917, pp. 122, 316-17; WD Bull 18, 7 Jun 1913, p. 12 (58-210, JAG, 17 May 1913); Harry L. Gilchrist, "The Necessity for a Uniform Organization for the Medical Corps of the National Guard," p. 22; United States (U.S.), National Guard Bureau (NGB), Report on Mobilization of the Organized Militia and National Guard of the United States, 1916, pp. 99-100.

30. William N. Bispham, "Sanitary Service With National Guard Troops," p. 47 (quotation); WD, ARofSG, 1916, pp. 207-08, and 1917, pp. 115-16, 123; U.S., NGB, Report on Mobilization, pp. 106-07; W. H. Blodgett, "The Doctor on the Border," pp. 432-33.

31. WD, ARofSG, 1914, p. 170, and 1915, pp. 168-69; Kriedberg and Henry, Military Mobilization, p. 194; William S. Terriberry, "The Medical Service in the Organized Militia," p. 399.

32. WD, ARofSG, 1914, p. 172, 1915, p. 170 (quotation), and 1917, p. 123.

33. Ibid., 1915, p. 170, 1916, pp. 206-07, and 1917, p. 317; Chamberlain, "Care of Troops," p. 1573; "Report of the Chief, Bureau of Militia Affairs, 1915," pp. 220-21.

34. WD, ARofSG, 1917, pp. 114-16, 121; John K. Mahon, History of the Militia and the National Guard, p. 152; Finnegan, Against the Specter, pp. 166-67; U.S., NGB, Report on Mobilization, pp. 4-5, 53-56, 108.

35. WD, ARofSG, 1916, p. 20, and 1917, p. 115; U.S., NGB, Report on Mobilization, pp. 54, 70.

36. WD, ARofSG, 1915, p. 169, 1916, p. 207, and 1917, pp. 114, 117, 122-23 (quotation); J. Harry Ullrich, "Sanitary Troops-State and Federal," p. 547; Bispham, "Sanitary Service," p. 44.

37. Banister, "Medical Mechanism," p. 415; WD, ARofSG, 1914, p. 179, and 1917, p. 323; Kreidberg and Henry, Mobilization, p. 234; Frederick C. Huidekoper, Military Unpreparedness, pp. 494-95; WD, SGO, SGO, p. 61.


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38. WD, SGO, SGO, p. 61; Sen/HofReps MilAffs Cmte Hearings, pp. 578-80, 583, 866-67, RG 287, NARA; WD, ARofSG, 1917, p. 317.

39. Henry I. Raymond and Edwin P. Wolfe, "Duties of Medical Supply Officers and Their Methods," p. 21 (quotation); Banister, "Medical Mechanism," p. 411; H. C. Fisher, "Preparedness of the Medical Department for War," p. 125; WD, SGO, SGO, 1:220-21, 559; Mary C. Gillett, The Army Medical Department, 1818-1865, p. 183.

40. Memo, P. Halloran to Col Fisher, 12 Nov 1914 (first quotation), and Mtg Mins, H. W. Jones, Recorder, 19 Feb 1917 (third quotation), both Entry 28, RG 112, NARA; WD, ARofSG, 1917, pp. 163, 245 (second quotation).

41. Ltrs, H. D. Snyder to Keeton Motor Co., 28 April 1914 (quotations), and Henry Raymond to SG, 8 and 19 May 1914, Entry 28, RG 112, NARA; Kent Nelson, "An Army Motor Ambulance," p. 152; WD, ARofSG, 1915, p. 164, and 1916, p. 162; Huidekoper, Military Unpreparedness, pp. 494-95; WD, SGO, SGO, p. 115; Sen/HofReps MilAffs Cmte Hearings, pp. 855-57, RG 287, NARA.

42. Quotation from Ltr, CO, Ambulance Co 3, to SG, 10 Oct 1916, Entry 28, RG 112, NARA. In loc. cit., see Ltr, Percy L. Jones to SG, 23 Oct 1916; Mtg Mins, H. W. Jones, 19 Feb 1917; and Ltr, Walter McCaw to SG, 12 Mar 1917, esp. "Distribution of Motor Ambulances, Southern Department." See also George C. Clendenen, Blood on the Border, p. 226; Haldeen Braddy, Pershing's Mission in Mexico, p. 62; WD, SGO, SGO, p. 71.

43. Mahlon Ashford, "A Proposed Motor-Ambulance Company" pp. 303 (quotations), 304-06, 394; E. C. Jones, "Transportation of Ambulance Companies," pp. 429, 431-33; WD, ARofSG, 1917, p. 149; Chamberlain, "Care of Troops," p. 1576; Norman M. Carey, Jr., "The Mechanization of the United States Army, 1900-1916," M.A. thesis, pp. 40-43, 59-60, 77, 84-85, 100-101; Konrad F. Schreier, Jr., "Army Motor Transport Won Spurs in Mexico," p. 9.

44. WD, ARofSG, 1917, pp. 114, 117; Fisher, "Preparedness," p. 127; WD, SGO, SGO, 1:61, 221-22; Erna Risch, Quartermaster Support of the Army, p. 598.

45. WD, ARofSG, 1914, pp. 174-76, 178, 1915, p. 82 (quotation), 1916, p. 211, and 1917, pp. 112-13.

46. Ibid., 1914, pp. 114, 131, 177-78, 1915, pp. 140, 172-73, 175, 1916, pp. 159, 162-63, 168, 171, 210, and 1917, pp. 221, 227, 236, 237, 240; Sen/HofReps MilAffs Cmte Hearings, p. 871, RG 287, NARA.

47. WD, ARofSG, 1914, pp. 176-77, 1915, p. 144, 1916, pp. 89, 176, 178-79, and 1917, pp. 109, 244-45, 249-50; "History of Military Records," pp. 3-5, Ms C16, Albert E. Truby Papers, National Library of Medicine (NLM), Bethesda, Md.; Sen/HofReps MilAffs Cmte Hearings, pp. 868, 870, RG 287, NARA.

48. WD, ARofSG, 1915, p. 148, 1916, pp. 17, 162, 181, and 1917, pp. 121, 254.

49. Ibid., 1917, pp. 156-57, 256-57, 267.

50. Ibid., 1914, pp. 83, 164; Louis C. Duncan, "The Wounded at Ojinaga," pp. 411-13, 415; Richard Johnson, "My Life in the U.S. Army, 1899 to 1922," p. 174, Spanish-American War, Philippine Insurrection, and Boxer Rebellion Veterans Research Project, Military History Research Collection, U.S. Army Military History Institute, Carlisle Barracks, Pa.; Mahon, National Guard, p. 151.

51. Clendenen, Blood, p. 180; WD, ARofSG, 1915, pp. 51, 64, 81, 121, 169, 1916, pp. 12, 24, 30, 57-58, 72, 91, 96-98, 111, 113, 141, 145, 151, 186, 208, and 1917, pp. 13, 15-16, 27, 33-34, 48, 59, 60, 68, 75, 116, 125, 129, 131, 274; Charles F. Craig, "The Occurrence of Endamoebic Dysentery in Troops Serving in the El Paso District From July 1916 to December 1916," pp. 286, 296, 302, 423, 427-28, 434; Edgar F. Haines, "The Modern Treatment of Amoebic Dysentery," pp. 816, 818; Glenn I. Jones, "The Treatment of Intestinal Amoebiasis," pp. 982-83; G. Foy, "Health in the United States Army," pp. 292-93; Henry J. Nichols, "Possible Reasons for Lack of Protection After Antityphoid Vaccination," pp. 267-68; Eugene R. Whitmore, "Antityphoid Vaccination," pp. 259, 262, 264; William J. L. Lyster, "Present Status of Artificially Treated Drinking Water in the Field," p. 401; Banister, "Medical Mechanism," pp. 409-10.

52. Edward B. Vedder, "Prevalence of Syphilis," pp. 309 (quotation), 310; WD, ARofSG, 1914, p. 149, 1915, pp. 11, 68, 151, 1916, pp. 16, 75, 113, and 1917, pp. 17, 79, 131; Edgar King, "The Military Delinquent," p. 577; Richmond C. Holcomb, "Has Our Propaganda for Venereal Prophylaxis Failed?," p. 30.

53. Edward B. Vedder, Syphilis and Public Health, p. 167 (quotation); Albert Neisser, "War, Prostitution, and Venereal Diseases," p. 539; Richard C. Cabot, "Are Sanitary and Moral Prophylaxis Natural Allies?," pp. 21, 23; WD, ARofSG, 1915, pp. 56-57, 81, 83, and 1917, p. 17; Allan M. Brandt, No Magic Bullet, pp. 52-53; Mazyck P. Ravenel, "The Prophylaxis of Venereal Disease," p. 190; Charles W. Clarke, Taboo, p. 40; Linda Gordon, Woman's Body, Woman's


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Right, pp. 64, 205; E. Kilbourne Tullidge, "Venereal Disease in the European Armies," p. 50; Ronald G. Walters, ed., Primers for Prudery, p. 135.

54. Henry P. Birmingham, "Sanitary Work of the Army at Vera Cruz," pp. 205, 215 (quotation), 216-17, 219; idem, "Coordination of the Medical Departments of the Army and Navy in Campaign," pp. 377-78; Clendenen, Blood, p. 161; WD, ARofSG, 1914, p. 160, and 1915, pp. 128-30.

55. Clendenen, Blood, p. 166 (first quotation); Birmingham, "Sanitary Work," pp. 205-06 (second quotation), 207, 211-13, 220-21; WD, ARofSG, 1915, pp. 129-30; "Correspondence," p. 184; "Mexican Notes," p. 907; "Reprints and Translations," p. 165.

56. Birmingham, "Sanitary Work," pp. 214-15 (quotations); WD, ARofSG, 1915, p. 128; Clendenen, Blood, p. 171; Brandt, No Magic Bullet, p. 54.

57. Raymond C. Turck, "Field Maneuvers of Divisional Sanitary Troops, Leon Springs, Texas, November 1916," p. 156 (quotations); Clendenen, Blood, pp. 201-02, 297, 341; WD, ARofSG, 1916, p. 20, and 1917, p. 23; Friedrich Katz, "Pancho Villa and the Attack on Columbus, New Mexico," p. 101; Mahon, National Guard, p. 151; Chamberlain, "Care of Troops," p. 1573.

58. WD, ARofSG, 1917, pp. 23 (first two quotations), 24, 159 (remaining quotations); Braddy, Pershing's Mission, pp. 1, 8-9, 16, 43-45, 56, 59, 72n38; Clendenen, Blood, pp. 216, 221, 224n14, 237, 244, 248, 262-63, 272, 310; Robert S. Thomas and Inez V. Allen, The Mexican Punitive Expedition Under Brigadier General John J. Pershing, United States Army, 1916-1917, ch. 2, p. 11, ch. 4, pp. 24-28, 34.

59. WD, ARofSG, 1917, pp. 122, 158, 162-63; idem, ARofSW, 1916, 1:291; Turck, "Field Maneuvers," pp. 157, 166; Frank E. Vandiver, Black Jack, 2:612; Braddy, Pershing's Mission, pp. 43-45, 56; Clendenen, Blood, p. 310.

60. Clendenen, Blood, pp. 329, 334-38; WD, ARofSG, 1917, pp. 160-61; Braddy, Pershing's Mission, p. 61; Vandiver, Black Jack, 2:612; James A. Sandos, "Prostitution and Drugs," pp. 623, 626-27, 633.

61. WD, ARofSG, 1917, p. 160.

62. Ibid., pp. 23, 159-61; Bayne-Jones, Preventive Medicine, p. 147; Clendenen, Blood, pp. 241-43, 335; Braddy, Pershing's Mission, pp. 9, 10; Chamberlain, "Care of Troops," p. 1577; Ashburn, History of MD, pp. 236-37.

63. Mahon, National Guard, p. 151; Finnegan, Against the Specter, p. 168; Kriedberg and Henry, Military Mobilization, p. 199; U.S., NGB, Report on Mobilization, p. 54; WD, ARofSW, 1916, 1:9-13, 193.

64. WD, ARofSG, 1917, pp. 114-17; Miller, "New Manual," pp. 307, 315.

65. WD, ARofSG, 1916, p. 93, and 1917, pp. 132 (quotations), 133, 137; Chamberlain, "Care of Troops," pp. 1577-78; Bispham, "Sanitary Service," p. 45.

66. Bispham, "Sanitary Service," pp. 47 (third quotation), 55; WD, ARofSG, 1916, 20 (fifth quotation), and 1917, pp. 24, 133 (first two quotations), 134, 136-37 (remaining quotations); Chamberlain, "Care of Troops," pp. 1573, 1578. "Disinfecting" here apparently referred to eliminating vermin.

67. Chamberlain, "Care of Troops," pp. 1574-76; Clendenen, Blood, p. 297; WD, ARofSG, 1916, pp. 20, 209, and 1917, p. 142.

68. WD, ARofSG, 1917, p. 122 (first quotation); Chamberlain, "Care of Troops," pp. 1574 (second quotation), 1575-76; Jay D. Whitham, "Paratyphoid Infections," pp. 491-96.

69. WD, ARofSG, 1916, pp. 69-70, 91-92 (remaining quotations), 188, and 1917, p. 133 (first quotation); Clendenen, Blood, p. 183.

70. WD, ARofSG, 1917, p. 131. Nichols was promoted from captain to major on 1 July 1916.

71. Brandt, No Magic Bullet, pp. 53-54; Blodgett, "Doctor on the Border," p. 431; M. J. Exner, "Prostitution in Its Relation to the Army on the Mexican Border," pp. 208-12, 214; Sandos, "Prostitution," pp. 629-30.

72. Whitham, "Paratyphoid Infections," p. 496; WD, ARofSG, 1915, p. 149, 1916, pp. 64, 66, and 1917, pp. 15, 68, 116-17; WD, SGO, SGO, p. 73.

73. WD, ARofSG, 1915, p. 84, 1916, pp. 14, 77, and 1917, pp. 16, 19-20, 81, 130, 151; Wesley W. Spink, Infectious Diseases, p. 67.

74. WD, ARofSG, 1917, p. 131; Joseph F. Siler and C. L. Cole, "The Prevalence of Hookworm Disease in the Fourth Texas Infantry, First Mississippi Infantry and First Alabama Cavalry Regiments," p. 96; George B. Foster and Charles G. Sinclair, "Hookworm Infection as a Medico-military Consideration," pp. 431-33.

75. Edward L. Munson, "The Effect of Marching on the Rates for Non-efficiency of Newly Raised Troops," pp. 171-72, 176 (quotation); Chamberlain, "Care of Troops," pp. 1574, 1580-81; WD, ARofSG, 1916, p. 21, and 1917, p. 133.

76. Turck, "Field Maneuvers," p. 156 (first quotation); WD, SGO, SGO, pp. 73-74 (second quotation), 83; Chamberlain, "Care of Troops," pp. 1573, 1582 (third quotation); W. F. Lewis and R. B. Miller, "Recent Developments in Camp Sanitation," p. 510 (fourth quotation); WD, ARofSG, 1917, p. 123 (re-


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maining quotations); Exner, "Prostitution," p. 219; Kreidberg and Henry, Military Mobilization, p. 199.

77. Albert E. Truby, "The Airplane Ambulance," Ms C16, NLM; WD, SGO, SGO, p. 488 (quotations); Mae M. Link and Hubert A. Coleman, Medical Support of the Army Air Forces in World War II, pp. 6-8.

78. WD, SGO, SGO, pp. 488 (quotation), 489, 494, 501; WD Bull 16, 22 Jun 1916, p. 16; Link and Coleman, Medical Support, p. 8.

79. War Department, Surgeon General's Office, Administration, American Expeditionary Forces, p. 13; idem, SGO, pp. 75 (first quotation), 83 (third quotation), 92; idem, War Surgery of the Nervous System; WD, ARofSG, 1915, p. 164, 1916, pp. 11, 18, and 1917, p. 22 (second quotation); Memo for SG, 24 Sep 1908, Entry 245, RG 112, NARA; Sen/HofReps MilAffs Cmte Hearings, pp. 697, 874, RG 287, NARA. The Navy Department also had at least one observer in Europe in the person of Surgeon Archibald M. Fauntleroy USN, sent to Paris in the spring of 1915 (see Fauntleroy's Report on the Medico-military Aspects of the European War From Observations Taken Behind the Allied Armies in France).

80. Frank R. Keefer, "The Sanitary Problems of Trench Warfare," pp. 618, 621 (first quotation); "A Consulting Staff for the Medical Department," p. 484 (second quotation); Clyde S. Ford, "Some Medico-military Observations," p. 58 (third quotation); Memo, E. B. Babbitt to Gen Scott, 1 Mar 1915, Entry 28, RG 112, NARA; WD, SGO, SGO, p. 84; Sen/HofReps MilAffs Cmte Hearings, pp. 875-76, RG 287, NARA; John R. McDill, Lessons From the Enemy.

81. WD, SGO, SGO, pp. 76, 92-93, 95-96; F. B. Lund, "The Surgery of the War and the Part Played Therein by American Surgeons," p. 698; George W. Crile, "The Work of American Units in France," p. 710; idem, "The Unit Plan of Organization of the Medical Reserve Corps of the U.S. for Service in Base Hospitals," p. 68; WD, ARofSG, 1916, p. 16; Jefferson R. Kean, "New Role of the American Red Cross," p. 541; Terriberry, "Medical Service," p. 399.

82. WD, SGO, SGO, pp. 97-100, 104.

83. WD, ARofSG, 1917, p. 12 (quotation), and 1918, pp. 15, 17; Finnegan, Against the Specter, p. 189; Coffman, War To End All Wars, pp. 7, 18, 20; Munson, "Training," p. 714.