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Chapter X

Contents

CHAPTER X

ARMY SANITARY SCHOOL

MEDICAL SECTION

ORGANIZATION AND INSTRUCTION

    The Army Sanitary School was organized in accordance with the general school project for the American Expeditionary Forces, involving army and corps schools and divisional training, which was approved August 30, 1917.1 (See pp.571 and 572, in the preceding chapter.)

FIG. 33. - Army Sanitary School, A. E. F., Langres

    The original plan of conducting this school at the 2d Replacement Division of the First Army Corps, together with other Army schools, and of employing it for the training of instructors for corps schools, was never extensively carried out,2 but in October, 1917, the Army Sanitary School, among other Army schools, was ordered to be established at Langres.3 The commandant reported for duty November 1, 1917, 4 and the school was opened December 3, 1917.4
    While, from time to time, a few graduates of the school were recommended, in accordance with the original plan, as instructors for corps schools, the major


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purposes of the Army Sanitary School, as finally evolved, were: (1) To train selected officers from each division, who would return to their organizations and instruct their colleagues; (2) to collect information concerning the work of the Medical Department in war and to distribute this information in mimeographed pamphlets throughout the American Expeditionary Forces.4 (See Appendix.) For the accomplishment of these purposes, courses which had been proposed by the commandant and approved by the chief surgeon, A. E. F., were employed.5

    When a copy of the original memorandum for training medical personnel, American Expeditionary Forces, reached the Surgeon General, it called forth the following suggestions concerning the coordination of training of Medical Department personnel at home and abroad. 6

    1. In connection with your letter to General Birmingham of November 12, 1917, on the subject of Medical Department training overseas, and the attached data, including the general scheme of training all troops overseas and the detailed course for medical officers in France, the following information is furnished for your information as to the nature of the instruction being given in this country and for consideration as to the proper relation between it and the training done abroad.

    2. Training of the Medical Department in the United States is based on a comprehensive plan to reach all personnel, commissioned and enlisted, wherever they may be serving.
    All are being materially benefited. The relative degree of efficiency depends on local opportunity, equipment, and thoroughness of instruction and supervision.
    The instruction everywhere is coordinated, and is the same where conditions permit.
    A certain scope of basic information is necessary for all officers and for all enlisted men. This is approximately the same in all the courses later referred to, but the time allotted thereto is not always the same for different courses preparing for different varieties of duty.

    3. Instruction is given through the following channels:
    (a) Departmental. Required per circular letter, Surgeon General’s Office, of May 14, 1917, to all department surgeons.
(b)Medical officers’ training camps. Required per circular letter, Surgeon General’s Office, to commandants of medical officers’ training camps, dated May 15, 1917.
    Also by Special Regulations 49a, War Department, 1917.
(c)In all organized divisions. Required per circular letter, Surgeon General’s Office, to all division surgeons, dated October 3, 1917.
(d)In all base and general hospitals. Required per letter, Surgeon General’s Office, of October 15, to all hospital commanders.
    This letter was further supplemented by memorandum, Surgeon General’s Office, of November 15, to all hospital commanders.
    (e)For the training or elimination of all substandard medical officers. Required per letters, Surgeon General’s Office, to all department and division surgeons, and to all hospital commanders. Both letters dated December 14.

    4. The so-called basic course of three months in training camps was developed primarily for the training of sanitary personnel for service with fighting troops in the zone of operations. This need has now largely been filled by the creation of most of the sanitary organizations required for the troops authorized under existing law.
    However, a considerable number of officers and men are continually needed for replacement purposes, and enough are being given this basic course to meet all such needs. This three months’ course is also more thorough and satisfactory than the special courses of two months, later referred to. As all personnel is conceivably liable to this service with fighting troops at the front, if time permitted all would receive this three months’ course and be given any special instruction necessary to lines of communication formations in addition.


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    After a four months trial of the same, Colonels Page, Ashhurn, Persons, Bisphamn, and Lieutenant Colonel Bingham, commanding the several medical training camps, in conference decided that the basic course for such camps, prescribed in Special Regulations 49a, met all needs and should not be changed. It has now been tried out for seven months and no need for change has as yet been presented in this country.

    5. A shorter course than the so-called basic course is given to personnel to he assigned to duty with formations intended for line of communications work. This course is of two months. It leaves out a considerable amount of training which relates especially to service with fighting troops, and at the same time adds somewhat to the professional training.
    Present plans contemplate that at the conclusion of this two months line of communications course, such organizations as evacuation hospitals and base hospitals will have their personnel as a unit attached as supernumeraries for about one month prior to embarkation at fixed base hospitals. This will give them practical training in hospital management and care of patients. This plan is suspended for the present for lack of available accommodations surplus at any suitable base hospitals.

    6. Around the basic course of the training camp, and the condensed course for line of communications service, a number of special schools to supplement the former have beenestablished. These latter are largely professional, but have the purpose of training officers to be specialists along certain lines for military purposes and in the military environment and under its limitations.
    The special schools thus already established include:
    (a) School of applied military hygiene and camp sanitation.
    (b) School for military roentgenologists,
    (c) School for military orthopedists.
    (d) School for military psychologists.
    (e) School for military sanitary engineers.
    (f) School for laboratory workers.
    (g) School for veterinarians.
(h)School for internists.
(i)School for hospital administrative officers.
    (j) Schools for military surgeons, general and regional.
(k)Practitioners courses in laboratory work.
(1)School for military dentists.
 
    *    *    *    *    *    * 

   (8) (a) The hospital facilities at Medical Officer’s Training Camp, Fort Oglethorpe, where there is a general hospital, as at present planned, will aggregate 2,500 beds. But it is proposed to expand this to any such number as may be required to furnish abundant material for clinical courses and adequate instruction. It is well located to be expanded to 4,000 or more beds.
    Selected cases are to be sent to Fort Oglethorpe for this purpose from the 10 great camps, with their soldier population of some 400,000, which are located within a night’s run of Fort Oglethorpe; which latter will, in addition, have its own population of 35,000 to 40,000 to draw upon.
    Cases from overseas will further be sent to the reconstruction hospital to be operated here.
    The plan is to make it the greatest clinical center, as well as medical training camp in the world.
    A selected staff of experts, drawn from the best medical centers, will conduct the clinical and other professional work.
(b)At the present time, there are about 1,400 cases under treatment in the general hospital at Fort Riley. No expansion of clinical facilities here, beyond local supply, is contemplated if this training camp can be merged in the one at Fort Oglethorpe, as mentioned in paragraph 10 herewith.

    9. Whether or not all basic training can be done in the United States before embarkation depends on the size of the training facilities authorized here.
    At this date there are about 2,600 medical officers under instruction in medical officers’ training camps, or actually under orders to proceed there.


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There are about 8,000 enlisted men of the Medical Department similarly under training at medical training camps, and this number is rapidly to be increased. Ten thousand more drafted men are expected at them on February 15.

    The facilities at Medical Officers’ Training Camp, Fort Oglethorpe, immediately in sight, are as follows:
        Now occupied, cantonments....................................................6,000
        Tent camp under rapid construction ......................................6,000
        Artillery cantonment just being turned over .........................1,500
    13,500

The facilities at Medical Officers’ Training Camp, Fort Riley, immediately insight are:
    Now occupied, cantonments.......................................................3,500
    Just ready to occupy, cantonments.............................................1,500
    Ready in three weeks, gunsheds converted into barracks.......1,500
    Tentage......................................................................................400
    6,900
    Total, both camps, 20,400.

    10. However, the Medical Department has asked that it be given all of the structures and facilities at Chickamauga Park and Fort Oglethorpe. These are now accommodating over 35,000 officers and men, mostly of line organizations. If all these accommodations become available, the Medical Department will concentrate all training there. In the meantime, it will need to maintain the camp at Fort Riley also.

    11. For present purposes, the medical officers’ training camp in this country camp be counted on for the following:
    (1) To give basic training and special instruction to all medical officers hereafter entering the service.
    (2) To organize all sanitary formations created in this country, and to fundamentally train the officers and men composing their personnel.
    (3) To train more than one-half of all other enlisted men of the Medical Department entering the service.
    The remainder will have passed into the service direct to divisions, hospitals, etc., and received their training there.

    12. If the Medical Department gets all the accommodations at Chickamauga, it will endeavor to send all enlisted men, as well as all officers, through the training course there.

    13. The general plan for the early development of a single great medico-military training center in the United States is embodied in memorandum for General Birmingham, dated January 11, entitled “Final policy for training officers and men of the Medical Department.”

    14. The general plan of the training committee, General Staff, looks to the separate training of each arm or branch of the service by itself in this country, with combined training of all branches and arms in the camps abroad.
    The Medical Department plan agrees with this, except that its personnel under instruction may have the benefit of association with a certain number and type of line troops in this country. If such opportunity for combined training exists in this country at or near the medical officers’ training camp, the Medical Department will, to a reasonable extent, take advantage of it.

    15. As far as possible, it is believed that nearly, if not all, training in theory, and some at least of the training in practice, should be done in the United States.
    On going abroad, the individual should already have received his fundamentals of instruction and be able to intelligently participate at once in the application under special conditions of the general principles he has learned.

    16. The school abroad should thus be primarily a school for advanced students, both officers and men, and should further be especially a school of practical application.

    17. The general idea of the relation which it would seem desirable should exist between the training facilities of the Medical Department at home and abroad is given in memorandum for General Birmingham, dated December 28, entitled “Training of Medical Department at home and abroad.”


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   18. It is possible that necessities of the service may require that a certain number of uninstructed men, and a still larger number of only partially instructed men, shall be sent abroad from time to time. Insufficient training facilities in this country and shortness of time has made such action necessary in the past.
   Such men, of course, will need training overseas in theory and practice, according to the nature and extent of their deficiencies--and for them a suitable course, probably closely approximating the instruction given in this country, should be maintained overseas.     But this last course should be regarded merely as incidental to the main school, which should be one of application for advanced training of personnel grounded in their fundamentals in the United States.

    19. The courses of training overseas should take into consideration the courses given here, and information should be required of new arrivals as to the nature and extent of their previous training in this country. Repetition of training in a subject, if satisfactorily understood, and duplication of effort, should of course be avoided.

    20. It is requested that the training overseas be so amended as to give full consideration to the preliminary training here.
    Also that this office be informed as to the manner in which the courses of training in this country should be amended so as to better coordinate with the training carried out by you and needs of the service abroad.

    The following reply to the above communication not only shows clearly wherein and why complete coordination of Medical Department training in the American Expeditionary Forces with that in the United States was impracticable, but it gives a lucid exposition of the purposes and methods of the Army Sanitary School: 7

    The inclosed letter reached me for the first time 24 hours ago, due to the fact that I was on a tour of instruction at the British front with 25 medical officers, and have just returned.

    The programs of instruction for the Medical Department in the United States have been gone over with care, and it is believed that the best interests of the service are subserved in the manner in which these programs are being carried out, as there is neither time nor opportunity to train men in many of these subjects where their services are needed in the trenches. A knowledge of the regulations and record keeping of the Army, and a full knowledge of drill with its effect in desciplining officers and men, is keenly appreciated by those of us here who literally are unable to do this work without neglecting exigencies of war service, and, in general, with the exception of some men hurriedly sent with base units, this intensive training has produced remarkable results.

    As a matter of fact, when this school was organized a plan of the commandant, submitted to the chief surgeon and approved by him, was to teach the methods necessary for our Medical Department to render its best service in this war, and as this has been a war of trenches up to the present time this phase was chiefly taught. * * * It is believed that in general the plan of this school in France should be continued, namely, that the actual working out of not only our own, but the system of other armies, should be demonstrated practically where war is being carried on, in the front lines of the armies and the lines of evacuation. To this end classes of selected students have been carried up to live for three weeks under these conditions, and the aid of both the French and British Armies has been solicited, not only to give practical talks, where the substance of their remarks could be demonstrated on patients and terrain, but where our officers would be able to visualize the difficulties at the same time that they are furnished with the solution. The school has been unique in that the spirit of the students has been kept at its very highest pitch under the stimulus of the war going on about them. Much of the data they have secured have been obtained from the immediate front, from the first line trenches back to the casualty clearing stations or evacuation hospitals, where they lived during their stay, often under fire and at least once of great assistance to their hosts in sudden emergency.

    Shortly after reaching France, while yet division surgeon of the 1st Division, I drew up a program for the instruction of officers and men of the Medical Department. * * * In addition to this program, and at times in substitution for this regular routine, Medical


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Department troops were ordered, at favorable opportunities, to take part in combined operations of battalions, regiments, and the whole division, which had, itself, set about vigorous training of its combatant units. In addition to this, medical officers were assembled each Saturday afternoon for instruction at 3 p. m., and in spite of the difficulties attendant thereon, owing to the great lack of transportation in the area covered by the division, 15 miles long and 10 miles broad, there was given an opportunity for interchange of opinion as well as to hear various invited surgeons, chiefly of the French Army, on vital subjects connected with the medical services in war. Some of these lectures, especially those of Aide-Medecin-Major Bernard, were of extreme value. I was fortunate in having an office with the division surgeon of the 47th Chasseurs, Colonel Cultin, who took such a great interest in cooperating with us that he at one time spent an entire day with us inspecting the personnel and equipment in detail of the medical units of his division, the divisional units under his command being brought up in military formation at one spot for this purpose. On another occasion, after a week of hard labor, he staged a field exercise involving battalion aide stations, regimental aide stations, and ambulance company evacuation, at full distances, with dug trenches and marked routes of evacuation; and the influence and instruction received from this officer is reflected in a “Report of a visit made to the French front, per instruction of commanding general, 1st Division,” section 3, “Personnel and equipment of regimental and divisional sanitary organizations of French Army”; section 4, “Recommendations of changes which should be made in sanitary organization of the American Army,” submitted about September 6, 1917. The success of all of the schools of the 1st Division in rapidly training their men led, I believe, to the establishment of the present school system. Up to this time we had but one ambulance company and field hospital, both of which were involved in serving the routine medical necessities of the division--the one being used to man the divisional camp hospital, the other to evacuate the sick from the numerous cantonments in which it was situated to that hospital. In addition to this, after a preliminary visit of the division surgeon to a French sector in our vicinity, authority was secured from the chief surgeon for a visit of two weeks to the British front of about 20 per cent of our medical officers.

    On October 15, 1917, the First Corps Sanitary School was established as one of the corps schools in the heart of the 1st Division, and I was relieved as division surgeon to become its director. Over half of this course was a practical one in the field, many of the so-called lectures being demonstrations. By this time two more ambulance companies and two more field hospitals had reported and were used in field excercises and problems as per program, the intrenched positions being the ones actually dug for the use of the division. Apart from this, a number of Medical Department dugouts were built by the divisional sanitary troops under the general supervision of the Engineer Corps and the French Medical Corps. On November 3, before the course had been finished, it had been the plan to have a course of five weeks for each class in the Corps Sanitary School, but at the end of the first three weeks I was ordered to the Army schools to become commandant of the Army Sanitary School and left November 3. The course, which was to have continued at Base Hospital No. 18, was in my absence abandoned, due I was informed to an epidemic of scarlet fever there.

    I was informed that plans for this school should be based upon the principle that at least 100 medical officers at a time would attend, and that these would be field officers, and I was instructed to make plans which should embrace not only the higher branches of practical work but which should reach out into all of the specialties pertaining to the Medical Department. The plan was to have a division of troops cantoned in the vicinity of the school, which, at the same time it was being trained, would serve as a means of instructing students who came to the school, and that the population of the school area would, in addition to the division, be about 15,000. Upon this information I based the tentative plan, heretofore referred to, but on reaching the school area it became evident that for the present at least the school could not reach the proportions first contemplated by the officers directing the training section. Accordingly, a memorandum to the chief surgeon was forwarded, and approved, and upon the main features of this memorandum the school is now working, although it seems probable that much of the original plan will be attained as the base hospital of 2,000 beds, the division sanitary train complete, medical supply depot, and the hospitals for officers and men, and


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dispensaries, are to-day facts, although the base hospital and the division sanitary troops have no relation to this school, with which they are actually in contact. The important change is that the entire class receives the same instruction Instruction in military medicine is provided by the commandant in addition to his other duties.

    The school, at present, is in a comfortable building used as a young girls’ school and conjointly with them, but the lack of sufficient accommodations, on the one hand, and the difficulty of getting student officers in the numbers at first contemplated, on the other, somewhat changed the actual working plan of the school as at present carried out. It was decided to make the school a place of instruction for selected medical officers in a position to spread information which could not be attained by the reading of books or papers, or from the divisional or corps schools. Moreover, it was considered that the work of this school should he distinctly separated from training for which other provisions and another bureau was provided. The object of this school was to give information by practical talks and demonstrations as well as tours of instruction at the front and not to attempt long training periods. It was believed that no base or line of communications medical officer could be of such efficiency as the conditions of this war required until he could visualize the scenes and conditions from which his patients came, and vice versa. In this manner the school aimed to coordimate all parts of the medical service and bring about cooperation between front and rear, the lack of which caused much confusion and not a little suffering in times past in the armies of our Allies. After this bird’s-eye view of the entire medical department from front to rear, with concentration of attention on vitally important features, all medical officers would he in possessions of enough basic knowledge of any part to enable the chief surgeon to call upon anyone to serve in either front or rear. The training of these officers in their specialties could be taken up by some other bureau or be later provided for as a branch of this school. This allowed the staff of the school to concentrate their attention upon the vital and pressing matters connected actually with this war, and it was determined to make this instruction so practical that everything taught could be actually demonstrated. Accordingly the first class was taken to the British front, stopping a few days in Paris to receive a preliminary course in the best known military hospitals of that city, and in the fracture hospital commanded by Colonel Keller, one of the instructors. The British Army invited us to take our course at the school of instruction of the Royal Army Medical Corps for the First Army. We were quartered in a casualty clearing station about 4½ miles from the lines. On the last night of our stay, after heavy bombardment, the class furnished operators to assist in that hospital.

    The second class began January 10, 1918, and this time a tour of instruction was arranged with the French and the class proceeded to the school of instruction of medical officers of the Fifth Army. The notes on this course have not yet been completed, but it was an extremely valuable one.

    As a result of these two expeditions very strong and lasting relations of cooperation were established between the British and French Armies and ourselves.

    The present class is now just completing its course, the third of this school, and has just returned from a tour of instruction in the school of the Royal Army Medical Corps for the First Army, which had been sufficiently vaired from the first course to present features not heretofore covered, inasmuch as a most thorough demonstration of all of the lines of communication and base were included, even to the inspection of hospital ships ready to sail for England. The report of these two courses will be forwarded in due time.

    The policy of this school at the close of this course will change, a in that it will be limited to one month, the students will be increased from 25 to 50, 25 having heretofore supplied the demand, but now it is believed that 50 students can he spared from their actual duties at the front. At the conclusion of this course 25 students will be selected, in order of merit and aptitude from this class, to make a two weeks’ tour of instruction as other classes have made.

    Compared with the large training activities in the United States, the number of students who have passed through this school seems small, but in analyzing its results one should consider its functions. This school has the same relation to the Medical Department as the General Staff School has to the Army. The general instruction in divisions provides for all Medical Department personnel in the field, the corps schools prepared instructors for the

a See communication from the adjutant general, general headquarters, A. E. F., to the commandant, Army schools, re Army Sanitary School, Mar. 4, 1918, infra, p. 622. - Ed.


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divisions, and the Army Sanitary School (whose number of students is about that of the First British and Fifth French Army schools visited) prepared instructors for the corps schools. As a matter of fact that has been exactly what has happened. Before the Army Sanitary School existed the 1st Division supplied practically all of its instructors. After this the Army Sanitary School provided the main part of the instructors for the Second Corps school. Now with the abolition of the corps schools this army school will provide not only all instructors for divisions directly, but will furnish those for units in the line of communications.

    From the first all students to this school are required to take full notes on all lectures, demonstrations, and visits to the units of allied armies; the commandant has accompanied each expedition with at least one, and later two, of the faculty, and has done likewise. At the end of each course these notes are all written into a composite form by the faculty and mimeographed. The proceedings of each course will be furnished each division for permanent record and enough are supplied heads of large medical units and the general staff to secure liasion. Not only this, but it is the intention to place all alumni upon the mailing list of the school for literature in subjects not treated heretofore.

    In short, the present system has been based upon the principle that only those matters which could not be secured by instruction in the United States, in divisional areas, and in the corps schools should be handled here. It was long ago felt that corps sanitary schools rather complicated than helped the system of instruction that we were attempting to make possible for medical officers, and in fact these corps schools, not only in the medical department but of all arms, have been abolished. There is no time for drilling, paper work, or supplemental instruction, and as will be seen from the programs, the five great subjects taught are the tactical disposition of sanitary units, military administration of the medical department (meaning thereby the liaison between medical units, administration of organizations in the lines of communication, etc.), military hygiene as applied to this war, military surgery, and military medicine.

    In addition to the record of the first course of this school, certain papers and notes are hereto added for information and distribution in the schools of the Medical Department of the United States. Some of these papers refer to lectures and demonstrations in the second amid third courses of the school, and one especially--the translation of a lecture by Lemaitre--will probably be a classic, inasmuch as lie was the first to practice the so-called primitive suture and surgical sterilization of wounds.

    Other notable papers, also original and appearing for the first time (as in fact most of these papers do) are: “Notes on the Battle of the Somme,” furnished on request of the commandant by Lieutenant Colonel Cordillot, division surgeon of the 18th Division, French Army, made by him from a diary he kept at the time. “The organization and operation of aid stations in army corps and litter-bearer groups,” by Aide-Medecin-Major Collin, containing excellent plans for regimental dugouts. “The function, role, and methods of the division surgeon,” by Lieutenant Colonel Thooris, division surgeon, French Army. “Duties of the regimental medical officer during an advance,” by Major Griffin, English regimental surgeon.

    It is quite unnecessary to state that all of the material received from the British was so valuable as to make it impossible to point out one in preference to others; but the chief value of these papers lies in the fact that the subject matter therein treated has to a large extent been verified by demonstration. In fact, the course with the French was carried out at an evacuation hospital for a sector of the French lines of 3,000 beds where wounded were being constantly received, and much of the instruction not provided for in the program was given by Professor Lemaitre and Professor Leriche in the operating rooms and wards, at all hours of the day and night. It is believed that the surgical experience gained in these demonstrations has already had a tremendous influence in putting into practice one of the greatest advances in military surgery--the primitive and the primitive retarded suture and its limitations. It is unfortunate that larger groups can not be taken to these lines, and more frequently, hint, naturally, 25 is the extreme number that can be accommodated at any one time, and, besides, in the future the activity of our own troops will hemiceforth furnish a large amount of future instruction, this not having been possible heretofore, as it is only comparatively recently that our troops have become consolidated on the line. I can only state the self-evident fact that the excellence and uniformity of the British and French medical service comes mainly from its school system.


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    In addition to the Army Sanitary School, this school has under its supervision the Army Dental School, with a course of two weeks, and our officers cooperate with them, as theirs do with ours, on those branches of medicine and surgery which affect both. The course is two weeks. There is a director and two assistants--1 colonel, 1 major, and 1 first lieutenant.

    The following observations on the school system and programs in the United States are noted. Many of them may be unnecessary, but they are presented for whatever little they may be worth to an organization already so unusually thorough.

    1. It is questionable how much of our own perfected plans for open warfare can be utilized in this present war. While manifestly unsafe to neglect tent pitching, equitation, and drill, it is believed that, if other subjects seemingly requiring more time have to be extended, these branches might be called upon to yield some more room for such extension.

    2. The paper routine of the Army, knowledge of regulations, manuals, etc., is an important matter which can best be taught in the United States, but if, as it is hoped, simplification of methods of record can be further secured, as appears to be contemplated especially for the zone of operations, still further time could be secured.

    3. The importance of the evacuation hospital can not be overestimated. In this war this hospital has become the pivot on which moves the whole medical service of the front, and it is not an exaggeration to say that save in overwhelming periods of activity, which total perhaps 2 or 3 weeks in every 52, the real determinate surgery is done here; that is to say, the surgery of war has apparently moved, if not entirely, certainly to a large extent, from the base and general hospitals to the evacuation hospital.
    It is believed, therefore, that this hospital should receive a longer time for consideration 101 all training areas.

    4. Complementary to this, the use of field hospitals in this war has altered. Their utility is fully as great as ever, especially when one considers that they are the mobile hospitals upon which we have to depend in the critical momeist of a change to a war of movement. Meanwhile, they are the utmost necessity for sick and gassed cases.

    5. The course on rations and mess management is also apparently rather short. This is such a feature in the British Army that a cookery school is called upon to furnish a considerable amount of instruction at their schools.

    6. I strongly recommend the incorporation of Cowell’s treatment of shock and his Thomas splint drill. It has saved many lives and limbs here.
    The rifle splint drill not included herein provides for continuous extension and is a distinct improvement on all previous improvised methods I have seen. When prepared this will be forwarded.

    7. 1 earnestly recommend the teaching of Lenmaitre’s ideas on the primitive suture to all medical officers. While not yet universally used in the French Army, it is spreading with great rapidity and is the treatment par excellence in the First British Army. In fact, I am informed that the English have adopted it pretty generally in all their armies. I have seen its results, and it is being used at our own American front with astonishingly favorable results. The limitations of its practice should be minutely explained and the Carrel-Dakin method should not be displaced from its legitimate application.

    8. The work in trench warfare, construction of dugout, etc., might be increased, as in both French and British Armies medical personnel usually dig their own shelter and consolidate their own positions, usually, of course, under the supervision of the Engineer Corps.

    9. As far as I was able to determine, no general instructions on skin diseases is being taught. As fully half (some say 60 to 90 per cent) of the medical cases come from skin diseases, scabies and lice, and trench fever, whose proven vector time louse is, thorough instruction on this subject should be contemplated.

    10. The faculty of this school is impressed with the fact that the two absolutely new and the most important contributiomis to the efficiency of the Army by the Medical Department are (a) the excision of devitalized tissue and surgical sterilization of war wounds of the French and (b)the perfection of convalescent depots by the English. Both are examples of active participation by the Medical Department in helping to win the war. As we were reminded in both allied armies, our humanitariamm calling we have always and we shall always practice. This is nothing new but the prevention of disease, and the great reduction in number of days absent from the front of sick arid wounded is. This economy of men is vividly brought out


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by Lemaitre’s statement to me that he had returned 897 out of 1,130 men to the front during a period of six months after an average incapacitation of three weeks by means of his primitive or primitive retarded suture; and that of Colonel Miles, in command of a convalescent depot, who told me that 1,500 men were sent direct to the trenches fit for duty each month. The British medical service charges itself with what they call the “wastage” of the Army in men. Therefore, it would be desirable to give the subject of “convalescent camps” more time in the courses back in the United States. A full description of these camps in the British lines will go forward as soon as completed, giving details. The great point made by all was that they must be operated entirely by medical officers.

    11. It is believed that the contention of the British that a high-grade man should be selected to the position of regimental surgeon can not be too seriously considered. Aside from high qualities of morals and knowledge of men, he should be a keen diagnostician, to the end that much useless undoing of dressings and mistakes in the destination of patients who are sent according to the diagnosis tag may be avoided or lessened as much as possible. We were told at some large receiving hospitals that the dressings were never disturbed in the cases of certain regiments because the confidence in the diagnosis was absolute, and a man was sent according to that diagnosis, whereas in other cases diagnosis had to be laboriously remade where time was pressing and could be ill afforded.

PROGRAM FOR THE BASE HOSPITALS

    The following were the points most insisted upon and practiced during the nine months’ observation that we have had in France.

    1. For practical purposes all wounds are considered infected, and distinction is no longer made between bullet wounds and shell wounds unless there is not the slightest doubt that the wound was from a nondeformed bullet at medium range. Practically all such wounds are treated by ample exposure, removal of the missile and of the clothing and other foreign bodies blown into the flesh, together with such devitalized tissue as can be determined in the usual manner.

    2. A life-saving procedure is the immediate closure at the very front, before transportation to the evacuation hospital, of the large blowing wounds of the chest. If, as is usually the case, no formal operation can be done, the skin should be pulled together and sutured, and if this is impossible a large dressing, covered with adhesive plaster, should be tightly applied.

    3. Cushing’s method of intervention in wounds of the brain and peripheral trephining, together with removal of such liquified material from the tract of the wound as can be so removed by a No. 7 rubber catheter, is giving the best results in such cases.

    4. The necessity for a physician expert in examination of the chest on all chest teams which may have to be sent to the casualty clearing stations to work seems of importance.

    5. The conversation officially of the term “shell shock” which is abused, as well as ignorantly used, by badly shaken soldiers, sets in train conditions which lead up to hysteria and malingering. These cases are termed by the British “Not yet diagnosed” (N. Y. D.) and are sent back to a special hospital, generally a stationary hospital, for observation and treatment, their cases investigated and distinction made between concussion and its effects, and plain hysterical conditions, if possible. We have been advised by several good authorities that it would be justifiable to do a lumbar puncture at the casualty clearing station or first surgical hospital at which these cases are received to determine the presence of blood in the cerebrospinal fluid.

    6. Brain cases should not be considered as nontransportable save when in extremis, as such cases travel well before operation and are impossible to move thereafter. The best place for them is in the rear of the evacuation hospital, at some hospital specially designated for the treatment of such injuries.

    7. Fracture hospitals should be established in the rear of the evacuation hospital and among the various appliances for treatment, Sinclair’s hammock frame for fractures of the pelvis, perineum, and those fractures of the buttocks and hip which prohibit the applications of a Thomas splint, is considered to give the best results, both as regards comfort to the patient amid facility for treating the wound.
     In conclusion I have observed that many of the surgeons accredited to the fighting force in France are lamentably deficient in a correct knowledge of anatomy, and sonic rapid method, such as the teaching on sectional plates, seems imperative. Many physicians called upon to


611

do work in the evacuation hospitals, not to speak of those in the rear, while well versed in the special anatomy for formal operations in civil life, have shown themselves lacking in a sufficient knowledge of the relative position of bones, muscles, nerves, veins, and arteries at different levels of the extremities, as well as the functions and distribution of nerves and the insertioml and functions of muscles. A relatively little understood anatomical guide is the arterial and nerve supply of muscles. These matters become of first importance in the excision of devitalized tissue which might prevent infection but leave the patient with a functionless limb.

    8. The peculiarly close relations which to-day exist between Roentgenology, bacteriology, and surgery is noted, the radiologist being called upon to act always in an adjoining and connecting room to the operating room, frequently in the operating room itself with a localizer, side by side with the surgeon, the surgeon often being obliged to use the fluoroscopic bonnet and the aluminum top table to rapidly judge of the position of projectiles. This mechanical aid to the surgeon has been complemented, especially in the French hospitals, by an expert bacteriologist, who whenever possible cultures the wound before closing and determines the presence or absence of streptococcus, etc.

    The great necessity for the training of base hospital medical officers in military administration, not only to the end that they may be able better to conform, and to make their hospital conform, to military life, but because they will be called upon frequently to reinforce units in the advance zone where everything depends on not only professional ability but an unbending spirit of discipline and ability to exact that discipline of others.

    This memorandum has been shown to Colonel Stark, chief surgeon of the advance section, lines of communication, of our Army, and the faculty of this school, and they approve of the contents.

BAILEY K. ASHFORD,
Colonel, Medical Corps, United States Army,
Commandant, Army Sanitary School.
Dated March 29, 1918.

PROGRAM OF FIRST SESSION, ARMY SANITARY SCHOOL
(December 3, 1917, to January 5, 1918)

Class reported on December 2, 1917, Army Sanitary School, and left for Paris, December 3, 1917.

Dec. 4:
     7 a. m. to 8 p.m....................Clinic and lecture and demonstrations at fracture hospital, V.R. 76, By Lieut. Col. W. L. Keller, M.C., United States of America.
Dec. 5:
    9 a.m......................................Ward dressing demonstration by Carrel-Dakin method. By Doctor Chutro, at Lycee Buffom.
    4 p.m......................................Clinical lecture and demonstration of cases. By Professor Babinski, Lycee Buffom.
Dec. 6:
    9. a.m......................................Half of the class went to Beaugon Hospital to a lecture by Professor Tufflier on the organization of the French medical service and to see him operte thereafter. The other half to a special operative clinic by Professor Chutro, at the      Lycee Buffom.
    2 p.m.......................................Visit to Val-de-Grace Medical Museum.
Dec. 7:
    9 a.m......................................Visit to St. Nicholas Hospital to see ambrine treatment applied and the injection of specially prepared guaicol and oil from the diminution of scar tissue.
Dec. 8:
    9 a.m......................................Visit to Major Blake’s hospital, No. 6 Piccini.
    2 p.m......................................Visit to American ambulance at Neuilly.

    December 9: Left for the British front.

    December 10: Arrived at casualty clearing station 33, where the school of instruction for the Royal Army Medical Corps of the 1st  British Army was in session. The students remained at this center from December 11 to December 23, inclusive, and a separate program for this course is hereby appended.


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Program of first class Field Service School for Medical Officers, A. E. F., in the British lines, 1917


613

Program of first class Field Service School for Medical Officers, A. E. F., in the British lines, 1917--Continued.


    December 23 to 25: Enroute to the Army Sanitary School

PROGRAM AT THE ARMY SANITARY SCHOOL, FIRST SESSION

    December 25: Arrived at the Army Sanitary School from the British front.

    During the period of eight days remaining, from December 26, 1917 to January 5, 1918, inclusive, a period of three complete days was devoted to practical gas instruction, and in the remaining seven days each student was required to write a complete account of his course from notes taken on the tour of instructions just completed. In addition to this, the following lectures were delivered.

    Three hours, by Professor Lemaitre, who came on from the Fifth Army Sanitary School at the request of the commandant to give a lecture on the “Primitive suture of war wounds.”
One hour on the effects of new ordnance, by an officer of the Ordinance Corps.
Two hours on diverse subjects, by Colonel Ashford.
Three hours, by Medecin-Aide-Major Aime, of the French Army, on various phases of war surgery.


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PROGRAM OF INSTRUCTION FOR THE SECOND SESSION, ARMY SANITARY SCHOOL

    Class reported January 9, 1918, at Army Sanitary School, Left for Paris, January 10. Began course, January 11, 7 a.m.

    At the V. R. 76 fracture hospital by Lieut. Col. W. L. Keller, M. C., instructor in military surgery, demonstrator, and lecturer.

Jan. 11:
    8.30 to 10.30 a.m.....................Ward instruction in the treatment of fractures with the different types of splints recommended for use in the United States Army.
    11 to 12 m................................War wounds; wound bacteriology; primary suture--retarded primary suture and secondary suture; traumatic shock.
    1 to 2 p.m.................................Fractures, treatment, and prognosis. Extracts from Doctor DePage’s paper on fractures of the femur. Conclusions on fractures of the femur. Interallied Congress.
    2 to 3 p.m.................................The use of Dakin’s solution, dichloramine-T., and eusol in the treatment of suppurating wounds. Flavine chemical composition and germicidal properties.
    3 to 4 p.m.................................Diagnosis in chest conditions. Extracts from papers by Duval, Tuffier.
    4 to 5 p.m.................................Radiology.
Jan. 12:
    8.30 to 9.30 a.m.......................Ward dressings (staff).
    9.30 to 10.30 a.m.....................Chest and abdomen.
    10.30 to 11.30 a.m...................The new German asphyxiating gas.
    11 to 12 m................................Care of joints, muscles, tendons, and tendon sheaths during treatment of fractures.
    1 to 2 p.m.................................Extracts from paper by Professor Wilhelm on the treatment of joint injuries. Conclusions of Interallied Congress.
    2 to 3 p.m.................................Surgery of the head and spine; conclusions; review of two days’ work.
    3 to 4 p.m.................................Gas gangrene; tetanus.
    4 to 5 p.m.................................Radiology.

    January 13: En route to the school of instruction for medical officers, Fifth French Army.

    On our arrival we were given the following general instructions: The class at this school for this course consisted of 50 medical officers--28 American and 22 French. These were divided into two American groups and two French groups. Instruction was all in French, and after dinner each night the commandant and two other officers, being the only ones who understood the language, rehearsed the substance of the lectures during the day.

    Thus the instruction consisted of all the day and the evening up until 11 o’clock at night; and officers were frequently called in groups to witness operations until 2 a. m. The clinical work in wards and operating room in the daytime between lectures, as well as laboratory demonstrations, completely filled every hour of the day save those set aside for meals. Conferences of the French averaged at least two hours in length. These demonstrations were provided for as follows:

SCHEDULE FOR THE DOCTORS VISITING THIS HOSPITAL TO WITNESS THE VARIOUS PRACTICAL DEMONSTRATIONS

    In order to avoid overcrowding, which would be produced necessarily if all the doctors should present themselves at the same time at the same service, it is recommended that they group themselves in the following order:
    First, visits to the surgical services. - Operating group No. 10, service of M. M. Leriche (fractures) and Roux-Berger (visceral wounds). From the 14th to 19th inclusive, American doctors; from the 21st to 26th, inclusive, French doctors. Operating group No. 15, service of M. Lemaitre (wounds of soft parts). From the 14th to 19th, inclusive, French doctors; from the 21st to 26th, inclusive, American doctors.


615

   Visits and demonstrations of wounded will take place each day from half past 10 till 12 in tile morning.
    Second, practical demonstrations. -  These will begin January 16 and will be held at 3.30 in the afternoon.

    For the purpose of the above, doctors will divide into four groups--two groups American and two French.

[table]
 
GENERAL IN5TRUCTI0NS

    1. The conferences, according to the program appended, will take place at 9 o’clock in the morning and 2 o’clock in the afternoon, in barrack No. 64.
    2. Special exercises or demonstrations in surgical, medical, and laboratory centers will be announced, as the occasion may arise, in the assembly hall in the officers’ mess.
    3. Meals will he served in the various messes at half past 8 in the morning, midday, and 7 p.m.
    4. Visiting officers have at their disposal: (a) The shower baths situated near the mess; (b)the scientific and literary library of tile officers’ mess; (c)the post exchange of the hospital and of the officers in the village of -------
    5. There is a post office in the hospital near the laboratory barrack. Letters should be posted in the evenings before half past 7 in order to leave the next morning. The military address of the hospital is: Ambulance 12/1, Scientific Group, Postal Sector 1224.

Service de Sante Militaire

CONFERENCES ON WAR SURGERY WHICH WILL BE GIVEN IN THE RESEARCH AND INSTRUCTION CENTER OF_FROM THE 14TH TO THE 27TH OF JANUARY, 1918

    January 14 (9 a.m.): General consideration on wounds of war. By the consulting surgeon to the Army.
    January 14 (2 p.m.): Pathology and physiology and anatomy, common to wounds; spontaneous evoldtion; process of cicatrization. By the associate professor in the faculty of medicine of Lyons, chief of a laboratory group.
    January 15 (9 a.m.): Bacteriology of wounds, microbes and the habits of aerobes; suppuration. By a medical officer of the Pasteur Institute.
    January 15 (2 p.m.): Bacteriology of wounds, microbes and the habits of anaerobes.
    January 16 (9 a.m): Antitetanic serotherapy. By the associate professor of the faculty of medicine, surgeon of Paris Hospital, consulting surgeon of the Army.
    January 16 (2 p.m.): Gas gangrene, clinical forms, and treatment. By the chief of a surgical group.
    January 17 (9 a.m.): Treatment of wounds of the soft parts in general by primitive suture; indications, contraindications, and technique. By the chief of a surgical group.
    January 17 (2 p.m.): Disinfection and secondary suture of wounds; indications and various methods of technique.
    January 18 (9 a.m.): Abdominal wounds in general. By the associate professor of faculty of medicine of Paris; consulting surgeon of an Army corps.
    January 18 (2 p.m.): Frost bite of the feet, and trench foot. By the associate professor of Val-de-Grace, medical chief of an evacuation hospital.
    January 19 (9 a.m.): Shell shock. By the associate professor of faculty of medicine, physician to the Hospital of Paris, chief of a medical group.


616

    January 19 (2 p.m.): Fresh wounds of articulations. By the associate professor of the faculty of medicine of Lyons, chief of a surgical group.
    January 20 (9 a.m.): The wounds of the brain.
    January 20 (2 p.m.): General discussion by surgeons--regimental, ambulance, evacuation hospital, base hospital, and biologists--on traumatic shock. Presided over by Charles Richet, member of the Academie Francaise; originator of the theory of anaphylaxis.
    January 21 (9 a.m.): Complications, secondary and late, of wounds of the cranium and brain.
    January 21 (2 p.m.): Spirochetal jaundice.
    January 22 (9 a.m.): Wounds of nerves.
    January 22 (2 p.m.): The open fractures of the diaphysis; principles of their early operative treatment.
    January 23 (9 a.m.): The open fractures of the diaphysis; principles of their orthopedic treatment.
    January 23 (2 p.m.): The wounds of the pleura and the lungs. By a surgeon of the Paris hospitals, chief of a surgical group.
    January 24 (9 a.m.): Indications and general technique of amputations thue to fresh wounds of war. By the chief of auto-chir.
    January 24 (2 p.m.): The technique of radiologic assistants to the surgeon in the surgical units of the advance; the demonstration of apparatus and methods. By the associate professor of the faculty of medicine of Lyons, chief of the base laboratory of radiology.
    January 25 (9 a.m.): The wounds of the eyes. By an ophthalmologist of the Paris hospitals, chief of the opthalmologieal center of a surgical group.
    January 25 (2 p.m.): Lecture by an officer of the General Staff of the French Army on the tactical disposition of medical units of the advance and lines of communications.
    January 26 (9 a.m.): Wounds of the blood vessels.
    January 26 (2 p.m.): Organization and administration of first-aid units and divisional ambulance companies. By an associate professor of the faculty of medicine of Nancy, chief of a divisional ambulance.
    January 27 (9 a.m.): Gas in War; general review; treatment of intoxication produced by asphyxiating gases. By the chief of medical legal center for the Army.
    January 27 (2 p.m.): Visit to Rheims and regimental and field ambulance stations therein.
    January 28 (9 a.m.): Visit to the trenches by the two groups of American medical officers.
    January 29: Visit to the trenches of the otimer two remaining groups of American medical officers.
    January 30: En route to Paris. On the way, visit to hospitals and a medical legal center for the French Army.
    January 31 (9 a.m.): Operative clinic; removal of projectiles from healed chests on the X-ray operating table at Hospital 16, Rue Leroux.
    January 31 (4 p.m.): Plastic surgery.
    (1) Conference, with the following subprogram, on the mutilation of the palate and vestibulo-palatine region of war wounds.
    (2) Operative clinic:
    (a) Restoration of lower lip by autoplasty.
    (b) Reparation of a loss of substance from the cranium by cartilaginous -transplanting.
    (c) Reconstruction of the cheek bones by cartilaginous graft.
    (d) Restoration of the lower eyelid.
    (e)Rhinoplasty.
(f)Various plastic operations.
    February 1 (9.30 a. rn): Demonstration of wound dressing by the Carrel-Dakin method.
    February 1 (4 p. m.): Nerve lesions incident to war wounds.
    February 2 (8.30 a. m.): Special operative clinic. At the Lycee Buffom.
    February 2 (2 p. m.): Inspection of the Val-de-Grace Medical Museum.
    February 3: En route from Paris to the Army Sanitary School.


617

PROGRAM AT THE ARMY SANITARY SCHOOL

    (NOTE--The total number of hours concerned in instruction each day was from 5 to 6 hours; but the officers completed a full 9 hours each day by writing up their notes on the visit to the front.)

Feb 4:
    9.30 to 11.30 a.m ..................Field messages.
    3.10 to 4.30 p.m.....................Tactical problems (staff college).
Feb. 5:
    9.30 to 11 a.m. ......................Personal hygiene.
   1.15 to 4.30 p.m......................Gas instruction (at Army Sanitary School)
Feb. 6:
    8.30 to 10. a.m........................Obturators fo the ears of artillerymen. By a medecin-aide- major of a French surgical hospital.
   10 to 11:30 a.m........................Wounds of soft parts. By a medecin-major major of a French surgical hospital.
   1.15 to 4:30 p.m......................Gas instruction.
Feb. 7:
    8.30 to 10. a.m.......................Obturators for the ears of artillerymen.
    10 to 11.30 a.m........................Lesions of bones and articulation in war. By a medicin-major of a French surgical hospital.
    1:15 to 4.30 p.m.....................Gas instruction.
Feb. 8:
    10 to 10.50 a.m. ......................Fractures in war.
    10.50 a.m. to 12 m..................Casualty clearing stations.
    2 to 3:30 p.m..........................Map reading (engineer school).
Feb. 9:
    9.30 to 10.30 a.m...................War game (at staff college).
    10.30 to 11.30 a.m.................Casualty cleaning stations.
    2 to 3 p.m..............................The Medical Department in the trenches.
Feb. 11:
    9.30 to 10.30 a.m...................Comparison of medical services.
Feb. 12:
    9.30 to 10.30 a.m...................Regimental surgeon in trench warfare.
    10.30 to 11.30 a.m.................Line of communications.
    2 to 3 p.m...............................Field hospitals.
    3 to 4 p.m................................Report of a visit to scabies hospital, corps rest station, motor ambulance convoy, stationary ambulance 29, and General Hospital 70, in The British lines.
Feb. 13:
    9:30 to 10.30 a.m...................Line of communications.
    10.50 to 12 a.m......................Genitourinary surgery and venereal disease.
    2 to 3 p.m...............................Comparisons of medical services.
    3 to 4 p.m...............................Some medical aspects of the Battle of Cambrai. By an officer who took part in this battle.
Feb. 14:
    9.30 to 10.30 a.m...................Ambulance companies.
    10.50 to 12 a.m......................Genitourinary surgery and venereal diseases.
    2 to 3 p.m................................Casualty clearing stations and evacuation hospitals.
    3to 4 p.m.................................Battle of Cambrai.
Feb. 15:
    9.30 to 10.30 a.m...................Oral hygiene.
    10.30 to 12 a.m.......................Genitourinary surgery and venereal disease.
   2 to 3 p.m................................Pneumonia. By commander of officers’ hospital for the Army school area.
   3 to 4 p.m................................Comparison of medical services.


618

Feb. 16:
    10 a.m.....................................Shock
    1.30 p.m.................................Dugouts. By officer of Engineer Corps.
Feb. 18:
    9 to 10.20 a.m........................Map reading, conference.
    10.30 to 11.30 a.m..................Hygiene in trenches and rest areas.
   1.30 to 4.30 p.m.....................Map reading, problem
Feb. 19:
     9 to 10.20 a.m......................Map reading, conference.
    10.30 to 11.30 a.m.................Hygiene in trenches and rest areas.
    1.30 to 4.30 p.m.....................Map reading, problem.
Feb. 20:
    9 to 10.20 a.m........................Map reading, conference.
    10.30 to 12 a.m......................Map reading, problem.
    2 to 4 p.m...............................Demonstrations of French system of physical exercises.
Feb. 21:
    9 to 10 a.m.............................Operative treatment of wound shock.
   10.30 to 11.30 a.m..................Shock.
   1.30 to 4.30 p.m......................Map reading, problem.
Feb. 22:
    Trench fever. Return of class to their stations.   

CHART  -  PROGRAM OF THIRD CLASS OF THE ARMY SANITARY SCHOOL

PROGRAM OF THIRD SESSION OF THE ARMY SANITARY SCHOOL
March 4 to 28

TRIP TO BRITISH FRONT

     The class left as per the attached order for the school of instruction of the Royal Army Medical Corps, of the First Army, March 4, arriving March 6, 1918.
    One of the class, Major Poole, was called to the American front on an operating team the 3d of March and did not accompany the class.
    The English had arranged for instructions to be given conjointly with a British class of some 20 medical officers.
    The course of this school concluded March 16, and the class left for a course at the base, 13 officers going to one of the largest base ports in the English Army and 14 going to a similar base port elsewhere. The course of these two groups was similar, but tile instruction its Group 1 was more extensive. These programs are separately attached under headings program, Group 1, and Group 2, at base.
   These groups left their respective base ports on the 21st of March and were again consolidated into a single class to spend five days in the hospitals of Paris, arriving there on the 21st.


619

FIRST ARMY, R. A. M. C., SCHOOL OF INSTRUCTION


620

Second American medical officers' course--third class Army Sanitary School, March 3 to 16, 1918

PROGRAM AT A BASE PORT, BRITISH ARMY
Group 2, under the command of Lieutenant Colonel Porter

March 16:
    Arrived at Etaples; met by representative of C.C.M.S. and taken to a British Experitional Force canteen club, where the class was installed in cubicles adjoining the officers’ club and dining room.
March 17:
    10 a.m. Reported to Colonel Bearford, C.C.M.S. and met Captain Childs, special sanitary officer.
    2 p.m. Visit to large camp laundry and ablution huts, and reinforcement Camp E.
March 18:
    a.m. Visit to fat reclamation establishment, sanitary section camp and workshops.
    p.m. Visit to kitchens of reinforcement camps and latrines of same.
March 19:
    a.m. Visit to W. A. A. C. Camps. Visit to St. Johns Ambulance Brigade Hospital.
    p.m. Visit to No. 51, General Hospital (venereal), and No. 15, General Hospital.


621

March 20:
    a.m. Visit to observation surgical wards (experimental). Visit to Canadian General Hospital No. 1, femur wards.
    p.m. Visit to hospital ambulance ships, Bologne; convalescent camp.
March 21:
    Return to Paris.
March 22:
    9.a. in. At the Hospital Beaujon; lecture on “Surgery of the Chest,” followed by operative clinic, and demonstration of the orgazization of the French Medical Service in War.
    2 p. m. Visit to the Val-de-Grace Museum.
March 23:
    7 a.m. to 6 p. m. Visit fracture hospital, French Army, V. R. 76.
(a)Bedside clinic and demonstration of cases and appliances.
    (b) Lecture on war surgery, and organization of the Medical Service or the French Army.
    (c) The débridement of war wounds.
    (d) Transfusion of blood.
(e)Wilhelm’s treatment of joint injuries.
(f )Lecture and demonstration of apparatus and a lantern exposition, by radiologist of the hospital.
March 24:
    Visit and demonstration of cases at St. Nicolas Hospital for the burned; ambrine treatment and the injection of refined guiacol with oil for the diminution of scar tissue.
March 25:
    9 a. in. Demonstration of dressing by Carrel-Dakin method in the Hospital Lycée Buffom.
    4 p. in. Clinic lecture with demonstration of cases and methods of diagnosis at Professor Babinski’s Clinic at Lycée Buffom, subject: “The diagnosis of obscure nerves of the diseases and injuries of the nervous system in war.”
March 26:
    8 a. m. Special operative clinic on war surgery at the Lycée Buffom; p. m., visits to the various hospitals in Paris.
March 27:
    8.15 a.m. Lecture by Professor Morestin, military hospital at Val-de-Grace on cranioplast in wounds of war; followed by operative clinic at which the following operations were performed:
    (1) Rhinoplasty.
    (2) Cancer of the tongue with a complete removal of glands surrounding vessels of the neck, the external dissection of the tonsils and part of the palatine arch, by Professor Morestin.
March 28:
    En route from Paris to the Army Sanitary School.

[table]


622

     As noted in the following communication, beginning with the fourth course the policy of the school was changed with respect to the length of the course and the number of students attending. These changes were in line with the following communication from general headquarters, A. E. F., to the commandant, Army schools :

GENERAL HEADQUARTERS,
AMERICAN EXPEDITIONARY FORCES,
France, March 4, 1918.

From:  The Adjutant General.
To: The commandant, Army schools.

Subject: Army Sanitary School.

    1. In order to secure economy, efficiency, and systematized training of officers of the Medical Department, it is desired to consolidate all school instruction of medical officers at the Army Sanitary School; and for the purpose of securing a greater flow of students through this school, to increase the classes to at least 50 medical officers and to shorten the length of the period of general instruction to one month at the Army Sanitary School. But it is still desired to semsd 25 studersts of each class who have shown the greatest aptitude in their work to some sector of the allied front on a visit of instruction of two weeks duration where they may receive special trairsing in order to render them available for duty as instructors in the corps and division.

    2. Instruction of medical officers as outlined should begin with the fourth class, which will be ordered to report to the Armny school about April 7, 1918, and should follow as closely as practicable the inclosed schedule, particular attention being given to instruction by map problems and terrain exercises. It is desired that such arrangements as may be necessary he made for future classes upon this basis.

    3. In view of the necessity for instruction of dental officers in order to prepare them for duty with troops; the inadvisability of establishing a new dental school in Paris arid elsewhere; and the economy in teaching force, equipment, and housing of the dental school, established as it now is as a section of the Army Sanitary School, it is deemed best that it corstinue at Langres.

By command of GENERAL PERSHING:
F.R. KINNEY, Adjutant General.

PROGRAM OF INSTRUCTION, ARMY SANITARY SCHOOL - ONE MONTH

1. Administration:         Hours
    General orders and circulars, American Expeditionary Forces; bulletins and circulars, chief
     surgeon, A. E. F.; field records of sick and wounded;Property and individual accounts........4
2.  Military sanitation:
   Personal hygiene, venereal prophylaxis, care of feet.................................2
     General hygiene-march, camp, trench, combat, disposal of the dead.........................................4
    Water--supply, examination, treatment....................1
     Food--supply, preservation, preparation..................1
    Clothing--supply, cleansing....................1
    Laundries--devices, methods......................1
    Bathing--devices, methods, delousing, insecticides.................2
    Shelter--selection, improvization, construction of huts, barracks, billets, and their
sanitary inspection...................1
    Disposal of wastes--human, animal, kitchen, and camp garbage..................................................2
    Standard sanitary devices--demonstration and description of use..............................................2
3.  Military surgery:
    Sepsis, antisepsis, shock--special wounds, special methods of treatment................................10
4.  Military medicine:
   Psychology, psychiatry, malingering, special diseases, including treatment of gas poisoning..........10


623

5. General instruction:         Hours
    Organization of the expeditionary forces..........................................1
    Disposition of combatant and auxiliary troops--march, attack, defense, retirement. trench.....4
    Field orders........................1
   Field sketching.....................16
    Artillery and infantry weapons--effects...............1
   Fire cover--use and construction, trenches, dugouts, bombproofs, drainage, and
ventilation.....................4
   Field transportations-use and care of animals, their equipment, wagons, and motors...............8
     Gas defense--agents used, wind, alarms, methods, and devices for protection  and
    removal; gas drill................18
6. Military tactics:
    Sanitary units--equipment and functions.......................4
   Casualties--classification and disposal........................2
    Field duties-of unit commanders, directors, surgeons........................2
    Problems--map and terrain exercises, battalion, regiment, brigade, division in attack,
    defense, retirement....................54
7. Visit of instruction: At the close of each course 25 officers of each class showing the
    greatest aptitude will he coiaducted on a visit of instruction of two weeks’ duration to
    some sector of the allied front where they will he given special opportunities for observation
    and training.

    The instruction will consist of demonstrations and problems for the purpose of training officers in handling sanitary units and the evacuation of casualties of field service. Instruction in hygiene, sanitation, administration, and medicine and surgery will be limited to preparation for the mastery of problems presented by service conditions to be encountered by the expeditionary forces. The time to be given to the various subjects as laid down in program is merely advisory, except in regard to sanatary tactics to which full time will be given.

    After the fourth session of the school the tours for instruction were made principally to the American sector and written reports were not made by the officers conducting these tours.

PROGRAM, ARMY SANITARY SCHOOL

FIFTH SESSION (OFFICERS)

    Daily, except Sundays and holidays, 6.15 to 7 a. m., drill and setting-up exercises.

    First period, 9 to 10.30 a. m.; second period, 10.30 a. m. to 12 m.; third period, 1.30 to 3 p. m.; fourth period, 3 to 4.30 p. m.

FIFTH SESSION (OFFICERS)


624

FIFTH SESSION (OFFICERS)


625

CANDIDATES FOR COMMISSION IN MEDICAL RESERVE CORPSb


626

SIXTH SESSION (SECTION I)


627

SIXTH SESSION (SECTION I)[continued]


628

SIXTH SESSION (SECTION II)


629

SIXTH SESSION (SECTION II)[continued]

SEVENTH SESSION


630

SEVENTH SESSION [continued]


631

EIGHTH SESSION


632

EIGHTH SESSION [continued]

NINTH SESSION

    Daily, 7.45 a.m., breakfast.

    (NOTE. - The numbers after the titles refer to articles in the mimeographed literature of the school which should be studied the day previous. When there are many numbers and the time is limited, use index in making selections.)
    First period, 8.30 to 9.30 a.m.; second period, 9.40 to 10.40 a.m.; third period 10.50 to 11.50 a.m. fourth period, 1.30 to 2.30 p.m.; fifth period, 2.40 to 3.40 p.m.; sixth period, 3.50 to 4.50 p.m.

Saturday, November 2:
    Clinic at Base Hospital No. 53.
Monday, November 4:
    Departure for central Medical Department laboratory.
Tuesday, November 5:
    Course in shock and hemorrhage and the treatment of these conditions, at central Medical Department laboratory.
Thursday, November 7:
    Return to Army Sanitary School.
Friday, November 8:
    Lecture, demonstration, and drill in the use of the Thomas splint and other splints.
Saturday, November 9:
    The treatment of venereal cases, clinic.


633

Monday, November 11:
    1. The Army kitchen and the feeding of men: Conservation of food (42, 51, 135).
    2. Mental hygiene (40, 52).
    3. Evacuation of wounded (1, 2, 11, 20, 27, 50, 64, 92, 120, 138).
    4. The field hospital and ambulance company (135, 54, 73, 76, 91).
    5. The regimental and battalion surgeon and the battalion aid station in trench warfare (9, 13, 14, 18, 19, 100, 102, 103, 104, 120, 143).
    6. Duties of the evacuation officer of an army.
Tuesday, November 12:
    1. The regimental and battalion surgeon in a war of movement (12, 63, 100, 120, 143).
    2. General personal hygiene (4, 5, 7, 34, 116, 118, 130).
    3. Map reading.
    4. Sanitation in billeting areas and during troop movements (25, 26, 55, 58, 126, 129).
    5. Medical supplies.
    6. Medical supplies.
Wednesday, November 13:
    1. Evacuation of wounded in a war of movement; experience in the 1st Division (27, 92, 138).
    2. Reserve and front-line samiitation (25, 26, 34, 80).
    3. Map reading; lecture.
    4. Baths, disinfestation, and field laundries (37, 118).
    5. General orders, bulletins, and cireulars, American Expeditionary Forces.
    6. Map reading; lecture. Thursday, November 14:
Thursday, November 14:
    1.| General gas instruction (beginning at 8.30 a. mu.); gas school.
    2.| General gas instruction (beginning at 8.30 a. mu.); gas school.
    3.| General gas instruction (beginning at 8.30 a. mu.); gas school.
    4.| General gas instruction (beginning at 8.30 a. mu.); gas school.
    5.|General gas instruction (beginning at 8.30 a. mu.); gas school.
    6.| General gas instruction (beginning at 8.30 a. mu.); gas school.
Friday, November 15:
    1. Demonstration of sanitary appliances in the school area; sanitary squads (25, 55,
    2. 58, 126).
    3. Sanitary devices in the school area (25).
    4.| Map problem; a move by rail.
    5.| Map problem; a move by rail.
    6.| Map problem; a move by rail.
Saturday, Novemnber 16:
    Map problems; comiferemice; defense schemes.
Monday, November 18:
    Map problem; conference; a raid.
Tuesday, November 19:
    Map problem; conference; preparation for attack.
Wednesday, November 20:
    Map problem; conference; road block; liaison.
Thursday, November 21:
    Return to proper stations.

TENTH SESSION

    (NOTE - The numbers after the titles refer to articles imi the mimeographed literature of the school which should be studied the day previous. When there are many numbers and time is limited, use index in making selection.)

    First period, 8.30 to 9.30 a. m.; second period, 9.40 to 10.40 a. m.; third period, 10.50 to 11.50 a. m.; fourth period, 1.30 to 2.30 p. m.; fifth period, 2.40 to 3.40 p. m.; sixth period, 3.50 to 4.50 p. m.


634

Thursday, November 21:
    1. Opening address.
    2. Tactics (151).
    3. Evacuation of wounded (64, 92).
    1. 3 0 to 3 p. m. The amnbulamuce company and the field hospital (13, 14, 18, 19, 73, 76, 91, 102, 103, 104, 110, 145).
    3 to 4.30 p. m. Organization of the American Expeditionary Forces (141b).
Friday, Novemnber 22:
    1.The medical problem of regiments and battalions (25, 26, 55, 58, 126, 129).
    2. Map reading; lecture.
    3. The prevention of venereal diseases (7, 8, 16, 125).
    4. The treatment of venereal diseases (31, 39, 56, 107, 108, 134).
    5. Neurological problems in army hospitals.
    6. War neuroses (pamphlet in library).
Saturday, November 23:
    1. General gas instruction.
    2. General gas instruction.
    3. General gas instruction.
    4. General gas instruction.
    5. General gas instruction.
    6. General gas instruction.
Monday, November 25:
    1. Area sanitation (25, 26, 55, 58, 126).
    2. Disposition of combat and auxiliary troops on the march and in combat.
    3. Sanitary tactics (151, 153).
    4. Map reading; lecture.
    5. The regimental surgeon.
    6. The functions of the director of ambulance companies.
Tuesday, November 26:
    1. Map reading; lecture.
    2. Disposition of combat and auxiliary troops on the mnarch and in combat.
    3. The treatment of effects produced by mustard gas (72, 132, 139, 140, 147).
    1.30 to 3 p. m. Shock and hemorrhage and the treatment of these conditions (106).
    3 to 4.30 p. m. Shock amid hemorrhage amid the treatment of these conditions (106).
Wednesday, November 27:
    1. The treatment of effects produced by phosgene (72, 132, 147).
    2. Field transportation.
    3. The division psychiatrist.
    4. The division orthopedist.
    5. The division medical supply officer.
    6 Skin diseases.
    Venereal diseases.
Thursday, November 28:
    Thanksgiving Day.
 Friday, Novemnber 29:
    1 The care of wounded in advance areas.
    2. Investigation and treatment of shock (46, 115).
    3. Chest wounds (44).
    4. Chest wounds (44).
    5. Sanitation in corps areas (25, 26, 55, 58, 126.)
    6. Consideration of the heart under war conditions; the effort syndrome (136).
    7. Convalescent camps (23, 122, 128, 149).
Saturday, November 30:
    1. General orders, bulletins, etc., American Expeditionary Forces (141b, 150, 152).
    2. Artillery and Infantry weapons (117).
    3. Skin diseases in the American Expeditionary Forces.
    4. The mobile hospital.


635

Monday, December 2:
    1. Medical supplies.
    2. The division urologist.
    3. The duties of the evacuation officer of an army.
    4. The organization and general activities of the division of orthopedic surgery.
    5.  The organization and general activities of the division of orthopedic surgery.
    6. The organization and general activities of the division of orthopedic surgery.

Tuesday, December 3:
    1. Problem; billeting and moving.
    2. Problem; billeting and moving.
    3. Problem; billeting and moving.
    4. The intervention of the military surgeon in otolaryngological cases (127).
    5. Duties of the director of ambulance companies.
    6. The divisional medical supply officer.
Wednesday, December 4:
    1. Problem; defense plans.
    2.  Problem; defense plans.
    3. Problem; defense plans.
    1.30 to 3 p. m. Duties of the director of field hospitals.
    3 to 4.30 p. m. The evacuation hospital. 
Thursday, December 5:
    1. Problem; defense plans.
    2. Problem; defense plans.
    3. General considerations in the wounds of war (17, 33, 43, 74, 97, 131, 137).
    4. Film; “Fit to Fight.”
    5. Film; “Fit to Fight.”
    6. Film; “Fit to Fight.”
Friday, December 6:
    Return to proper stations.
    The following problems were given in connection with the training in Field Service Regulations and sanitary tactics: c

MAP PROBLEMS Nos. 1 TO 20, INCLUSIVE (DECEMBER 1, 1917, TO DECEMBER 17, 191

    I. Miscellaneous problems in map reading: February 5, 8, 11, 19, 20, 21, 1918.
    II. General problems in sanitary tactics (open warfare): Problem I, Problem I (solution), Problem II, Problem II (solution), Problem III, Problem III (solution), Problem IV, Problem V.
    III. Specific problems in sanitary tactics (with required map): Problem VI (with solution), sanitary service of an Infantry division intrenched in defense (issued by G-5, general headquarters, A. E. F.). Problem VII (with solution), distribution of equipment and personnel and transportation (based on Problem VI). Problem VIII (with solution), a move by rail with Notes on tactical moves,” and Tables of Organization. Problem IX (with solution), relief of a division in the line, with “Notes on reconaissance and relief.’’ Problem X (with solution), “A division in defense” (following the St. Mihiel offensive). Problem XI (with solution), a raid by two battalions (sequel to problem E). Problem XII, a divisions attack (with solution). The beginning of the Foret d’Argonne offensive with “Notes on attack.” Problem XIII (with solution), difficulties arising during attack. Part I. Roach block; Part II. Liaison, with “Notes on liaison.
    NOTE--Problems X to XIII, Part I (inclusive), are based on actual situations that arose in the American Expeditionary Forces, and the orders mused are extracts from the actual orders as issued.

C Problem No. IX is reproduced in this volume as an example of the problems given.


636

MAP PROBLEM IX
(Map of Langres, 1: 20,000)

    The sanitary service of a regiment during the relief of a division in the line.

(a)General situation:
    The American 2d Division holds the Langres sector of the line, Chanoy--Humes--Brevoines--St. Geomes--Cohons, facing west.
    The American 1st Division is located in corps reserve in the Lecey area.
    At 8.30 a. m. on September 13 the following telegram is received from the First Corps (headquarters at Plesnoy):
    The American 2d Division will be relieved in the line by the American 1st Division. Relief to be completed by September 20. Arrangements between divisions. Completion of relief to be reported by wire. Acknowledge.

(b)Special situation:
    The 1st Infantry is billeted as follows: Headquarters 1st Infantry, Mont Landon; 1st Battalion, Mont Landon; 2d Battalion, 3d Battalion, Celsoy.
    At 6 p. m., September 14, the colonel, 1st Infantry, sends for the regimental surgeon and gives him the following instructions:
    This regiment will relieve the 8th Infamutry which now occupies the subsector on the extreme left of the divisional sector. The relief will begin on September 17 and will be carried out as follows:
    On September 17 the 2d Battalion, 1st Infantry, will relieve the reserve battalion, 8th Infantry. Relief to be completed by noon.
    The 1st Battalion, 1st Infantry, will march so as to reach the support line at 10 p. m., relievimig the support battalion, 8th Infantry.
    On September 19, the 3d Battalion, 1st Infantry, will relieve the 2d Battalion, 1st Infantry, by noon; after dark the 2d Battalion will relieve the 1st Battalion, 1st Infantry, and the 1st Battalion, 1st Infantry, will move forward and relieve the battalion, 8th Infantry, now in the line.
    You will go ahead with our advance party. Motor transportation will be provided for the party. It will leave here tomorrow at 1 p. m. Examine the sanitary situation carefully and be prepared to go over your findings with me on the 16th. You will meet me at the post of command, 8th Imufantry, at 6 p. m., September 16.”

    The regimental surgeon, 8th Infantry, says he will turn over to the 1st Infantry the following list of trench stores, now distributed throughout the regimental sector:
    Thomas half ring length and leg splints (BK)....................18
    Thomas arm splint (hinged) Murry’s modification............12
    Wire, gauze rolls ........................24
    Stretcher bars....................18
Z.O. adhesive:
     5-yard rolls.....................4
     2-inch rolls...................12
      Standard litters.................24
    Blankets................50
    Burner’s oil......................6
    A.T. S. (1, 500 units each)....................2,000
    French gas masks....................200

    Front dressing packets, assorted sizes. Exact number unknown, but thinks there are a good many.
    Requirements.--(1) As regimental surgeon of the 1st Infantry relieving the 8th Infantry, make the actual reconnaissances and submit a written report to the division surgeon, 1st Division, covering the following points:
(a)Date and hour at which reconnaissamuces were made.
    (b) Adequacy of present sites occupied by aid posts, and changes recommended, if any are desired.
(c)A list of trench stores (not included in regimental combat equipment) that will be needed to supplement those taken over from the 8th Infantry.
    (2) As battalion surgeon of the 1st Battalion, 1st Infantry, relieving the battalion, 8th Infantry, in the line, write out in detail your action immediately prior to and during the relief.


637

A SOLUTION TO MAP PROBLEM IX

OFFICE OF SURGEON, 1ST INFANTRY,
September 16, 1918 - 8 p. m.

From: Regiment surgeon, 1st Infantry.
To: Division surgeon, 1st Division.
Subject: Report of reconnaissance of left subsector, 2d Division.

Requirement I

    1. The following recommendations are based on reconnaissances made after 8 p. m., September 15, and between 5 and 7 a. m., September 16.
    2. (a)Aid station, first-line battalion, is very far to the right of the sector and 300 mu. from battalion P. C. The dugout, however, is excellent. No change recommended at present.
(b)Aid station, support battalion, is located away from trenches on high ground in an open field. Have planned to reserve this for handling of gassed cases only. Regiment aid station is so located as to be able to care for support battalion for the present.
    (c) Aid station, reserve battalion, has both a good location amid an excellent dugout. Owing to the proximity of the ambulance dressing station (250 m.), have planned, subject to approval of director of ambulance company, to hold in reserve the station of reserve battalion, equipped and ready for use, as an alternative ambulance head in case shelling makes either untenable. The ambulance dressing station can then serve the reserve battalion direct. I can reinforce their station with my personnel if necessary.
    3. The following list of trench stores will be needed to supplement those taken over from the 8th Infantry:

[table]


638

[table continued]

    NOTE. - This is special surgical equipment and not intended to replace battalion combat equipment, paragraph 866, Manual for the Medical Department, but will be in addition to it.

    X,  
    Major, Medical Corps.

    Requirement 2. - Upon notification (morning of September 15) by battalion major of the proposed relief; advise that the battalion be given, on September 16 (1) a complete physical inspection including feet; (2) a special gas drill, with careful inspection of gas masks.
    September 15: Check over the battalion’s share of the regimental combat equipment. Inspect equipment of Medical Corps detachment. Go over with them: (1) The care of gassed cases; (2) the importance of secrecy in all moves; forbid discussion of move; (3) action to be taken in case of capture.
    September 16: Hold physical inspection of battalion; talk to them on “care of feet” in trenches. Evacuate all sick with command. Move forward with the battalion.
    September 17: Distribute two dressers and a litter to each company. The rest of the detachment, I divide with assistant battalion surgeon. I take the head of the battalion and he stays with the rear group. Division surgeon has arranged to have a horse ambulance assigned to the battalion for the march. This is held at the rear of the battalion.
    10 p. m.: I relieve the battalion surgeon 8th Infantry. I find my regimental surgeon has arranged for him to leave his assistant battalion surgeon and two enlisted men with me until the night of September 18. As soon as my assistant battalion surgeon arrives, I leave him at the battalion aid station and go over to regimental aid station. I get all the details of situation fromn regimental surgeon. I open only enough equipment for emergency work, in view of the short stay at this point.
    September 18, at daybreak, I go up to the first line battalion aid station and with the battalion surgeon, 8th, make reconnaissances of fire trenches, company aid posts, routes of evacuation, number and location of the “direction markers” for litter hearers, gas curtains of dugouts, water bags, trench latrines, drying facilities, etc.
    September 18, at nightfall, I send my assistant battalion surgeon up to make similar reconnaissances. Send one litter squad along to remain there and become familiar with the trenches prior to the relief.
    I carry out the relief on the night of the 19th, relieving all men at battalion aid station and in company aid posts of the first line battalion.


639

Sample of a march and relief table (accompanying a field order)


640

NOTES ON RECONNAISSANCE AND RELIEF

(For issue in connection with map problem No. IX)

     Study Field Service Regulations, pars. 9 to 32.
     The formal relief of combat units in the line is a most frequent event. It is carried out by divisions within Army Corps; by battalions within divisions; by companies within battalions. In trench warfare it serves a twofold purpose in that troops on the firing line are prevented from “going stale” and opportunity is afforded for periods of training and rest of a degree which is impossible while actually in the line. In open warfare temporary checks will certainly occur entailing reliefs in the front line of the advancing columns. As in the case of all troop movements, success depends upon teamwork in which every detail has been thought out and provided for in advance. This is ordinarily done and issued in the form of an administrative order prepared by the G-1 branch of the divisional staff. Occasionally when a relief is of a very hurried nature, supplementary instructions may be necessary. Upon the division order, subordinate commanders in turn base their instructions to their subordinates and so on down to the last soldier. In the case of hurried reliefs the younger officers must take the initiative and not wait for those higher up. This demands that they have thought out their course of action often enough to be in a position to interpret in their act the will of their commander.

    The movements of the troops in and out of the line may be carried out by road march, bus and trucks, or tactical trains, according to distances to be covered and the condition of the men. Billeting parties should invariably be sent forward by march or truck 24 hours ahead of their units, with suitable advance parties for taking over any trench stores, dumps, etc. As soon as possible after the orders for the relief are received the commanding general and a representative of each branch of the staff proceed to the new area in order to hold the necessary conferences and make any desired reconnaissances. The G-1 representative at once notifies his technical advisers. The division surgeon is the one with whom we are especially concerned--and they proceed to the new area to familiarize themselves with the new situation.

    The division surgeon will consult, first, with his new corps surgeon and then with the division surgeon of the area which he is to take over. His reconnaissances will include the situation of battalion aid and ambulance dressing stations, stations for slightly wounded, locations of field hospitals, and ambulance companies, routes of evacuation, quantity and quality of the water supply, sanitation and bathing facilities. He will also make inquiry regarding the enemy’s shelling routine and the location of any regularly shelled points; any outstanding features of the situation and finally (if necessary from his division G-1) the defense scheme which has been adopted for the area--especially the section dealing with gas defense. This information will then be distributed and certain phases turned over to selected subordinates for further investigation.

    In the meantime the divisional staff will have drawn up a general plan to which the details of the relief will be made to conform. It is the policy to allow subordinate commanders to arrange their own methods of relief in accordance with the general plan. This is especially true with regard to the medical units. Consequently it is all the more important that they understand fully the entire system of relief, in order that the plans they submit be reasonable. The division surgeon is asked to submit draft tables of relief to be woven into the general table of relief and made to coincide with the total scheme. This latitude is given because the medical units and certain other branches like the Engineers and Artillery serve a dual interest as they participate in general schemes reaching outside the divisional limits. The corps medical officers initiate and control the territorial responsibility of the divisional Medical units.

    The plan of relief is adapted to each local situation but in general observes the following rules:

    The front-line Infantry of contiguous regimental fronts are not relieved simultaneously.

    The relieving unit should be in support or reserve the day before relieving a front line unit to allow for final reconnaissances and the completion of arrangements generally.

    The Infantry and machine guns in a regimental sector should not be relieved on the same day.


641

   All the batteries in a Field Artillery battalion should not be relieved on the same day.

    Guns are usually exchanged instead of moving them from their emplacements.

    Combat equipment is exchanged as far as possible. Trench stores are taken over and signed for. This applies especially to the equipment of aid stations.

    Regimental surgeons are usually sent forward with the advance parties, to familiarize themselves with the locations of the aid stations, and take over any medical stores which will be left by the outgoing unsits. It is customary in a divisional relief for at least one medical officer of the outgoing regiment to remain 24 hours if necessary after the relief of his unit-- until the new medical group is functioning smoothly.

    Ordinarily, when time permits, the relieving division moves up into a corps staging area immediately in the rear of the first line division, and the units exchange places observing the rules just cited. It is important to arrange for guides to meet the new units going in at night and conduct them in small groups to their new post. This requires clear and concise arrangements. Simplicity is the secret of success.

    The supply question during relief is usually carried out by mutual arrangement. The division holding the area is responsible in either case for all troops in its area and changes with the change of command. In fact all units entering the new area are under the command of the commanding general of the division being relieved, until the command passes which is usually upon the relief of the last unit in the front line.

    It is the policy of relieving divisions to occupy the billets and horse standings of the previous similar unit. It is a good general rule not to change anything, except in the case of glaring defects, until you have tried it out a while. There are so many details to be arranged that no matter how much time there is it will never seem enough. You will always feel that the division being relieved is taking away more equipment than it should and also that they are not taking sufficient precautions to conceal the relief, which is often true owing to the relaxation of the troops upon being relieved. These are some of the difficulties which require considerable tact if they are to be properly dealt with.

    Every precaution must be taken to prevent the enemy becoming aware that the relief is in progress--for the hour of relief is the most vulnerable point of a combat unit’s normal life. This fact is known to the enemy and always taken advantage of in case the relief is detected while in progress. It is essential that there be no departure from the usual appearance of the sector. All reconnaissances should therefore be made in the very early hours of the morning or late in the evening. If there is any departure from the habits of the relieved units, it is quickly noted in the observation posts of the enemy and surprise attacks will be quickly delivered in order to obtain identifications and knowledge of the relieving unit. If any changes are to be made in the new sector they should be made only after the relieving division has become settled in the sector and knows the need of the changes from actually living there. I heard Major General Duncan say that at the battle of regiments, the regiment made two attacks in 5 days, advancing their line absolutely according to schedule as planned, but were relieved at the end of 12 days in the line. The enemy obtained information of the relief going on, and the losses of this regiment in withdrawing were as great as they had been during the two attacks.

    In order to make observation from hostile airplanes difficult, the following rules should be adhered to:
    (1) While a hostile plane is directly overhead, stand perfectly still; if the plane is seen approaching, and time permits, get in the shadow of a tree or house before he gets overhead.
    (2) Trucks and ambulances should be stopped to one side of the road in the shadow of trees or along the edge of a wood or in a town.
    (3) At night--when a flare or star shell suddenly bursts--stop moving until darkness again intervenes.
    (4) Camouflage is only valuable if put up before any changes of the ground are made. Remember that camouflage in itself arouses the enemy’s curiosity.
    (5) Smoke can give away the location of rolling kitchens. The practice of lining up with mess kits should not be used in forward areas. A shell directed at a rolling kitchen may get the whole line.


642

     During a relief it is essential that the Medical Department function smoothly. It must at no moment be unprepared for casualties due especially to a hospital raid or gas attack. The medical units must continually bear in mind the main issues:
    1. The interest of the outgoing units.
    2. Security during the relief.
    3. Security immediately after the relief.
    4. The comfort of all troops.

    Simultaneously with the school for medical officers, there was established a section for officers of the Dental Corps,4 the history of which follows.

DENTAL SECTION d

ORGANIZATION AND INSTRUCTION

     With the arrival of the first contingent of the American Expeditionary Forces in France, the question of training officers and men in various arms of the service became one of the most serious problems. In a large measure the men who composed the 1st Division had seen previous service, thus making the training problem more simple. However, officers of the Dental Corps, drawn largely from civil life, were badly in need of organized instruction before they could function in their proper capacities. Their ideas and standards of dental service had their foundation in long-established customs of civilian life, where equipment was complete and where environment was more favorable for the practice of the profession. The new conditions as presented in France at the start seemed to bring up the difficulties of proper adaptation and proper observance of military discipline. There was a serious demand for efficient training in Army Regulations, military discipline and customs of the service, Manual for the Medical Department, and Manual for Courts-Martial. Furthermore, in anticipation of future needs some courses in oral surgery and in oral surgical prosthesis were deemed necessary. Plans were made, therefore, for organized training of officers of the Dental Corps, and the first program for school instruction of dental officers was prepared by the chief of the dental section of the personnel division of the chief surgeon’s office.

    The demand for organized instruction was begun in the 1st Division by a course of training instituted by the division surgeon, who later became commandant of the Army Sanitary School, and by the division dental surgeon, later acting director and assistant director of the dental section of this school. This instruction anticipated the demand which was later felt for training in first aid, bandaging, and dressing, and, with the exception of the lectures on oral surgery, was quite similar to the course which was given during the first session of this school, from December 10 to 17, 1917 (q. v., p. 648.).

    The aims of the representative of the Dental Corps in the Chief Surgeon’s Office, in presenting the plans for the training school for dental officers, are set forth in the following communication from that officer to the commandant of the Army Sanitary School:

d The statements of fact appearing herein are based on: “History of the Dental Section of the Army Sanitary School, Army Schools, American Expeditionary Forces, France, December 10, 1917, to December 10, 1918.” (Compiled from the official records of the school.) The history is on file in the dental division, Surgeon General’s Office, Washington, D. C. - Ed.


643

HEADQUARTERS AMERICAN EXPEDITIONARY FORCES,
November 18, 1917.

Memorandum in re dental section of the Army Sanitary School, A. E. F.

    1. Assignments: In view of the scope and character of instruction contemplated in the dental section of the Army Sanitary School it is recommended that two specially qualified dental surgeons be assigned as instructors thereat. One of the senior dental surgeons of the Army has been requested for this detail by cable to the Surgeon General November 17. The only other available man in France with special qualifications for this detail is Lieutenant Rice, on duty as division dental surgeon, 1st Division, Gondrecourt. Lieutenant Rice will he a major under recent enactment of law, October 6, 1917. He has had experience as recorder at the Army Dental School conducted by the undersigned last year at Fort Bliss, Tex., for the instruction of National Guard officers, and has within the past few months conducted the 1st Division school for instruction of dental officers (reserve) of that command. It is believed Major Rice is sufficiently capable of conducting the dental sections of the Army Sanitary School until the arrival of the senior dental officer requested above.

    Attention is invited to the following program of instruction for the dental section, Army Sanitary School, which has been carefully considered and modified to meet the requirements of that institution.

    2. Program of instruction:
 First day:
    7.45 a.m. to 11.45 a.m.............Duties of dental officers serving with sanitary organizations at regimental and battalion aid stations and field hospitals (administration and records, admissions, evacuation and transportation).
    1.30 p.m. to 4.30 p.m..............Practical instruction in gas defense.
Second day:
    7.45 a.m. to 11.45 a.m.............First aid to the wounded embracing: Hemorrhage, wounds and dressings, fractures, tetanus, shock, nutrition.
    1.30 p.m. to 4.30 p.m..............Demonstrations in the use of field equipment, dental and medical.
Third day:
    7.45 a.m. to 9.30 a.m...............Bandaging and splinting (general).
    9.30 a.m. to 11.45 a.m.............The sanitary service in the zone of the advance (general).
    1.30 p.m. to 4.30 p.m...............Dental surgery at the front, first aid for jaw cases, surgery, dressings, and transportation (ambulatory and litter).
Fourth day:
    7.45 a.m. to 11.45 a.m.............General and local anesthetics (technique amid administration).
    1.30 p.m...................................Special duties in which dental officers may be utilized in emergencies.
    2.30 p.m...................................Oral manifestations of systemic diseases.
    3.30 p.m. to 4.30 p.m..............Pathodonthia; relation of oral diseases to systemic infection, or oral surgery to rhinology, otology, laryngology, and opthalmology.
Fifth day:
    7.45 a.m...................................Dental sterilization and method employed in the field.
    8.45 a.m...................................Wounds of the jaw.
    9.45 a.m. to 11.45 a.m............The interrelation of the oral and dental surgeon with the brain surgeon, general surgeon (plastic), nose and throat surgeon, and eye and ear surgeon in the work contemplated for the head surgical teams.
    1.30 p.m. to 3.30 p.m..............Oral surgical prosthesis.
    3.30 p.m. to 4.30 p.m..............Military duties of the dental officers. (Equitation, elementary, motor-car technique--driving, mechanism, and minor repairs.)


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Sixth day:
    7.45 a.m...................................Oral hygiene.
    9 a.m........................................Special oral surgery.
    1.30 p.m...................................Personal hygiene.
    2.30 p.m. to 4.30 p.m..............Oral surgical prosthesis.
   N0TE. - Student officers for this course to be selected from those on duty in divisions or separate brigades, who have previously taken the course prescribed for the division dental school.

    3. Division dental schools (and for separate brigades); a course of instruction conducted bythe division dental surgeon under the direction of the division surgeon:
    (a)Army Regulations (pertaining to officers in general, and Medical Department officers inparticular).
    (b) Manual for the Medical Department (dental instruction and administration).
    (c)Manual for Courts-Martial and Military Law (administration of military discipline and justice, charges, specifications, trials, etc.).
    (d)Customs of the service.
    (e)Paper work (correspondence, records, reports, and returns).
 
    4. Correspondence course of instruction for dental officers stationed at base hospitals, engineer regiments and other isolated commands:
   To cover preceding subjects of instruction and conducted from the Army Sanitary School in accordance with plans followed in the usual correspondence course for medical officers of the Army.

    5. A post-graduate school of instruction:
   To be established at the American Red Cross Hospital No. 1, Neuilly, under the direction of the commanding officer. Said course to embrace lectures on hospital administration, admissions, evacuations, records, diet, internal economy, etc., by Lieut. Col. George P. Peed; and oral surgical technique (major and minor) by Majors Hutchinson and Powers. Clinical oral surgical prosthesis (technique, construction, records, cases, etc.), and special dental X-ray and photographic instruction by Dr. George P. Hayes. Student officers for the post-graduate course to be selected from those specially qualified or who show special aptitude for oral surgery and oral surgical prosthesis; selection to be made on the recommendation of the chief surgeon, A. E. F., and the commandant of the Army Sanitary School.
    N0TE. - The course of instruction at the division schools may be handled in six to eight sessions, held two afternoons per week for the period. The duration of the term for instruction at the Army Sanitary School (dental section) is contemplated as one week. The period of instruction at the post-graduate school may be covered in two weeks intensive study. This may be extended in certain particular cases where deemed desirable for the best interests of the service.

    Prior to the completion of the organization of the First Army Corps, although coincident with the plans for corps training, a program was instituted for a school for dental officers as a part of the First Corps Army Sanitary School. However, the sanitary school was later moved as a part of the Army schools, at Langres, and this course was never given, although the program of instruction was incorporated in the courses which were given during the first two months of the school at Langres.

    It was the original intention to institute courses of instruction for dental officers not only at the Army Sanitary School, but throughout the various Army corps, as well as in the divisions. In some divisional organizations, good results were gained, but, as a rule, the difficulties of transportation and the conditions in general were such as to make continuous training for dental officers impracticable. The plans for corps schools for dental officers were instituted and a program for a course at the headquarters of the First Army Corps was laid out, but there is no record that any school was ever established in corps organizations in France for dental officers.


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   It will be recalled that it was not until February, 1918, that American troops occupied the front lines to any extent. Prior to this time, the majority of all instruction for dental officers was experimental and speculative, for no one knew and no one could prophesy what combat conditions would be for dental officers. No parallel could be drawn from the experiences of our Allies, for in no army is the allowance of dental personnel as complete as in our own. Nothing could be foretold of the difficulties which would arise in the transportation of the portable outfits, soon proven to be hopelessly bulky. No one could foresee that the dental officer would be called upon for almost every other duty as well as that of dental work, such as battalion or regimental surgeon, sanitary inspector, censor officer, mess officer, burial officer, and many others. It is apparent that the problem of adequate instruction was a serious one.

    After American troops finished their preliminary training and began to occupy different sectors on the Western Front, it was found that the training of dental officers in routine subjects of military administration was not sufficient. For instance, while the tables of organization allowed enough medical officers to a combat division to do all necessary medical work during quiet periods, actual combat conditions found the number insufficient, and the dental officer began to be employed in an auxiliary medical capacity. Furthermore, every division found its transportation problem a difficult one, and it was impossible in many instances to bring the heavy portable outfit to a place where it could be used to advantage. In fact, this worked two ways. In the first place, there were no transportation facilities to insure the carrying of the dental equipment with the regiments into combat, and, if through some fortunate chance the outfit did arrive in the combat area, the dental officer found himself in a position where dental work was impossible, and where the excitement of battle left little time for constructive dental work. Consequently, he either performed what duties the Medical Department demanded of him or there was little left for him to do.

    This was the problem which confronted the director of the dental section of the Army Sanitary School as soon as the facts became known. Two courses were open. In the first place, the elimination of the larger part of the portable dental outfit, in favor of a small, easily transportabile equipment, by means of which the dental officer could render the emergency service demanded of him while in combat. Secondly, and by no means less important, it became the obligation of the dental section of the Army Sanitary School, and the duty of division dental surgeons, to see that dental officers on duty with combat troops were trained in the proper performance of the duties required of them should they replace or function with the medical officers.

    To this end, the courses at this school were modified to teach less in detail the more professional and theoretical subjects and to lay more emphasis upon first-aid bandaging and splinting, map reading, orientation, field sketching, sanitation, hygiene, and evacuation of the wounded. The program for the fifteenth session (p.658, infra) demonstrates the policy of the school shortly before its close. In brief, the school gradually developed into a field service institution, and laid its greatest emphasis upon the preparation of dental


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officers for combat service. The officer in the combat division had to live the life of the infantryman, and he had to be able to hike where the organization went. The classes of student officers of this school received training in Infantry drill for over seven months as a part of their course of instruction. They were subject to strict military discipline at all times; in other words, they learned the meaning of the word “soldier.”

    The difficulties caused by the too bulky portable outfit were adjusted from the chief surgeon’s office by the Dental Corps representative on duty there, and this equipment was reduced to make a modified portable outfit, and the emergency kit. This latter was carried on the person of the dental officer and his enlisted dental assistant, and made it possible to take care of emergency cases, even though the dental officer were being employed in medical capacities. In other words, dental service could be rendered with this equipment, without regard to transportation difficulties, and even under combat conditions.

    While certain subjects and phases of oral surgical prosthesis constituted a part of the school curriculum, the dental section of the Army Sanitary School never was primarily a school for oral surgery. Nevertheless, efforts were made to bring the best methods in plastic and prosthetic restorations before the student officers.

CURRICULUM

    During the life of the dental section of the Army Sanitary School (December 10, 1917, to December 10, 1918) 16 courses of instruction were given, and certificates were awarded to 320 officers of the Dental Corps. The succeeding pages contain outlines of programs of typical courses of instruction together with a summary of the courses and a detailed consideration of the purposes of the subjects included.

    Classification of the subject matter:
    I.Military discipline.
    a.Setting-up exercises.
b.Drill.
    II.Military administration.
    a.Army Regulations.
b.General orders and bulletins.
c.Manual for Courts-Martial.
d.Military Law.
e.Manual for the Medical Department.
    1.Dental records and reports.
    2.Dental supplies.
    3.Dental requisitions.
    4.Medical records and hospital administration.
f.The problem of medical supplies in American Expeditionary Forces.


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    III. Professional.
a.Dental.
    1.The organization of the Army Dental Corps.
    2.New methods of operative practice (Howe treatment).
    3.Conducting a general Army practice.
    4.Local and conductive anesthesia.
    5.Oral surgery.
    6.Oral surgical prosthesis.
    7.Oral manifestations of systemic diseases.
    8.Special prosthetic appliances.
b.Medical.
    1.General anesthesia.
    2.The Thomas splint.
    3.First-aid bandaging, dressing, and splinting.
    4.War surgery.
    5.Internal medicine.
    6.Surgical technique.
    IV. General field service problems.
a.Sanitary tactics.
b.Field sanitation.
c.General and personal hygiene.
d.Map reading and field sketching.
e.Map problems and terrain exercises.
f.Sanitary appliances.
g.Evacuation of the wounded.
h.Field transportation.
 
MILITARY DISCIPLINE

    Had it been possible to plan for a longer school course, greater emphasis would have been laid upon military training, but under the program or the time allotted for the instruction of each class (two weeks) it was practicable to give it only an hour each afternoon and about 20 minutes early each morning. The dental officer had served as an integral part of combat troops. It was consequently the obligation of the school to give this training. Only the most elementary instruction in Infantry drill was attempted. The sole intention was to give the dental officers the foundation upon which they could build their own military success.

MILITARY ADMINISTRATION

    It was contemplated, when the program of the school was modified to include the more practical instruction in field service problems, and that subjects incident to dental administration would be handled by the divisions and the different sections of the Services of Supply. For various reasons, however, the plan never worked out with any uniformity. Army Regulations, Manual for Courts-Martial, and Military Law, and certain subjects of dental adminis-


648

tration were eliminated as a part of the school course. These subjects were regarded as being important and it was the intention of the director of the dental section to present as much of this instruction as regulations governing the policy of the school would permit, but they were subordinate to the practical problems of combat service.

PROFESSIONAL INSTRUCTION

    For the most part subjects classified above as “dental” were taught by officers of the Dental Corps. During the sixteenth session, however, one lecture on the corelationship between the otorhinolaryngologist and the dentist was added to the curriculum. In the associated subjects of oral surgery and oral surgical prosthesis, a medical and a dental officer of the French Army furnished valuable aid. Furthermore, the maxillofacial department, under the chief medical consultant, furnished one lecture during each session.

    The subjects classified as medical were taught by the medical officers of the Army Sanitary School and by the staff of consultants called upon as special lecturers.

GENERAL FIELD SERVICE PROBLEMS

Explanation has been made of the change of policy, which expanded the instruction in the more practical subjects of field service, but the real basis for the most efficient field service school was laid just as the armistice was signed. Reference to the subjects taught under this heading demonstrates the completeness of this instruction.

PROGRAM FIRST SESSION (DECEMBER 10 TO 17, 1917)

Monday, Dec. 10:
7.45 to 9.45 a.m ..............Dental administration, records, requisitions, reports, and returns.
9.45 to 11.45 a.m...........Regimental and battalion aid stations, field hospitals, medical administration, records, and reports.
1 to 2 p.m...........First aid to the wounded.
2 to 3 p.m...........Dental surgery at the front. Sterilization of dental instruments, and methods employed in the field.
3 to 4.30 p.m...........First-aid bandaging and dressing. Practical instruction and demonstration.
Tuesday, Dec. 11:
7.15 to 8 a.m.............Clinic at sick call.
9 to 10 a.m......................Military discipline, property accountability, personal and efficiency reports, and official correspondence.
10 to 11.45 a.m...............Bandaging and splinting.
1.30 to 4.30 p.m....................Gas instruction.
Lecture--gas warfare, materials used, methods of use.
Practical--fitting and drill with respirator and mask.
Lecture--proper inspection of the respirators and masks.
Gas officers.
Wednesday, Dec. 12:
7.45 to 10 a.m....................Oral surgery and oral surgical prosthesis. The work of the dental surgeon at a base hospital, showing the treatment of individual cases.
10 to 11.45 a. m.......................Practical instruction in bandaging and splinting. Students required to employ the various methods and appliances described.


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1.30 to 3 p.m.................Gas instruction.
Lecture--wind observations, gas alert, gas alarms.
Practical--drills, respirators and masks.
Lecture--gas poisoning and treatment.
Gas officers.
Thursday, Dec. 13:
7:45 to 11.45 a.m.......................Oral surgery and special oral surgical prosthesis (continued).
1.30 to 3.30 p.m.......................Gas instruction.
Lecture--gas-proof dugouts; description and use.
Practical--drill and testing of respirators and masks in lacrymatory gas.
Lecture--treatment of gassed patients; discussion and questions answered.
Gas officers.
Friday, Dec.14:
7.45 to 11.45 a.m.........................Wounds of the jaw, first-aid to jaw cases, surgery and dressings.
1.30 to 2.30 p.m.........................Oral manifestations of systemic diseases.
2.30 to 4.30 p.m.........................General and special orders. Army Regulations.
Saturday, Dec. 15:
7.45 to 10.45 a.m........................Local anesthesia, instruments and materials, their care and use;
Technique of producing local anesthesia of mouth and tissues of the face.
10.45 to 11 45 a.m...................The interrelation of the dental and oral surgeons with the general surgeon (plastic), nose and throat surgeon. Special plastic surgery.
1.30 to 2.30 p.m..........................Manual for Courts-Martial, Military Law.
2.30 to 4.30 p.m..........................Oral hygiene as applied to uninjured and injured mouths.
Monday, Dec. 17:
7.45 to 9.30 a.m..........................General anesthesia--ether, nitrous oxide, nitrous oxide and oxygen.
9.30 to 10.30 a.m..........................Trench mouth. Relation of oral diseases to systemic infections. Relation of oral surgery to otology, rhinology, laryngology.
10.30 to 11.45 a.m..........................General and personal hygiene.
1.30 to 2.30 p.m..........................Customs of the service.
2.30 to 4.30 p.m..........................Duties of dental surgeons; conducting of general Army dental office. Methods of handling patients.

EXPANSION OF COURSE

   The fourth session (February 2 to 17, 1918), was mai’ked by some radical changes in the program of instruction. The important provisions of Army Regulations were considered more in detail than had been the case in the preceding sessions, and an officer of the Judge Advocate General’s Department was detailed as an instructor in the Manual for Courts-Martial and Military Law. Furthermore, a lecture on map and compass reading was added to the program. This was the extent of the expansion in the lecture subjects.

    It had been noted among various combat organizations that dental officers were used to command men in time of emergency, and were relieving medical officers, at times, of their military duties; this was caused partly by the insufficiency of the quota of medical officers during times of combat and partly by the fact, which became increasingly evident during later developments, that dental equipment, as constituted, could not be transported and used efficiently in combat areas. With a view to making the dental officers as conversant as possible with matters of military discipline and with Infantry drill, the commandant of Army schools detailed an officer of the Cavalry, United States


650

Army, to drill the student officers for one hour each day. This instruction continued to be a part of the school course until its close.

    Up to the commencement of the fourth session six lectures of one hour each had been given each day. With the initiation of the training in drill the lecture hours were reduced to five, the hour for drill instruction occupying the sixth period.

    During the period from the fourth to the seventh sessions an attempt was made to combine field service and practical instructions for combat conditions with the more detailed training in military administration and discipline. This plan was successful, but only for the reason that the problem of the training of dental officers to function properly in times of battle was not sufficiently understood to enable the school to give a comprehensive course concerning it. Furthermore, it was expected that many of the dental officers who seemed especially fitted would be employed in the special work of oral surgery. This theory was later found to be a mistaken one, for the demand for men who could do routine dentistry was so great that this special work was assigned to other fields, and the dental officer, not only in combat divisions but throughout France, was employed, for the most part, when he did dental work at all, in the practice of the routine methods of his profession.

FOURTH SESSION

Monday, Feb. 4, 1918:
8.30 to 9.30 a.m ....................................................Opening lecture. Scope of dento-military instruction; responsibility as officers; conduct during course.
9.40 to 10.40 a.m...................................................The work of a dental surgeon at a base hospital. Organization of the unit to care for personnel and patients. Equipment in instruments, materials, and men.
10.50 to 11.45 a.m.................................................Practical instruction in first aid; precautions against hemorrhage and shock.
1.30 to 2.30 p.m.....................................................Dental administration; Mammal for the Medical Department.
2.45 to 3.45 p.m....................................................Antitetanic injections; care of wounds of the face and neck associated with fractures of the maxillae and mandible.
Tuesday, Feb. 5:
8.30 to 9.30 a.m.....................................................The Army Dental Corps; organization; status; duties.
9.40 to 10.40a.m....................................................Treatment of fractured jaws; vertical and longitudinal fractures of the maxillae.
10.45 to 11.45 a.m.................................................First aid to the wounded; latest methods of handling fractures in the field.
1.15 to 4.30 p.m.....................................................Gas course; gas warfare, methods and use; drills, respirator, and mask.
Wednesday, Feb. 6:
8.30 to 9.30 a.m......................................................Treatment of fractured jaws; fractures of the maxillae with little or no loss of substance.
9.40 to 10.40 a.m ...................................................Supplies and materials; requisitions; Manual for the Medical Department (continued).
10.50 to 11.45 a.m..................................................Practical instruction in first-aid bandaging and dressing.
1.15 to 4.30 p.m.....................................................Gas course; wind observations; gas alerts and gas alarms gas poisoning and treatment.
Thursday, Feb. 7:
8.30 to 9.30 a.m......................................................Transfer of supplies; vouchers and receipts; Manual for the Medical Department (continued).
9.40 to 10.40 a.m....................................................Treatment of fractured jaws; compound, comminuted fractures with loss of substance.


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Thursday, Feb. 7—Continued.
10.50to 11.45 a.m.........................Practical instruction in first-aid bandaging and dressing, the students being required to apply various methods and materials shown.
1.15 to 4.30 p.m.........................Gas course; gas-proof dugouts, description and use. Testing of respirators with lacrymatory gas. Questions and discussions.
Friday, Feb. 8:
8.30 to 9.30 a.m.........................Army Regulations.
9.40 to 10.40 a.m...................Treatment of fractured jaws; compound comminuted fractures of the symphysis of the mandible.
10.50 to 11.45 a.m.....................Practical instruction in first aid bandaging and dressing.
1.30 to 2.30 p.m.....................Map and compass reading.
2.45 to 3.45 p.m..........................Military discipline and customs of the service.
3.45 to 4.30 p.m .........................Drill
Saturday, Feb. 9:
8.30 to 9.30 a.m..........................Local anesthesia; advantages over general anesthesia; Instruments necessary for producing.
9.40 to 10.40 a.m..........................Property responsibility and accountability.
10.50 to 11.45 a.m....................Practical instruction in first aid.
1.30 to 2.30 p.m......Local anesthesia, subject completed; Ottesen method (intra-osseous); anesthesia of soft parts of face for plastic operations.
2.45 to 3.45 p.m......................Property responsibility and accountability.
3.45 to 4.30 p.m..............Drill.
Monday, Feb. 11:
8.30 to 9.30 a.m .....................Forms of the Medical Department.
9.40 to 10.40 a.m....................Oral surgery in connection with the general surgeon.
10.50 to 11.45 a.m................Army Regulations (continued).
1.30 to 2.30 p.m......................Army Regulations.
2.45 to 3.45 p.m .....................Medical Department in the zone of the advance.
3.45 to 4.45 p.m......................Drill.
Tuesday, Feb. 12:
8.30 to 9.30 a.m......................Army Regulations.
9.40 to 10.40 a.m......................General anesthesia.
10.50 to 11.45 a.m................Forms of the Medical Department (continued).
1.30 to 2.30 p.m......................General anesthesia; operating-room technique.
2.45 to 3.45 p.m..................Diseases and casualties of war.
3.45 to 4.45 p.m...................Drill.
Wednesday, Feb. 13:
8.30 to 9.30 a.m...................Plastic operations of head and neck; removal of foreign bodies.
9.40 to 10.40 a.m..................Responsibility and accountability, additional facts,
10.50 to 11.50 a.m...............Army Regulations.
1.30 to 2.30 p.m....................Manual for Courts-Martial and Military Law.
2.45 to 3.45 p.m...........................General and personal hygiene.
3.45 to 4.30 p.m..............Drill.
Thursday, Feb. 14:
9.40 to 10.40 a.m...........................Military correspondence.
10.50 to 11.45 a.m...........................Army Regulations
1.30 to 2.30 p.m...........................General anesthesia; operating-room technique.
2.45 to 3.45 p.m...........................Relation of oral disease to systemic infections.
3.45 to 4.30 p.m...........................Drill.


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Friday, Feb. 15:
8.30 to 9.30 a.m........................Conducting a general army practice.
9.40 to 10.40 a.m........................Dental surgery at the front; dental sterilization in the field.
10.50 to 11.50 a.m........................Oral manifestations of systemic diseases.
1.30 to 2.30 p.m........................Manual Courts-Martial and Military Law.
2.45 to 3.45 p.m........................A study of the causes of displacement following fractures of the mandible.
3.45 to 4.45 p.m.......................Drill.
Saturday, Feb. 16:
8.30 to 9.30 a.m.......................Charge to the class.
9.45 to 12 m..........................Examinations.
1 to 3.30 p.m........................Examinations.
4 to 5 p.m.................Lecture.

CLINICAL DEMONSTRATIONS

   The school had been in operation until May before it was possible to secure any clinical material for instruction purposes. One of the disadvantages of a training institution located in such a town and locality as Langres was that clinical material was not easily available, and what little there was could be drawn only with great difficulty from the few French hospital formations located in the vicinity. But with the occupation of Camp Hospital No.24 by an American unit, the opportunity arose for the use of the clinical demonstrations for the student officers.

    The first of these clinics, which were held continuously after that time, was in charge of an officer of the Dental Corps attached to the hospital, who, during the seventh session, gave two clinical demonstrations of local and conductive anesthesia at Camp Hospital No. 24. In addition to this, two lectures were arranged for, to be given by an officer of the Medical Corps, on surgical technique and minor surgery, and this work was soon supplemented by a lecture on general anesthesia by another officer of the Medical Corps who, after that time, gave many demonstrations before the class at Camp Hospital No. 24.

    The growth of the information which was contained in the orders and bulletins of the American Expeditionary Forces necessitated the giving of a lecture on these regulations, and this instruction, as it was intimately associated with the problems which were constantly arising in the field, formed a part of the course of instruction.

    As a supplement to the training which was being given in Infantry drill, morning setting-up exercises were initiated, under the direction of a Cavalry officer.

    During the first week in June the faculty of the dental section spent several days in studying the work of the French maxillofacial surgeons at Hospital No.45 at Vichy. It was here that the idea of the cast splint for cases of jaw fracture was being worked out efficiently, and much information toward the improvement of the maxillofacial work in our own service was gained. This trip to Vichy formed the basis for a series of lectures which were given later before the dental and medical classes by the chief of service of Hospital No. 45, and who succeeded in arranging a scheme for collaboration between the French and American oral surgeons in the hospitals at Vichy.


653

SEVENTH SESSION

Friday. Apr. 19:
6.30 to 7 a.m..................Setting-up exercises and drill.
8.30 to 9.30 a.m..................Opening lecture: (a) Scope of dento-military instruction responsibilities as officers(b)conduct--(1) discipline(2) requirements during school term.
9.40 to 10.40 a.m...........................The work of the dental surgeon in a base hospital; organization to care for large personnel and many patients.
10.50 to 11.45 a.m...........................Military discipline and customs of the service.
1.30 to 2.30 p.m...........................Antitetanus injections; care of wounds of the face and neck associated with fractures of the maxillae or mandible.
2.45 to 3.45 p.m...........................Hospital administration; Manual for the Medical Department. Medical records and hospital administration.
3.45 to 4.30 p.m.....................................................Drill
Saturday, Apr. 20:
6.30 to 7 a.m..........................................................Setting-up exercises and drill.
8.30 to 9.30 a.m.....................................................Dental supplies and materials, requisitions, transfers, vouchers, receipts.
9.40 to 10.40 a.m...................................................Treatment of fractured jaws; vertical and longitudinal fractures of the maxillae.
10.50 to 11.45 a.m..................................................The Army Dental Corps; organization, history, status,
1.30 to 2.30 p.m......................................................Practical instruction in first aid, hemorrhage and shock, tetanus, nutrition.
2.45 to 3.45 p.m...................................Regimental and battalion aid stations; field hospitals; the battalion and regimental surgeons in trench warfare.
3.45 to 4.30 p.m......................................................Drill.
Sunday, Apr. 21:
9.30 to 11.30 a.m....................................................Clinic (conductive anesthesia and extraction), Camp Hospital No. 24
Monday, Apr. 22:
6.30 to 7 a.m............................Setting-up exercises and drill.
8.30 to 9.30 a.m............................Property accountability and responsibility; relief from accountability in the zone of the advance.
9.40 to 10.40 a.m............................Treatment of fractured jaws; fractures of the maxillae with little loss of substance.
    10.50 to 11.45 a.m..................................................Army regulations; American Expeditionary Forces orders and bulletins.
    1.30 to 4.30 p.m.....................................................Gas instructions.
Lecture--gas warfare, materials used and methods of use.
Practical--fitting and drill with respirator and mask.
Lecture--inspection of respirators and masks.
Tuesday, Apr. 23:
6.30 to 7 a.m...................Setting-up exercises and drill.
8.30 to 9.30 a.m........................Army Regulations; American Expeditionary Forces orders and bulletins.
9.40 to 10.40 a.m........................New forms and regulations for the Medical Department in American Expeditionary Fores; medical section; salvage service.
10.50 to 11.45 a.m......................Treatment of fractured jaws; compound, comminuted fractures with loss of substance.
1.30 to 4.30 p.m..............................Gas instruction.
Lecture--wind observations, gas alerts, and gas alarms.
Practical--drills, respirators, and masks.
Lecture--gas poisoning and treatment.


654

Wednesday, Apr. 24:
6.30 to 7 a.m.......................Setting-up exercises and drill.
8.30 to 9.30 a.m..................Treatment of fractured jaws; fractures of the mandible.
9.40 to 10.40 a.m................Special dressings and splints; demonstration of the Thomas splint.
10.50 to 11.45 a.m...............Army Regulations; American Expeditionary Forces orders and bulletins.
1.30 to 4.30 p.m...................Gas instructions.
Lecture--gas proff dugouts; description and use.
Practical--drill and testing of respirators and masks with lacrymatory gas..
Lecture--treatment of gassed patients; discussions and remarks. 
Thursday, Apr. 25:
6.30 to 7 a.m..........................Setting-up exercises and drill.
8.30 to 9.30 a.m.....................Local anesthesia (continued).
9.40 to 10.40 a.m...................Dental records and reports, methods of rendering in the American Expeditionary Forces.
10.50 to 11.45 a.m..................Local anesthesia (continued).
1.30 to 2.30 p.m......................Army Regulations.
2.45 to 3.45 p.m......................Dental records and reports (continued).
3.45 to 4.30 p.m......................Drill.
Friday, Apr. 26:
6.30 to 7 a.m............................Setting-up exercises and drill.
8.30 to 9.30 a.m.......................Oral surgery in connection with the general surgeon.
9.40 to 10.40 a.m.....................Army Regulations.
10.50 to 11.45 a.m...................Military forms and correspondence.
1.30 to 2.30 p.m.......................Plastic operations of the face; removal of foreign bodies from the head and neck.
2.45 to 3.45 p.m.......................General and personal hygiene.
3.45 to 4.30 p.m.......................Drill.
Saturday, Apr. 27:
6.30 to 7 a.m.............................Setting-up exercises and drill.
8.30 to 9.30 a.m........................General anesthesia.
9.40 to 10.40 a.m......................Methods of handling wounds and fractures in the field, where medical supplies are limited.
10.50 to 11.45 a.m....................General anesthesia (continued).
1.30 to 2.30 p.m........................Practical instruction in first-aid bandaging and splinting.
2.45 to 3.45 p.m........................Surgical technique and assisting at operations.
3.45 to 4.30 p.m.......................Drill.
Sunday, Apr. 28:
9.30 to 11.30 a.m.......................Clinic: Conductive anesthesia and extraction.
Monday, Apr. 29:
6.30 to 7 a.m...........................Setting-up exercises and drill.
8.30 to 9.30 a.m......................Military correspondence completed.
9.40 to 10.40 a.m....................Relation of oral diseases to systemic infections.
10.50 to 11.45 a.m..................Diseases and casualties of war.
1.30 to 2.30 p.m......................First-aid bandaging and dressing.
2.45 to 3.45 p.m......................Oral manifestations of systemic diseases.
3.45 to 4.30 p.m.......................Drill.
Tuesday, Apr. 30:
6.30 to 7 a.m............................Setting-up exercises and drill.
8  to 9.30 a.m...........................Clinic (depressive craniotomy), at Camp Hospital No. 24.
9.40 to 10.40 a.m.....................Military correspondence, subject completed.
10.50 to 11.45 a.m...................Frequency of mouth cleaning in cases of severe injuries.
1.30 to 2.30 p.m.......................Manual for Courts-Martial and Military Law.
2.45 to 3.45 p.m.......................Instruction in first aid, bandaging and dressing.
3.45 to 4.30 p.m.......................Drill.


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Wednesday, May 1:
6.30 to 7 a.m..............................Setting-up exercises and drill.
8.30 to 9.30 a.m.........................Oral manifestations of systemic diseases, completed.
9.40 to 10.40 a.m.......................Military forms and correspondence.
10.50 to 11.45 a.m.....................Oral hygiene, discussion at length.
1.30 to 2.30 p.m........................Manual for Courts-Martial and Military Law.
2.45 to 3.45 p.m........................Oral hygiene as applied to injured and uninjured mouths.
3.45 to 4.30 p.m.........................Drill.
Thursday, May 2:
6.30 to 7 a.m............................Setting-up exercises and drill.
8.30 to 9.30 a.m........................Further remarks on general anesthesia.
9.40 to 10.40 a.m......................Methods of conducting an office practice.
10.50 to 11.45 a.m....................Charge to the class.
1.30 to 2.30 p.m........................Application of the Dental Corps to the zone of advance.
2.45 to 3.45 p.m........................Concluding remarks on oral hygiene and general anesthesia. 
Friday, May 3:
9.a.m. to 3 p.m..........................Completion of theses; oral examinations.

MEDICAL INSTRUCTION FOR THE DENTAL CORPS

    Reference to the programs which outline the policy of the dental section previous to July, 1918, will reveal the fact that development toward a practical field-service course had taken place, but that this development had been slow. With the seventh session, clinical instruction had been made possible. Soon after this it was possible to glean accurate information from the dental officers in divisions concerning just what their difficulties were, together with some suggestions as to the most efficient methods of solution.

    With a view for amplifying the training which had already been given the student officers of the dental section, the commandant of the Army Sanitary School made the following recommendations in a letter:

ARMY SANITARY SCHOOL, ARMY SCHOOLS, AMERICAN EXPEDITIONARY FORCES,
France, June 26, 1918.

From:  The commandant, Army Sanitary School.
To:  The chief surgeon, S. O. S., American Expeditionary Forces (through commandant, Army Schools).

Subject: Medical instruction of Dental Corps.

    1. It is being constantly reported to the commandant of the Army Sanitary School that dental officers are being employed to do the work of medical officers not only in the back areas hut in those at the front, such as battalion aid stations.

    2. In order to meet the demands for knowledge of duties they would be required to perform in first-aid and in emergency, the commandant of the Army Sanitary School has provided instructors for the dental section of this school to give them an elementary knowledge of such first aid work and of the relative positions of medical units on the battle field and their functions as they might be called upon to perform in emergency.

    3. As will be seen from the appended program now being followed, the following is the distribution of the time allotted to the class of the dental section:

Hours
(a)Dental hygiene, dental diseases, and injuries affecting the practice of stomatology..........15
(b)Anesthesia, local and general.......................................................................................5
(c)General instruction in gas protection and treatment of the gassed...................................9
(d)Purely military subjects...............................................................................................4
(e)Drills and setting-up exercises......................................................................................13
(f)Purely medical subjects................................................................................................12
(g) Administration, general knowledge of regulations, including property account ability and
regulations of the Medical Department....................................................17
Total.........................................................75


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    4. As this gives only 20 per cent of the time to the purely professional side of the Dental Corps and provides no opportunity, save one hour, for clinics and demonstrations on professional subjects, it is recommended that the previous recommendation some months back, to the effect that some practical demonstrations be given these officers, should be provided in the future by a tour of instruction for the purposes of practical demonstrations to the Franco-American dental center now being formed at Vichy, the division of time of the class being as follows: One week of didactic instruction in the school area and one week of practical demonstrations at Vichy.

    5. That division surgeons be instructed to provide for their dental surgeons all necessary instruction in the paper work of the Army, drill and first aid, in order to thus reduce to a minimum this elementary instruction at a center like this, which should devote its time to the teaching of those things which can not be learned in a division. Inasmuch as such instruction in first aid, bandaging, etc., should be limited to that knowledge which should be possessed byall branches of the Medical Corps, it is believed that the proper person to be made responsible for such instruction should be the division surgeon and not a school devoted to the higher branches of professional work. Such instruction can be given, as it has been given for the last six months, but always at the expense of things which can not be obtained in a division and by duplication of the work of our own faculty, inasmuch as the lectures given our medical officers are too technical to be used by the dental surgeons, who, by the way, have but one-third of the time given our medical officers for instruction at this school.

    6. The recommendation herein does not intend to exclude intervention of medical officers at this school in those special and necessary presentations of phases of first-aid work which they can best give; in fact, the commandant of this school desires to have at least three or four periods at his disposal for the presentation of such medical subjects; but the intention of this letter is to try to have defined the principles underlying dental instruction at this center and have time which is today taken for elementary training in military and medical subjects provided for by division surgeons, under the general head of training, instruction which can never bear fruit unless such training is continued over a period far in excess of the time which it is possible to allot to these subjects at this center, and the dental school here will be enabled to divert its energies to more important subjects and to instruction which could not be given in the division.

    (Signed)  BAILEY K. ASHFORD,
    Colonel, Medical Corps, United States Army,
     Commandant.

    The results of this recommendation were later made evident in the publication of the policy of the Training Section of the General Staff concerning the dental section in the following letter:

 GENERAL HEADQUARTERS,    
 AMERICAN EXPEDITIONARY FORCES,
 France, July 20, 1918.

 Memorandum for commandant, Army Schools, A. E. F.
  Subject: Program of instruction, dental section, Army Sanitary School.

    Examination of the program of instruction of the dental section of the Army Sanitary School and correspondence relating thereto leads to the following conclusions:

    (1) The purpose of this school is to give dental surgeons attached to combat divisions or the Services of Supply instruction in preparation for field service in the American Expeditionary Forces which will supplement that given in the training camps in the United States and with troops in France.
   (2) General first-aid instruction is required for all sanitary troops in divisions in France, and is given in training camps in the United States.
    (3) Instruction in military law, customs of the service, Army Regulations, and general instruction in military correspondence and reports and returns is given in divisions and training camps in the United States.
   (4) In view of the fact that the course for dental surgeons is short and instruction in the subject is available elsewhere, it is desired that instruction in first aid, except as it relates


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to oral or dental wounds or accidents, military law, customs of the service, military correspondence, Army Regulations and reports and returns (except as changed by the American Expeditionary Forces), be discontinued in the dental section of the Army Sanitary School and the time secured used for instruction in other subjects relating to field duties of dental surgeons.
    (5) There is no immediate probability of the establishment of a special-course center of oral surgery near the site of the Army Sanitary School, and until such a center is established visits of instruction for student officers of the dental section are deemed impracticable.

   (Signed) H. B. FISKE,
   Brigadier General, General, Staff,
    Acting Chief of Staff, G-5.

FIELD SERVICE SCHOOL

    It had been the aim of the director of the dental section for several months to present a course of instruction to the dental officers which would embody both the principles of dental service in the field and the consideration of the multifold auxiliary medical duties which become a part of the life of the dental officer during combat. For numerous reasons, this plan had not been practical up to October, 1918. But with the initiation of the plans for the program of the fifteenth session of the dental section of this school, a plan was considered jointly with the director of the Army Sanitary School, which contemplated the holding of 14 joint lectures of dental and medical officers, embodying practically all the essential points of medical duties and sanitary tactics which had been proven to be very important for the dental officer.

    A study of the program for the fifteenth session will demonstrate the carrying out of this plan. In the first place, in order to give the dental officer some conception of the organization of the machine of which he was a part, one lecture on the organization of the entire American Expeditionary Forces was presented, and also a lecture on the organization of the Medical Department. This gave the dental officer an idea of the workings of the different sections of the general staff, of the functionings of the Services of Supply, and of the coordination of the Medical Department plans with those of the line organizations in a combat division.

    Furthermore, in addition to theoretical instruction in sanitary tactics, one afternoon was devoted to practical terrain exercises, in charge of an officer who was a graduate of the General Staff College, and who had studied the divisional problem from every side.

    The previous 14 sessions had contained as part of the course the preparation of a notebook, which held the different lectures in the form in which they were given. This notebook had been corrected, and was later returned to the student officer, but not until the book had been carefully studied, and the gradings given by the faculty entered upon the student’s record, and made part of the official report which was made concerning him.

    This notebook was a complete résumé of the student’s work while at the school. But this did not give any conception of the difficulties which this man might have encountered or any questions which might have come up in his mind which it was the business of the school to answer. To the end of finding out just what problems and difficulties the student officers were confronted with, a thesis was required of each student, to be written during the first week he was at the school. This was short, 500 to 800 words, and the arrangement of the


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titles was such that the student could choose the one which applied particularly to his case. For instance, there were such titles as the following: “The dental officer on duty with a division”; The dental officer with field, evacuation, or mobile hospitals”; “The dental officer with base hospitals”; “The dental officer with detached organizations.”

    This thesis considered the difficulties of dental treatment, the problems of transportation, suggestions for the improvement of the particular branch of the service with which he might be connected, and furnished the faculty with the definite basis for some of their more important instruction, and gave them the opportunity of clearing up in the minds of the student officers certain of the difficulties with which they had been confronted.

    After the beginning of the fifteenth session an effort was made to carry out the instruction along the lines of practical field service, with a view to helping the man with the division, who needed aid the most, and making the base hospital problem subsidiary to the larger question.

FIFTEENTH SESSION

First day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.30 to 9 a.m..........................................................Opening lecture.
    9 to 10.30 a.m........................................................Opening remarks.
    10.30 a.m. to 12 m.................................................Organization of the American Expeditionary Forces.
    1.30 to 3 p.m..........................................................Organization of the surgical services, American Expeditionary Forces.
    3. To 4.30 p.m........................................................Mental hygiene.
    4.30 to 5.15 p.m.....................................................Drill.
Second day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.30 to 9.30 a.m.....................................................General orders and bulletins.
    9.40 to 10.40 a.m...................................................The work of a dental surgeon at a base hospital.
   10.50 to 11.50 a.m..................................................The Army Dental Corps.
    1.30 to 2.30 p.m.....................................................Fractures of the maxillae and mandible, general considerations. Treatment of fractures of the maxillae illustrated by records.
    3 to 4.30 p.m..........................................................Map reading.
    4.30 to 5.15 p.m.....................................................Drill.
Third  day.
    7.20 to 7.40 a.m....................................................Setting-up exercises.
    8.30 to 9.30 a.m.....................................................General orders and bulletins.
    9.40 to 10.40 a.m...................................................Treatment of fractures of mandible with large loss of substance.
    10.50 a.m. to 12 m.................................................Map reading.
    1.30 to 3 p.m..........................................................Histopathology of war wounds.
    3.30 to 4.30 p.m.....................................................Treatment of fractures of mandible with large loss of substance.
    4.30 to 5.15 p.m.....................................................Drill.
    8.30 to 10 p.m........................................................Shock.
Fourth day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.15 to 9.15 a.m.....................................................Hospital organization.
    9.20 to 10.20 a.m...................................................Diseases of the oral cavity.
    10.30 a.m. to 12 m.................................................Organization of the Medical Department.
    1.30 to 3 p.m..........................................................Organization of the Medical Department.
    3 to 4.30 p.m..........................................................General anesthesia.
    4.30 to 5.15 p.m.....................................................Drill.


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Fifth day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.30 a.m. to 4.30 p.m.............................................Gas instruction (by gas officers in lecture room and gas chambers).
Sixth day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.30 a.m. to 4.30 p.m............................................Gas instruction (by gas officers in lecture room and gas chambers).
Seventh day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.55 to 8.30 a.m.....................................................Clinic, Camp Hospital No. 24 (general anesthesia).
    8.30 to 9.30 a.m.....................................................Evacuation of the wounded.
    9.40 to 10.40 a.m...................................................The regimental and battalion surgeon and battalion aid station in trench warfare.
    10.50 to 11.50 a.m.................................................Oral manifestations of systemic diseases.
    1.30 to 2.30 p.m.....................................................Treatment of hemorrhage in connection with fractures and associated wounds.
    2.40 to 3.40 p.m.....................................................Sterilization and surgical cleanliness.
    3.50 to 4.50 p.m.....................................................Duties of the evacuation officer of an army.
Eight day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.30 to 9.30 a.m.....................................................Special dressings and splints.
    9.40 to 10.40 a.m...................................................Medical records amid hospital administration.
    10.50 to 11.50 a.m.................................................Local anesthesia; consideration of the instruments and drugs.
    1.30 to 2.30 p.m.....................................................Operative technique; minor surgery.
    2.45 to 3.45 p.m.....................................................Methods of producing local anesthesia.
    3.45 to 4.45 p.m.....................................................Drill.
Ninth day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.30 to 9.30 a.m.....................................................Special dressings and splints.
    9.40 to 10.40 a.m...................................................Reserve and front line sanitation.
    10.50 to 11.50 a.m.................................................Oral hygiene as applied to uninjured mouths.
    1.30 to 2.30 p.m.....................................................Administration of dental department.
    2.45 to 3.45 p.m.....................................................Conducting a general army practice; base hospital and service of supplies.
    3.45 to 4.45 p.m.....................................................Conducting a general army practice.
Tenth day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.30 to 9.30 a.m.....................................................The regimental and battalion surgeon in the rest areas.
    9.40 to 10.40 a.m...................................................Character of professional services in combat areas.
   10.50 to 11.45 a.m..................................................Cooperation of the dental surgeon with the maxillofacial department; divisional dental surgeons; dental surgeons at field and evacuation hospitals.
    1.30 to 2.30 p.m.....................................................Problems of the battalion surgeon in war.
    2.45 to 3.45 p.m.....................................................Recent development in operative procedure as applied to Army practice. 
   3.45 to 4.30 p.m.....................................................Drill.
Eleventh day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.30 to 9.30 a.m.....................................................The Thomas splint.
   9.40 to 10.40 a.m....................................................Technique of facial plastic operations.
    10.50 to 11.50 a.m..................................................Field sketching.
    1.30 to 2.30 p.m......................................................Dental records and reports.
    2.45 to 3.45 p.m......................................................Oral hygiene as applied to uninjured mouths.
   3.45 to 4.30 p.m......................................................Drill.


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Twelfth day:
    7.20 to 7.40 a.m.....................................................Setting-up exercises.
    8.30 to 9.30 a.m.....................................................Evacuation of wounded in war of movement.
    9.40 to 10.40 a.m...................................................Anesthesia by nitrous oxide, and nitrous oxide and oxygen.
   10.40 to 11.50 a.m..................................................The aluminum plate.
    1.30 to 4.45 p.m.....................................................Examinations.

    Two clinics on conductive anesthesia, of two hours each, were held at Camp Hospital No. 24, on October 20 and 27.

    Sunday afternoon, October 27, the class was given instruction in map problems.
           
    The Army Sanitary School was closed December 31, 1918.2

REFERENCES

  (1) Memorandum from the chief of training section, G. H. Q., A. E. F., for Chief of Staff, August 27, 1917. Subject: School project for American Expeditionary Forces. (With approval by Chief of Staff, August 30, 1917.) On file, Record Room, S. G. O., 353 (Training).
  (2) Medical Department training in the American Expeditionary Forces, undated, by Col. Bailey K. Ashford. Copy on file, Historical Division, S. G. O.
  (3) G. O. No. 46, G. H. Q., A. E. F., October 10, 1917.
  (4) History of the Army Sanitary School, American Expeditionary Forces, Langres, France, undated, by Lieut. Frederick P. Hall, S. C., adjutant. On file, Historical Division, S. G. O.
  (5) Memorandum on the proposed course at the Army Sanitary School, by Col. Bailey K. Ashford, M. C., commandant, November 10, 1917. On file, Record Room, S. G. O., 353 (Training, A. E. F.).
  (6) Letter from the Surgeon General, U. S. Army, to the chief surgeon, American Expeditionary Forces, France, January 28, 1918. Subject: Coordination of training of Medical Department personnel at home and abroad. On file, Record Room, S. G. O., 353 (General).
  (7) Memorandum by Col. Bailey K. Ashford, M. C., commandant, March 29, 1918. Subject: Army Sanitary School, A. E. F. On file, Record Room, S. G. O., 352-1 (A. E. F., France) Y.
  (8) Letter from the adjutant general, general headquarters, A. E. F., to the commandant, Army Schools, March 4, 1918. Subject: Army Sanitary School. On file, Record Room, S. G. O., 352.01 (Training, A. E. F.) Y.