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Section II, Chapter XVII

Contents

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SECTION II.

CHAPTER XVII.

DIVISION OF MILITARY ORTHOPEDIC SURGERY.

ORGANIZATION.

At a meeting of the American Orthopedic Association held in Washington in May, 1916, it was voted that in consideration of the possible contingencies which might arise in this country from the war in Europe there should be appointed a preparedness committee, whose duty it should be to consider the needs and equipment of orthopedic hospitals, should such be required in any future emergency. The president of the association appointed this committee, which, during the year, formulated a standardization of special hospital supplies and equipment and reported to the association at its meeting in Pittsburgh in May, 1917.

It was evident, from the experience of England, France, and Canada, that there would be need of preparation for the care of disabled soldiers when they should be returned to the United States. The large number of men engaged in the fighting forces in this war resulted in a larger number of disabled soldiers than it had been necessary to deal with in previous wars, and it was early recognized by the countries engaged that it was not only humane, but necessary, to provide for the soldiers who should return disabled in such a way as to enable them to carry on their previous occupations or other occupations more suitable to their handicapped condition.

In April, 1917, it was recognized by the Surgeon General that steps should be taken, even in this early period of the conflict, to provide for these men. Accordingly, it was arranged and so directed that hospitals intended for the reconstruction of disabled soldiers should be established, and through the military director of the Red Cross it was arranged that two such hospitals should be started, one in Washington in connection with the Soldiers’ Home and one in Boston in connection with the Robert Brigham Hospital on Parker Hill.1 These hospitals were to be considered as reconstruction hospitals, and were not only to be devoted to the surgical and medical care of the men who should be returned, but were also to be so equipped and planned as to reinstate the disabled soldier in the industrial world and thus allow him to become an independent wage earner.

In May, 1917, the British liaison officer brought the request that a number of orthopedic surgeons be sent to England to aid in this work,1 the very great necessity of which among the disabled soldiers in England had been demonstrated, as well as how much could be accomplished toward putting the disabled back into service or into industrial activity. The number of available orthopedic surgeons in England was far from being sufficient to meet the demand for this work, and in recognition of this need, the request was brought. It was then directed by the Surgeon General 2 that there should be selected 20 ortho-


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pedic surgeons for this orthopedic reconstruction work in the hospitals in England. Accordingly, 20 orthopedic surgeons, who volunteered to enter the service and to engage in this work overseas, were collected from different parts of the country and an orthopedic surgeon was detailed to accompany the group to England, to help distribute them, to study the situation on the other side of the water, and on his return to report to the Surgeon General. It was arranged with the British Government that these places should be kept filled; that, in case these men were needed for work among the American soldiers on the Continent, others be sent to England to fill their places.2

In view of the evident need of providing for physical reconstruction of the  soldiers who should be returned from overseas, and as the time when these men  would be sent home was uncertain, it seemed to the Surgeon General desirable  to continue with these general plans and to canvass the different parts of the  country with a view to ascertaining where such might best be carried out. To put this into action, the following letter was sent with the directions to make investigation for future use:

WAR DEPARTMENT,
OFFICE OF THE SURGEON GENERAL,
Washington, June .1, 1917.

Maj. E. G. BRACKETT, M. R. C.,
166 Newbury Street, Boston, Mass.

My dear Major BRACKETT: It is the desire of the Surgeon General that, during the absence of Major Goldthwaite, M. R. C., you continue the work of organizing the orthopedic units for the United States Army, and that you take such steps for securing hospital accommodations and sites for temporary construction as were covered in verbal advice recently given you by this office.

Very sincerely,
(Signed)    H. P. BIRMINGHAM,
Colonel, Medial Corps.

At a meeting of the American Orthopedic Association, held in Pittsburgh in May, 1917, it had been voted that the association offer the services of its members to the Government in any way most acceptable, and it had been suggested that aid in orthopedic methods of examination and treatment and instruction with regard to conditions affecting the soldier in training would be a practicable activity. On July 2, 1917, the resolutions passed by the association were presented to the Surgeon General, who at once accepted the suggestion, and asked that a brief of directions be prepared at once for distribution to the surgeons in the camps and to serve as a basis of instruction and of examination on the matters of orthopedic interest. It was decided that this brief should comprise instruction in regard to the foot and to footwear, and to the various orthopedic affections, and should be the guide for standardization of the orthopedic work in military usage. Several members of the association were at once telegraphed to come to Washington to aid in the preparation of this. The representative of orthopedic surgery in the Surgeon General’s Office met with and assisted this committee with the preparation of this bulletin of instruction, which was incorporated in the first list of directions for use by the camp medical officers.3

In line with the plan of the Surgeon General to place in his office a number of men who should represent the special departments of medicine and surgery, in order that each might act in an advisory capacity in matters pertaining to his specialty, and might organize and correlate its activities with the general


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plan of military medical organization, on July 25 an orthopedic surgeon 4 was detailed to the Surgeon General's Office to take charge of that part of the work which included orthopedic surgery and orthopedic reconstruction.

It was evident at once that a large amount of work would be necessary at the time of the incoming drafts in camps, and, as reports from abroad showed the rapid development of the need of orthopedic surgery among the disabled soldiers, and as it was apparent that there would be need of preparation on a large scale for the care of the soldiers when they would be returned to this country, plans were at once formulated to provide for the work at the Surgeon General’s Office. An Orthopedic Advisory Board was formed, composed mainly of ex-presidents of the American Orthopedic Association, and of those representing the orthopedic section of the American Medical Association.5 This orthopedic board had several meetings and was of great assistance to the division. The duties of the board were to consider and report on the plans and requirements for orthopedic reconstruction work and other orthopedic problems on which advice was needed by the division.

The first meeting was held on August 2, 1917. It was decided at this meeting that a letter regarding the formation of the board be sent to orthopedic surgeons, requesting that all questions of an orthopedic nature be submitted to, and go through the chairman of the board; also that a circular letter be sent to orthopedic surgeons, for the purpose of obtaining data on their qualifications and their availability for service. In view of the large number who would be called upon for orthopedic service during the war, it was the opinion that instruction should be instituted in the universities and hospitals to give additional training to those who should take up the work, and it was suggested that a circular bulletin be sent at intervals to all those who were interested in orthopedic surgery giving information in reference to the activities of this division. Accordingly, a bulletin announcing the formation and purposes of the council was sent to all the surgeons in the country who were known to be interested in orthopedic surgery. 6

In August the orthopedic surgeon detailed to study orthopedic conditions in England returned with his report of the condition in England and France. The great need of this work, as shown by its development in those countries, was presented, urgent statements from the medical authorities abroad were given, and plans by which the work should be begun were proposed. It was then decided by the Surgeon General, after several conferences with the senior officers, to create a Division of Orthopedic Surgery to plan for the providing of the proper personnel both in France and in the United States and to arrange for the necessary hospital equipment overseas, which would provide for the special care of the soldier as soon after his injury as possible, for the development of the orthopedic reconstruction in the United States, and for the work of orthopedic surgery in the Army. Two orthopedic surgeons were therefore directed by the surgeon to submit to him a report which would serve as a basis for the development of such a division. This was submitted and approved on August 17, 1917.7 The functions of the division are shown in Chart XVIII.

It was evident at this period that the immediate needs, in addition to the work already outlined for the cantonments, were to provide for the care of orthopedic patients in France by the establishment of hospitals specially


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Chart XVIII.—Division of Military Orthopedic Surgery, Surgeon General’s Office, June, 1918.


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equipped and supplied with the special personnel; to provide for the demand for a large increase of available surgeons who could aid in carrying on this work, both in France and in the United States; to provide hospital facilities for the orthopedic reconstruction of disabled soldiers returning to the United States; and at the same time to provide the means for the industrial reeducation of these men, to fit them for return to civil life, and to arrange for the installation of the necessary equipment; to provide a large corps of specially trained masseurs to treat the joint, muscle, and deformity conditions which were being met with in the other countries; and to organize these workers into some official position.

It was decided by the Surgeon General at this time that the plans for the work of orthopedic reconstruction should be carried on under the Surgeon General’s Office, and directions were given to the Division of Orthopedic Surgery to proceed in their development.4 In order to secure the best advice, a vocational education committee (Active Vocational Board) was appointed 5 and approved by the Surgeon General. At a meeting of this board and the Division of Orthopedic Surgery in August, 1917, the general plans were discussed. As a result it was decided that there should be a broad plan of reconstruction, comprising all departments of medicine and surgery involved in the problem, and that there should be a central division of reconstruction and special hospitals to correlate the work of the different departments which had the special reconstruction problems to consider. This was recommended to the Surgeon General, who created a Department of Special Hospitals and Physical Reconstruction (later, Division of Physical Reconstruction, q. v.).

THE SOURCES AND METHODS OF REPLENISHMENT OF ORTHOPEDIC PERSONNEL.

After the original personnel of the Division of Military Orthopedic Surgery was more or less automatically supplied and determined by the enrolling of the available trained orthopedic surgeons, it was quite apparent that this force must be considerably augmented as the demands upon its numbers increased. It was clear that the source of this supply must be found among the younger general surgeons and a number of the many young practitioners who had already obtained acceptable training along surgical lines. The policy of this division was to depend entirely upon recommendations or personal applications for the first contact with the candidate. When such recommendation or application was received, the person recommended or submitting the application was immediately reserved to orthopedic service if not commissioned, or if commissioned and not reserved for other service. An effort was made to verify all statements concerning the experience and qualifications of the applicant and to decide as to his desirability and his availability. Applicants who appeared desirable and available were then either transferred to this service, if already commissioned, or were advised as to seeking a commission before assignment. As soon as possible these officers were assigned in classes to the various courses of instruction in orthopedics in order to receive special instruction in both military and surgical aspects of their future work before assuming their camp duties. It was evident, further, that it would be necessary to give special instruction in the principles of orthopedic surgery to some of the younger


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surgeons who desired to enter the Division of Orthopedic Surgery in order to train them as assistants in hospitals to serve under qualified orthopedic surgeons.

In line with these views, early in September, 1917, arrangements were made with the postgraduate department of Harvard University to establish a course of instruction and a definite syllabus of this instruction was prepared with the advice of the advisory council. On October 15, arrangement was made for a course to be given in Philadelphia.8 Early in November, with the experience gained in the university courses, a meeting of the council and teachers was held in Washington, and a standarized course of instruction was determined upon. This schedule was used in all courses of instruction. 9 Through the cooperation of the orthopedic surgeons of New York, another course was arranged for that city, instruction to begin November 1, 1917.10 As many of the men from the far South and Southwest applied for the opportunity of entering this division, and for instruction, it was decided that in order to avoid the expense of long transportation, a similar course should be established in that part of the country. Accordingly, such arrangements were made with the University of Oklahoma City.11

The facilities of the Army Medical School, Washington, D. C., were offered for special orthopedic instruction, and property adjoining the Army Medical School was leased for this special purpose. About this time an orthopedic service was established at the Walter Reed Hospital, and the use of the wards and clinical material was offered in connection with the proposed course established officially through the approval of the Surgeon General. 12 The first class under this arrangement entered upon the course on November 12, 1917. The establishment of the course as a part of the Army Medical School was forecast in announcement by the commandant of the school, from which the following extract is quoted: 13

It is quite possible that this may mark the beginning of a transition of the Army Medical School from an institution designed to train officers for general purposes into one whose special province shall be to train men in the general fundamentals for Army work and with special reference to their work in special lines.

Other schools were established, following the same plan and schedule of instruction, and in the summer of 1918, courses were being given in Boston, New York, Philadelphia, Washington, Camp Greenleaf, Chicago, Oklahoma City, and Los Angeles. In all, 691 officers passed through the different schools.14

ARTIFICIAL-LIMB PROBLEM.

The Surgeon General, in August, 1917, assigned to the orthopedic surgeons the care of “cases requiring surgical appliances, including artificial limbs.” 15 The artificial-limb problem had already become a serious one abroad; the supply  was far short of the demand, and in many particulars the substitute failed to  permit the restoration of function of the lost member to the degree that it  seemed reasonable to expect. It appeared wise, therefore, to study the problem as exhaustively as possible. Accordingly, one member of the Division of Military Orthopedic Surgery was assigned to this work, and the Division of Physical Reconstruction turned over to him the questions of equipment and supply in which it was interested. Further, the Surgeon General authorized the establish-


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ment of a laboratory for investigation and experimentation along the lines of artificial-limb construction.16 The proper understanding of the problem necessitated its study from the standpoint of the amputation, the construction of the artificial limb, and the occupational demand to be made upon the substitute.

The literature on the subject which had appeared since the beginning of the war was considerable. It appeared desirable, first, to study this carefully to determine any possible change in the viewpoint of the surgeon regarding amputation, and any improvements in artificial-limb construction and manufacture, as well as to see how the general questions of supply, demand, and method of distribution were being solved. A decided aid in the understanding of the problem was obtained by a study of the Canadian situation, the Military Orthopedic Hospital at Toronto being visited for this purpose during the early fall of 1917.

The artificial-limb industry was undoubtedly further advanced in efficiency and more widely distributed in the United States at the beginning of the war than in any other country. Moreover, a number of manufacturers had visited Europe during the early years of the war, and several had established factories abroad for the benefit of the Allies. The manufacturers, therefore, were in a position to render most efficient assistance. At the suggestion of the Council of National Defense, they met in Washington, in October, 1917, and organized the Association of Artificial Limb Manufacturers of the United States,17 with the object of more efficiently coping with the situation. In order to obtain the benefit of their wide experience, conferences were held, whenever possible, with individual members, and a questionnaire covering various details of the problem was sent to all.

The information obtained from these various sources indicated that the views of the artificial-limb makers were in the main in accord with the best modem surgical experience, except as regards the possibilities of end-bearing; moreover, it developed that they were able without increasing their facilities, to care for approximately 1,000 cases per month.18

A comprehensive plan for carrying on the work was finally evolved,19 but as  it had been decided by the Surgeon General that only provisional limbs should  be provided to the men while in service, the work was limited to the development of this form of prothesis and a means of providing such.. The greatest  help was given by the manufacturers of artificial limbs in developing the most  practical form of leg and arm; they also undertook to furnish the necessary parts. and this form was used throughout, with very little modification, and with satisfaction. The problem of providing the permanent prothesis, after the discharge of the soldier, was delegated to the War Risk Bureau.20

It seemed advisable in the early days of planning for this problem to concentrate the work of caring for the amputation cases in as few places as possible for reasons both of expense, of equipment, and of lack of a sufficient trained personnel. It was decided, therefore, to confine this work to the Walter Reed Hospital. Washington, D. C., and to General Hospital No. 3, at Colonia, N. J.21 The work of caring for the amputation involved the surgical care of the stump, provision for and fitting of the temporary prothesis, and the training in their use. Later, in response to orders, it was necessary to extend the field of this activity,


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and therefore additional centers were established in General Hospital No. 6, Fort McPherson, Atlanta, Ga.; Fort Sheridan, Ill.: Letterman General Hospital, San Francisco; General Hospital No. 26, at Des Moines, Iowa: and General Hospital No. 29, at Fort Snelling, Minn.22

PHYSIOTHERAPY.

In the early period, when reconstruction work, surgical and otherwise,was being considered, it became evident that there would be a large demand for special massage and the allied therapies of the kind which would require special training, and also that the development and control of this supply should be begun as soon as possible. At this period certain hospitals were being established with the aid of the Red Cross, and therefore the following letter was sent to the military director of the Red Cross from the chief of the division, on July 12, 1917, setting forth the need of this work and suggestions as to its fulfillment:

In planning out the necessary equipment of a reconstruction hospital, the facilities for mechanical hydrotherapy, and also for massage, have seemed to be of the very greatest importance. This special kind of reconstructive work would require not only a corps of individuals who are trained but also it would seem necessary to have a corps under supervision and control, so that the work could be standardized, not only in an individual unit, but also in this reconstructive work in general. It seemed to us wise, therefore, if in some way this work could be standardized, so to speak, and we could have a national training corps. We have, therefore, made plans for an organization of this kind, and I am sending you this tentative plan for your criticism or for your approval. If you think it wise, it will require a certain amount of investigation and further elaboration of the details of the organization. Would you be good enough to let me hear from you on this point? I am sending you on this copy, asking if you could put it in the book of plans of the reconstruction hospital, all of which can be discussed whenever the time comes.

This met with immediate response. Because of the corroboration of the needs of this movement, as shown in the reports of the work in England as well as in France and Canada, it was decided that it would be necessary to provide for this work by some form of enrollment of a special group of workers who would be given an examination as to their qualifications for the necessary training. To obtain the best advice, the directors of recognized schools of physical training and allied therapies were invited to a conference in Washington to meet with the members of the division to discuss this subject and the means of meeting the need. At this meeting, representatives from the following schools were present: The Boston School of Physical Education; The New Haven (Conn.) Normal School; The Normal School of Physical Education, Battle Creek, Mich.; The Possé Normal School, Boston, Mass.; the teachers’ department of physical education, Oberlin College, Oberlin, Ohio; department of physical education of Leland Stanford Junior University. It was decided by these representatives and the division that the list of specially trained workers was entirely inadequate and that training should be given by a three months’ intensive course. The well-recognized schools of physical education were asked to arrange for a census of their graduates and to arrange for a short course to be given persons qualified for special training. The qualifications, applications, and the schedule of instruction necessary for such an intensive course were decided upon by the representatives of the conference, and a report thereof was rendered to the Surgeon General.19 It was understood


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that the Government should take no part in the responsibility of this training, but when an applicant was considered eligible as a candidate, having qualified in the requirements decided upon in the Surgeon General’s Office, she should present herself for examination and for enrollment if accepted.

In the latter part of December, 1917, the division was directed to proceed with plans necessary to select suitable applicants and to determine standards of qualifications.23 A supervisor was to be installed to work in conjunction with the Department of Nursing and to select these applicants under the same general plan as applied to the general nurses. The Red Cross offered to co-operate, and to furnish lists of selected names. It was decided that the name of Physical Reconstruction Aides be used. On December 31, 1917, the plan of organization had been completed and was approved and signed by the Surgeon General. This plan of organization included occupational aides as well as the physical reconstruction aides. Schools were established for the beginning, the graduates of which were those who were first sent over seas. Later, in the spring of 1918, with the establishment of the Division of Physical Reconstruction, this work was transferred to that division.

INSTRUCTION IN CARE OF SOLDIER’S FOOT.

A serviceable foot is one of the most important requisites of the soldier, and it was early recognized by those experienced in the work of the Medical Department of the Army that orthopedic surgeons could do nothing that would be of greater importance than the assistance they might render in the preservation of foot efficiency. With the exception of the classical work, the Soldier’s Foot and the Military Shoe,24 nothing was available in military publications beyond the rules governing the rejection of men with foot defects of certain types. Hence attention was first directed to the preparation of a circular containing specific directions for the orthopedic examination of the recruit.25 In this the attempt was made to estimate the relative significance of the various signs and symptoms associated with weak feet, so that the examining surgeons might be in a position to decide whether an apparently suspicious foot would be capable of meeting the requirements of military service or would be likely to fail to measure up to its demands. The spine and its affections were similarly considered, but in a more brief manner, as befitting their relative importance.

Supervision of the condition of the soldiers' feet is recognized as a duty properly demanded of the regimental officers; they are expected to possess a sufficient knowledge of minor foot ailments to intelligently direct their treatment by the noncommissioned officers or the selected enlisted men trained for this work. Conferences with shoe manufacturers, orthopedic surgeons, and other medical officers from the camps, and all those having some knowledge of the conditions did much to make clear the main points of difficulty with the shoe problem. Considerable trouble was experienced, not only at the start but throughout the war, in securing sufficient shoes of the proper sizes, and in having the proper attention paid to fitting; moreover, the men themselves often strongly objected to accepting shoes of the proper length, and when forced to take them, would even exchange them with their comrades for smaller ones. To meet the situation, the division sought to secure the active coopera-


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tion of all departments of the Army, and laid more and more emphasis on the intensive instruction of the orthopedic personnel in all the details of foot care.26 Courses of instruction in the care of the foot and its coverings were also given to line officers and candidates for commission, selected enlisted men of the Medical Department, and all enlisted men of the Army, and it was directed that particular attention be given by medical officers to the condition of the feet at each regular semimonthly physical examination.

To supply the necessary information in a form suitable for the newly commissioned regimental officers, the men selected to carry out the treatment, as well as the enlisted men themselves, a small Manual of Minor Foot Ailments 27 was prepared and issued in November, 1917. This manual aimed to supply in a condensed form and in simple language the essential facts about the care of the foot and its coverings, and the ordinary methods of treatment of the simpler foot affections incident to active military service.

The importance of orthopedic surgery in the medical work of the modern army was a development of the World War, and the necessity for including this subject in the list of those to be covered by the war manuals, planned by the Medical Department of the Army and the Council of National Defense, was early recognized by the editorial committee of the council. The several years’ experience of the English in the use of orthopedic measures had proved their value not only in restoring apparently hopeless cripples to some degree of economic usefulness, but also in the actual return of a high percentage of the wounded to the firing line. This experience had resulted in the publication of two epoch-making books by an officer of the Royal Army Medical Corps. In view of our lack of experience, it was obviously wise for us to draw largely from the original sources in the preparation of our Manual of Military Orthopedic Surgery 28 and this the author of the books referred to above generously permitted. Much of the matter for the various chapters on the foot and its care had already been collected by the Orthopedic Advisory Board in the preparation of the circular on orthopedic examination, and other chapters were added by various members. The chapter on Methods of Fixation, by agreement with the Division of General Surgery, was so prepared as to cover the subjects of splints in such a manner as to make it suitable for all surgical needs, and particularly for the use of the Fracture Section.

During the early months of the war, when the camps were being filled with recruits, there was not a sufficient number of experienced and trained personnel to provide for the sudden demands of a medical military nature. It was necessary to distribute men of professional experience over as wide an area as possible and, therefore, the plan was evolved of placing men of lesser experience for permanent duty in the camps and in the camp base hospitals, and dividing the country into areas, determined by transportation facilities rather than purely geographical means, and detailing men of greater experience to act as consultants and teachers for these various areas. Although some difficulty naturally resulted at first, because of the lack of military experience and the constantly changing requirements made upon these men, this plan eventually became most successful and was continued throughout the war. Through this system, routine examinations for special conditions were made of all recruits, and the more difficult conditions were reserved for the opinion of


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the consultant on his round. Instruction was given to line officers as well as noncommissioned officers both by the men in the camps and by the consultants on their rounds.

It was necessary to provide the equipment for conditions which, before the war, had not existed and for which no provision was made. To meet this, it was necessary to determine the requisite supplies, to furnish lists for such, and to arrange for their provision on a large scale. For this latter purpose, aid was obtained from large manufacturers, who gave the benefit of their experience, as well as assistance in furnishing the supplies quickly and in large quantities. In most camps or hospitals, shops were equipped in which the mechanical appliances could be made or adjusted, and in practically all of the camps cobbling outfits were established for the repair and alteration of shoes.

REORGANIZATION.

With the reorganization of the Surgeon General’s Office in the autumn of 1918 (see Organization Chart XXIV) the Division of Orthopedic Surgery became a section of the Division of Surgery, 29 continuing so until September 9, 1919, when the Division of General Surgery became a section of the Hospital Division.30

PERSONNEL.a

(April, 1917, to December, 1919.)

Brackett, E. G., Col., M. C., chief.
Allison, Nathaniel, Col., M. C.
Breckinridge, S. D., Col., M. C.
Goldthwaite, Joel E., Col., M. C.
Baer, William S., Lieut. Col., M. C.
Begg, A. S., Lieut. Col., M. C.
Osgood, Robert, Lieut. Col., M. C.
Rugh, J. T., Lieut. Col., M. C.
Silver, David, Lieut. Col., M. C.
Adams, Z. B., Maj., M. C.
Colvin, A. R., Maj., M. C.
Emerson, Kendall, Maj., M. C.
Erving, William G., Maj., M. C.
Haynes, Henry R., Maj., S. C.
Magnuson, Paul D., Maj., M. C.
Peters, William C., Maj., M. C.
Yount, C. C., Maj., M. C.
Miller, O., Capt., M. C.
Morison, H., Capt., S. C.
Morse, J. H., Capt., S. C.
Pannaci, C. E., Capt., M. C.
Pearce, Samuel B., First Lieut., M. C.


a In this list have been included the names of those who at one time or another were assigned to the division during the period, April 6, 1917, to December 31, 1919.
There are two primary groups—the chiefs of the division and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.


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ADVISORY BOARD.

Brackett, E. G., Col., Ml. C.
Goldthwaite, J. E., Col., M. C.
Albee, F. H., Lieut. Col., M. C.
Davis, G. G., Lieut. Col., M. C.
Silver, David, Lieut. Col., M. C.
Corbusier, H. D., Maj., M. C.
Freiberg, Albert H., Maj., M. C.
Lovett, Robert U., Maj., M. C.
Porter, John L., Maj., M. C.

REFERENCES.

(1) Correspondence. On file, Record Room, S. G. O., 155420, 167136, 170660, and 173885 (Old Files).
(2) Letter from the Surgeon General to the American Red Cross, Washington, D. C., July 14, 1917.  On file, Record Room, S. G. O., 167136 (Old Files).
(3) Circular No. 23, W. D., S. G. O., August 13, 1917.
(4) S. O., No. 171, W. D., July 25, 1917, par. 130.
(5) Announcement made by the Surgeon General, United States Army, of Department of Military Orthopedics, August 20, 1917. On file, Record Room, S. G. O., 167136 (Old Files).
(6) Letter from the Surgeon General, United States Army, to surgeons, August 20, 1917. On file, Record Room, S. G. O., 730 (Orthopedics).
(7) Special report from the Division of Orthopedic Surgery, to the Surgeon General, United States Army, October 17, 1917. On file, Record Room, S. G. O., Weekly Report File. Plan for organization and development of Orthopedic Department, submitted by Maj. E. G. Brackett and Maj. J. E. Goldthwait, approved August 17, 1917. On file, Record Room, S. G. O., 210122.
(8) Article on Division of Military Orthopedic Surgery, November 11, 1917. On file, Record Room, S. G. O., 730 (Orthopedics). Reports and Correspondence. On file, Record Room, S. G. O., 353 (Orthopedics).
(9) Schedule of orthopedic instruction. On file, Record Room, S. G. O., Correspondence File, 730 (Orthopedics).
(10) Correspondence on instruction orthopedics. On file, Record Room, S. G. O., 353 (New York City, N. Y.) (F); 353 (Orthopedics, General); 730 (Orthopedics).
(11) Correspondence. Subject: Instruction Orthopedics. On file, Record Room, S. G. O., 353 (Oklahoma City, Okla.) (F); 353 (Orthopedics, General); 730 (Orthopedics).
(12) Correspondence. On file, Record Room, S. G. O., 353 (Walter Reed General Hospital (K; 353 (Orthopedics, General); 730 (Orthopedics).
(13) Letter from Brig. Gen. William H. Arthur, commandant, Army Medical School, to the Surgeon General, outlining course for twenty-second session, November 3, 1917, par. 4. On file, record Room, S. (G. 0., 730 (Orthopedics).
(14) Abstract of reports Orthopedic Division, S. G. O. On file, Record Room, S. G. O., 024.14 (Orthopedic Section).
(15) Letter from the Surgeon (General, United States Army, to Col. Alfred E. Bradley, August 20,1917. On file, Record Room, S. G. O., 167136 (Old Files).
(16) Annual Report of the Surgeon General, United States Army, 1918, 399.
(17) Letter from Association of Artificial Limb Manufacturers of America, dated October 19, 1917, to the Surgeon General. Subject: Meeting in Washington. On file, Record Room, S. G.O., 442.3 (Artificial Limbs).
(18) Correspondence. On file, Record Room, S. G. O., 442.3 (Artificial limbs). Weekly Reports. On file, Record Room, S. G. O., Weekly Report File.
(19) Weekly report, Division of 'Military Orthopedic Surgery, March 9, 1915. On file, Record Room, S. G. O., Weekly Report File.


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(20) Letter from Surgeon General to commanding officers of general and base hospitals, December 27, 1917. Subject: Provisional and Permanent Appliances. On file, Record Room, S. G. O., 442.3 (Artificial Limbs).
(21) Amputation reports. On file, Record Room, S. G. O., 707.2 (Walter Reed General Hospital)(K); 707.2 (General Hospital No. 3, Colonia, N. J.) (K).
(22) Amputation reports. On file, Record Room, S. G. O., 707.2 (General Hospital No. 6, Fort McPherson, Atlanta, Ga.); Fort Sheridan, Ill.; Letterman General Hospital, San Francisco, Calif.; General Hospital No. 26, Fort Des Moines, Iowa; and General Hospital No. 29, Fort Snelling, Minn.) (K).
(23) Reports on file, Record Room, S. G. O., Correspondence File, 353.91-1 (Reconstruction).
(24) Munson, Edward Lyman: The Soldiers’ Foot and Military Shoe. A handbook for officers and noncommissioned officers of the line. George Banta Publishing Co., Menasha, Wis., 1917.
(25) Circular No. 23, S. G. O., W. D., August 13, 1917. On file, Record Room, S. G. O., 196967 (Old Files).
(26) Correspondence. On file, Record Room, S. G. O., Correspondence file, 444.8 (Orthopedic Equipment).
(27) Minor Foot Ailments, Shoe Fitting. A manual for noncommissioned officers and selected enlisted men. Prepared by War Department, S. G. O. On file, S. G. O., Finance and Supply Division.
(28) Medical War Manual No. 4, Military Orthopedic Surgery. Prepared by the Orthopedic Council, Medical Department, United States Army. Lea & Febiger, Philadelphia and New York, 1918.
(29) Office Order No. 97, November 30, 1918, S. G. O. On file, Record Room, S. G. O., Correspondence File, 024.1 (Administrative Division).
(30) Office Order No. 777, S. G. 0. On file, Record Room, S. G. O., Correspondence File 024.14 (Division of Surgery).