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THE GENERAL HOSPITAL (CONVERTED)
GENERAL HOSPITAL NO. 2, FORT McHENRY, BALTIMORE, MD.a
Fort McHenry, perhaps the best of the few examples of the "Star Fort" type, or bastioned polygon, in this country, is chiefly famous for its protection of Baltimore at the time of the bombardment by the British fleet in 1814. It is also notable as commemorating the occasion upon which Francis Scott Key was inspired to write the poem which afterwards became our national anthem-The Star Spangled Banner. The construction of the fort was begun in 1776 as a shore battery, but it was not until 1794 that the star fort was built. It was named in honor of General Washington's Secretary of War, James McHenry, of Baltimore, and was constructed during Washington's administration. In 1795 the Government acquired that part of the reservation on which the star fort stood, and in 1838 the entire reservation was ceded. In 1914 the area was transferred to the city of Baltimore for use as a public park, with the understanding that the fort would be occupied by the Government in time of war.
PROCUREMENT OF STRUCTURES
On June 20, 1917, the Surgeon General recommended that Fort McHenry be turned over to the Medical Department for general hospital purposes. Approval for this was given by the Secretary of War on August 2, following.
On the morning of August 22, 1917, a sergeant and 15 enlisted men of the Medical Department arrived at Fort McHenry and unfurled the American flag on the remains of the historic old star fort. On the 29th of the same month a medical officer arrived and assumed duty as commanding officer of the hospital. From then on various officers reported and were assigned to duties in the different departments of the forming organization.
At the time when Fort McHenry was taken over for use as a hospital the buildings and grounds were the remains of a former coast artillery post which had been unoccupied for several years, and in consequence the place was considerably out of repair. The Government was just building three brick buildings to be used as an immigration station.
The preliminary efforts of those in charge were to prepare temporary quarters for the administrative forces and barracks for the enlisted men of the Medical Department detachment. The brick building to the right, as one entered the gate to the fort, was the first one to be renovated, and for several months was used as headquarters as well as a barracks and mess hall for the personnel then on duty. In addition to cleaning and repairing the buildings which had been on
the post since the Civil War, it was necessary to clean up the grounds, as the roadways and walks were overgrown with grass and weeds. At this time no new construction had been definitely planned, and the future of the hospital was still being determined by the Surgeon General.
On October 5, 1917, a group of 60 Medical Department men arrived from Fort Ethan Allen, Vt., and were housed for a while in the chapel and guardhouse, but later were moved to one of the brick barrack buildings which had formerly been used by the Coast Artillery. In this same building a mess and permanent headquarters for the detachment were established.
The first patients to be on sick report were two members of the Medical Department detachment who were admitted as patients on October 18, 1917.
The operating room, equipped for emergency operations, was opened on the 29th, in the old post hospital building, afterwards barracks No. 2.
Arrangements had already been made with the Mercy, Johns Hopkins, and the Baltimore Eye, Ear, Nose, and Throat Hospitals to send a group of 10 detachment men at a time to each of these institutions to take a four-weeks' course of special training, particularly in surgery.
Plans were forwarded from Washington on September 2, 1917, for new buildings which, with the three brick immigration buildings, were to be completed and turned over to the Army and which would accommodate 1,000 patients. The work on the new cantonment buildings was begun on December 24. However, the 1st of June, 1918, found the hospital occupying temporary quarters in the old brick barracks and any other of the original buildings at the post that could be made habitable. From September to December, 1917, the following
changes had been made, as appear in the report of the commanding officer to the Surgeon General:
By December 31, 1917, all of the old buildings had been completely renovated; new sewers had been constructed and the old ones cleaned; necessary plumbing had been installed in the buildings; and the following activities had been placed in operation: Wards with a total bed capacity of 200; the barracks and mess; officers' quarters and mess; the quartermaster clothing room and the commissary; the bakery; the quartermaster shop; shops for the plumber, the carpenter, the electrician, and the painter; a garage and stable; a post exchange; a reading room; a writing room; a pool room; a tailor shop; and a barber shop.
The first new building to be completed was the nurses' home No. 1. In the meantime construction was going on at a rapid pace on 18 one-story frame
buildings, including a central kitchen and mess, a receiving ward, and an isolation ward. At the same time that the new buildings were being constructed work on the immigration buildings was being rapidly pushed, and by February, 1918, the new administration building-one of the immigration buildings-was occupied.
Word was received that the first group of overseas patients would soon arrive; and as the immigration buildings were not completed and the regular hospital buildings were still in process of construction, it was necessary to provide temporary quarters in one of the old brick buildings which had been in existence since the Civil War.
In February, 1918, the immigration buildings were completed, the receiving building having a capacity of 800 beds. The surgical building was completed
and equipped with X-ray, eye, ear, nose, and throat apparatus and a modern surgery. On February 22 the second group of 107 overseas patients arrived and on the 28th 248 more patients came. During this period the hospital was used largely as a clearing house, patients arriving from the port of debarkation, Hoboken, on special trains, being reclassified and then transferred to definite points such as New Haven, Conn., Fort McPherson, Ga., and Cape May, N. J., according to the nature of their disabilities.
In the spring of 1918, due to the necessity for augmenting every hospital to its fullest extent, buildings with a capacity of 1,200 beds were added to this hospital. Owing to the limited area and the resultant congestion, these buildings were constructed of tile; whereas, those in the first project were of frame; all, however, were equipped with steam heat and other modern improvements.
Additional buildings were subsequently erected to meet new needs, causing further congestion; in consequence of which, considerable fireproofing of the
frame buildings was necessary; and an automatic alarm system, such as was put in all large hospitals, was installed.
Construction continued, and by March, 1919, 2,500 beds were available. In the summer following, construction for 200 beds was added, making a total constructed capacity of 2,700 beds.
Over 130 separate construction authorizations from the Surgeon General's Office were necessary to complete this hospital. This number of authorizations was greater than was usually required and was due to the facts that the hospital was developed early and that there was an enforced absorption of old buildings in a confined area.
Nurses' quarters, as well as quarters for all other personnel, were provided on the grounds. In fact, every activity of the hospital was so provided, thus greatly simplifying administration.
The first permanent buildings of the Bureau of Immigration were used with practically no alterations.
The special buildings for physiotherapy, school, and shopwork for the physical reconstruction service, were not installed until rather late in the construction period of this hospital.
Special provision for the blind was made until accommodations elsewhere could be effected. A most complete orthopedic workshop, a feature not common to all general hospitals, was added. Special provisions for the treatment of maxillofacial, brain, and peripheral injuries were also made.
In all, 75 new buildings were added to those originally at the fort, which, with the four buildings of the Bureau of Immigration, made a total of 111. The total cost of this 2,700-bed hospital was $2,160,000.
CHRONOLOGICAL SEQUENCE OF EVENTS
At the close of the first six months, that is, March 1, 1918, there were 187 enlisted men, Medical Department, 33 officers, and 400 patients. Two of the frame buildings were occupied and many others were under construction, but there was still a margin of 400 vacant beds. The three immigration buildings had been occupied for several weeks and were fulfilling every need. On March 6, Base Hospital Unit No. 48, comprising 148 men, the first of several such units to receive their training at this hospital, arrived.
The month of March, 1918, was a memorable one in the history of this hospital because it was during this month that the educational department was established. At this time the Government had not adopted any definite policy regarding the reeducation of disabled soldiers, nor had any appropriation for this purpose been made. The establishment of this school was made possible through the liberality of one of Baltimore's prominent citizens who placed at the disposal of the commanding officer a sum of money to conduct what started to be a department of reeducation of the soldiers at this hospital. From this small beginning schools and shops developed into one of the most complete educational departments.
On April 4, 1918, a branch post office and a telegraph station were opened, and on the 27th of the month the first number of the Trouble Buster was printed from the press in the educational department.
On May 31, authorization was received to enlarge the capacity of the hospital to 3,000 patients, the construction to be two-story tile buildings.
At about this time a post exchange was established and recreation of various sorts was being given daily for patients. Many relief organizations which had developed in the city were lending their assistance to the hospital in various ways, furnishing many comforts and delicacies which the Government did not provide.
A printing press, with full equipment, was donated by the Broadway War Relief Association and the American Type Founders Co., establishing the Fort McHenry press, which printed the Trouble Buster and The Medical Bulletin.
During the month of June, 1918, the hospital was very active. Base Hospital Unit No. 48, having been equipped, left on the 20th for duty overseas. Base Hospital Unit No. 78 arrived for mobilization and training. A convalescent camp on the Severn River was opened for the reception of patients. The cantonment buildings were occupied, grounds about the hospital were being beautified by the planting of flowers and shrubbery, and in spite of the great amount of new construction the hospital presented an attractive appearance.
On July 20, a class of instruction for noncommissioned officers was started and lectures were given daily by the various officers. On the 25th, Base Hospital Unit No. 102 arrived for mobilization and training. During this month 30 enlisted men left for overseas. On the 19th, the new psychiatric wards were formally opened.
August 4, Base Hospital Unit No. 102, known as the Italian unit, most of its personnel comprising Italian-Americans, embarked from the port of Baltimore for the Italian front. In this unit there were 35 officers and 198 enlisted men. On the 27th, Base Hospital Unit No. 78 left for overseas, taking with it 22 officers and 191 enlisted men. During this month several hundred limited service men arrived for minor operations; and while the active affairs of the hospital were somewhat crippled, the work went on without interruption. The construction of new buildings was constantly going on and hundreds of workmen went in and out daily. Twenty-three two-story tile and concrete buildings were in process of construction and a large amount of débris covered the grounds, necessitating the policing of the entire grounds daily by both personnel and available patients.
During the month of September the first annual meet of the Army and Navy Athletic Association was held on Homewood Field at Johns Hopkins University. Athletes from the near-by camps participated. A parade of several thousand soldiers and sailors, with several bands, marched to the field, where 10,000 spectators witnessed the contests. The gate receipts, amounting to nearly $10,000, were used to establish and equip the convalescent camp on the Severn River. It was during this month that the first of the two-story tile buildings was completed and opened. This building was finished within two weeks after the work had started. A central kitchen and mess hall was also completed and opened, with a capacity of over 1,600 men.
At this time the influenza epidemic began, and a number of serious cases were admitted to the hospital from Camp Holabird, Md. Every day showed an increase in the number of influenza patients; but, fortunately, few cases occurred among the hospital command. At the end of the month there were 300 influenza and pneumonia patients, overtaxing the wards and requiring officers, nurses, and enlisted men to work overtime. Five surgical wards were given over to the medical service, and all operating ceased for this period. During the month there were admitted 1,052 patients; discharges numbered 730, and deaths 14.
During October the epidemic of influenza was still raging, over 1,000 cases having been treated in 30 days. There were 121 deaths among the patients, mostly from pneumonia. Many of these cases came to the hospital in the later stages of the disease. Many autopsies were performed and the involved tissues closely studied. A very large percentage of the autopsies exhibited
an infection with streptococcus hemolyticus. Many cases showed a very early pleural exudate, rapidly changing to pus, though some died before the pus became microscopic. Many showed multiple abscesses in the lungs, and a purulent pericarditis.
During the month of November an officer arrived to take charge of athletics; and new life was instilled into these activities, the officers taking daily exercise in the gymnasium and the patients appropriate exercises to assist them in overcoming their physical handicaps. A bowling alley and shooting gallery were opened; boxing bouts became weekly affairs; and a spirit of competition arose which tended to improve the morale of the post. Weekly dances, moving pictures, and other entertainments were given both for the patients and enlisted men. It was during this month, also, that the local director of the American Red Cross arrived and began his work in the office of the chaplain, pending the completion of the Red Cross building.
During December the new laboratory was opened, providing adequate facilities for routine as well as experimental work.
The end of the year 1918 found the hospital in a splendid condition, with nearly all of the buildings occupied.
At the first of the year 1919, the personnel of the hospital consisted of 78 officers, 123 nurses, a detachment of 863 men, and 947 patients. During the month of January, the maxillofacial service was instituted. The neurosurgical department had already been in operation a few weeks, and the operating rooms were kept busy all day long. The orthopedic service had been moved into the large immigration building, containing over 300 beds, which, with those in three other hospital wards, made one of the largest services in the hospital. Of the 2,000 patients in the hospital nearly one-half required some form of prosthetic appliance, so that the orthopedic shop was a center of great activity, since practically all of the shoes and appliances were made and fitted there. The department of physiotherapy was operating in full swing with about 50 aides on duty and hundreds of patients receiving daily treatment.
During February the new Red Cross building was opened with appropriate exercises, and proved to be a constant source of comfort and pleasure to the personnel of the hospital. The officers' club was opened, and made an important adjunct to the social life of the post. The Red Cross fitted the rooms of the club with reading tables, writing desks, easy chairs, library, and a small restaurant.
On March 13 the new Young Men's Christian Association building was opened. This contained a large, well-equipped gymnasium, pool tables, and lounging and reading rooms for the use of both patients and enlisted men.
On April 4 Arbor Day was celebrated. The entire staff of officers, enlisted men, and ambulant patients turned out and planted trees and shrubs over the post. Over 2,500 trees and shrubs were planted. The greenhouse was complete and provided an abundance of flowers for the wards. The school of wireless telegraphy was opened and several pupils enrolled. On the 13th, the convalescent camp on the Severn River was formally opened and presented to the hospital, to be used as a camp for convalescent patients.
In May 230 orthopedic patients arrived from General Hospital No. 9, Lakewood, N. J., and General Hospital No. 1, Williamsbridge, N. Y. On May
31 a Memorial Day parade was held in Baltimore in which 7,500 patients from the hospital participated. A large exhibit of the work which was being done at the hospital was sent to the meeting of the American Medical Association held at Atlantic City. The Jewish Welfare Board hut was opened with appropriate ceremonies.
During July the commanding officer organized a central welfare board, which coordinated all the welfare activities of the post, and there was started a series of weekly lectures on American citizenship.
In Osler Hall, at the Medical Library, 1211 Cathedral Street, Baltimore, an extensive exhibit portraying the work of the various departments of the hospital was held for a week. The educational department, the maxillofacial, and others, demonstrated by models, photographs, and charts the comprehensive character of the work being done by the hospital.
During July and August patients were being taken to the convalescent camp daily. The Red Cross and other welfare organizations were very active, planning entertainments of various kinds for the patients and providing them with many comforts.
The month of November marked the beginning of the end of the hospital's existence, when the various welfare associations discontinued their activities at the hospital. A detachment men's service club was organized and took over the Young Men's Christian Association building as a gymnasium and club house.
On the last of the year the personnel of the hospital comprised 81 officers, 173 nurses, 701 enlisted men. There were 1,193 patients.
In this office were kept the records of each patient in the hospital from the time he was admitted thereto until he was ready for final discharge, when his record was completed and sent to the Office of the Surgeon General of the Army. From the time the patient was admitted his record (register card) moved step by step through each subsection of the department.
The following figures for the year 1919 will give some idea of the work done in the registrar's office: The number of register cards for patients admitted to hospital, 14,277; the number of complete records sent to the Office of the Surgeon General, 13,048; the average daily number of patients admitted, recorded, diagnosed, completed, checked, etc., was 40.
PERSONNEL ADJUTANT'S OFFICE
This office handled the records of a shifting personnel of enlisted patients, as to pay, insurance, class A, B, C, D, and E allotments, and Liberty loans, for approximately 21,800 men, or a monthly average of about 2,000. In many instances the records of these men were received in poor condition, 50 per cent of the men who arrived from overseas and were transferred to this hospital having temporary service records and pay cards only, making it essential to execute affidavits and to interview individual enlisted men to determine the merits of each case. The back pay due some of these soldiers ranged from two months to two
years. This department handled the pay, insurance premiums, class A, B, C, D, and E allotments, and Liberty loan bond deductions for the members of the Medical Department, Quartermaster Corps, Utilities, and Motor Transport Corps on duty at this station. This number averaged 850 per month. There were also executed all papers required by demobilization circulars and orders in the discharge of about 250 patient officers and the transfer of 75 to other stations for duty or discharge. In this office were made monthly rosters and musters of officers and enlisted men, the post returns of the command, returns of medical officers, weekly reports, reports of duty status of officers, and a daily report of changes to The Adjutant General of the Army for every change of status of officers and enlisted men, averaging 150 officers and 1,770 men per month.
DETACHMENT OF PATIENTS
The office of the detachment of patients was charged with the pay of enlisted and officer patients; banking the patients' money and depositing their valuables in the vault; keeping the service records of patients admitted to hospital, or sending the records to proper organizations with necessary indorsements when sick were transferred or returned to duty; completing the service records for discharge; preparing temporary records and pay cards; affidavits when original papers had been lost or destroyed; supervising War Risk allotments; preparing surgeon's certificates of disability; issuing furloughs to patients; and issuing clothing to patients.
The greatest part of the work of this office was in connection with keeping the enlisted patients' records up to date so that the men could be discharged when such was ordered by reason of a disability, or when the patient was returned to duty. The following figures show some of the work accomplished by this office during the year 1919: Patients admitted to hospital with service records, 14,277; patients departed from hospital for discharge, transferred for further treatment, or to a duty status, 13,048; approximate monthly pay of patients in hospital, $35,000; number of furloughs issued to patients in hospital, 1,855.
One of the busiest places in the hospital was the receiving ward. Here the patients were admitted or discharged, and it was here the medical and surgical officers of the day made their headquarters, where, in the event of an emergency, they would be most readily available.
The evacuation department consisted at first of three separate and distinct offices, namely, evacuation, demobilization, and transportation. On September 22, 1919, they were consolidated into what was later known as the evacuation department. This department was charged with the duties of demobilization, evacuation, and transportation of personnel at the hospital.
When a member of the organization was demobilized his records were completely audited by the commanding officer, detachment of patients, and the personnel adjutant, before his papers reached the demobilization office. So soon as the demobilization office received a soldier's service record he was
notified to appear, his papers were completed, and he was then ready for discharge. During 1919, approximately 13,000 patients were discharged or otherwise disposed of at this hospital.
Fort McHenry was taken over as a general hospital August 22, 1917. At that time the sanitary conditions of the post were very poor as the result of an inefficient sewerage system and the methods of disposal of garbage and refuse. Steps were immediately taken to install an adequate sewerage system, and to correct the existing insanitary conditions. A field incinerator was built for temporary use for the disposal of wastes, and the garbage was deposited on a scow and removed by the city of Baltimore. Water was supplied by the city system.
During the months of September, October, November, and December, 1917, and January, February, March, and April, 1918, the above mentioned methods of sanitation were in operation. In June, 1918, a modern steam incinerator was built and efficiently operated for the needs of the hospital. Following this, water pressure tanks were installed and connected with the city water supply. Shortly thereafter, a modern incinerator was built, and it adequately cared for the disposal of the waste of the post.
In the early part of 1918, as a result of the rapidly increasing size and capacity of the hospital, an officer, selected from the staff, was definitely assigned as hospital and sanitary inspector. In addition, several enlisted men, Medical Department, were assigned to duty as a part of the sanitary personnel of the hospital and under the direction of the hospital inspector.
The duties of the hospital inspector and sanitary squad were: Frequent inspection of the buildings and grounds; the drainage, sewerage, condition of sanitary appliances (incinerators, sterilizers, and filters); the amount and potability of the water; the character and cooking of food; and the character and causes of prevailing diseases and measures taken to prevent them.
All the wards and corridors were screened as a precaution against mosquitoes, and the drainage was carefully looked after to prevent the formation of stagnant pools of water. Places which were habitually damp were covered with a fine film of oil.
The first nurse reported for duty at General Hospital No. 2, January 5, 1918. She was detailed as chief nurse. On January 26, 1918 , the first duty nurse arrived; the following day two more nurses reported; and by the end of February there were 12. Not many wounded were being brought back to this country at that time so that the number of nurses was increased very gradually.
The accommodations in ward 1, provided for the nurses, were soon outgrown and it was necessary to build nurses' quarters No. 1. These were completed about March 1, 1918. By June, 1918, about 50 nurses were quartered in this building, and it then became necessary to have additional quarters, and a dormitory consisting of eight beds. Quarters Nos. 26 and 27 were opened for nurses early in November, 1918, when the roster had increased
to about 75. All these buildings provided private rooms, parlors, and reception rooms for the nurses; and all of the rooms were tastefully decorated and furnished by the Red Cross and other patriotic organizations of Baltimore.
The nurses' rest house on the water front filled a longfelt want. This building included a large living room, with laundry, two small guest rooms, and on three sides a screened porch that proved a delight on hot summer days. The rooms were furnished and decorated attractively by the Red Cross. Apart from being a rest house, it was used as a recreation hall for nurses, officers, and others of the post, and for the entertainment of nurses' guests.
About October 15, 1918, the influenza epidemic was at its height. Twelve wards, with 40 patients to each ward, were in operation. Nurses were arriving daily in large numbers, so that shortly after the roster reached 200. About one half of the nurses were taken sick with the influenza, doubling the work of those remaining on duty.
On October 10, 1917, the first chief of the surgical service was assigned. On October 29, 1917, an operating room was planned and equipped for emergency operations in the old post hospital building. The first operation performed at this hospital was on November 23, 1917.
The activities of the department of general surgery, which during the early months included the subdivisions of surgery, orthopedics, maxillofacial, and neurosurgery, were confined to operations of an elective character which included a large number of hernias. The usual acute surgery from the surrounding camps was also taken care of. Beginning in November, a few operations on the late effects of gunshot wounds of bones were performed-removal of sequestra.
The majority of the cases of compound fracture arriving from overseas, up to this time, had required only the usual surgical dressing, splinting, etc., and the surgical department had been largely concerned in the study of radiography and clinical signs, having in mind the proper selection of cases requiring surgical intervention. The study of the cases requiring surgical intervention necessitated a grouping of surgical conditions in suitable wards in order that these conditions might be more readily and frequently reviewed. It was found that, due to the splendid surgical care given the patients abroad, there were very few malunited fractures, and cases of nonunion were comparatively rare. These cases of nonunion were subjected to bone-grafting operations with very good results. The empyema cases operated upon represented old empyemas of more than six months' duration.
During the month of December, 1918, the department of neurosurgery was formed.
During the year 1919, 3,579 operations were performed, with but 18 deaths. These figures include a number of operations on general surgical cases which represented long-standing complications that had been transferred on the closing of other general hospitals.
One of the innovations during the year was the system of charting, by graphic charts, the results obtained by the orthopedic and physiotherapy depart
ments. Graphic charting of a patient's improvement not only encouraged and convinced the patient of his progress, but it was a stimulus to the aides and others working on the case.
Every effort was made to keep a smooth liaison between all the departments of the surgical service and between each ward and the office of the chief of the surgical service.
This department was not well organized until September, 1918. From that time on a system of case records was established and a separate ward opened. The clinic became a large and active one, operating practically all day.
The surgical work of the service was of a very high order, consisting of plastic repair of old gunshot wounds, the restoration of cul-de-sacs, fat and fascia orbital implantations, enucleations, and the fitting of artificial eyes. The most marked and interesting cases of repair work were sketched in crayon and colors; plaster casts made before and after the various operative procedures, and the complete collection later became a part of the exhibit of the Museum and Library of the Surgeon General's Office.
This section of the hospital was not well organized until the spring of 1919. During 1918, the clinic was inaugurated and a large number of patients treated and many consultations were held in the wards. As the demand for space for patients of this department became more urgent a separate ward for the service, having a capacity of 80 patients, was established. The section soon became an integral part of the surgical department of the hospital and the clinic ran daily, including Sundays and holidays, from 8.30 a. m. until noon. The service was a very active one, cooperating with the other departments of the hospital and caring for military cases from the city of Baltimore, Aberdeen Proving Grounds, Camp Holabird, and Camp Meade, Md. Many patients from the latter-named points were naturally in the out-patient clinic, and hospitalized when necessary.
The operative work, of which there was considerable, was done in the afternoons.
The most frequent lesions met with were those of the accessory nasal sinuses, usually postinfluenzal, some following gassing, and others resulting from high explosives and other war injuries. There was a large number of ear affections, principally of the chronic suppurative type, with a very low percentage of mastoid involvement. Acute mastoid cases were found to be few and far between for such a large clinic. Acute tonsillitis was found to be frequent, with a number of cases of peritonsillar abscess, and there were a few cases of Vincent's angina.
The maxillofacial department, at General Hospital No. 2, was in charge of an officer, with four surgical assistants, and two artists. In all there were about 450 maxillofacial cases; of this number about one-fourth were discharged in practically as good condition as they were before entering the Army. These cases consisted of a great variety of facial injuries, including many with a partial loss of the nose and a few with entire loss of the chin, and a great many
with deep deforming scars and loss of bone in many parts of the face. In the repair of these cases it was necessary to have a great many of the appliances made by the dental department.
In order that a permanent record of the work might be made, two artists were employed. One was in charge of the plaster and wax work and clay modeling. A cast was made before and after operations in each distinctive case. In many cases, noses and chins were modeled in clay, as a pattern for the surgeon to go by. In a number of cases water colors were made where sketches and casts did not show sufficiently the nature of the injury. Another artist was in charge of the sketching, and made excellent free-hand sketches of all cases, before and after operation. In addition, the department had photographs of all cases, also tracings of X-ray plates and many X-ray films. The dental records consisted of splints mounted on plaster casts, copies of the various
appliances used, and pictures of others not deemed worthy of publication. In this way it was possible to place in the Army Medical Museum at Washington a complete record of the work of the department, with a card index of all cases shown, giving a brief history of each.
It was learned from the experience of the Allies, long before we entered the war, that injuries to nerve structures calling for surgical intervention would reach a high percentage. The Surgeon General's Office then created a division to be known as neurosurgery. There were very few men, at home or abroad, trained in this branch of surgery, and one of the first steps of the new service was to open schools, known as neurosurgical institutes, at several medical centers, to which were sent selected officers for this training. There were also designated, at a later date, certain hospitals in this country to be equipped as neurosurgical
centers. General Hospital No. 2 was one of this group, and in November, 1918, patients with nerve structure injury were being admitted for treatment.
It was with the withered hands and feet and arms and legs that this department had to deal. Patients, with very few exceptions, were those in whom partial or complete paralysis had followed gunshot wound of the brain, spinal cord, or the larger nerve trunks. The injuries varied greatly in severity: in some cases a large portion of the brain matter was destroyed or irreparably injured; in others there was nothing more than a bruise. So also was it in cases of spinal-cord injury. With the peripheral nerves the injuries varied from bruises to complete division.
The total number of cases treated was 655, of which 550 were peripheral nerve injuries, 103 head injuries, and 12 injuries of the spinal cord. Two hundred and forty-one peripheral nerve cases and 65 head cases were operated on. In addition to the nerve injuries, about 25 per cent of the men had serious injury to bones, tendons, or joints, requiring treatment in some other department.
The early recognition of the necessity for cooperation between the orthopedic ward surgeons and the departments of physiotherapy and of education was evidenced by the assignment of a liaison officer for this purpose in November, 1918. In this manner, by consultation, it was determined what curative or educational therapy should be undertaken in each case. Both of these departments proved of inestimable value to the orthopedic department.
In connection with the physiotherapy department, and largely due to the efforts of the liaison officer, there were developed apparatus and forms for the measuring and recording range of voluntary motion and the strength of motion in disabilities of the joints and muscles. These instruments were designed from the various forms of apparatus in use in other Army hospitals, supplemented by improvements worked out by the officer in charge. These measurements and records proved of great value not only in stimulating and encouraging the patients, but also in furnishing a definite record of improvement for the information and guidance of ward surgeons and members of the physiotherapy and educational departments.
The orthopedic service was organized soon after the first contingent of overseas patients was received, in June, 1918. These patients were placed in a small building afterwards used and outgrown as the appliance shop, becoming the repositorium. As the hospital rapidly filled with patients, other wards were assigned to the service, and to one of these, ward 17, a sun porch was added for the segregation and open-air treatment of orthopedic tuberculous patients.
In August, 1918, it was found necessary to establish and equip an orthopedic appliance shop. The small building used as the first ward was remodeled for the purpose; and two men, trained at the Army Medical School orthopedic laboratory, were secured to augment the nucleus of mechanics developed locally. The first shop equipment, soon afterwards replaced by a complete Medical Department issue, was secured through the generosity of patriotic organizations and citizens of Baltimore.
In April, 1919, a wing of the physiotherapy building, the gymnasium, was secured and converted into an appliance shop, office, and consultation room.
Throughout the remaining months of the year the shop mechanics, all emergency enlisted men of the Medical Department, turned out the required
appliances for the entire hospital, with the exception of the cork-sole shoe raises, which required the services of an expert orthopedic bootmaker, and an occasional back, or leg brace.
No separate urological department was maintained at General Hospital No. 2 during its early days, all venereal patients being taken care of in a small ward by the general surgical service. It was not until large numbers of venereal patients began to be received from overseas that it became necessary to organize a distinct department, though several hundred cases had been taken care of up to September, 1919, when the big influx began. During November, 1919, some 400 venereals were received from overseas, representing all kinds and stages of disease.
DEPARTMENT OF ROENTGENOLOGY
One of the most important departments of the hospital was that of roentgenology, located on the first floor of the surgical building. Originally but four rooms were occupied. The largest one was arranged for operating and fluoroscopy, and in it were a Campbell table, Kelly-Koett tube stand, vertical plate changing device, vertical fluoroscopy, and a complete chest for localizing apparatus. Protection from X rays was afforded by lining the walls with heavy sheet lead. In a room opening from the main operating room a Wappler transformer, Belleview model, was installed. Adjoining was the diagnostic room, which contained a built-in view box, plate-filing cabinet, Wheatstone stereoscope, typewriter and table, and a card-filing cabinet wherein a complete record of each patient was kept, a system having been inaugurated by which plates and dates referring to each case might be located promptly. The dark
room was conveniently arranged and equipped with large developing tanks, the contents of which might be brought to the necessary temperature by means of running hot and cold water.
As the hospital grew in size so did the department until it occupied 10 rooms. An additional operating room was installed, the walls of which were lined with heavy lead, and the equipment consisted of a United States Army table, Kelly-Koett tube stand, and vertical plate-changing device. In the adjoining room was a Kelly-Koett transformer. In addition to the abovementioned equipment there were two portable bedside units.
With the increase in work the plate-filing space in the diagnostic room became inadequate and it was found necessary to take over another room for this purpose. In this were a Wheatstone stereoscope, two large built-in plate-filing cabinets, and a view box in which a number of plates could be shown at one time. This room was commodious and afforded an opportunity for studying plates by members of the staff.
The work was varied and interesting, a vast majority of the patients having been injured overseas, and bone injuries were observed in practically every bone of the body. Many other cases, likewise unusual, presented themselves.
The number of patients examined was 8,002, for which 16,329 plates were filed; 4,855 new cases were examined and 3,147 were old cases reporting for further examination. Of the number of patients examined, 4,616 were found to be pathological. Of this number, 2,636, or 57 per cent of the pathological causes, were fractures. The humerus was found most frequently fractured, there being 351 cases.
A fully equipped photographic laboratory was connected with this department and was under the supervision of the X-ray service. Seven hundred and forty-six patients were photographed, of which there were 2,388 plates.
The dental clinic was established February 15, 1918. At that time it was located in what was known as the surgical building, and there was provided but a single room and one base outfit. It was soon found that supplies and equipment were far too inadequate to cope with the constantly increasing quantity of work to be done, especially when the hospital was designated as a maxillofacial center.
On February 1, 1919, the entire upper floor of ward 28 was decided upon as the future place for the dental clinic. Additional dental equipment and supplies were immediately requisitioned; gas, water, and air lines were installed; and hasty preparations were made to care for the great number of patients who already filled many of the wards, as well as those constantly arriving with each convoy.
The rapid growth of the clinic will be seen in the comparative numbers which follow: On January 1, 1919, there were but 3 dental officers and 3 dental assistants on duty, while in April, there were 19 dental officers and about 25 enlisted men in the clinic. Subsequent to the 1st of January, 1919, 4,365 patients were cared for, 13,000 sittings were given, there were 276 restorations, and about 255 splints for maxillofacial cases were made.
A dental officer of the day was designated daily to care for any emergency which might occur within the 24 hours, while each of the other officers had a
definite class of work to do. Certain ones were assigned to prosthetic restorations, others to operative dentistry, one to the surgical room, where all extractions and other work of a surgical nature were done. One officer was designated as property officer and was responsible for all equipment and supplies, this being in addition to his other duties.
The medical service at the hospital was created October 7, 1917. Up to this time the hospital had been in a process of organization, and it was not until October 15 that patients began to appear on sick report. For months the sick report showed a few entries only, representing men from the detachment on duty at the hospital and from the water-front guard near by. It was not until January, 1918, that the first group of patients arrived from elsewhere. At this time the great debarkation and distribution hospitals at the ports were not entirely ready for use, and from January to April, 1918, group after group of patients was sent to General Hospital No. 2, immediately on debarkation from France, for diagnosis and separation into disease classification, on completion of which many of them were transferred to other hospitals for definitive treatment. So it happened that a large percentage of the patients admitted in these early days of the hospital's existence was assigned to the medical service, and as a result a demand was created for medical officers to rapidly build up the personnel of the medical service.
The most striking characteristic, speaking in a medical way, of these early groups was the preponderance of the transfer diagnosis of tuberculosis. It soon became evident, however, that many of the cases had been hastily and erroneously diagnosed overseas; these were kept under observation for a time and usually returned to limited duty.
In April, 1918, this hospital ceased to be a distributing center and thenceforward the cases sent remained for treatment. It is interesting to note that never thereafter was a tuberculosis ward (the standard ward of 32 beds) completely filled with undoubted cases of the white plague. Now began the proper and steady work of the medical service. Few changes of officers occurred and there was in consequence an efficient and harmonious staff.
The ward facilities, however, were still inadequate. Only four of the cantonment wards were available for patients, and these had to shelter the growing number of surgical, especially orthopedic, cases, as well as the medical patients. Recourse was had to the use of the big immigration building, a structure poorly adapted in every way for ward purposes. Two of the wards were huge, and consequently hard to administer, and the noise of riveting on steel ships night and day, less than half a block distant, prevented sleep for the patient, accurate ausculation for the doctor, and at times ordinary conversation for everyone. In spite of such drawbacks things went on smoothly, with a service growing to 220 in September, when the medical service was then comfortably housed in the cantonment wards which subsequently constituted the medical row.
During the early summer of 1918, Base Hospital No. 78 mobolized at this post and trained to a large extent. On September 3, 1918, they were ordered to the port of embarkation and took with them the chief and four other members of the medical service.
The hospital at Fort McHenry had a double function: In addition to being a general hospital it served as a post hospital for the surrounding camps and posts. The water-front guard, General Hospital No. 7, the ordnance depot at Curtis Bay, and the huge motor transport depot at Camp Holabird, all looked to this post for hospital facilities and furnished a fair proportion of patients. Their dependence on the hospital became the absorbing factor in the activities in mid September, 1918, when the great influenza epidemic began. On the 18th of that month the first cases were received, and the medical service mounted rapidly to its maximum of 754 on October 5. All operating was stopped except in the most urgent cases, and officers were transferred in numbers to the medical service from the surgical service. The whole row of wards from 10 to 18 was thrown open to influenza and pneumonia alone. Inadequate as were conditions in Army posts, as they were throughout the country, to meet the emergency, this hospital fared as well as any in the proportion of nurses and attendants, and its morale was unbroken. The only deaths among the hospital personnel were two enlisted men. None of the officers was seriously ill, and of the 40 or more nurses who were off duty at one time or another during the epidemic not more than two or three caused any real concern.
The measures that accomplished this creditable result were those prescribed by the Surgeon General's Office. Masking was ordered and was fairly well carried out. The formation of cubicles by the use of pendant sheets was required and done. The morale of the nurses was maintained partly by frequent automobile trips away from the post. In fact throughout the terrible devastation and depression of the epidemic period the medical service functioned smoothly and well.
After the epidemic the most pressing medical question was the proper treatment of the sequelæ. The unresolved pneumonia consolidation, the vestigial râles at apices, which resembled so much the typical râles of active tuberculosis, and especially the many myocardial changes, furnished many patients for months.
From time to time accessions of groups of patients from overseas arrived. The bulk of these were surgical; in fact the medical service, except in time of epidemics, was numerically small compared to the surgical service. The diseases represented at any one time in the medical service were much the same as those in any civilian hospital among young men. The particular war-time maladies were scarce. Pediculosis, trench foot, trench fever, trench nephritis, the neuroses, were rarely seen, practically not at all. A certain portion of the medical cases were the ordinary acute infections, colds, tonsillitis, and the like, of local origin; arthritis was represented by a fairly large group of patients; nephritis, goiter, cardiac conditions causing disorders, were present in their usual proportion. The exanthemata were continuously represented in the wards by 2 to 10 cases, and small epidemics of scarlet fever, measles, and mumps were cared for from time to time. In each epidemic the patients were brought from other posts and no epidemic spread beyond the wards where it was isolated.
It was the policy in this hospital for the chief of the medical service to make complete rounds every day and to know personally the history, condition, and progress of every patient. The system of medical supervisors of groups of
wards reporting to the chief, who was to be called in only on special cases, was never adopted. The one-man close supervision, moreover, was carried out in such a way that the ward surgeons always felt that they were being supported and advised by the chief rather than being checked up and limited by him. To this was due the feeling and hearty cooperation that characterized the service throughout.
The neuropsychiatric service was opened in March, 1918; but adequate facilities were lacking at that time; and it was not until the month of May when the patients were moved into the new standard psychiatric building that the real effective work of the service was begun.
The care of the patients was accomplished without any of the old-time methods and they were given every benefit of the modern school of neuropsychiatry. The interior of the building was decorated and painted in soft restful colors, while potted plants and flowers distributed throughout and lace curtains at the windows, all combined to make the place as attractive, homelike, and pleasant as possible. In the rear a spacious porch was converted into a sun parlor and made an ideal place for the activities of occupational therapy.
The building had its own hydrotherapy room equipped with showers, continuous tub, etc.; and the soothing effect of the sedative bath, especially in maniacal cases, was successfully demonstrated. In addition to its use in this way the hydrotherapy bath was employed with gratifying results in a number of chronic ulcer cases from the surgical service. Full advantage was taken of the hospital's physiotherapy department and nearly all of the neuropsychiatric patients were sent out daily for some kind of treatment in the more elaborately equipped building. No effort was spared to provide every therapeutic benefit to be derived from diversional occupation and recreation for the patients. A reconstruction aide spent her time entirely with these patients, doing all that was possible to keep their minds and hands busy, and splendid results were achieved. In addition to this occupational therapy a teacher of calisthenics spent some time each day giving the patients brisk exercise and conducting games which were greatly enjoyed. A large pool table, a victrola, and a wellstocked library, all donations of interested friends, were available for use at all times.
The fundamental principles underlying the treatment of the patients admitted to this service were psychotherapy, hydrotherapy, and occupational therapy. The patients were treated individually and not collectively. No routine or "system" methods were used in administering to those who were admitted complaining of the many and varied symptoms incident to a nervous or mental disorder. The happy results attending the use of these three important agencies, especially in the large group of the functional neuroses and the incipient mental disorders, amply justified the principles of nonrestraint which were insisted upon when the department was inaugurated early in 1918.
The neuropsychiatric wards were built on the same plans as those in all of the Army general hospitals, with the important exception that there were never locked doors, or barred or screened windows. The wards were dehospitalized and made as homelike and as attractive as possible.
This department received, daily, patients referred for consultation, and kept in close touch with patients or members of the enlisted personnel who had, for any reason, been confined to the guardhouse. The attitudes of the commanding officer and the disciplinary officer, regarding men who required discipline, were to first establish their mental responsibility. It is interesting to note that a large majority of the men who did not respect the honor system were those who were later classed as psychopaths or defectives.
The first occupational aide at this hospital was assigned to the neuropsychiatric ward.
A special feature was made of recreation. Several times a week, afternoon parties were given for the patients, at which there were music and refreshments, and when the occasion arose the holidays were celebrated with proper ward decorations and games.
In connection with the treatment of patients in this department mention should be made of the splendid results which were accomplished by sending patients to the convalescent camp on the Severn River. The recovery of a number of patients dates from the time they spent at this delightful summer camp, where boating, swimming, fishing, and many popular sports were available. The camp was especially beneficial in giving the patients the opportunity to get away from the routine of hospital life, and the feeling of freedom and stimulating effects of the outdoors.
Patients admitted to the department of neuropsychiatry were always treated as sick. The idea of anyone being sent as a punishment, the presence of curious visitors, or the use of any slang terms in referring to the patients in the service, were constantly discouraged.
Although at no time subsequent to the opening of the service were more than two ward buildings occupied, an effort was always made to handle as many patients as possible, the plan being to have the patients admitted to the neuropsychiatric division, their examination made, and their histories written, and then their transfer to a convalescent ward or to the convalescent camp on the Severn River effected to make more room for new cases.
On March 22, 1919, the scope of the service was considerably broadened by making arrangements to care for a number of the neuropsychiatric officer patients, and a ward was set aside for their use. In addition to this the Surgeon General's Office gave this service general supervision over a number of neuropsychiatric cases among Army nurses, aides, etc., who were sent to the Shepherd and Enoch Pratt Hospital at Towson, Md., and to the Henry Phipps Psychiatric Clinic at Johns Hopkins Hospital, Baltimore.
The real beginning of the laboratory service may be stated to date from February 1, 1918, when a chief of the laboratory service was assigned to duty. In the following month four women technicians came to the hospital for duty in the laboratory to relieve enlisted men. In December, 1918, nine enlisted men who had been trained in the Army Laboratory School at Yale University were assigned to duty in the laboratory.
From February 1, 1918, to December of the same year the laboratory was housed in the small room in the surgical building, where conditions were very
unfavorable: the room was too small for the personnel on duty, and it was impracticable to put into service all the necessary equipment because of the lack of available space for its proper use and care. In December, 1918, the laboratory was moved to a building comprising four large rooms, which had been especially designed and equipped for the service. The laboratory animals were kept in one room of this building until June, 1919, at which time a small house was fitted up for use as an animal house, and the room formerly used as an animal room became a general storeroom. The animal house was steam heated and contained cages for the animals, arranged in tiers in the center and about the sides of the room.
Subsequent to its removal to its permanent location the development of the laboratory service proceeded at a more or less uniform pace until its equipment was fairly adequate to the work demanded of it.
From time to time surveys of various kinds were conducted in the laboratory. These surveys included examinations of the water supply, examinations of various articles of food, surveys of enlisted men on duty in the mess to discover possible typhoid and para-typhoid carriers, surveys of groups of the population of the post to segregate diphtheria carriers and carriers of the microorganisms or other transmissible diseases, and of still other groups to determine their individual susceptibility to diphtheria by means of the Schick test.
During the summer months of 1919 an interesting study was made of the metabolism and renal efficiency of a group of nephritics. Graphic charts showing the results of all these analyses were prepared. This study was intended particularly to partake of the nature of research, but was undertaken to deter-
mine the actual condition of the patients involved and to establish a scientific basis for their treatment.
The mortuary consisted of a small building of two small rooms. In one room there was a closet in which articles of medical property were kept under lock and key. In the same room were four metal-lined receptacles, each containing a wooden slab, for the accommodation of cadavers awaiting autopsy. In another room there was a concrete floor with the opening of a drain pipe in the center. The autopsy table was an old operating table, about the edge of which a metal rim, one-half inch in height, was placed. At the head of the table was a metal-lined box, into the bottom of which water was admitted from an overhead pipe. Water was drawn from the box near the top through a pipe the terminal arm of which extended across the top of the autopsy table and was pierced by several holes. This allowed a continual flow of water on the surface of the table from one end to the other under the body for the purpose of flushing away fluids which escaped during the process of necropsy. Special attention was paid to the performance of autopsies and to the careful and detailed study of all abnormal conditions encountered in tissues and cultures derived therefrom. Autopsies on patients dying during the night were usually performed at 9 a. m. the following day.
Experimental investigations conducted in the laboratory fell under two headings. One of these sought to determine the relation of the streptococcus hemolyticus to influenza and pneumonia. The results of this work were published in the American Journal of Medical Sciences for August, 1919. The other experimental investigation was a study of the suitability of a substitute for Loeffler's blood serum. This medium consisted of a mixture of egg and veal infusion bouillon, and it was found that it was in no way inferior to Loeffler's blood serum.
At General Hospital No. 2 one of the first physiotherapy departments was established. On August 1, 1918, the department comprised 1 officer, 4 reconstruction aides, and 3 enlisted men. The personnel greatly increased in number having in December, 1919, a maximum of 61 aides and 4 enlisted men.
The work of the department was divided into three main sections, as follows: Massage, electrotherapy, and hydrotherapy. The large majority of patients had gunshot wounds involving bone, muscle, and nerve injuries. The average patient received a local whirlpool bath, or treatment with radiant light and heat to stimulate and make flexible the part affected. The muscles were then fully massaged, scar tissues softened, and stiff joints given careful exercise, passive, active, or resistive. Electrical treatments of a wide variety were given, as this department was particularly well equipped. Tonic treatments for general weak conditions, stimulation in cases of local paralysis, and the healing of stubborn open wounds were included in this work. The hydrotherapy rooms contained all modern apparatus for the treatment of injury or disease by water, hot and cold. Cabinet baths were used for both eliminating and tonic treatments in mental cases. The sedative pool was invaluable in the treatment of shell shock and other psychiatric cases. The cleansing, healing, stimulating, and sedative properties of water were used to the greatest possible
advantage by means of whirlpool baths for arms and legs, Sitz baths, shower baths, needle spray, and the Scotch douche.
Over 480,000 treatments were given to about 5,000 patients, of whom more than 3,000 were returned to duty or discharged cured or with maximum improvement.
DEPARTMENT FOR MEASUREMENT OF VOLUNTARY MOVEMENTS AND STRENGTH IN STIFF JOINTS
There was established at General Hospital No. 2 a department for the purpose of measuring in degrees the range of voluntary movements in stiff joints and measuring in pounds the strength of voluntary movements in stiff joints. The instruments were designed in the various forms of apparatus that were provided the hospital, and in addition further modifications and improvements were devised. These instruments were all made in the orthopedic shop. Instruments were available for the measurements of the following functions: Flexion and extension of the finger joints, flexion and extension of the wrist, abduction and adduction of the wrist, flexion and extension of the elbow, supination and pronation of the forearm, abduction of the shoulder joint, flexion of the shoulder joint, flexion and extension of the knee, and flexion and extension of the ankle. The strength tests were made by the use of the dynamometer and of an ordinary weighing scale with a small runner attached to the dial. The purpose of these measurements was to obtain necessary information for the proper assignment of patients to curative work; and to obtain, in numerical and graphic form, reports which might be used to encourage and stimulate the patients to persist in the prescribed curative work by showing them definitely the progress of improvement, as well as to furnish the surgeon with definite information as to the patient's progress; and to keep the physiotherapist and instructors in the curative workshop informed as to the patient's progress that they might adapt the treatment and curative work to the changing needs. These measurements were made semiweekly. Records were kept and a chart, indicating the gradual and maximum improvement, was maintained for reference, should such information be desired by the ward surgeon or the chief of the service.
EDUCATION AND RECONSTRUCTION WORK
The history of the development and evolution of the educational service at this hospital reflects the changes in policy and practice made necessary by the varying conditions of the Army and the work in general. Beginning as it did at the time when the first patients began arriving from overseas and before the enactment of legislation providing for reeducation of disabled soldiers under the Federal Board for Vocational Education, and continuing through the signing of the armistice and the return of practically all disabled men to civilian life, the educational work at the hospital necessarily changed in character as well as in personnel several times. Early in the war the Surgeon General issued plans in bulletin form for the physical reconstruction of disabled soldiers in general hospitals. This hospital was listed as one of those designated for the work of physical reconstruction. This bulletin stated:
From the military standpoint, disabled soldiers may be placed in three general classes: (A) Those who can be restored to full duty; (B) those who can be fitted for limited service; (C) those disabled to the extent of unfitting them for further military service.
Patients of the first class (A) should have, when circumstances warrant it, the benefit of therapeutic treatment through play, work, and study, as may be prescribed by medical officers, in order that their morale may be stiffened, their special skills improved, their future usefulness increased, and their recovery hastened.
Patients of the second class (B) should have, whenever conditions permit and the medical officers approve, such specific training-physical and vocational-as will in the judgment of the educational officers best fit such patients for limited service of a particular kind.
In the early days of the educational service considerable emphasis was placed upon training men for various occupational use in the Army which would make it possible for them to return to limited service and thus relieve a more able-bodied soldier for service in France.
After the signing of the armistice, retaining men for limited service was, of course, unnecessary. This change in conditions modified the character of the educational work in hospitals, and more emphasis was placed upon giving disabled men the initial stages of what was later to be vocational reeducation.
Originally the department was designated the "occupational therapy service"; later, it was termed the "department of education and occupational therapy," and then became known as the educational service.
The first educational officer arrived at the hospital for duty on February 18, 1918. At that time no special allotment of funds had been made for this work and its status was somewhat uncertain. Congressional action upon the care of the disabled soldier was pending, and there was considerable uncertainty as to the final developments of the work.
On the arrival of the educational officer a hasty survey was made of the patients and their previous education and occupations. Several patients were found who were qualified to act as instructors in commercial and technical subjects. Through the generosity of a resident of Baltimore, $1,000 was placed in the bank subject to the draft of the educational officers. Several typewriters, sets of drafting instruments, drafting boards, and other educational paraphernalia were thus provided. Within a few days patients were studying shorthand and typewriting, drafting, and English. Several patriotic organizations of Baltimore provided yarn and knitting machines, and on February 21, 1918, the first occupational work in wards was initiated. Knitting was provided for men with disabled hands and patients who could not do any more active work. Typewriting and shorthand was given to those who wished it and whose injuries were such that they could be efficiently assigned to limited service use. Patients requiring light outdoor work were given light work, such as raking the lawns and the preparation of gardens.
It should be remembered that at that time there were only the permanent buildings. Medical patients were quartered in the large immigration building, surgical patients were in the wards of the surgical building, and the tuberculosis patients were in what became known as barracks No. 3. Considerable construction work was progressing on the newer buildings and a great deal of policing was necessary.
As more patients arrived, enlargement of the scope of educational work was necessary. For the psychiatric patients willow-basket making was introduced through the generosity and cooperation of the officials of the State asylum at Crownsville, who furnished the hospital an instructor and the material for willow-basket making. In a small room on the lower floor of the immigra-
tion building a willow-basket shop was soon in operation and several patients were trained who later acted as instructors. The necessity for a diet kitchen, to be placed in the immigration building, caused the basket shop to be moved to the basement of what was later known as ward No. 1, and for several months this work was carried on there.
Among the patients to arrive early at the hospital was a master senior electrician, who was an expert telegrapher. In a very short time he had organized a class in Morse telegraphy; and, as soon as it could be arranged, a classroom was opened for this subject in one of the old noncommissioned officers' quarters, and for several months a thriving class in Morse telegraphy was conducted in that building, many patients in the wards doing similar work.
The arrival of Base Hospital No. 48 brought a number of trained men who could be spared from the hospital work to act as teachers; and soon classes were established in various grades of English, mathematics, and drafting, both in wards and classrooms.
The first shop work was given in a shop that was later the physiotherapy building, and in the space later occupied by the bowling alleys. The first shop was a woodworking shop, and was followed immediately by the cement shop and a shoe shop.
In May, 1918, the first allotment of funds was made for the work and this gave a great impetus to it. Additional shops were opened in the first wing of the physiotherapy building and gardens were planted around the star fort.
Early in April, 1918, the Broadway War Relief Club of Baltimore offered a small printing press to the educational department. This was installed in
one of the upper rooms of the post exchange, and on April 24 the first issue of Trouble Buster was published. Two enlisted men were found in the detachment who were printers, and from that time the instruction in printing developed rapidly.
The influenza epidemic in 1918 temporarily disrupted the entire organization of the department, as it was necessary for all enlisted men to be utilized as ward orderlies as well as for caring for the sick. The work was not reorganized after the epidemic until the new shop buildings were completed in October, 1918, when all the shops were brought together in these buildings, and a somewhat permanent organization of shop work was effected. On the completion of the new two-story building in November, 1918, all the classes were brought together in the educational buildings where they subsequently remained.
Previous to the signing of the armistice practically all of the instruction given in the department was done by men inducted into the Army especially for the reconstruction service, and by qualified convalescent patients. About the time of the signing of the armistice the first reconstruction aides were assigned to the hospital by the War Department, and from that time on enlisted men were rapidly replaced by civilian aides.
When adequate teaching personnel had been provided the work was organized in three divisions: The occupational and educational work in wards was arranged under a definite head aide, the class rooms were organized under a supervisor of academic subjects, and the shops under a supervisor of shop instruction.
The abandonment of reconstruction work at Camp Meade made a large addition to the equipment of the service at General Hospital No. 2, as the entire school of photography, vulcanizing equipment, and radio equipment were transferred.
The policy of the department was to provide diversion, occupation, recreation, and instruction which would contribute most to the physical reconstruction and the future occupational efficiency of the patients. Where diversion was necessary, such was provided. Where more stimulating active work seemed advisable, this was provided. Where outdoor work or calisthenics in the gymnasium was needed, these were given. As patients arrived in their convalescence at that point where serious educational or technical vocational work was possible, this was prescribed and furnished. In all shops and classrooms it was the policy to make the work exceedingly practical and conforming to the best educational, industrial, or vocational practices. For example, the shoe repair shop repaired the shoes of the entire Medical Department detachment. For many months during the emergency this shop did all the shoe repairing of the hospital. The print shop did a vast amount of printing, which was necessary in the operation of the hospital. In the early days of the hospital the woodworking shop made practically all the tables and hat racks placed in the wards. The furniture repair shop repaired the large amount of chairs and other furniture which arrived in bad order. The automobile shop for many months did all of the automobile repair work on ambulances and other motor vehicles. The commercial art department painted a very large number of signs. In its early days the class in telegraphy operated the local telegraph office of the post. The electrical shop installed the electric bells in the administration building. The cement shop did ornamental concrete work, and laid several concrete sidewalks about the post. Classes in typewriting did a great deal of mimeographing. The vulcanizing shops repaired hundreds of tires for the Motor Transport Corps at Camp Holabird, Md. The radiator repair shop secured its materials and radiators on which the work was demonstrated from Camp Holabird, and returned these damaged radiators in first-class condition. The photographic shop made hundreds of photographs for the Army Medical Museum and for other departments.
At one time there was a number of blind men in the hospital for treatment, during whose stay a complete organization for the instruction of the blind was effected. Typewriting, craft work, and Braille were taught to all blind men. The American Red Cross presented each blind man who successfully completed a prescribed examination with a Corona typewriter.
The deaf and men with speech defects received special attention. Lip reading was taught, and for some months instructors were busy teaching aphasia patients to talk. A class in expression, taught by an instructor furnished by the Red Cross, proved very effective.
The scope and division of work provided by the department is illustrated by the fact that classes were conducted in the following subjects: Bookkeeping, mechanical drawing, higher mathematics, radio, agriculture, French, Spanish, sign painting, scenario writing, psychology, Morse telegraphy, and pronunciation. The shops provided instruction in automobile repair work, electricity,
vulcanizing, jewelry, photography, carpentry, shoe repairing, printing, monotype and linotype operation, oxy-acetylene welding, gas engine theory, and radiator repairing.
In October, 1918, the scope of the department was enlarged somewhat by the addition of a recreational officer. This officer took charge of the athletics and recreation of both patients and detachment men. Various athletic teams were organized and the plan arranged whereby the recreational officer took care of the parties of patients leaving the hospital for short trips and entertainments of various kinds. Subsequent to that time the department was very active in recreation of both patients and detachment men.
There were enrolled in educational work, 4,031 patients, exclusive of those in recreational activities. A total of 113 civilian aides were at one time or
another on duty. Sixty-one enlisted men and noncommissioned officers were assigned and later were transferred to other hospitals or were discharged. Eighteen different officers served in the department.
Until November 1, 1919, the Young Men's Christian Association, the Knights of Columbus, and Jewish Welfare Board had representatives in the hospital; and the various welfare organizations cooperating with the educational department, arranged a very active schedule of activities for both patients and detachment men.
From its early organization the educational department received a great deal of assistance from the American Library Association, and with the arrival of a representative of this organization at the hospital arrangements were made by which the American Library Association could have its library in the
educational building. The library was utilized as a study room for the members of the various academic classes, who found their reference material in the library.
With the arrival of the first officers and enlisted men in August, 1917, it was necessary to establish two messes, one for the officers and one for the enlisted men of the detachment. Additional messes were established for patient
officers, for enlisted patients, and for the nurses. The first officers' mess was in ward 1, then the administration building, while the enlisted men's mess was in the basement of the same building. From ward 1 the officers' mess was moved into a set of officers' quarters, where it remained until the mess hall was completed in the spring of 1918.
About January 1, 1918, the enlisted men's mess was moved from the basement in ward 1 to barracks 2 and 3, and then to the immigration building, in May of the same year. At this time the mess for patients and enlisted men was consolidated. The permanent mess was sufficiently complete about August 1, 1918, to permit establishing therein the mess for the patients, about 800 in number. Several weeks later the enlisted men's mess was moved there from the immigration building.
As the number of patients and enlisted men increased it was found necessary to inaugurate the cafeteria system of serving meals. This was done about the middle of August, 1918, and was found so successful that it was continued in operation thereafter. It was exclusively for patients able to wait upon themselves.
About January 1, 1919, approximately 7,200 men were fed daily. The amount of food required for this number of men is indicated by the following figures: For a single meal, 16 dozen cans of corn, 350 pounds of potatoes, 16 dozen cans of tomatoes, 16 dozen cans of peas, 16 dozen cans of string beans, 800 pounds of meat, and 16 dozen quarts of milk. For breakfast 150 pounds of sliced bacon were consumed. Nine hundred pounds of bread, 100 pounds of butter, 140 gallons of coffee, 350 pounds of sugar, 5 crates of eggs were consumed daily. One hundred and twenty-five pounds of cereal, 100 gallons of ice cream, 6 crates of fresh fruit, 60 gallons of pudding, 8,000 to 10,000 cakes, 20 gallons of sirup were consumed. To cook and prepare this large amount of food required 150 employees. The mess hall contained a complete refrigerating plant, electrically driven meat choppers, and three large double ranges.
The special diet kitchen was installed in the lower wing of the general mess and was under the charge of the chief dietitian, who supervised the preparation of all diets connected with the general mess. It was operated very satisfactorily, and there were but few complaints. All purchases for this mess were made by the mess officer, and only sufficient food for 48 hours was purchased in advance.
The post exchange was opened November 1, 1917, a small stock of merchandise being obtained on credit. The sales for the first month amounted to $210.
Subsequent additions to the exchange were a modern antiseptic barber shop, with 8 chairs, a well-equipped soda fountain, a tailor shop, restaurant, and laundry.
The total sales at the exchange amounted to $240,834.55. Dividends were paid to the hospital mess fund amounting to $7,647.50.
The first quartermaster arrived for duty at the hospital September 21, 1917. At the time the armistice was signed and until May, 1919, about 200 enlisted
men were on duty with the Quartermaster Corps, most of them being emergency men who were replaced by civilians; and from June until September, 1919, there was the same number of civilians carrying on the activities of the corps.
The functions of the quartermaster department were varied and were divided into 10 divisions, the names of each indicating its activities: Supply office (administration); finance division; medical supply division; subsistence division; clothing and equipage division; salvage division; transportation division; operating record division; Motor Transport Corps, and Quartermaster Detachment.
The utilities department was subdivided into departments of electricity, carpentry, plumbing and painting, police and fatigue, and the post fire department. The electrical shop was developed into a highly efficient working unit. Additional street lamps were installed throughout the post. The necessary poles were erected and the wiring was done by the utilities. A telephone fire alarm system was installed as well as an electric alarm connection from the fire station to the steam fire alarm whistle at the power house. Much of the wiring throughout the post had been changed in order to take care of the increasing load through the use of water heaters, sterilizers, and medical appliances. This was especially true in the X-ray and psychiatric departments, where many complicated machines were being used, requiring almost constantly the services of one electrician. A school of photography of the educational department, installed in building No. 50, necessitated much new wiring. The 56 electric motors throughout the post were overhauled and put in new condition. Nearly 6,000 electric lamps were used on the post, which, in order to conserve electricity during the period of the coal famine, were reduced about one-third. The carpenter shop force comprised five carpenters and four carpenter helpers. The frame type of construction used at the hospital necessitated many repairs. The acid fumes from manufacturing plants, just across the Patapsco River, caused many hundreds of yards of wire screening to disintegrate. All this had to be replaced, and in addition the new screening had to be painted. In May, 1919, this office completed the addition to the receiving ward at the cost of $3,000. Most of the material therefor was transferred from other camps by the Construction Division. Lockers for both nurses and patients were built and installed in all wards and quarters, and work benches and lockers were built in all the ward schools. The plumbing force consisted of 4 civilians, 1 enlisted man, and 1 helper. Changes in location of diet kitchens for bed patients made demands upon the plumber for new sinks, steam tables, etc. The sewage ejector of the immigration station was found to be too small to handle the increased load caused by crowding patients into these buildings, and a new and larger type of ejector was installed by this department in the spring of 1919. The water supply early in the year was found to be inadequate, so much so that at times it had to be cut off to permit refilling the storage tanks; so in July, 1919, funds were secured with which to augment the water supply. This was done by increasing the size of the city supply pipe for a distance of about 1,000 feet west of the post. The incinerator erected under the supervision of the utilities was well constructed and operated efficiently; all the garbage and trash from the entire post was disposed of through this
plant, about 6 tons of material being handled daily, using about 600 pounds of soft coal for incineration. The fire-fighting equipment consisted of one combination hose and chemical truck and seven hand-drawn chemical wagons. Throughout the wards and corridors there were 367 chemical fire extinguishers, and water barrels and buckets were placed at every strategic point. Fire drills were held daily by the fire department personnel, and every second Thursday a general fire drill was attended by the entire post personnel.
In view of the fact that many unique and wonderfully successful operations were performed on the wounded men in this hospital, it was thought advisable to make a permanent record of these operations, to be sent eventually to the Army Medical Museum in Washington. These records were made by means of charcoal, and pen and ink drawings, plaster casts, wax models, photographs, X-ray prints, model splints, and pathological specimens.
For the purpose of centralizing the responsibility and care of these records and of still further stimulating interest in the medical cases under treatment, a repositorium was created. Building No. 56, in which the old orthopedic workshops were located, was given over for this purpose, and here, in April, 1919, the staff of artists and modelers was established.
Among the interesting exhibits of work done subsequent to that time were many drawings and plaster casts showing the wounds of the head in different stages of healing, both before and after operation. The entire time of a sculptor was devoted to work connected with the maxillofacial department, making models in plaster and wax to represent as nearly as possible the original features of the men disfigured by high explosive injuries, thus greatly assisting the surgeons in their work of facial reconstruction.
Two very interesting exhibits were held in connection with the repositorium, one at Atlantic City during the week of the medical conference there in June, 1919, and the other later in the summer at the Medical and Chirurgical Building in Baltimore.
The following is a list of the exhibits received from the chief departments of the hospital.
SCHOOL OF PHOTOGRAPHY
Notwithstanding the fact that it was one of the youngest of the hospital schools, the school of photography grew so rapidly that in less than six months the number of students in attendance was more than 60. In June, 1919, great truck loads of photographic materials were brought from Camp Meade to Fort McHenry, and after the delays caused by the necessity of building dark rooms, and the installation of apparatus, the school was opened, subsequently playing an important part in the pictorial work of the hospital. The students of the school, with their large, complicated Graflex cameras soon became a familiar sight about the hospital, and no events of general interest were allowed to pass unphotographed. Both instructors and students worked together to make the school of photography not only a place where
the enrolled could learn the photographic profession, but also to make it of help and benefit to the hospital. The school supplied the educational officer with a set of photographs of all the schools on the post, for the educational booklet which was printed at the hospital; it furnished the hospital paper, the Trouble Buster, with numerous photographs from time to time; and made photographs of the jewelry and other articles manufactured by the different schools.
The school of photography was established in ward 28. This space was rapidly outgrown and the entire upper floor of building No. 50 was assigned to it and equipment was then secured.
All together about 150 men were enrolled for the course given in the department. Of this number, many advanced to such a stage as to cause them to decide that photography in one of its many branches would be their
profession after discharge. The school averaged about 1,250 photographs per month, of which approximately 3,000 prints were made. Enlargements numbered 100 and Kodak developments about 100 per month.
THE LIBRARY SERVICE
In the first week of December, 1918, the organization of the library at the hospital was begun. During the early days there was no regular system of circulation and no arrangement for the collection of books to be placed in the wards and changed from time to time. One of the wounded men who had been quietly watching the progress of the work asked one day if he could assist in any way, though he had but a left hand to offer. From that day and through many months to follow this thoroughly trained business man stood as adviser and assistant.
The generous support of the American Library Association made it possible for the soldier assistants to receive a small remuneration for the services rendered. This kept the library group intact for a longer period of time and made the hours spent there more worth while. It was through the medium of this training in library duties that more than one soldier with unsteady nerves came back to his former self in performing the small details necessary to maintain the efficiency of the work. During the 10 months that this little library school was in existence 8 patients spent from 1 to 3 hours daily at the library during some part of the 12 hours that the study room was open.
The room in the post exchange, which had been assigned for library use, soon became too small for the needs of a reading room which would serve the entire post. The Young Men's Christian Association hut was not ready for occupancy and the Red Cross Convalescent House was not finished by the 1st of March, 1919, so the educational officer set apart a large sunny schoolroom for library purposes, which became a distinct asset to the educational department of the hospital in that it served the double purpose of a study room and reading room for all, and a circulating department for the text books needed in the schools. When the circulation increased to meet the needs of the class room and the requests of the reconstruction aides, who taught the bed patients in the wards, there were at all times between 500 and 550 books charged to the educational department.
A reading room was provided, but how to furnish it became a problem. An appeal was made to the Secretary of the Peabody Institute of Baltimore, which brought a ready response in the nature of furniture, old and new; and a sufficient number of Windsor chairs was obtained from another post to equip the reading room of the library very comfortably.
The main library and reading room in the educational building soon became the center of the little system which very soon included a collection of fiction in the Young Men's Christian Association hut and the Red Cross house, where the object of each was more recreational than otherwise, and where the assistants in charge referred back to the study room when books of nonfiction were desired.
The ward collections were changed or added to from time to time, the supply coming from the main library in the educational building.
While the chief aim was always service, yet there was a well-formed plan to reach the men and persuade them to visit the library themselves rather than to serve them too generously in the wards. If a man could make an effort to go to school he could pass through the library in his own school building or in the building adjoining, coming to or from classes, and obtain his study books or fiction.
In the meantime the wards were distributed daily with home newspapers, for the patients who could not get out, and with popular stories, magazines, and books especially requested by the patients.
The library at General Hospital No. 2 laid stress upon the educational side of the library work, due to the character of the hospital and the large part played by the vocational school.
THE CONVALESCENT CAMP
Situated on a delightful site on a bluff overlooking the Severn River, about 7 miles from Annapolis, was an ideal spot for a convalescent camp. Through
the generosity of a resident of Baltimore, the use of this site, the Kelly Estate, was donated, and after the camp was started a large number of workmen from Baltimore went down to the place on several occasions and gave their services in erecting the buildings.
On April 13, 1918, the camp, Camp Purnell, was officially presented to the hospital. On September 7, 1918, a monster military athletic meet was held at Homewood, Baltimore, teams from every Army and Navy camp in the State participating, and the proceeds, amounting to about $10,000, were donated to the camp. A special mess hall was built where about 100 men were fed daily; a separate lighting system was installed and a pumping system for the camp water supply. In addition there were built a bungalow for the commanding officer, special barracks for the officer patients, and tents for the enlisted men.
Some of the most attractive features of the camp in the way of recreation were the fishing and bathing in the Severn River. Several boats and numerous bathing suits were bought for the camp and furnished free of charge to the patients. Every week the officers and nurses made special trips to the camp for an outing. The Red Cross gave moving picture exhibitions weekly; the American Library Association supplied books; and in addition there were victrolas and pool tables supplied by the Young Men's Christian Association, so there was no lack of amusements.
A separate mess consisting of liquid and soft diets for the maxillofacial patients was established by the Red Cross, which sent several volunteer workers several times a week to prepare this food.
There were on an average 100 patients at a time at the camp. As a result of the recreation and change they improved rapidly in health.
The patients' Fifty-Fifty League was formed by the commanding officer of the hospital on July 4, 1919, for the purpose of permitting the patients to govern themselves. In this way the commanding officer proposed to make better citizens of them. The first meeting of the league was held on October 20, 1919, at the Red Cross Convalescent House. Thereafter, the league met every Monday afternoon at the Red Cross House, each ward being represented by a delegate elected by the majority vote of his ward. At these meetings the delegates transacted all business concerning the welfare of the patients and the hospital and drew up resolutions which were presented to the commanding officer for his approval.
The league made every effort to cooperate with the administrative officers of the hospital. Through the efforts of the league the patients were issued honor cards, which literally solved the problem of passes. Every patient was entitled to make application for these cards. The league officers then investigated the character of the man and upon approval presented the application to the commanding officer to be signed. In this way the ward surgeons were relieved of the old and troublesome daily pass system, and over 700 men enjoyed the privileges of a permanent pass. The league, in addition, came to the assistance of ward surgeons by issuing mess tickets to the men who were unable to eat after cafeteria fashion. The league was entrusted with the distribution of street car tickets, which were given to the patients by the street car company of Baltimore, that they might travel around the city on the cars, free of charge.
The executive officers helped the men straighten out their allotment troubles and insurance difficulties, and from time to time informed them of the changes in soldier legislation.
A preamble of the constitution and by-laws, written entirely by the soldiers, explains how the patients cooperated in making the hospital a happy and contented place.
We, the patients of U. S. A. General Hospital No. 2, have gathered together for the purpose of creating a strong and effective public opinion, founded on the higher principles of citizenship, which obligate us to support existing authority and to make it increasingly effective.
Our purpose is to cooperate with those in authority in carrying out law and order and to make it possible for them to grant a maximum of liberty to all concerned.
We believe that by force of public opinion we can persuade men to so conduct themselves that a higher degree of law and order will result, thus rendering many of the present regulations and restrictions unnecessary.
For these reasons, and for the purpose of meeting the commanding officer in the effort to give the maximum of liberty, we, the delegates, have, with his approval, adopted the following constitution:
l. This Association shall be known as the Patients' Fifty-Fifty League.
2. The purpose of this league will be to foster and perpetuate real Americanism and respect for constituted authority in ourselves and our respective communities; to inculcate a strong sense of personal responsibility, loyalty, and individual obligations to our local governments and to our Nation; to combat selfishness and disloyality wherever found; to promote at all times self-sacrifice, cooperation, harmony, and respect for the rights of others; to consecrate ourselves to the furtherance of the principles of justice, freedom, and democracy.
1. The membership of the league shall be made up of all patients of this hospital who shall be represented by one delegate, or his alternate, from each ward, who shall be elected by a plurality vote of that ward, at a monthly meeting on the last Tuesday of each month.
2. The delegate shall represent his ward at all meetings; transmitting to the main body all resolutions and complaints or suggestions brought to his attention.
3. He shall acquaint his ward with all the business transacted at the meetings of the delegates.
4. It is the duty of every patient of this hospital to make himself personally responsible for the strict observance by himself and others of the principles laid down in this constitution.
5. No member shall decline an office to which he is elected or appointed, or refuse any duty assigned to him in accordance with the provisions of this constitution and by-laws, unless excused by the league by vote of general consent, or by the president, to whom any member may appeal.
1. The officers of this league shall consist of a president, vice president, and a secretary.
2. The officers of this league shall be elected by a plurality vote of the delegates.
3. The officers of this league shall hold office for a term of two months.
4. The president shall preside at all meetings. The vice president shall act in the place of the president in his absence. The secretary shall keep a record of all matters pertaining to the league and attend to the necessary correspondence. The officers shall perform such other duties as are connected with their office and as set forth in the by-laws.