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Section I, Chapter I

Contents

1,

SECTION I
 
IN THE UNITED STATES
 
CHAPTER I

PLAN AND DEVELOPMENT
 
PRE-WAR PERIOD
 
For many years before the United States entered the World War the training of Medical Department personnel was carried out chiefly by the regular courses of instruction given medical officers at the Army Medical School, in Washington, D. C., and at the Army Service Schools, Fort Leavenworth, Kans.; by the courses given the Hospital Corps in field hospitals, ambulance companies, and detachments; and by the teaching of hygiene and first aid to other branches of the Army.1 This training which, at first, was confined to the Regular Army, was extended, in time, to the National Guard and to Medical Reserve officers in limited numbers. The field service and correspondence schools for medical officers, Army Service Schools, Fort Leavenworth, Kans., established in 1912, had annually graduated classes of medical officers of the Regular Army and Organized Militia, and had conducted extensive correspondence courses. This school developed the nucleus of men who were later to make possible a broader training on the Mexican border and throughout the Army and the Organized Militia.

ON THE MEXICAN BORDER

During 1916-17 a more elaborate scheme of training, to include officers and enlisted men, was carried out on the Mexican border, under a comprehensive plan prepared by the general sanitary inspector and approved by the commanding general, Southern Department.2 Under the provisions of this plan, the training of medical officers and enlisted men of the Medical Department was prescribed, standardized, and enforced.
 
The value of this border scheme of instruction in carrying out the final Medical Department war training can scarcely be overestimated. Through it, a considerable number of instructors, more or less adequately equipped, were listed, and the best type of training necessary to meet needs became apparent. Hence, when the final need for training suddenly developed, the Medical Department was prepared, in a way, to meet it.
 
WAR PERIOD
 
On the day that the United States declared war, the following letter, urging the immediate necessity of instituting measures for the training of Medical Department personnel, was submitted to the Surgeon General:


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1. Simultaneously with the organization of the military forces, the special technical training of the sanitary personnel necessary thereto should be begun. There should be no delay or lost motion. It should be continued without cessation or depreciation so long as the military forces remain in being.

2. On the basis of the raising of the initial war forces of 1,000,000 men, this means a complementary force of 7,000 medical officers immediately required; of whom 500 may be regarded as now well trained, 1,000 as partly trained, 5,500 not trained at all. A further reserve of at least 1,000 officers to meet wastage will be required, and are likewise now untrained.

The same force, for the meeting of its war needs, implies about 100,000 enlisted men of the sanitary service, of whom perhaps 5,000 may be regarded as now trained, 5,000 as partly trained, and 90,000 as not trained at all.
 
The urgent need for the immediate creation of some effective administrative machinery capable of transforming the above mass into an efficient trained sanitary personnel, without unnecessary delay and difficulty, is obvious.

3. Recent experience on the border has demonstrated that sanitary personnel constantly tends to become sedentary and lose interest, and its work to degenerate into a brief daily internal routine of little training value, except under the stimulus of constant pressure from above. Also that forced training, if recognized as helpful and constructive, greatly promotes contentment among medical officers.

It has likewise demonstrated that line commanders appreciate their own lack of special technical information about sanitary work, leave all initiative in such matters to their medical subordinates, but heartily support plans for sanitary training if these are presented to them.

Whatever of training is done will be due to the initiative, force, and ability of the sanitary service itself. It will strain to the limit every resource of the inadequately manned Medical Department to well acquit itself in the tremendous task now before it.

4. The general scheme for training should be planned, organized, directed, and controlled in the Office of the Surgeon General. If left to local authorities, it will be imperfect and largely ineffective. One officer in the Surgeon General  s Office should direct this training. It will take practically his entire time and effort.

The training must be coordinated, comprehensive, and progressive, yet at the same time elastic enough to meet the needs of new increments of untrained medical officers and men. It should cover every phase of the duties of a medical officer and sanitary soldiers.

Local commanders and local sanitary training officers should have no power to disregard or modify such a training scheme in any important essential.

5. The details of the training should be general; requirements, to be specified by the Surgeon General, should be supervised and enforced by a sufficient number of specially designated medical officers attached to troops and selected for their abilities in this respect.

In view of the comparatively recent attention given in our Army to sanitary tactics and field work, only a relatively few officers are probably qualified to act as instructors. An insufficiently qualified instructor will invite criticism and dissatisfaction.

It is earnestly recommended that those who are qualified be given this duty, so that the great mass of untrained personnel may be leavened as quickly as possible, even though the interest of lesser fields of activity suffer slightly thereby.

These training officers should prescribe all details necessary to carrying out the general scheme of the Surgeon General under divers local conditions, see that the training is fully and efficiently carried out through frequent inspections and direct participation in the work, and arrange all local matters necessary to lectures, conferences, war games, drills, marches, tactical exercises, field maneuvers, etc.

6. The sanitary personnel to be trained should not only include those actually with the colors, but also those in civil life obligated to render service at call, or whom it is desirable to train up against future need.
 
 At the outset, those with the colors should first be trained so as to secure as large a number as possible of trained men to help with the work of instruction of later increments.

7. The scheme of instruction naturally divides itself as follows:
(1) To sanitary personnel on duty with the colors: The subjects for this class, so far as officers are concerned, divide themselves into (a) sanitary organization and sanitary tactics,


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(b) military hygiene amid sanitation, (c) clerical functions, (d) general professional methods as modified by the environment of war, (e) military information relative to the government of medical officers and men as part of the Army.

For enlisted men, the training should cover that now laid down in the Manual for the Medical Department, Drill Regulations for Sanitary Troops, and Mason' s Handbook.

The theoretical training connected with the above should include prescribed courses of reading, recitations, conferences, demonstrations, and map maneuvers.

But the training should as far as possible be practical, making use of all the usual facilities of hospitals, camps, marches, and maneuvers for the purpose. In addition, periodic sanitary maneuvers Oil a large scale should be carried out.

The personnel for instructors of this class is mentioned elsewhere.
 
(2) To officers of the medical section, Officers' Reserve Corps, not yet called to the colors: The same subjects as are mentioned under (1), except in a more elementary way. From the nature of things, this instruction must largely be theoretical and didactic. It is preliminary to the more comprehensive training contemplated when called to service with troops.

No training of potential soldier recruits still iii civil life, in advance of their enlistment, seems practicable, unless the Red Cross will charge itself with such work.

Instruction to this class of reserve officers may be given in connection with that for officers in active service in their vicinity, by medical officers on special duty, by conferences among the student officers themselves, and by correspondence.

(3) To students in medical colleges, as prospective medical officers: The subjects for this group include: (a) First-aid and emergency surgery from the military standpoint; (b) schools of the sanitary soldier, litter drill, and transportation of wounded; (c) elements of sanitary organization and sanitary tactics; (d) elements of military hygiene and sanitation.

The instruction here should he given in the present emergency by their present civilian instructors, who should be appointed in the Officers' Reserve Corps and would themselves learn much through the necessity of having to teach others.
 
(4) General information: This includes dissemination of diverse items of current medico-military value through -
(a) Orders, circulars, bulletins, books, etc.
(b) The Military Surgeon.

This is a very valuable aid to supplement the standardized instruction and should be utilized to the utmost.

8. With each field army there should he, under the chief surgeon thereof, a medical officer as training officer, with the rank of colonel. It is his duty to see that the training of all officers and men throughout the field army is suitable, sufficient, and coordinated. His work is one of direction and inspection.

9. With each division there should be, under the division surgeon, a medical officer as training officer, with the rank of lieutenant colonel. He directs, teaches, and inspects.

He should have direct military control, under the division surgeon, of the sanitary personnel of the division. For this purpose, the sanitary personnel of the division should be organized as a regiment of three battalions--one battalion of which may be assumed as on detached duty with the component combatant organizations of the division and under the orders of the commanders thereof. The other battalions in actual being to consist of divisional troops, one battalion to be the ambulance battalion and the third the field hospital battalion.

But whether this proposed organization is accepted or not, a training officer is absolutely necessary for the education of all the sanitary personnel with the division. It will take the entire energies of one officer on this work alone to bring about even reasonably satisfactory results.

Officers who have had suitable experience with ambulance companies and field hospitals should be designated as directors of ambulance companies and field hospitals, thereby greatly facilitating the training of these units. Unfortunately the entire available supply of these trained men will not equal the demand.


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Instruction in the clerical work with the division will have to be done by a special officer, not necessarily of higher rank than captain; such an officer should be attached to the division surgeon' s office and work directly under the training officer. His work is to remove at their source all the present great difficulties connected with the paper work of untrained officers, and thereby save a vast amount of inaccuracy and resulting correspondence.

10. For independent forces smaller than a division, a training officer with the rank of major is necessary.

11. If troops are not organized into the large tactical organizations, the same plan as above, applied to departments, districts and camps, will serve.

12. The enclosed  Memorandum of instruction for medical officers and sanitary units, prepared by the undersigned and issued in the Southern Department for troops along the Mexican border, should serve, with but little change, for the training of sanitary personnel in the mobilization camps contemplated.

13. The foregoing scheme does not include the training of medical officers and sanitary soldiers at special medical camps or training schools, as has been found desirable in the British service for the personnel not actually required with troops to serve their immediate needs.

Such separate training is most desirable; but its details have not been entered into pending any plan by the General Staff for the training of the officer class as a whole, with which the sanitary training should as far as possible be coordinated.

14. If desired, the undersigned is prepared to work up a complete scheme for training, in detail.
 
PLAN FOR TRAINING

The above letter and its purpose were approved by the Surgeon General, and its author was directed to prepare the necessary plan and to put it into practical execution after conference with the Bureau of Militia Affairs, which had just prepared a short course of armory training for the Medical Department of the Organized Militia. This was done after conference with the representative of the Medical Department in the Bureau of Militia Affairs, and a joint report was sent in by them on April 16, 1917.3

This joint report was forwarded on April 21, 1917, by the Surgeon General to The Adjutant General, with the following remarks:3

* * * * * * *

As soon after enrollment as their services can he spared from recruiting or other preliminary duty, all officers of the medical section of the Officers' Reserve Corps will report in turn, as their services can be spared, at such camps as may be designated for a three months' course of instruction, the scope of which will be fixed by the Surgeon General.

2. The attached scheme affords a plan for starting, without delay, the necessary training of the officers and men of the Medical Department. It can be modified later as experience may warrant. It proposes to carry out an intensive training of both officers and enlisted men, both in special training camps and in addition to necessary service with troops. For the former class, the course covers three months; for the latter, six months.

3. The nature and scope of the proposed course, sample daily routine, list of textbooks, etc., are given therein.

4. For the above instruction purposes it is believed that four medical training camps should be established. The Medical Department, among other cogent reasons, can not furnish instructors or equipment for more than this number. They should be established in conjunction with the general officers' training camps at Fort Oglethorpe, Fort Riley, Leon Springs, and Fort Benjamin Harrison, and later, if found desirable, one on the Pacific coast; but if a suitable camp and maneuver ground can be found on the Atlantic seaboard south of New York, this should be substituted for Fort Benjamin Harrison.

5. If approved, I recommend that the necessary facilities for shelter, messing, supply, etc., be provided without delay for the use of these training camps at the above points.

b
This memorandum is on file in the Office of the Surgeon General (Old Files, 7,832) Ed.


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6. Authority is also requested for the bringing to these training camps of a training staff of approximately one officer instructor to each 50 student officers, together with such enlisted personnel as may be necessary.

7. I also request that 1 ambulance company and 1 field hospital be sent to each of these training camps, and that 3 additional ambulance companies and 3 additional field hospitals he organized at each without delay. Also that each training camp be further provided with an enlisted force equivalent to six regimental sanitary detachments. The above personnel is necessary to visualize medical organizations, equipment, and field work, and serve as a service corps in looking after the training camp and the many hundreds of student officers to he in attendance.

8. Authority is further requested for the establishment of a training course for the sanitary personnel with troops, the appointment of officers as training officers, with divisions or separate camps, amid the establishment of a system of inspection sufficient to insure the efficiency of the same.

9. It is requested that this matter be given decision as soon as possible. It is understood that the general training camps are to begin operation on May 15. The Medical Department should begin its work at least by that time, and, if possible, one or more of its camps should he put into operation before that time.

10. Attention is invited to the fact that the work of the Medical Department actively begins the moment troops are raised or brought together, and that the equipment of these training camps, the detailed organization of the training course, and the provisions of the staff of instructors should therefore he made as soon as possible.

11. Attention is invited to the attached plans, which is concurred in.

W. C. GORGAS,
  Surgeon General, United States Army.
 
The plan was approved and acted on by the War Department, as follows:
 
[First endorsement]
 
2581692
WAR DEPARTMENT, ADJUTANT GENERAL' S OFFICE,
 May 11, 1917
 
To the SURGEON GENERAL.
 
With the information that the establishment of additional subdivisions of the work in the Office of the Surgeon General, as referred to herein, is approved with the following exceptions:

That no increase of the Medical Corps in number or grades shall accrue therefore:

That the chief of the sanitary section may consult with, and make recommendation to, the Quartermaster General in regard to construction of a sanitary character, and may also recommend sanitary orders, but all orders will be issued in the way now prescribed by regulations; and that four medical training camps, to begin June 1, 1917, with an attendance of officers for training at each to be not over 600, are approved; and that the tentative scheme of instruction is approved and will be submitted in form to be published as a general order.c

In this connection attention is invited to copy of letter sent to commanding generals, Central, Southern, and Southeastern Departments, relative to the establishment of the medical training camps referred to above.

By order of the Secretary of War:
 WM. M. CRUIKSHANK, Adjutant General


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WAR DEPARTMENT, ADJUTANT GENERAL' S OFFICE,
May 11, 1917.
 
To the QUARTERMASTER GENERAL:
For his information, and with request to provide cantonments at each of the medical training camps mentioned herein, as follows:

Infantry cantonment for 600 men.
Cantonment for 4 ambulance companies and 4 field hospital companies of the Regular Army.
The cantonments to be ready for occupancy before June 1, 1917.

By order of the Secretary of War:
WM. M. CRUIKSHANK, Adjutant General.
 (Copy of first endorsement on 2581692 to Surgeon General accompanying.)
 MAY 11, 1917.

From: The Adjutant General of the Army.
To: The Commanding General, Central Department, Chicago, Ill.
Subject: Medical training camps, 1917.

1. The Secretary of War directs that you establish medical training camps in connection with officers' training camps already authorized, to begin June 1, 1917, at the following Posts in your department:
  Fort Riley, Kans.
  Fort Benjamin Harrison, Ind.
2. The purpose of these medical training camps will be for the training of reserve medical officers; the attendance at each camp not to exceed 600; the course of instruction to begin June 1, 1917. The Quartermaster Corps will provide an Infantry battalion cantonment for 600 men and cantonment for 4 ambulance companies and 4 field hospital companies of the Regular Army, these cantonments to be ready for occupancy before June 1, 1917.

WILLIAM M. CRUIKSHANK, Adjutant General. 

The same letter was sent to the commanding general Southern Department, Fort Sam Houston, Tex., substituting Leon Springs for Fort Riley and Fort Benjamin Harrison, and to the commanding general Southeastern Department, Charleston, S. C.

The proposed medical officers' training camp at Leon Springs, Tex., was never established, through inability to provide the necessary staff of instructors therefore.3 However, authority was later received to raise the quota of student medical officers from 600 to 1,000 at each of the other three camps, with the net result of an increase of 600 medical officers in all.

To each of these camps a training staff of selected regular medical officers, each one recognized as an expert in his line, was assigned.3 These staffs varied from 10 to 12 officers.

The camps had to be organized and buildings erected at a time when large numbers of officers and men were arriving, frequently without advance notice and often without equipment.3 It was a period when the facilities of the Quartermaster' s Department were strained to the limit by new construction, but some tentage was secured and put up, and buildings subsequently were erected rapidly enough to meet actual needs.

There was much shortage and delay in respect to clothing, equipment, and other supplies, due to inability of the supply department to meet the needs of a rapidly expanding army.3 Fortunately, no hardships resulted, and participation in the actual organization was in itself a valuable phase of training.


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The work of instruction was at once started. As the first need for medical personnel was obviously to be with the regiments and divisions shortly to be organized, a course was worked out to meet such need for the zone of operations and this remained as the basic course of the training work throughout the period of the war.3 Later, courses for line of communications work, for special training in various medical branches, and courses for the several nonmedical branches of the Medical Department were organized.3

The plan of instruction, including the basic course of training, to be carried out at these medical training camps was covered in the following letter of instructions:d
 
1. These instructions are imitated to coordinate time work at the various medical camps of instruction so that it will be carried out on common lines.
Also so that the instruction given at these camps, and that which it is proposed to give the medical personnel necessarily serving with troops to meet their needs in the field and at posts, shall have similar basis and method.
To the end that the instructions to be given, and the results to be secured, shall be standardized, the general provisions of this letter will he strictly carried out All details of execution are left to you, and you are held responsible for proper results.

2. The course at the medical officers' training camp is intended to give the student officers a general idea of the basic duties of a medical officer and prepare them for service with troops in the field.
Training will be intensive and pushed as rapidly as possible. It will be borne in mind that the service of thousand of instructed medical officers must be available at an early date.

3. The training to be given is intended to prepare these officers to conduct the service of the Medical Department without either the supervision of experienced medical officers or time aid of well-qualified noncommissioned officers. The limited number of these two classes in the Medical Department, and the necessity of assigning many of them to important administrative duties, render it probable that few will be available for regimental duty, and only a small number with ambulance companies and field hospitals.

For this reason, also, upon the reserve medical officers graduated from these training camps will fall the duty of themselves drilling and training the very many thousands of enlisted raw recruits which will be assigned to the Medical Department, and they must be put into a condition to carry out effectively this most important work.

4. Each camp will have accommodations for 600 medical officers. They will be organized into companies, duly officered and noncommissioned officered from among themselves, and trained on a basis of medical cadets. It is desired to impress upon these new officers, by actual experience, what will later be required by them of their subordinates.

5. Your staff will be composed of an assistant commandant, an adjustment, and a quartermaster, all of whom will be instructors in addition to their other duties. It is proposed, if possible, to assign you additional instructors on the basis of 1 to each 50 student officers. Due to the shortage of regular officers, specially qualified militia medical officers may be assigned to such duty. Officers with regimental detachments, ambulance companies, and field hospitals will, in addition to their duties as such, serve as instructors.

You will mistake such assignment to instruction duty as you deem best, making due effort to assign to each subject officers known to you to have given special attention thereto and to possess ability to impart information.

You are authorized to use as instructors any student officers found specially qualified in any subject, and to give them special authority while so serving, irrespective of rank.

Your staff of instructors will, if desired, give the necessary instruction in hygiene and first aid to the line officers of the adjacent training camp. Conversely, you should ask the assistance of the line officer instructors at line camps in teaching map reading, in special lectures and in the tactical part of medico-military problems and maneuvers.
 
dThe basic course was found satisfactory, practically without change, after a year' s trial.


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6. Instruction by lectures, except in special subjects, will, as far as possible, give place to recitations. Lectures are not considered as effective as recitations in imparting detailed information, nor do they afford opportunity to test the capacity and grade the student.
Lessons will, therefore, be assigned in the authorized textbooks, and quizzes held thereon, for the purpose of grounding them in theory and insuring that a competent knowledge of methods and principles has been acquired.

7. But coincident with this theoretical instruction, the student officers should as far as possible be made to visualize the organizations, apparatus, and methods concerned. In addition to study and lectures, it is most important that they should learn by seeing and doing. So far as possible, instruction will be made practical.

To this end, for example, all sanitary appliances and methods likely to be of use in field work will be procured or constructed and continually kept in effective operation at the camp, and the officers will be shown their purpose and practical use.

Bombproofs for trench warfare and gas chambers for practical trial of protection against poison gases will be constructed.

In connection with paper work, all papers required by the medical and other departments will be actually made out until familiarity therewith, and correctness of result, is secured.

Mess management, taught in theory, will be actually demonstrated in the organization kitchens. Applied camp sanitation will be taught by sanitary inspectors. Drill will be taught until every officer can himself effectively handle and instruct therein the units and detachments of the Medical Department.

The internal economy and administration of regimental detachments, ambulance companies, and field hospitals will be taught not only by books but by assignment to such organizations and quartering and subsistence therewith, and by actually handling them in marches and comprehensive field problems. To permit of the latter it is expected that 4 ambulance companies, 4 field hospitals, and 6 regimental sanitary detachments, all complete and kept recruited up to war strength, will be organized at your camp without delay. The regimental detachments will be organized as two provisional companies, to be split into their integral parts for demonstration purposes.

8. You will assign student officers to duty with regimental detachments, ambulance companies, and field hospitals as junior officers and supernumeraries, to familiarize them with these organizations, the handling of men, etc. Officers so assigned should be quartered and messed with these organizations, but will pursue the regular curriculum of training at the camp. Assignment should be made in rotation, and ordinarily for 10 days with each organization.

9. The training course will be divided into three periods of one month each. The first, while instructing the officer as such, is intended especially to familiarize him with the duties of his enlisted subordinates whom he must shortly train. The second takes up his training in his own special functions as an officer. The third carries on and completes the work of the second period.
 New training classes should as far as possible be started at the conclusion of each month' s training period. However, to meet immediate needs, officers needing training will be sent to camps at any time and will be organized at once into groups for instruction.

10. The following textbooks are authorized for the course of instruction: Army Regulations; Mammal for the Medical Department; Field Service Regulations; Drill Regulations for Sanitary Troops; Manual for Courts-Martial. Such other school textbooks as may he authorized will he announced later.

These books will be invoiced to you without requisition. You will issue one copy of each to each student officer, who will take them with him when he leaves camp for duty elsewhere, for reference and use in training his subordinates.

Maps and war-game sets will be sent out on requisition.

You will procure maps of the maneuver grounds in the vicinity of your camp from the commanding general of your department. One map should be available to each student officer.

11. The daily instruction, except Saturday afternoon and Sunday, should approximate 7 ½ hours daily.


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It is left to the commandant of each medical officers' training camp to prepare schedules for the hours available in each period of instruction among the subjects and time therefore required. This will enable the meeting of the needs of emergency, stormy weather, etc. Copies of the detailed schedules so prepared by you will be furnished this office as soon as practicable.
 
12.The following general scheme is suggested for the daily schedules for the first month:

A.M.

6.00

Reveille.

6. 15- 6.30

Setting-up exercises.

6.35- 7.25

Breakfast; police of quarters.

7.30- 8. 25

Drill (marching).

8.30- 9.25

Drill (special).

9.30-10.25

Quiz or lecture.

10.30-11.25

Quiz or lecture.

11.30-12. 55

Dinner; rest, etc.

PM.

1.00- 1.55

Quiz or lecture.

2.00- 2.55

Quiz or lecture.

3.00- 4.25

Equitation.

4.30- 5. 55

Care of animals, supper, rest, etc.

6.00

Retreat.

 

13. On this general plan, 180 hours of formal instruction will be given monthly. No evening exercises are contemplated. Time will be needed for study. Saturday afternoon should be a rest period. Officers should be encouraged in equitation on Sunday, preferably in form of tactical ride. The schedule for the third month will vary materially from above, due to the practical field sanitary problems contemplated, and the fact that at least one full half day is ordinarily needed for each. This provides for a total course of 580 hours of instruction.

  14. The following scheme shows the Proposed scope and distribution of training of medical officers during the first period of 1 month of 30 days:

 

 

Hours

Setting up (15 minutes daily for 26 days)

6. 5

Drills (marching, litter, ambulance, other means of transport.)

52

Inspections

4

Equitation, bridling, saddling, care of animals, etc

33

Tent pitching, shelter tent

2

Tent pitching, pyramidal tent

2

Personal equipment of time sanitary soldier

1

Field anti surplus kits

1

Care amid maintenance of soldier' s equipment

2

First-aid, using soldier' s equipment only

2

Examination of recruits, with papers and finger prints

8

Nature and employment of regimental medical supplies

8

Customs of time service

2

Duties of time soldier

4

Relations of Medical Department to rest of Army

1

General organization of Medical Department for war>

4

Army Regulations

12

General organization of military forces

2

Manual for time Medical Department

12

Military hygiene amid sanitation

6

Field Service Regulations

6

Paper work, relating to the Medical Department

4

Map reading, use of compass, orientation, etc

6

 

180


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The following scheme shows time scope and distribution of training of medical officers (hiring the second period of 1 month of 30 days:


Hours

Setting up (15 minutes daily for 26 days)

6.5

Drills, marching

26

Inspections

4

Equitation, and care of animals

33

Tent pitching, hospital tentage

4

Elementary road and position sketching

4

Time regimental detachment, its use and internal administration

8

Time ambulance company; its equipment, use and internal administration

8

Time field hospital; its equipment, use and internal administration

8

The tactical use of Infantry (lecture by line officer)

1

The tactical use of Cavalry (lecture by line officer)

1

Time tactical use of Field Artillery (lecture by line officer)

1

The use of the Engineer and Signal Corps (lecture by line officer)

 

The service and mechanism of supply in the field (lecture by quartermaster)

1

Paper work, relating to the Medical Department

12

Paper work, relating to the Quartermaster' s Department

4

Paper work, relating to the Ordinance Department

2

The Medical Department iii campaign

8

The principles of sanitary tactics

8

Map problems

4

War games

8

Military hygiene amid sanitation

12

Army Regulations

6

Manual for time Medical Department

6

Lectures on special subjects

4

 

180


The following scheme shows the scope and distribution of training of medical officers during the third period of 1 month of 30 days:


 

Hours

Setting imp (15 minutes daily for 26 days)

6. 5

Drills (service as drill master in drills of diverse nature)

26

Inspections

4

Equitation

15

Handling of rations and mess management

2

Manual for Courts-Martial and military law

8

The Articles of War

1

The Geneva acid Hague conventions

1

The rules of hand warfare

1

Military surgery

8

Poison gases, protection against, symptoms and treatment (demonstrations) ; liquid fire

2

War psychoses amid neuroses; such shock; malingering

3

Trench warfare; " trench foot"

1

Demonstration of trench system, including bombproofs, dugouts, entanglements, abatis, etc

1

Cantonment hospitals, organizations and management of

2

The sanitary service, line of communications

1

Hospital ships, ships for patients, hospital trains, trains for patients

2

Base hospitals, their organization and management

1

General hospitals, their organization and management

1

Contagious disease hospitals; casual camps, convalescent camps, camps for prisoners of war

1

Organization, functions, and limitations of the American Red Cross

1

The civil sanitary function of the Army Medical Department in occupied territory....

1

   

11

Hours

 

War games

2

Tactical rides

6

Sanitary inspections, practical demonstration of methods

4

Practice march and bivouac (2 days)

13

Practical field maneuvers, including brigade amid divisional problems, with two night problems, and utilizing regimental detachments, ambulance companies, field hospitals stations for slightly wounded, etc., in coordination. Problems will include the attack, retreat, planned defense and rencontre - - - -

60

Lectures on special subjects

  4


180

NOTE. - For the proper conduct of the large medical maneuvers contemplated during this period the services of a company or battalion of the Signal Corps are desirable. The duties assigned to them, however, are such as pertain to their normal functions and training. When line troops are available the above problems should be carried out with them as part of their training as well as that of the sanitary personnel.

15. Dental surgeons and veterinary surgeons will be required to take the general course for medical officers, with the exception of the subjects which pertain more or less exclusively to the work of medical officers as such, with the substitution therefore of subjects directly relating to the dental or veterinary service. Pending instructions from this office, you will arrange tentatively this special instruction.

16. To stimulate student officers to their best work a certain number of places in the grades of captain and major, Medical Department, Officers' Reserve Corps, will be left unfilled. Appointment will be made to these vacancies from among the student medical officers, who, on vote of our staff of instructors, are recommended by you as possessing some exceptional knowledge, aptitude, and efficiency as would qualify them for such increased rank.
To this end you will establish and maintain a graded system of marking, by which relative efficiency will be recorded.

17. Also medical officers satisfying the age and other requirements and after passing such examinations as the Surgeons General may require may, on your recommendation, and subject to the vote of your staff of instructors, be commissioned at once as first lieutenants in the Medical Corps of the Army.

18. If any reserve officer is found unfit for the service by reason of physical, mental, moral, or temperamental reasons, you will, on vote of your staff of instructors, recommend him to this office for separation from the service.

19. Attention is invited to the great administrative as well as training problems presented by your camp. The large number of medical officers under training must be sheltered, fed, supplied and administrated, their camp policed, wastes disposed of, mounts cared for, etc.

The personnel of the regimental detachments, ambulance companies, and field hospitals, in addition to their other duties, be used by your as a service corps to carry out the above duties.

20. You will, without delay, secure definite accommodations and facilities for our medical training camp, in respect to any other training camps near bay, so that there may be no latter interruptions, medications, or entailment of the work of the Medical Department camps.
 
21. You will request by wire the number of noncommissioned officers and clerks which you will require for your headquarters and the number of cooks necessary for the officers' messes.

22. For the purpose of practice in equitation on will make requisition at once for the necessary number of mounts, and saddle equipment therefore, on the basis of one mount for each four student officers.

Mounts pertaining to ambulance companies, field hospitals, and regimental detachments will likewise be used by student officers in equitation when not actually needed in the work of these organizations.


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23. The sick from your camp will receive infirmary treatment from a camp infirmary to be maintained by you. Hospital treatment will be given at the hospitals provided for the needs of the local coordinated training camps as a whole.

You will arrange to have the use of this hospital for the instruction of medical officers in the administration of such hospitals and the training of enlisted men as nurses and as surgical and dispensary assistants.

24. In conjunction with the training camps for medical officers it is proposed soon to establish training camps for enlisted men of the Medical Department. As soon as possible you will prepare a tentative plan for the training of these men in conjunction with the medical officers' training camp and forward it to this office for consideration.

Courses should be based on a three months' period, having in mind that the needs of the service may require the detachment of some of these men after six weeks or two months' training.

25. You will also prepare and submit to this office plans for advanced courses of training for enlisted men, to cover not more than one month, to be specially instructed as (a) nurses, (b) surgical assistants, (c) dispensing assistants, (d) dental surgeon' s assistants, (e) clerks.

26. You will also prepare and submit a plan for the instruction of selected privates who have finished the basic course proposed in paragraph 14, with a view to their promotion as noncommissioned officers. This course should not exceed six weeks. It is proposed to appoint men who, after satisfactorily finishing the basic course for enlisted men and the additional course for candidates as sergeants, are reported by you as qualified for such promotion.

27. Instruction as cooks, horseshoes, farriers, saddlers, mechanics, and chauffeurs of enlisted men who have finished the basic course of training will, it is contemplated, be given in the general schools in such subjects which are or may be established for the Army as a whole.

The Medical Officers' Training Camps at Camp Greenleaf, Fort Oglethorpe, Ga., Fort Riley, Kans., and Fort Benjamin Harrison, Ind., were opened on June 1, 1917, although an effort was made to have orders for student officers amended so as to have them report on June 15 (see history of individual camps, infra). This effort for delay failed through clerical error in the War Department, and considerable numbers of student medical officers arrived at these camps on June 1, and immediately thereafter. This, though regretted at the time, proved to be fortunate, as it gave an extra fortnight of much-needed training to many.

What this training meant may be inferred from the fact that on August 27, 1917, one week before drafted men were to arrive at National Army divisional encampments, there left from each of the three rnedical training camps five trains of medical officers and enlisted men of the Medical Department.3 Each train went to its separate camp and contained a quota of about 60 medical officers and 310 enlisted men, who were not only suitably organized for the formations with which they were to serve, but in each detachment officers and men were specially selected for fitness in the duties which they were intended to perform.

These 900 medical officers and 4,600 enlisted men went to the 15 divisions that were ready for them, and were able to provide for themselves, attend to sanitary matters, and arrange for the handling of recruits in great numbers in advance of the arrival of the latter.3 By this means the Medical Department met the strain imposed upon it at the start, and, by drawing from the trained reserve in the training camps, was equal to all subsequent emergencies.


13 
 
At this time a considerable number of physicians from civil life were entering the Army and were being sent direct to service with troops at posts and camps, without having the benefits of training given at a medical officers' training camp. It was realized that, unless attention was drawn to their shortcomings, and a way prescribed for remedying them, outside of the daily routine, little, if anything, would be done in preparation for future, and probably quite dissimilar, duties. Accordingly, a letter of instruction was sent to all department and Regular Army division surgeons, similar to that given above, outlining the instruction at medical training camps.3 It was realized, however, that many of the facilities at the medical training camps would not be available at posts, garrisons, and small camps, and the course of instruction at such places, therefore, was appropriately modified. A full course of reading was everywhere prescribed, with such practical field work as local facilities afforded. Commanders were charged with enforcement of the requirements of the course, the Inspector General' s Department being asked to specially check up this matter. On the whole, this garrison training was very helpful, and a vast amount of work was done by untrained medical officers who, in the absence of such guidance, would have recognized neither its need nor the nature and manner of attempting it.
 
The next step in the plan of instruction was that for the training of medical personnel with the new divisions. On October 3, 1917, a letter of instruction was sent to all division surgeons, prescribing a course of training effective November 1, to be carried out as rapidly as local conditions permitted and to be concluded only when the Medical Department personnel had demonstrated reasonable qualifications therein before a board of medical officers. (See Chap. IV, infra.) The total ground to be covered approximated that included in the medical officers' training camp course, and a training officer for each division was ordered designated. As each division contained officers and men who had practically completed the course at training camps, others who had only partially completed it, and still others who had not been trained at all, it will be realized that it was no easy task to give each individual the exact training necessary to remedy his deficiencies.

After covering the prescribed course, and thereby securing the fundamental training of the great majority of medical personnel, no further medical training was officially required in divisions, it being believed that it could be left to division surgeons to require the proper training of such new medical officers and enlisted men as might require training after joining.3 It was believed, also, that the prescribed course of training would furnish any necessary number of instructors for any later course of instruction. In general, these assumptions proved correct.

In the late fall of 1917, it became apparent that a certain proportion of medical officers who had gone direct from civil life into hospitals were not being qualified for their duties as rapidly as desired. The division of hospitals of the Surgeon General' s Office was requested to take steps to rectify this condition, which it did by the issuance of a letter dated November 1, and a memorandum in detail dated November 15. In each of these a course of study, training, exercises, clinics, etc., was prescribed. This work is given in detail in Chapter V, infra.


14

After the immediate need for medical personnel for service with troops in the zone of operations had been satisfied, it became apparent that a somewhat different scheme of training from that embodied in the basic course for medical officers' training camp would be necessary for personnel intended for service in line of communications formations, including members of Red Cross and other units, elderly or less robust men, and professional experts whose special talents were too valuable to be wasted by service with front-line troops.3 About this time, a cablegram from overseas urged the sending for duty overseas as rapidly as possible  of these urgently needed troops. A two months' course was organized, therefore, for line of communications men, being essentially an abridged basic course, from which much of the front-line training in sanitary tactics, map work, equitation, etc., had been cut out, and certain additions made in matters of professional training, especially in respect to military medicine and surgery.4
 
Applying the foregoing line of communications course, it early became apparent that the number of medical and surgical specialists entering the Army was not equal to the demand, and that special technical training of a certain number of medical officers would be necessary.3 In this professional training, the great training camps afforded the widest kind of selection of the medical officers apparently best qualified to profit by training in a professional specialty. If, on trial, an officer was not found to measure up to expectations, no further time was spent on him but he was returned to the student body, subject to general duty or other assignment. The better grounded and more adaptable men were thus selected, time was saved from instruction, and the tendency of some officers to pose as experts in a subject in which they merely desired to be trained was thus offset. (See Chap. VI, infra.)

In addition to the special schools for the training of medical officers in the professional specialties, beginning in the early fall of 1917, special schools were established in the medical centers of the United States in which courses of instruction were given in general war surgery and fractures, including the Carrel-Dakin method of treating war wounds; oral and plastic surgery; neurosurgery; Roentgenology; neuropsychiatry; urology; laboratory methods; cardiovascular lesions.3 Each of these special schools was established largely through the efforts of the medical officers in charge of the division under which the specialty came in the Surgeon General' s Office, in cooperation with the medical committee of the Council of National Defense.3 (See Chap. VII, infra.)
 
Prior to our entry into the war the medical journals of the country frequently published the observations and studies of independent observers of American and foreign nationality, of both the medical service of the armies of the nations with whom we were finally allied and those of our enemies.

As training developed, the obvious need for epitomized texts on medico-military subjects caused the Surgeon General to have compiled and published a series of manuals, edited by competent officers, which were distributed among the various schools. The subjects covered follow:

Medical War Manual No. 1. Sanitation for Medical Officers.
Medical War Manual No. 2. Notes for Medical Officers.


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Medical War Manual No. 3. Military Ophthalmic Surgery.
Medical War Manual No. 4. Military Orthopedic Surgery.
Medical War Manual No. 5. Lessons from the Enemy.
Medical War Manual No. 6. Laboratory Methods, United States Army.
Medical War Manual No. 7. Military Surgery of the Zone of the Advance.
Medical War Manual No. 8. Military Surgery of the Ear, Nose, and Throat
Manual of Surgical Anatomy, United States Army and Navy.
X-ray Manual, United States Army.
Manual of Neuro-Surgery.

Concurrently with the publication of texts in this country the chief surgeon, A. E. F., developed and published Splints and Appliances, A. E. F., and a Manual of Urology, which were used, in conjunction with other texts, in the schools in the United States.

With the encouragement and support of the chief surgeon, A. E. F., the American Red Cross undertook and successfully published a journal of progressive medicine and surgery under the title, War Medicine, which was distributed to all medical officers of the forces abroad. This publication fulfilled an important function in conveying information to medical personnel.

These publications were used as guides for medical officers and made possible a text for instruction as well as a book of ready reference for the officer busy with intensive courses of instruction and work in the United States and in Europe.

Considerable help was obtained through lectures and demonstrations given from time to time to medical officers in the service schools and medical officers' training camps by experienced allied officers.5

A number of our specialists were ordered overseas early in 1918 to make tours of inspection of the allied and American hospitals, to observe the methods employed h the allied hospitals in organization and in treatment of special medical and surgical conditions, and to discuss with and obtain from allied specialists their views as to the best methods of organization and utilizing the specialties. These officers were returned to the United States and rendered reports to the Surgeon General covering these problems.6

Besides the training of medical officers at the medical officers' training camps it later became necessary to respond to the request of the Dental Corps, Veterinary Corps, and Sanitary Corps to train their officers.3 Schools were accordingly established for this purpose, these non-medical schools including separate schools for dental surgeons, veterinarians, sanitary engineers, psychologists, and nutrition experts. The courses were based on two months' training, and instruction was limited to the fundamental necessaries of the individual service.3

Schools for the training of enlisted men in special work were early developed.3 These enlisted men' s schools included those for the making of noncommissioned officers, nurses, and ward men, dispensary, laboratory, X-ray, and surgical assistants, clerks, cooks, chauffeurs, and gas-engine mechanics. Classes of medical officers and enlisted men in automobile maintenance were also maintained

The medical officers' training camps were required to organize, maintain, and supply a large number of practically every formation which the Medical


16
 
Department provides.3 Some of these were permanently attached to the camps as training units, others were provisional organizations without official status but used for training purposes until needed for conversion into new official organizations. Still others were organized solely for the purpose of being sent away at an early or later date.
 
Besides the three training camps already mentioned, a similar camp was established at Fort Des Moines, Iowa, for the training of colored medical officers and colored enlisted men of the Medical Department. Its official capacity was 125 officers and 1,000 enlisted men, and it was in operation between July 21, 1917, and December 1, 1917, when the need for colored medical officers was satisfied. The training given in this camp was in regimental work only, as it was understood that colored sanitary personnel would habitually be attached to colored organizations. (See Chap. II, p. 262.)

The number of medical officers under training was sufficient to fill all drafts made on the medical training camps, but not sufficient to insure that officers so drafted would at all times be adequately trained. The needs of the Medical Department required that 3,000 medical officers, 500 officers of the Dental Corps, Veterinary Corps, and Sanitary Corps, and 35,000 enlisted men of the Medical Department should as a minimum be constantly under training. These numbers, however, were never attained during the war.3

From the foregoing it is seem that Medical Department training in the United States, as finally developed, was conducted in schools and organizations which may be considered under six groups: (1) Medical officers' training camps; (2) divisions camps, and posts; (3) United States Army hospitals; (4) special schools, (5) special professional schools in military and nonmilitary institutions; and (6) miscellaneous schools. These constitute the subject matter of the succeeding chapters.
 
REFERENCES
(1) Manual for the Medical Department, 1916, Art. II, 131..
(2) Memorandum of instructions for medical officers and sanitary units, headquarters, Southern Department, Fort Sam Houston, Tex., August 12, 1916. On file, Record Room, S. G. O., 167,580 (Old Files).
(3) Report of the Division of Medical Department Training, Surgeon General' s Office April 6, 1917, to May 10, 1918, by Col. E. L. Munson, M. C. On file, Record Room, S. G. O., 353 (Training, General).
(4)
Letter from the Surgeon General, U. S. Army, to commandants, Medical Officers' Training Camps, Fort Benjamin Harrison, Ind., Fort Riley, Kans., Leon Springs, Tex., Fort Oglethorpe, Ga., May 16, 1917. Subject: Direction as to nature and scope of instructions to be given at above training camps. On file, Record Room, S. G. O., 353 (Training, General).
(5) Memorandum from P. M. Ashburn, colonel, M. C., U. S. Army, to J. B. Gowen, colonel, general staff, G-5, general headquarters, A. E. F., March 4, 1919. Subject: Lectures and demonstrations given in service schools and medical officers' training camps by allied officers. On file, Record Room, S. G. O., 201 (P. M. Ashburn).
(6) Report of a special tour of observation to certain hospitals in an English sector, a French sector, a U. S. Naval Hospital, two American base hospitals in France and a number of hospitals in and near London, by Maj. George E. de Schweinitz, M. R. C., and Maj. Harris P. Mosher, M. R. C. On file, Historical Division, S. G. O.