Books and Documents

MEDICAL DEPARTMENT

OF THE UNITED STATES ARMY

IN THE WORLD WAR
         
VOLUME V
         
MILITARY HOSPITALS

IN THE UNITED STATES
         
         
PREPARED UNDER THE DIRECTION OF
         
MAJ. GEN. M. W. IRELAND, M. D.,
Surgeon General of the Army
         
         
By
         
LIEUT. COL. FRANK W. WEED, M. C., U. S. ARMY

WASHINGTON :

         GOVERNMENT PRINTING OFFICE, 1923
         

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CHAPTER XV
         
THE GENERAL HOSPITAL (PERMANENT).
         
WALTER REED GENERAL HOSPITAL, WASHINGTON, D. C.^a
         
PRE-WAR PERIOD

         
    Walter Reed General Hospital is a monument to the memory of Maj. Walter Reed, Medical Corps, United States Army, whose biography is so rich in records of research work of far-reaching consequences. It is also an unfinished monument to the Medical Department, whose aim it is ultimately to make it not only an adequately-sized group of attractive buildings, permanently constructed and equipped for the definitive care of all classes of patients, but an educational center where will be located technical schools for the advancement of knowledge of the members of the different branches of the Medical Department. This effort to have established in the city of Washington a permanent general hospital, and in connection with it a training school, germinated during the early days of the Civil War.

    In the Annual Report of the Surgeon General of the Army, 1862, a recommendation was made to the Secretary of War that a permanent general be established in Washington, and in connection therewith, the establishment of an “Army Medical School, in which medical cadets and others seeking admission to the corps could receive such special instruction as would better fit them for commissions.” This recommendation came to naught. In 1893, however, Surgeon General Sternberg succeeded in accomplishing the establishment of the Army Medical School in Washington; but it was not until 1898, as an incidence of the Spanish-American War, that the organization of a permanent general hospital in Washington was effected. General Orders, No. 140, War Department, September 8, 1898, designated the post hospital, Washington Barracks, D. C., a general hospital, and placed it under the exclusive control of the Surgeon General of the Army.

    While this was a step forward in securing a permanent Army general in the city of Washington, a step which demonstrated the great advantage such an institution, the building in itself was in no way adequate and it was necessary to add one-story ward buildings of a temporary character. These temporary buildings rapidly deteriorated and there was a ceaseless and untiring effort on the part of the Medical Department to secure a more permanent hospital of sufficient capacity to meet the requirements of the Army during  peace times, with reasonable possibilities for expansion during war. Certain conditions arising in 1903 rendered the situation acute. In the Annual Report

___________________________       
           ^a The statements of fact appearing herein are based on the “History, Walter Reed General Hospital, Washington, D. C.,” by Capt. H. C. Dean, M. A. C., U. S. A., while on duty as a member of the staff of that hospital. The material by him in the compilation of the history comprised official reports from the various divisions of the hospital. The is on file in the Historical Division, Surgeon General’s Office, Washington, D. C.—Ed.
         

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of the Surgeon General, United States Army, for the fiscal year ending June 30, 1903, this statement appears:

    The work of construction at Washington Barracks, now well under way, will render the removal of the general hospital imperative in the near future. Plans for the War College and Engineer School contemplate a new building on the present site of the hospital. It has been proposed to move the present building and use it as a post hospital during the construction work, and for the purpose it is neither too large nor too good.

    It is inadequate in size for a general hospital, however, and, being largely built of timber it has shrunk and settled until is is no longer possible to maintain it in the perfect sanitary condition absolutely necessary where aseptic operations are to be performed.

   The building is about 10 years old and cost about $40,000. It is always crowded, so that nurses must be lodged outside, and there are no private rooms for officers or special cases. The location is not suitable, even if it were possible to retain the site, as the ground is low and the heat excessive in summer.     
        
   The Company of Instruction of the Hospital Corps is quartered in temporary wooden pavilions in bad repair, which were built during the war with Spain and are now worthless for any purpose.

   I repeat most earnestly my previous recommendation that a general hospital of sufficient size and perfect in every respect be built in the District of Columbia for the following purposes:

            First. Treatment of cases needing the services of specialists, surgical or other observation, and treatment of officers incapacitated for service prior to their appearance before retiring or examining boards.

            Second. Training enlisted men of the Hospital Corps in nursing and military duties.

            Third. Instruction at the Army Medical School in military surgery, hospital administration, Hospital Corps drill, and establishment of field hospitals.

            Fourth. To serve as a nucleus around which, in time of war, temporary wards may be erected without delay to any extent and at minimum expense.
         
    The recommendation of the Surgeon General was followed closely by official action looking to its realization. On October 12, 1903, The Adjutant General of the Army appointed a board of officers “To meet as soon as practicable for the purpose of ascertaining the most suitable location within the District of Columbia for the erection of a general hospital.” Subsequent to the receipt of the order the board met at different times and its individual members carefully scanned the District for land which might be available.

    In deciding upon the suitability of a site the board was governed by the use to which the hospital was to be put, and these uses dictated the following requirements: That the site be well drained, that it have water and gas supply, and an accessible sewer, if possible, and that it be situated on a good road, accessible to street cars and near a railroad so that sick might be transferred directly to the hospital without being carried to the city. This combination of requirements limited the choice of locations, and from 32 available tracts the less desirable were gradually eliminated until the judgment of the board narrowed to the final selection of the “Cameron tract.” This tract had an elevated, suburban situation, near the northern boundary of the District, two street car connections with the city of Washington and direct communications with the cars running near the Army Medical School, and was less than a mile from a station of the metropolitan branch of the Baltimore & Ohio Railroad.

    The purchase of this site, as recommended by the board, was accomplished on May 20, 1905, the tract containing 43.27 acres at $2,311.07 per acre, the total cost being $100,000. Funds for the purchase were made available by act of Congress approved March 3, 1905, which appropriated $100,000 to be immedi-

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ately available, and provided that the “total cost of said hospital, including site therefore, * * * shall not exceed the sum of $300,000.”

    The tract thus purchased was announced as a military reservation May 2, 1906, in War Department general orders of that date, the name of hospital having been previously announced in General Orders No. 172, War Department, October 18, 1905. Under the urgency deficiency bill approved by the President February 27, 1906, there was made available the sum of $200,000 for the building of a general hospital.

    The main building, known as building No. 1, was completed December 4,1908. It was of brick, its dimensions being 192 by 48 feet. Its total floor area was 27,648 square feet.  The
         
        FIG. 88—Administration building, Walter Reed General Hospital.
         
foundation was concrete and there were a basement, three floors, and an attic, with a tin roof. The building was heated by hot water, lighted by electricity, and provided with water and sewer connections. It was intended primarily for administrative purposes principally, its bed capacity was only 65. On the first floor space was provided for following activities: The commanding officer, adjutant, clerks, first sergeant, reception hall, resident physician, eye, ear, and throat, officer of the day, library, reception room, laboratory, etc.; on the second floor were one large ward and several small ones, the prison ward, reception room, rooms for ward masters, toilets, etc.; on the third floor were the operating suite, recovery rooms, dressing rooms, and several small wards.

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    The original construction cost of the main building was $197,860, but additional cost has been incurred by improvements and additions as follows: In 1909, $1,985; 1910, $705,000; and in 1912, $106,540. The cost of repairs  made to March 1, 1918, a period covering practically the first 10 years of the life of the building, totaled $9,204.37.

Building No. 2, a double set of hospital stewards’ quarters, was completed April 18, 1908. It was of brick, with a concrete foundation; and contained a basement, two floors, and an attic, with slate roof.

      FIG 89 —Hospital stewards’ quarters, Walter Reed General Hospital.
         
Building No. 3 was similar to No. 2 in construction and use to which it was put.

Building No. 4 was a storehouse for quartermaster and supplies.

Building No. 5 was a stable; and No. 6 was a wagon shed and garage, with capacity for 12 animal-drawn vehicles in addition to three automobiles.

Building No. 7, a barracks for the enlisted personnel, had a capacity 200 men. This building was completed March 8, 1910. It was of brick concrete foundation and a roof of slate. Its dimensions were 137 by 119 feet, with total floor area of 21,230 square feet. It was heated by steam and by electricity. Water and sewer connections were provided.

Building No. 8 was a captains’ set of quarters and was completed March 8,1910. This building was likewise of brick with concrete foundation and slate roof. Its dimensions were 33 feet by 46 feet 5 inches, and its total area 3, 812 square feet; it was heated by steam, lighted by electricity, and was

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provided with water and sewer connections. The original cost of this building was $12,757.

Building No. 9 was completed March 8, 1910, and was similar to building No.8.

Building No. 11 was the mortuary.

Building No. 12, the Army Nurse Corps home, with capacity of 20 nurses, was completed April 9, 1911. It was of brick with concrete foundation, and roof of slate; it was heated by hot water, lighted by electricity, and with water and sewer connection. The original construction cost of this building was $24,998.
         
            FIG. 90.—Detachment barracks, Walter Reed General Hospital.
         
Building No. 13, the isolation hospital, with a capacity of 12 beds, was completed on November 15, 1913. It was constructed of brick with concrete foundation and a roof of slate. The total cost of its original construction was $22,302.24.

    On April 6, 1914, Ward A, the west addition to the main building (building No. 1) was completed. It was of brick construction to correspond with the main building, and had concrete foundation and a tin roof. The dimensions of this west wing were 43 by 54 feet, and the corridor connecting it with the main building was 17 feet by 34 feet 6 inches. The total floor area, including the corridor, was 2,380 square feet. This addition had a basement and one floor. In the basement there were a recreation room, toilet, closet, corridor, and

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stair hall. On the first floor there was a ward, 51-by 24 by 13 feet; The cost of the construction of this wing was $23,158.

    A second addition to the main building was completed December 28, 1914. This addition, joined to the rear of the main building, was the kitchen and mess, and was constructed of material similar to that of the parent building. Its dimensions were 28 by 37 feet and 28 by 63 feet. There were three and a basement. The basement was used for the storage and preparation of
food; the first floor contained the dining hail; and on the second and third floors the rooms were used as wards. The construction cost of the building was $43,258.
         
              FIG 91.—Officers’ quarters, Walter Reed General Hospital
         
    On May 8, 1915, Ward B, the east addition to the main building was completed. It was similar in size and appearance to the west addition, and was used for wards. In the basement were the wards for the insane.

    On April 26, 1915, the addition to the nurses’ home (building No. 12),  with a capacity of six beds, was completed. The original construction cost of this addition was $18,729.

    On May 1, 1909, when there were only the main building and the two sets of hospital stewards’ quarters, the hospital opened for the reception of patients, in compliance with General Orders No. 702, War Department, April 14, 1909. The post return for May, 1909, shows that there were on duty at the opening, 5 officers, 62 enlisted men of the Hospital Corps and 3 civilian employees—a carpenter, an engineer, and a cook. There was also a matron.

 

278             

Company C of the Hospital Corps, representing 1 officer and 82 enlisted men was attached to the hospital for quarters and rations. That the hospital began to function promptly is indicated by the post return record Of the patients remaining at Walter Reed on May 1, 1909, the end of the first month of activity. At that time 5 officers and 11 enlisted men, 2 retired enlisted men and 1 civilian were under treatment at the hospital.

    Members of the Army Nurse Corps were first assigned to the in June, 1911, after completion of the nurses’ quarters. One chief nurse and three nurses joined for duty on June 21, 1911, and a fourth nurse joined on
      
         FIG 92.—Nurses’ quarters, Walter Reed General Hospital.
         
         
June 24. Their assignment to the hospital facilitated the admission of female patients, who, prior to that date, had been dependent upon the matron for nurse’s care.

    The annual reports for the years preceding 1917 indicate steady progress in the work at Walter Reed General Hospital and marked improvement in the physical aspect of the buildings and grounds. The register shows that up to April 6, 1917, the day on which war was declared, 7,017 cases had been admitted to Walter Reed.

    The post return for April, 1917, gives the following personnel record for that month: On duty—15 officers, 145 enlisted men of the Medical Depart-

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ment and 13 enlisted men of the Quartermaster Corps; patients—19 officers, 89 enlisted men, 3 retired officers and enlisted men and 10 members of the National Guard.

    The administrative system at that time was comparatively simple. There were one commanding officer, one chief of the medical service (who, in addition, performed the duties of the summary court officer), one chief of the surgical service, one chief of the eye, ear, nose and throat service (who also performed the duties of recruiting officer and acted as assistant professor of ophthalmology at the Army Medical School, Washington), one officer who performed the
         
        FIG. 93.—Isolation building, Walter Reed General Hospital.
         
duties of post quartermaster, post ordnance officer, signal and medical property officer, and the commanding officer of the detachment, Medical Department and Quartermaster Corps, one officer who acted as adjutant, registrar, and mess officer, and one officer who performed the duties of pathologist and roentgenologist. One dental officer was on duty and gave dental service to the entire command. The additional officers on duty were assigned as assistants in the various departments and performed such additional duties as members of boards, post exchange officer, athletic officer, and librarian.

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HISTORY SUBSEQUENT TO BEGINNING OF WORLD WAR.
         
 PHYSICAL CHARACTERISTICS.

    Geographic location—Walter Reed General Hospital is located at Takoma Park near the northern limit of the District of Columbia. It may be reached by street car in one hour’s time from the center of the city of Washington. A main highway, Sixteenth Street, likewise connects it with the center of the city, extending directly from the Executive Mansion, the White House, through
an attractive part of Washington to the western entrance to the hospital grounds.

    Terrain.—The site of the hospital possesses a varied terrain. Portions of the grounds are gently rolling and admirably suited to building purposes; other portions are roughly hilly and not adaptable to the orderly arrangement of large numbers of temporary buildings in regular rows. The grades for the necessary roads are moderately easy. Serpentine curves of the main roads through the grounds, which are covered with a wide variety of well spaced
        
       FIG. 94 —Aerophotograph, Walter Reed General Hospital.
         
trees, furnish a vista both parklike and picturesque. The elevation of the site averages 300 feet.
             
    Soil.—The tract is situated where the Coastal Plain and the Piedmont Plateau meet. The resultant soil is diversified in character: it is gravelly and varies in color from grayish yellow to yellowish gray. The subsoil is composed of partially weathered Piedmont Rock and is reddish yellow to brownish. The physical characteristics of both soil and subsoil are such that  moisture is moderately well conserved except during unusually dry periods.

    Climate.—The climate is moderate throughout the year. The winters are usually relatively short and “open”; the summers are proportionately long. The prevailing winds (averaged for 20 years) are northwest for January, February, March and April; south for May, June, July, August and September; and northwest for October, November and December.

    Roads.—Within the hospital grounds the roads are of well-kept concrete, bordered by side walks of similar material.

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    Hospital environment .—T he sanitary status of the surroundings of the  hospital area is that of a well-managed suburban residential section, and is entirely satisfactory. Asphalt streets, maintained by the city of Washington, extend to the entrance to the hospital grounds.

    Water supply.—Water is supplied by the city of Washington, its original source being the Potomac River about 22 miles up stream. It is treated in sand filtration beds before it enters the city system.

    Sewerage.—The sewage of the hospital is disposed of through an adequate sewerage system, which becomes a part of that of the city of Washington. Surface drainage is likewise disposed of through the city system.

    Garbage disposal.—Garbage is stored in covered receptacles and is removed daily, except Sunday, by contract.

         

WAR-TIME PHYSICAL EXPANSION.

    The war emergency of 1917, necessarily assembling a number of troops in the vicinity of Washington, initiated the expansion of Walter Reed Hospital, which continued during the following three years. It will be recalled that, in his recommendation made in 1903, for the establishment of the hospital, the Surgeon General, United States Army, had contemplated such a war-time expansion in that provision of his report which urged that the hospital “serve as a nucleus around which, in time of war, temporary wards may be erected without delay to any extent and at minimum expense.”

    In addition to its functions as a general Army hospital and as the post hospital for Washington Barracks, Walter Reed General Hospital now served as a post hospital for the several camps in the vicinity of Washington.

    The construction of temporary buildings was commenced June 15, 1917. By the end of the year the hospital had a capacity of 950 beds, and the following buildings of the temporary groups had been completed:

    Nurses’ quarters: One-story frame construction, 24 by 497 feet (3 wings), used as quarters for the Army Nurse Corps (female), with accommodations for 50 nurses.

    Barracks: Two-story frame construction, 93 by 111 feet, used as quarters for enlisted men,
with accommodations for 250 men.

    Mess hail: One-story frame construction, 25 by 157 feet, used for enlisted men’s mess, with accommodations for 250 men at one sitting.

    Storehouse: One-story frame construction, 73 by 137 feet, used for storage of medical supplies.

    Guardhouse: One-story frame construction, 24 by 35 feet, used for confinement of prisoners.  Capacity: Guards, 4; prisoners, 15.

    Linen building: One-story frame construction, 24 by 70 feet, used for storage of linens.

    Receiving ward: One-story frame construction, 82 by 93 feet, used for the receiving of
patients, and storage of their personal effects, with accommodations for 8 patients, pending their
assignment to other wards.

    Ten single wards: Wards E, F, G, H, I, L, M, N, Q, and R, of one-story frame construction, 24 by 157 feet, used for the accommodation of enlisted sick. Capacity of each ward, 45. Thirty additional patients could be accommodated on the porches of each ward. (These wards were later designated as 11, 12, 13, 14, 15, 2, 31, 32, 33, and 34, respectively.)

    Three double wards: A and B, C and D, J and K, of one-story frame construction, 24 by 314 feet, used for the accommodation of the enlisted sick. Capacity of each ward, 85 patients.
(These wards were later designated as 1—2, 16—17, and 18—19.)
         
    All of the above enumerated temporary buildings, erected in 1917, as will appear from the individual descriptions, were of frame construction. They were built on concrete piers, had composition roofs and wooden floors, were lighted by electricity and were provided with water and sewer connections.

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    In May, 1917, there was commenced the construction of a central power  plant from which all temporary buildings were to be heated. As this powerhouse was not completed until the following year, the heating arrangements of such temporary buildings as were used during 1917 were necessarily of a makeshift character.

    The necessity for obtaining additional land to afford ground space for the rapidly multiplying buildings became apparent and immediate. Three adjacent sections of land were accordingly purchased during 1918. On January 30, 1918, a deed recorded in liber No. 4057, folio 174, of the land records of the District of Columbia, conveyed 0.118 acre. Release and quitclaim deeds of the same property were executed on February 1, 1918, and April 18, 1918. On February 2, 1918, a deed recorded in liber No. 4057, folio 177, of the land  records of the District of Columbia, conveyed 5.988 acres. Release and quitclaim deeds to this property were  executed       
         
            FIG. 95  [Map--Walter Reed General Hospital, Takoma Park, D.C.]
         
May 5, 1918. The land conveyed by the above-described deeds constituted two triangular sections. One section was bounded by Dogwood Street on the north and by Thirteenth Street on the west, while the hypothenuse of the triangle, to the southeast, lay along the northwestern boundary line of the original hospital reservation. The other section was bounded by Dahlia Street on the north and by Fourteenth Street on the west, while the hypothenuse of the triangle, to the southeast, coincided with the northwestern boundary of the original hospital reservation.  On March 25, 1918, a deed recorded in liber No. 4057, folio 173, of the land records of the District of Columbia, conveyed 19.76 acres. This addition extended the northern and southern boundary lines of the original reservation west of Sixteenth Street. The above enumerated purchases, consisting of 25.966 acres, added to the original purchase of 43.27 acres, brought the total area of the reservation up to 69.136 acres.

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    At the end of the year 1918 the annual report for the hospital shows a capacity of 2,500 beds, and in the same report the record of the completion of temporary buildings, which includes the construction for the years 1917 and 1918, stands as follows:

     Nurses’ quarters: Three 1-story frame constructions, 24 by 497 feet,^a 24 by 217 feet, and 217 feet, used as quarters for the Army Nurse Corps (female), with accommodations for 150 nurses. (Known as nurses’ homes, Nos. 2, 3, and 4, respectively.)

    Barracks: Two-story frame construction, 93 by 111 feet, used as quarters for detachment, Quartermaster Corps, and Motor Transport Corps, with accommodations for about 250 men.

    Quartermaster mess hall: One-story frame construction, 25 by 157 feet, used for enlisted men’s mess, with accommodations for 250 men at one sitting.

    Mess hall No. 2: One-story frame construction, 24 by 625 feet, used for enlisted patients’ mess, with accommodations for 700 men at one sitting.

    Medical Property storehouse: One-story frame construction, 24 by 261 feet,^a used for the storage of medical supplies.

    Kitchen storehouse: One-story frame construction, 24 by 70 feet, used for the storing of canned goods and other staple supplies used by the mess department.

    Linen building: One-story frame construction, 24 by 70 feet, used for the storing of hospital linen.

    Baggage storehouse: One-story building, 24 by 36 feet, used for the storing of baggage. Frame construction.

    Quartermaster storehouse: One-story frame construction, 100 by 118 feet, used for the storing of quartermaster supplies.

    Guardhouse: One-story frame construction, 24 by 35 feet 6 inches, used for the confinement of prisoners. Capacity: 4 guards, 15 prisoners.

    Receiving ward: One-story frame construction, 82 by 93 feet, used for the receiving of patients and storage of their personal effects, with accommodations for 8 patients pending their assignment to other wards. Also used as a post-office substation.

            Two 2-story isolation wards, 24 by 156 feet (designated as wards 23-24, and 27-28), of frame construction, each ward having accommodations for 72 patients.

            Two 1-story isolation wards, 24 by 151 feet (designated as wards 25 and 26), of frame construction; capacity, 36.

            Three double wards and lavatories, 24 by 314 feet (designated as wards 1-2, 16-17, and 18-19), of frame construction, 1-story plan.

    Twenty-six single-ward buildings: Wards 3 and 4 (orthopedic); ward 5 (used at present as a nurses’ home); ward 11 (orthopedic); wards 12, 13, 14, 15 (medical); wards 31, 32, 33 (orthopedic); wards 34, 35, and 36 (eye, ear, nose and throat); wards 41, 42, 43, 44, and 45 (psychopathic); wards 65 and 66 (orthopedic); wards 7l, 72; 73,74;and 75 (orthopedic). These ward buildings were frame construction and were used for the accommodation of enlisted sick. Capacity of each ward, 36.  Dimensions of each ward, 24 by 157 feet.

     Thirteen double-ward buildings: Wards 51-52 (used as quarters for detachment, Medical Department); wards 53-54, 55-56, 57-58, 59-60 (orthopedic); wards 61-62 (occupied by the construction quartermaster and used as office buildings); wards 63-64 (genitourinary); wards 81-82, 83-84, 87-88, 89-90, 91-92 (orthopedic); wards 85-86 (occupied as quarters by detachment, Medical Department). These ward buildings were 2-story hollow-tile construction. Each double ward had accommodations for 72 patients and was occupied by enlisted sick. Dimensions of each
ward, 24 by 157 feet.

            Officers’ pavilions 1 and 2: Two 1-story frame construction, 24 by 314 feet and 24 by 272 feet, used for the accommodation of officers’ sick. Capacity, 50 patients each.

            Red Cross building: Tile and frame, 82 by 120 feet.

            Post-exchange building and auditorium: One-story frame construction, 44 by 157 feet, used as a salesroom and auditorium by the post exchange.

            Bakery: One-story frame construction, 24 by 92 feet, used as post bakeshop.

            Wagon shed: One-story frame construction, 75 by 90 feet, used for the storing of wagons, and also occupied by the hospital fire department.
         
                                       ^aThis building had 3 wings.

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    Bacteriological laboratory: One-story frame construction, 24 by 170 feet. Laboratory addition, 40 by 81 feet 6 inches.

    Dental building: One-story tile construction, 24 by 350 feet, occupied by the dental, eye, ear, nose, and throat clinics.

    Oil shed: One-story frame construction, used for the storing of oils.

    One school building: Wards 93-94, 2-story hollow-tile construction, 24 by 157 feet, used as administrative and school building by the division of reconstruction.

    Wards 95, 96, 97, and 98: One-story hollow-tile construction, 24 by 157 feet, used as curative workshops by the division of reconstruction.

    The physiotherapy building: One-story hollow-tile construction, 24 by 410 feet, including rooms for the hydrotherapy department, electrotherapy department, massaging, and also a gymnasium. (This building was not actually ready for occupancy until 1919.)

    Animal house: One-story frame construction, 10 by 20 feet.
         
    Most of these buildings had concrete foundations (though a few were built on wooden posts), wooden floors, and composition roofs. The wagon shed, bakery, and animal house had concrete floors. All were lighted by electricity and provided with water and sewer connections.
         
        FIG 96.—A view of temporary buildings, Walter Reed General Hospital.
         
       
    In addition to the rapid temporary construction during the war period it was necessary to make certain permanent improvements in the hospital proper. The heaviest expense was incurred in the construction of a power house from which all the temporary buildings were heated. The power plant, although started in May, 1917, was not completed until the following year. The foundations are of concrete, the walls of brick, and the roof steel truss. It has two stacks of radial tile, 150 feet high. The dimensions of the plant 140 by 40 feet with an L wing 40 by 30 feet.

    Other permanent buildings erected at this time include an incinerator, a morgue, and a garage addition. The incinerator was a Nye odorless crema-

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tory incinerator, consisting of a basement and one story, of brick construction with concrete foundation.

    Aside from actual building operations the permanent construction of this period included the installation of various systems and devices, which, with other costs, are enumerated below:

         Roads, concrete                                       $38, 097.48
         Electric lighting system                                     794. 98
         Aero alarm system                                     19, 640. 00
         Water supply system (in reserve)                45, 886. 83
         Water supply mains (to reserve)                   27,071.96
         Sewer system                                              35,681.26
         Power house, heating, original                   293, 000. 00
         Heating system (exterior to buildings)          59, 311. 40
         Heating system (power house addition)       57, 331. 30
         Heating system (north stack)                         6, 250. 70
         Total heating system, part 2                        245,408. 90
    Total                                                               828,474. 81
         
    The cost of the permanent buildings erected during the war period is itemized as follows:

         Power house, building proper, original         $36, 000. 00
         Incinerator (old building)                                   8,000.00
         Garage addition                                             24, 373.00
         Morgue                                                          3, 346. 30
         Alterations, attic of barracks                          11, 830. 59
         Service club (a gift paid for from National Catholic War Council Fund)     85, 000. 00
             Total                                                       168, 549. 89
         
    In September, 1918, the Lane Convalescent Home was taken over as a convalescent home for enlisted sick. This home was located in Takoma Park, D. C., about one-half mile distant from the hospital, and had accommodations for 10 convalescent enlisted men.

    In November, 1918, the Friendship Home, also known as the McLean Estate, was taken over as a convalescent home for sick officers. This home, which was offered to the Government by the owner, was located on Wisconsin Avenue NW., Washington, D.C., about 5 miles from the hospital. It had accommodations for 50 convalescent officers.
         

ADMINISTRATIVE EXPANSION.

         
    After the declaration of war the personnel of the hospital rapidly increased until it was doubled and then redoubled. The picked men of the Regular Army of this time had furnished a small quota of sick, and Walter Reed General Hospital had been an uncrowded, unhurried sanitarium for the care of this small number. Under the pressure of the war emergency it expanded in a little over a year’s time into an institution the inhabitants of which were sufficient to make a thriving little town, and possessing many more than such a town would have known. The forced growth required unremitting care and control and the widely varied elements gathered at Walter Reed General Hospital had to be bound together with a tight organization. In

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perfecting such an organization a comprehensive set of regulations was evolved, in which was outlined the following administrative system:
         
HOSPITAL ORGANIZATION—THE COMMANDING OFFICER.        
        
Department of administration:
        1. The executive officer—
                      (a)  Officer of the day.
                      (B)  Night administrative officer.
        2. Correspondence and records—
                      (a)  Adjutant.
                      (b)  Personnel adjutant—
                                 (1)  Insurance officer.
                      (c)  Supervisor of clinical records—
                                 (1)     Registrar.    
                (2)     Curator, department of illustration
                (3)     Medical examining board for officers.    
                               (4)     Disability board f or enlisted men.
                               (5)     Demobilization board.
      3. Inspection—    
        (a)  Hospital inspector (inspection of administration and service departments).
        (b)  Sanitary inspector (inspection of grounds and buildings for sanitation and maintenance).
        (c)  Post surgeon (inspection of dairies, food supplies, etc.).
                  (d)  Adjutant (inspection of public funds).
                  (e)  Survey officer (inspection of unserviceable property).
      4. Detachment administration—
        (a)  Detachment commander, patients—
                      (1)  Receiving officer.
                            (2)  Disposition officer.
        (b)  Detachment commander, Medical Department.
        (c)  Detachment commander, Quartermaster Detachment.
        (d)  Detachment commander of nurses.
        (e)  Detachment commander of aides.
      5. Police and fire protection—
        (a)  Intelligence officer.
                  (b)  Prison officer.
                  (c)  Fire marshals.
                  (d)  Police officer.
                  (e)  Courts-martial.
Department of service and supply:
           1. Service of supply—
                  (a)  Supply officer.
                  (b)  Ordnance officer.
                  (c)  Finance officer.
                  (d)  Transportation officer
                  (e)  Salvage officer.
                  (f)  Medical supply officer.
           2. Constructing and utilities service—
                  (a)  Constructing quartermaster.
                  (b)  Utilities officer.
           3. Mess service—
                  (a)  Mess officer.
                  (b)  Dietitians.
           4. Motor transport service—
                  (a)  Motor transport officer.
            5. Telephone and telegraph service—
                  (a)  Signal officer.
                 

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Department of service and supply—Continued.
           6. Post exchange—
              (a)  Exchange officer.
           7. Recruiting service—
              (a)  Recruiting officer.
           8. Morale, education and recreation service—
              (a)  Chaplains.
              (5)  Morale officer.
              (c)  Education and recreation officer.
              (d)  Service club hostess.
              (e)  Librarian.

Department of professional services:
   1. Surgical service: Chief of service—
         (a)  Administration officers—
                     (1)     Assistant to chief of service.
                     (2)     Chiefs of sections.
                     (3)     Ward surgeons.
                     (4)     Surgical emergency officers.
          (b)  Professional sections—
                     (1)     General surgery.
                     (2)     Septic surgery.
                     (3)     Empyema
                     (4)     Maxillofacial.
                     (5)     Neurosurgical.
                     (6)     Eye, ear, nose and throat.
                     (7)     Orthopedic.
                     (8)     Amputation.
                     (9)     Dermatology and syphilis.
                     (10)   Urology.
                     (11)    Obstetric and gynecologic.
          (c)  Professional departments—
                     (1)     Dental.
                     (2)     X-ray.
                     (3)     Orthopedic appliance shop.         
                     (4)     Anesthesia.
        
    2. Medical service: Chief of service—
         (a)  Assistant to the chief of service.
         (b)  Chiefs of section—
                     (1)     General medicine section.
                     (2)     Neuropsychiatric section.
                     (3)     Contagious disease section.
         (c)  Receiving officer.
         (d)  Post surgeon.
         (e)  Ward surgeons.
         (f)  Medical emergency officer.
        Laboratory department—
         (a)  Bacteriological section.
         (b)  Chemical section.
         (c)  Pathological section (mortuary).
    
Reconstruction and education departments:
    1. Ward handicrafts: For patients unable to leave their wards.
    2. Curative shop work: For patients whose primary requirement is curative; occupational
               therapy.
        (a)  Wood working.
        (b)  Rug weaving.
        (c)  Clay modeling.
        (d)  Gardening.
        (e)  Typewriting.

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Reconstruction and education departments—Continued.

    3.    Educational and vocational training—
        (a)  Academic: English, reading, writing, arithmetic, etc.
        (b) Commercial: Shorthand, typewriting, bookkeeping, accounting, office appliances.
        (c) Trade and vocational training—
            (1) Auto mechanics.
            (2) Garden and greenhouse management.
            (3) Electrical wiring and dynamo tending.
            (4) Drafting.
            (5) Jewelry making and repairing.
            (6) Machine shop practice.
            (7) Motion picture operating.
            (8) Photography.
            (9) Rug weaving and repairing.
            (10) Wireless telegraphy.
            (11) Oxyacetylene welding.
            (12) Vulcanizing and tire repairing.
            (13) General printing.
            (14) Linotype operating.
            (15) Wood shop practice.
    Physiotherapy department:
        1.Measurement and record section.
        2.Hydrotherapy.
        3.Electrotherapy.
        4.  Massage.
        5.Medical gymnastics.
    Nursing  department:
        1.Army Nurse Corps—principal chief nurse—
            (a) Assistant chief nurse (records and correspondence).
            (b) Day supervisor for graduate nurses.
            (c) Night supervisor for graduate nurses.
        2.Army School of  Nursing—
            (a) Superintendent—
                (1) Theoretical instructor.
                (2) Practical instructor.
                (3) Circulating supervisors for student nurses.

         
HOSPITAL DEPARTMENTS.
         
    The activities of the hospital were organized under a commanding officer and divided into six departments, namely, administration, service and supply, professional services, reconstruction and education, physiotherapy, and nursing.
         
DEPARTMENT OF ADMINISTRATION.    
     
    In the department of administration there were five functional divisions: The executive officer; correspondence and records; inspection; detachment administration; police and fire protection.

    The executive officer was charged, under the direction of the commanding officer, with the coordination of all departments of the hospital. Under his supervision the duties of the officer of the day and the night administrative officer were performed. The officer of the day was detailed by the adjutant from the roster of the officers, below field rank, on duty at the hospital, and the detail took precedence over all other details. The tour of duty for this officer was for 24 hours, during which time he might not absent himself from the post. In the absence of the commanding officer and subordinate administrative officer,

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the officer of the day acted, and he was further specifically charged with the duties of making an inspection tour of the main building and all wards of the hospital at least once during his tour of duty; inspecting the guard at least three times during his tour of duty; inspecting at least one meal at each mess conducted for patients, nurses, and enlisted personnel of the hospital; in case of fire, taking charge pending the arrival Of the commanding officer or fire marshal, reporting in detail any fire occurring during his tour of duty and visiting the firehouse at least once during his tour to assure himself that the crew was on duty; acting for the commanding officer in carrying out hospital regulations regarding uniforms, passes for visitors, extinguishing lights, and in the maintenance of order and discipline; witnessing the preparation of the bodies of deceased patients and forwarding reports of deaths to the registrar’s office; opening all official telegrams received outside of regular office hours, and sending telegrams indicated by serious illness, deaths or other emergencies; conducting the guard detail, in which connection he was charged with the responsibility of safeguarding the prisoners.

    The night administrative officer was the night representative of the executive officer in the coordination of the hospital administration. He was called upon to render all possible assistance to the officer of the day in the maintenance of good order and military discipline, and particularly to maintain by frequent inspection and necessary action the police and fire prevention of the post.

CORRESPONDENCE AND RECORDS.
         
    The adjutant had charge of all incoming and outgoing correspondence, orders, and circulars, and had general control of all hospital records. He verified and issued all orders and details, including administrative assignments, both roster and special of officers and civilian employees. He examined in person all incoming correspondence and referred to the proper officer, letters, orders, or circulars, for guidance or action, maintaining such record of disposition of papers as would insure prompt and certain execution of public business.  He caused replies, indorsements, and reports to be prepared for the signature of the commanding officer and replied, in the name of the commanding officer, to letters of inquiry concerning patients. In cases of critical illness or serious operative procedure, lie was charged with the notification of relatives, and in case of death in the command, he was charged with the arrangement for the disposition of the remains and the effects of the deceased and the notification of all concerned. He insured the audit of all public  funds and submitted a report of audit, together with a statement of all funds, as soon as possible after the end of each month, to the commanding officer. He also acted as historian of the post.

    The personnel adjutant maintained the official records of all commissioned officers either on duty or sick at the hospital. He prepared all pay cards, pay rolls, and reports of changes in the status of officers and enlisted men, and all papers, other than professional, relating to the discharge of enlisted personnel on a surgeon’s certificate of disability.  He was further charged with the maintenance of records of enlisted casual sick, records of the naturalization of aliens,  with notarial duties, instruction in income-tax returns, and the supervision of  

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the insurance officer in all matters relating to insurance, compensation, and allotments under the Bureau of War Risk Insurance. The insurance officer was responsible for the preparation of all applications, alterations, conversions, or discontinuances of insurance, and the presentation to the War Risk Bureau of all claims for insurance in cases of permanent total disability.

    The supervisor of clinical records was responsible for the permanent record of all patients admitted to the hospital and the preparation of data for the commanding officer relating to the clinical records or professional pronouncement for record and correspondence. He was charged specifically with the following duties: Requiring the proper clinical records to be submitted. from the various professional services upon completion of cases whether by discharge, transfer, death, or other disposition; supervising the proper classification, indexing, filing, and preservation of clinical records; signing death certificates; filing records of clinical importance in connection with discharge or other disposition of officers admitted to the hospital; furnishing the commanding officer with a definite and authoritative statement concerning patients, when called upon to do so; representing the commanding officer on the advisory board of the department of exhibits.

    The registrar maintained in an indexed and available form all medical and surgical records, prepared all reports and returns pertaining to the sick and wounded and kept an accurate index of diseases.

    The curator had charge of the department of illustration. The purpose of this department was to collect, index, preserve and exhibit prints, slides, sketches, specimens and models of scientific interest in connection with the work of the hospital. The department was composed of a pictorial section (oil, black and white, water color); a photographic section (color, portrait, specimens, prints, slides, enlargements and reductions, microphotography); and a modeling section (plaster, wax). The curator received requests for work from any department of the hospital and assigned the execution of the work to the proper artists. He bore the responsibility for the care, preservation, and proper arrangement of all exhibits. The policy of the department and all questions arising in connection with the character of work and a priority of consideration, were determined by an advisory board consisting of the chiefs of the medical and surgical services, the chief of laboratory service, and the supervisor of clinical records.

    The medical examining board for officers consisted of the chief of the surgical service, the chief of the medical service, the chief of the eye, ear, nose and throat department, and the supervisor of clinical records. The last named officer was the recorder of the board. The board acted on recommendations for retirement or other disposition of officers of the Regular Army; the disposition of temporary officers; the disposition of nurses; and the review of cases of appeal
from action of the disability board.

    The disability board for enlisted men, the duties of which were those indicated by the name of the board, consisted of the supervisor of clinical records, the first assistant supervisor of- clinical records, a representative of the surgical service, a representative of the medical service, a representative of the eye, ear, nose and throat department, and a representative of any speciality, upon call of the chairman.

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    The demobilization board, organized for the purpose of examining officers and enlisted men prior to demobilization, consisted of the supervisor of clinical records, the first assistant supervisor of clinical records, the second assistant supervisor of clinical records and a representative of the eye, ear, nose and throat department.

INSPECTION DIVISION.

    The inspection division was organized as follows: Hospital inspector (inspection of administration and service departments); sanitary inspector (sanitary inspection of grounds and buildings); post surgeon (inspection of dairies, food, food supplies, etc.); adjutant (inspection of public funds); and survey officer (inspection of unserviceable property). The hospital inspector  was required to make a progressive study of the administration and service of the departments of the hospital, with a view to increased efficiency. The sanitary inspector made periodical inspections of all buildings and grounds of the station for the adequate maintenance of sanitation, police, fire prevention, upkeep of building, and general discipline of enlisted personnel on duty.

   Seven-noncommissioned officers were detailed to assist him in such inspection. The post surgeon furnished medical attendance to the personnel on duty. He held sick call and prescribed physical inspection for detachments of the enlisted men; he furnished medical attendance to nurses and aides. He was responsible for the furnishing of medical attendance to every man in confinement and acted as ward surgeon to detention wards. He was authorized to call upon the special professional services for special treatment, when necessary. He was responsible f or the maintenance of prison wards in a proper sanitary condition. He was expected to make a careful survey of conditions affecting health of the command, instituting corrective measures whenever indicated, and at the end of every month to prepare the surgeon’s sanitary report; to keep informed concerning the source, prevention, and disposal of food supplies; and to see that  food handlers were free from contagious or communicable diseases. The disinfection of buildings and property exposed to contagious diseases was in his charge. To the survey officer fell the duty of disposing of property which had been rendered unserviceable other than by fair wear and tear in the service, as indicated in paragraph 717, Army Regulations.
         
DETACHMENT ADMINISTRATION.

    The division of detachment administration included five commanders, for the patients, Medical Department, Quartermaster Department, nurses, and aides. The commander of the detachment of patients performed all duties of his office as prescribed in Army Regulations, Manual for the Medical Department, general orders of the War Department, and the regulations of Walter Reed General Hospital. Under his direction the receiving officer and the disposition officer performed their respective duties. The receiving officer was charged with the following duties and responsibilities:

    (1)  To receive, examine, classify, and send to the proper wards all incoming patients, exercising due precaution in the prompt isolation of contagious or infectious diseases.
    (2)  To keep informed at all times concerning the number of beds available in the various wards and to foresee and provide for expected arrivals.
    (3)  To supervise the transportation of sick and wounded to and from the hospital

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    (4)    To care for all incoming patients who required immediate or emergency treatment.
    (5)    To receive, receipt for, and safeguard the valuables of incoming patients.  
    (6)    To provide transportation and to receive and receipt for the baggage of the patient&
    (7)    To prepare all required forms, records, and notifications in connection with the admission of patients.
    (8)    To provide medical attendance, nursing, and ward service for patients in the receiving ward.
         
    In connection with the duty of safeguarding the valuables of incoming patients, when such patients were irresponsible, the receiving officer was required to cause the money or valuables of those patients to be collected in his presence and that of a competent witness The disposition officer was held responsible for the conduct of the disposition office, the post Office, the information desk, the patients’ baggage room, and the patients’ bank. He made all necessary arrangements for patients expecting to leave the hospital, providing special transportation for crippled or invalid patients. Information concerning railroad transportation was furnished as well as assistance in procuring it; the delivery of baggage and personal effects; and the furnishing of transportation to home or railroad station. Upon receipt of approved requests, the disposition officer issued passes to patients for temporary absence from the hospital. In performing his routine duties in connection with the personal effects and baggage of patients, the disposition officer was required to keep four files: A live file for the effects of patients in the hospital; a dead file for the effects of patients who had left the hospital and taken their belongings with them; a suspended file for the effects of patients who had left the hospital and had not taken their belongings with them; and a file of receipts for baggage held by the supply officer. An elaborate filing system was required for the maintenance of the bureau of information, for all patients and personnel of the hospital. The detachment commander, detachment, Medical Department, assigned personnel to duty in the hospital and made prompt replacements for casualties. He provided for the instruction of enlisted personnel assigned to him and maintained the discipline of the detachment. lie kept a detachment punishment book; personally investigated accusations before preferring charges; and he furnished a record of company punishments or prior court-martials, with recommendations, or a brief statement of his investigations in submitting charges. He performed such other special duties in connection with the personnel on duty at the hospital as were assigned to him, as well as all duties of a detachment commander. The detachment commander, quartermaster detachment, performed all duties of a detachment commander as prescribed in existent regulations and orders. The detachment commanders of nurses and aides were responsible for the discipline, performance of duty, and conduct while on duty, of nurses and aides assigned to their respective departments.
         
POLICE AND FIRE PROTECTION.

    The police and fire protection division of the department of administration included an intelligence officer, a prison officer, fire marshals, a police officer, and courts-martial. The intelligence officer carried out the instructions of the military information division and such other instructions as he received from the commanding officer. The prison officer exercised immediate command of the guard detachment and assigned the guard detail by roster. He kept a

293
         
record of all prisoners and made the necessary reports of prisoners; he also kept a guard report. He was charged with direct responsibility for the security of the guardhouse and other places of confinement of prisoners, and with the cleanliness and sanitation of such places. The prison was designated and occupied as follows: The main guardhouse, for garrison prisoners other than patients; the detention ward, for patients under detention; and ward “A,” separate rooms for the confinement of prisoners sick with contagious diseases, and for other special purposes. No prisoner suffering with a contagious disease was confined with other prisoners who were not similarly affected. All prisoners in confinement were equipped with proper clothing and bedding, and any prisoner claiming to need medical attention was given prompt medical examination. The fire marshal was charged with the inspection of fire apparatus, and to him fell the duty of making recommendations for fire prevention and of initiating additional measures for this purpose. He insured the instruction and drill of the regular fire crew and of the officers and enlisted personnel on duty. Pending the arrival of the District of Columbia fire department, he was expected to take immediate charge of fire fighting. The following is a résumé of the fire regulations of the hospital. In the fire protection branch of the hospital there were at least at all times a fire marshal, a first deputy fire marshal, a second deputy fire marshal, the officer of the day, and the fire chief (civilian).  One of the officials, in addition to the officer of the day, was on duty at all times.  The senior officer present assumed charge of fire fighting until the arrival of the commanding officer or fire department officials. In order to prevent fire, smoking was strictly prohibited in storerooms, garage, motor transport office, repair shops, stables, and workrooms of the reconstruction shops; floor brighteners and other highly inflammable materials were required to be kept in tightly corked original containers, and with the cloths used in applying them were stored in sealed lockers, not in wooden closets or storerooms. Smoking was prohibited in the post auditorium and Red Cross house during performances or assemblies, and the closing or blocking of exits from these buildings was prohibited. At the alarm of fire, the personnel other than those for whom special duties were provided in the regulations, proceeded with all possible speed to the scene of the fire and reported as follows:

    Administrative officers, and others not assigned to the professional services, to the executive officer or his deputy, for assignment to duty with sections of the fire-fighting department. Officers of the surgical service to the chief thereof or his deputy, for assignment to specific stations and duties. The function of the surgical service was the removal of patients from threatened buildings. The chiefs of litter squads, upon arrival at the scene oi a fire, were required to report to the chief of the surgical service or his deputy. Officers of the medical service to the chief thereof, or his deputy, for assignment to specific stations and duties in connection with salvage operations. The chiefs of salvage details, upon arrival at the scene of a fire, were required to report to the chief of the medical service or his deputy. All ward medical officers, whose wards were in the district in which the fire developed, repaired to their respective wards to  maintain order and prepare, if necessary, to remove their patients. Nurses  repaired to their wards and, if danger threatened, prepared their patients to be moved. Noncommissioned-officers in property and finance offices closed their offices and proceeded to the scene of the fire. Noncommissioned officers

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and attendants on duty in receiving and disposition wards remained at their posts of duty. Cooks preparing meals remained at their posts, but dining-room attendants proceeded to the scene of fire. All enlisted men in barracks, not otherwise provided for, assembled upon the detachment parade grounds under the supervision of the senior noncommissioned officer present, who conducted them at double-time to the scene of the fire and reported to the fire marshal or the officer in charge. Patients in buildings, other than the one which was on fire, did not leave them unless the fire marshal deemed it necessary to have them moved to a place of safety. The officer of the day made a personal check of all motor and hand-drawn equipment reporting at the scene of the fire and noted the time of arrival of each vehicle. The fire chief, or the first officer arriving at the scene of the fire, notified the telephone operator if it was apparent that the services of the Washington City fire department would be required.

    The fire chief was charged with the instruction, discipline, performance of duty, and conduct while on duty, of all personnel- permanently detailed or employed in the fire department. He was responsible for the maintenance in proper condition for instant use of all fire-fighting equipment in the post. He was further charged with a daily inspection of the hospital, with the view to the elimination of fire risks, and he was placed under immediate direction of  the fire marshal in all particulars. The fire marshal held frequent fire drills, subject to the approval of the commanding officer, and immediately following such drills all fire apparatus was inspected.

    The aero automatic fire-alarm system which was installed in practically all buildings could be set in operation in two ways: by breaking the glass rod in the signal box, and by means of sudden rise in temperature on the aero wires. Variations in temperature, not resulting from fire, caused frequent false alarms to come in over the automatic fire-alarm system, so that it became necessary to map out a procedure when this alarm sounded. All personnel heretofore specified were to proceed at once to the building from which the alarm emanated, and under no circumstance to leave the vicinity until the fire marshal or other competent officer made a thorough investigation of the cause of the alarm. If the alarm proved to he a false one, recall was sounded and personnel and equipment returned to their proper stations. In case of aero alarm, switchboard operators were not required to give notice of fire until notified by a responsible officer that a fire actually existed; nor did the sergeant of the guard have “fire call” and the siren sounded until after receipt of like information.

    The officer in charge of the utilities department was responsible for the proper manning of all equipment in the fire department. He was permitted to call upon the post supply officer and the motor transport officer for such number of men as he might need. The detachment commander, Quartermaster Department, detailed from his detachment properly trained day and night crews for handling hose and ladder -trucks and 22 carts. The detachment commander, Medical Department, detailed day and night crews to handle other hose carts. He also formed and instructed in their duties one salvage section, one bucket section, one fire extinguisher section, and one ladder section.

    The hospital was furnished with a complete fire-fighting equipment and was provided with numerous fire telephones, marked at night with red lights and with signal boxes.

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    The following fire-fighting equipment was maintained: One La France auto combination pump, chemical and hose truck; one Ford motor chemical tank (33 gallons); one Ford motor combination chemical and hose wagon (33 gallons); one hand-drawn hook and ladder truck with a 55-foot extension ladder, two 24-inch plain ladders, and one 10-foot roof ladder; four hand-hose reel carts with 45 feet of 2 ½-inch hose; three hand-drawn chemical carts (66 gallons); 15 hand-drawn chemical carts (33 gallons); 7 extension ladders, 40 and 50 foot lengths; 43 ladders, plain (30-foot lengths); 641 buckets, fire; 216 chemical fire extinguishers, 1 quart (Pyrene); 77 chemical fire extinguishers, 1 quart (Fight Fire); 144 axes (pick); 226 hand grenades; 45 fire hydrants; 1,750 feet of 3/4-inch rubber hose for chemical tanks; 3,250 feet of 2 ½-inch cotton hose.

    The automatic fire-alarm system was installed in the temporary wards and storehouses. It consisted of 126 circuits, 2 punch registers, and 10 aero gongs. In addition to the aero alarm system there was a local alarm system for the administration building only, with a signal alarm in the basement and on all floors. An electric siren and alarm was installed at the power house, but did not prove to be satisfactory.

    The police officer was charged with the general policing of the grounds of the post, and made a systematic inspection of each section of the post for this purpose. Courts-martial were conducted in accordance with the Manual for Courts-Martial, and all officers charged with the administration of justice or with the execution of military sentences were required to acquaint themselves with the provisions of this manual.
         
DEPARTMENT OF SERVICE AND SUPPLY.
         
    The department of service and supply included eight divisions, identified as follows: Service of supply; constructing and utilities service; mess service; motor transport service; telegraph and telephone service; post exchange; morale; educational and recreation service.
                
    The division of service of supply included six officers, namely, supply, ordnance, finance, transportation, salvage, and medical supply. The supply officer was charged with the procurement and issue of all supplies for the post, and the proper accounting for the supplies received. In the absence of a commissioned subordinate, he administered the ordnance, the commissary, the transportation, salvage office, and the medical supply office. The medical  property officer was in charge of the supply, issue, repair, care, and disposal of all medical property. He was the equipment officer of the hospital and was expected not to wait for requests but to seek in every way possible to obtain and issue the best equipment for the hospital. His responsibilities included receiving, accounting for, and transmitting to the United States Treasury all money collected for sale of medical supplies to civilians. The officer in charge of the dispensary transmitted to him all funds received for the sale of supplies to civilians, with the name of the purchaser, the date of sale, and the prescription number. A medical officer was designated as in charge of the pharmacy by the commanding officer. This officer supervised the work of the department and was responsible for its proper functioning. The functions of the pharmacy were as follows: Compounding prescriptions; issuing drugs upon prescription of the medical officer on duty; manufacturing

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compounds for the wards of the hospital; and procuring, recording, storing, and issuing supplies in accordance with regulations.

    The constructing and utilities service was administered by two officers—the constructing quartermaster and the utilities officer. The constructing quartermaster was responsible for the construction work in accordance with the plans, specifications, and instructions received from the Chief of the Construction Division, War Department. The utilities officer was charged with the repair and maintenance of all military structures on the post and with the maintenance of all utilities connected therewith, except the handling of passengers and freight. Specifically, the utilities officer was responsible for buildings and grounds, roads, walks and fences, sewerage and drainage systems, plumbing, heating, electrical energy, refrigeration, water supply, and fire protection.

    The mess service was administered by a mess officer, assisted by the dietitians. The mess officer was in charge of all messes on the post and was responsible for the procurement of proper food supplies and their satisfactory preparation and service. He exercised immediate control of both civilian and enlisted personnel assigned to mess duty, required necessary medical and   laboratory examination of all food handlers; supervised the assignment and performance of duty of dietitians and provided such special diets or articles as might be prescribed by the medical officers. The head dietitian cooperated with the mess officer, the professional services, and the chief nurse in the preparation of proper diets for patients in the hospital. She assigned her subordinates and was in direct charge of their discipline. The dietitian placed in charge of the mess was responsible for the dietary service of that mess. She was expected to acquaint herself, by consultation with the ward surgeon or head nurse, with the special needs of the individual patients, and strictly to follow instructions received from special services for special diets. A daily report was furnished by the head nurse of each ward to the principal chief nurse, giving constructive criticism upon meals served in her ward. This report was submitted to the mess officer through the head dietitian. The mess department conducted messes as follows:

    (1)   An officers’ mess which provided for officers and civilians in the status of officers who were patients in the main administration building, and also for ambulant patients of these classes in other wards.
    (2)   Patients’ general mess, which provided for all enlisted men and civilians upon such status.
    (3)   Detachment mess, conducted by detachment commander.
    (4)   Nurses’ mess, conducted by the stewardess assigned to this mess under the supervision of the chief nurse.
    (5)   Mess for officers’ pavilion No. 1, which provided for patients in said pavilion and other neighboring officer wards.
    (6)   Mess for the women’s ward.
         
    The motor transportation service provided four classes of service: Passenger, freight, ambulance, and fire-fighting equipment. The motor transport officer was charged with the procurement, maintenance, operation, and disposition of all motor transportation of the post; he controlled military and civilian personnel assigned to his department; and he required obedience to traffic laws, promptly investigating and reporting traffic accidents involving his equipment.

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    The signal officer maintained the telegraph and telephone service of the post. He employed and controlled the civilian personnel assigned to the service, and exercised immediate control of enlisted personnel detailed for this, duty.

    The exchange officer conducted the post exchange, in compliance with Army Regulations. The exchange, in addition to the usual store service, included a barber shop and a lunch counter. It also provided funds for conducting a cafeteria service by the service club. The net profits of the cafeteria service, after all operating expenses had been paid, were assigned by the post exchange to the educational and recreational officer, to be used for recreational service for the enlisted personnel and patients of the hospital.

    The morale, education, and recreation service included chaplains, a morale officer, an education and recreation officer, a service club hostess, and a librarian. The chaplains performed the usual duties of their office. The morale officer, under the direction of the commanding officer, established a morale organization, charged with the general functions indicated in War Department instructions. The education officer was charged with the institution and operation of schools for the enlisted personnel of the post. The recreation officer had supervision of the entertainment of patients and hospital personnel and of the recreational work of the welfare organizations and other volunteer organizations permitted on the post. He provided generous and varied opportunity for athletics and recreation for convalescent patients and for personnel on duty. Under his direction a service club was operated by a hostess and a post library by an authorized appointee.
         
DEPARTMENT OF PROFESSIONAL SERVICES.

THE SURGICAL SERVICE.
         
    The surgical service was administered by a chief of service, an assistant to the chief of service, chiefs of sections, ward surgeons, and surgical emergency officers.

    The chief of the surgical service was charged with the responsibility for all matters relating to his service, including the character of professional service rendered and the care and treatment given to surgical patients, the preparation, maintenance, and disposition of clinical records of surgical patients and the instruction of medical officers, nurses, and enlisted personnel assigned to this service.

    The assistant to the chief of the surgical service performed all the duties of an administrative officer to the service and such additional duties as might be assigned to him by his chief.

    The chiefs of section were responsible for the efficiency of professional services rendered; for the care and treatment of patients; for the maintenance of good order, military discipline, police, and sanitation; for the instruction of subordinate medical officers, nurses, and enlisted attendants; and for the preparation, preservation, and the proper disposition of records of patients in each section. Each chief surveyed all patients in his section at frequent and regular intervals, in company with the ward surgeon, and initiated measures for the disposition of patients at the proper time. In consultation with the ward surgeon, he caused to be prepared the disability reports for military patients who were recommended for disability discharge and insured that com-

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plete clinical records were forwarded with these recommendations to the supervisor of clinical records, through the chief of service. He required that a careful clinical history of all patients be submitted to him by the ward surgeon at his first consultation or within 24 hours thereafter; and that progress sheets and diagnoses be kept up to date. He held consultation with an officer representing the physiotherapy department for every patient in his section whose condition indicated such special treatment. He was responsible that any necessary dental examination, eye, ear, nose, and throat examination, and other indicated special examinations were accorded patients in his section. He maintained an office and forwarded routine papers at least twice daily. All requests for leaves or passes for officer patients, furloughs for enlisted patients, requests for transfer, or other disposition of patients were sent by the ward surgeon, with his recommendation, to the chief of section, who promptly forwarded the same, with recommendation, to the proper office. Furlough requests were forwarded direct to the commanding officer, detachment of patients. All other leave requests, transfer requests, etc., were sent to the chief of the surgical service. A chief of section was required to report to the office of the chief of service one-half hour prior to the beginning of the tour of duty of the senior surgical emergency officer and to inform the emergency officer concerning special treatment of serious surgical cases of his section. The chief of a section was further required to investigate complaints of patients and to make satisfactory disposition of such defects as far as possible. He controlled the transfer of patients within his section and made recommendation to the chief of service for transfers to other sections or services. He was responsible for measures of fire prevention in his section and assumed charge of the removal of patients and the salvage of public property in his section in case of fire. He submitted to the curator requests for work by the department of illustration.

    The surgical service included the following sections: General surgery, septic surgery, empyema, maxillofacial, neurosurgical, eye, ear, nose, and throat orthopedic, amputation, dermatology and syphilis, urology, obstetrics, and gynecology.

    The general responsibility of a ward surgeon included the care and welfare of all patients in his wards; the treatment and diet of his patients; the discipline of the attendants and patients; the police of his wards and porches; the rendition of reports and returns; and the enforcement of hospital regulations in so far as they applied to his ward. He made at least one round of his wards in the morning and at least one in the afternoon. Ward morning reports were prepared by him to cover all cases admitted, disposed of, or transferred from and to the ward in the previous 24 hours ending at midnight. Daily diet  requests and mess storeroom requests were signed by the ward surgeon and sent to the mess officer before 9.30 each morning. Diagnosis cards, received by the ward from the receiving officer, were completed by the ward surgeon and turned in to the sick and wounded office as soon as possible, preferably within 48 hours. Duty slips for all cases disposed of either as duty, discharged, transferred to other hospitals, sick leave or furlough, were completed by the ward surgeon and sent through the chief of the section, with complete clinical records, to the registrar, 24 hours previous to the patient’s departure. A complete examination and clinical history were made in every case by the ward

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surgeon as soon as practicable after the admission of a patient. Upon the disposition of a case the clinical record was completed and signed by the ward surgeon and sent to the registrar. In case of death of a patient, the clinical records were completed (including a statement as to the cause of death, signed by the ward surgeon) and sent to the registrar without delay. Requests  for consultation were prepared by the ward surgeon and were submitted to the chief of section. As soon as practicable after admission of a patient the ward surgeon called upon the dental surgery officer for a dental examination, and the chief of the eye, ear, nose, and throat section for an eye, ear, nose, and throat examination. When a patient was to be transferred from one ward to another, a transfer slip, signed by the ward surgeon and initialed by the disposing chief of section, was sent to the chief of section receiving the case, who indicated the ward to which the patient was to be sent. The transfer slip and clinical record were then sent with the patient to the ward indicated. The ward surgeon promptly sent the transfer slip to the registrar. Recommendations for transfer to other hospitals were prepared by  the ward surgeon and sent to the chief of section for the consideration of the chief of service. When a patient was discharged for disability, the ward surgeon arranged for a consultation with the chief of section and submitted the data for the preparation of a certificate of disability. Routine pass privileges were granted or refused by the ward surgeon. Special requests for leave of patients were submitted by the ward surgeon to the commanding officer, detachment of patients. For all contagious diseases, mumps excepted, the ward surgeon immediately made out a report card to the Health Department, District of Columbia. This card was sent, together with the diagnosis card, to the registrar; and when the patient had recovered from the disease, the ward surgeon sent a recovery card in the same manner. Every precaution was taken in contagious-disease wards to prevent spread of the contagion. The ward surgeon was responsible for the preparation of notifications of death or serious illness and their transmission to the proper officer. Upon the death of a patient he prepared the notification in quadruplicate and sent one copy to the adjutant, one to the detachment commander of patients, one to the supervisor of clinical records, and one to the officer in-charge of the mortuary. Upon receipt of this notice the adjutant, or in his absence the officer of the day, notified the nearest relative with utmost speed. All valuables were removed from the body under the direct supervision of the ward surgeon and were turned in to the adjutant. In case of serious or critical illness, or contemplated major operations, serious illness cards were sent by the ward surgeon to the adjutant. These slips included the names of such relatives as the patient wished to notify and stated whether the notification should be made by telegram or letter.  The ward surgeon was further required to notify the chaplain of cases of death and serious illness. He also kept relatives of the patients in his particular ward informed of the clinical progress of the patient. The ward surgeon signed requisitions for medical supplies, sending them to the medical property officer direct. He was required to exercise special care in the matter of requisitioning narcotics, intoxicating liquors, or habit-forming drugs, and after their receipt he was required to keep them under lock and key. Finally, he was responsible for the protection of the property of the patients, for the maintenance of discipline, and for observing precautions against fire in the ward.     

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    Two surgical emergency officers were detailed by roster from medical officers on duty in the surgical service. The senior member was an officer of field rank and his tour of duty was from 5 p. m. to 9 a. m. They, tour of the junior member was from 9 a. m. to 9 p. m. The senior member saw all acute surgical cases and visited all patients who had been operated on the day of his tour, taking any action indicated. He acted as consultant and advisor to the junior member and, upon request, to the medical emergency officer. The junior officer functioned in the absence of surgical ward surgeons. He made a complete inspection of the entire surgical service between the hours of 9 p. m. and 12 midnight. In case of death he saw that the body was properly tagged and removed to the mortuary.

    Professional departments which were subsidiary to the surgical service were the dental department, the X-ray department, the orthopedic appliance shop, and the department of anesthesia.

    The chief of the dental department was responsible for the dental service rendered at the hospital, for the supervision and instruction of all personnel assigned to his division, and for all the public property under his control. All military patients admitted to the hospital were examined by the dental survey officer, who furnished a report to the chief of his department. The chief of the dental department furnished imperative dental attention whenever indicated and elective dental attention as far as possible.             

    The chief of the X-ray department was responsible for the X-ray service rendered at the hospital, for the supervision and instruction of all personnel assigned to his division, and for all equipment and public property under his control. Before ordering an X-ray series, surgeons were required to ascertain whether a series had been taken within four weeks; and, if such a series were available and satisfactory, to refrain from ordering another series. In no instance was another series ordered within three weeks of a former exposure of a patient unless specifically authorized by the officer in charge of the X-ray department.

    The chief of the orthopedic appliance shop was responsible for the conduct of the shop, the supervision of the personnel assigned thereto, and the care of the equipment.

    The chief anesthetist supervised the administration of anesthetics, gave instruction in such administration, and took general charge of the operating rooms and personnel.

THE MEDICAL SERVICE.
         
    The organization of the medical service closely followed that of the surgical service and included a chief of service, an assistant chief of service, chiefs of sections, ward surgeons, and a medical emergency officer. With the exception of the last-named officer these officers were charged with responsibilities corresponding to those already outlined for the surgical service. The medical emergency officer was appointed by the chief of service from among the available officers of the medical service. His tour extended from 9 a. m. of the date designated to 9 a. m. of the succeeding day. During his tour lie did not leave the reservation and was required to keep the switchboard operator advised of his whereabouts at all times. The medical emergency officer was charged with the care of all persons and patients in the detention wards. In the absence of

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ward surgeons he was in charge of all medical patients. When patients of the medical service developed surgical conditions he consulted with the surgical emergency officer, and he likewise stood ready to give advice concerning surgical patients who developed medical conditions. When any patient died in the medical and detention wards he examined the dead and ordered the remains to be removed to the mortuary.
         
THE LABORATORY SERVICE.
         
    The chief of the laboratory department was responsible for the laboratory service rendered at the hospital, for the supervision and instruction of all personnel assigned to the laboratory, and for the care of all laboratory equipment. He maintained a bacteriology section, a chemical section, and a pathological section in his laboratory. He assigned responsibility for the care and conduct of the mortuary; and he was responsible f or the proper performance of autopsies, when authorized by the commanding officer, and for the proper disposition of the bodies of all deceased patients received at the mortuary. Upon request of the mess officer or detachment commanders he examined food handlers to eliminate typhoid carriers, and upon request of chiefs of service he examined any patients or personnel to identify carriers of communicable disease. At regular intervals he examined food supplies. Upon requests of chiefs of service or detachment commanders he administered vaccine. He maintained a list, by groups, of volunteer donors for blood transfusions, and supplied a donor when requested by chiefs of service.
         
THE DEPARTMENT OF RECONSTRUCTION AND EDUCATION.
         
    The department of reconstruction and education included three divisions, namely, ward handicrafts, curative shop work, and educational and vocational training. The department was administered by an educational director.
         
THE PHYSIOTHERAPY DEPARTMENT.
         
    The physiotherapy department was likewise administered by a director who was responsible for the conduct of his department, its personnel, and equipment. Physiotherapy was prescribed by chiefs of service or section, and frequent consultations were required between the medical officers prescribing the treatment and the officers who gave it.
         
THE NURSING DEPARTMENT.
         
    The nursing department of the hospital was administered by the principal chief nurse and the assistant principal chief nurse, the day supervisor of graduate nurses, the night supervisor of graduate nurses, and the superintendent of the Army School of Nursing.

    The principal chief nurse was responsible for the efficiency of the nursing and for the conduct of the Army School of Nursing. She had charge of the instruction, assignment, discipline, performance of duty, and conduct, while on duty of members of the Army Nurse Corps and Army School of Nursing, and the supervision of the female help employed for general kitchen and housekeeping purposes. She was responsible for the equipment and public property for the nurses’ quarters and for the sanitation of and measures for fire pre-

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vention in those quarters. She supervised the records of the Army dietitians and was responsible for the preparation and disposition of the records of her department.  
                               
    The assistant principal chief nurse was charged with the records and correspondence concerning the nurse corps on duty at the hospital and such other duties as might be assigned to her by the principal chief nurse. In the absence of the latter the assistant assumed complete charge.

    The day supervisor of graduate nurses made a daily inspection of wards for the purpose of determining the character of the performance of duty by the nurses. She devoted special attention to the care and nursing afforded the seriously ill, the preparation and service of diets in wards, and the measures taken to protect and. issue intoxicating liquors and habit-forming drugs.

    The night supervisor of graduate nurses made a nightly inspection of all wards corresponding to the daily inspection made by the day supervisor.

    The superintendent of the Army School of Nursing conducted the school for undergraduate nurses at the hospital. She was guided by instructions received from the commanding officer and from the principal chief nurse; and she supervised the work of the nurses in charge of instruction in theoretical nursing, practical nursing, and supervision of undergraduate nurses in the wards.

PERSONNEL.

STRENGTH OF COMMAND.
         
    The mean daily strength of personnel on duty at the hospital in the year 1917 was: Medical officers, 22.8; Medical Department and Quartermaster Corps, 223.1 ; Army Nurse Corps, 44.7. During the year 1918, the mean strength of the command was: Medical officers, 86.3; detachment, Medical Department, 889.1; detachment, Quartermaster Corps, 136.7; Army Nurse Corps, 147.8; reconstruction aides, 33.6; civilian employees, 18.9.

    The post return for December 31, 1919, shows 451 officers present and absent; and a total strength of command of 3,188, the latter figure including a military total of 2,661, present and absent, and a civilian total of 527, present and absent. An analysis of the figures shows the strength of the detachment, Medical Department, as 648 men. At the beginning of 1919, 1,090 enlisted men of the Medical Department were on duty at the hospital. All but 70 of this number were emergency men who, during the year, were discharged and replaced by enlisted men of the Regular Army. In June, 1919, 166 nurses were on duty. During the year replacements and transfers were effected and at the end there remained 201 nurses on a duty status.
         
ARMY SCHOOL OF NURSING.
         
    The first student nurses arrived at Walter Reed General Hospital August 5, 1918. In September, there were about 45, 9 of whom were of the training class of Vassar College. In November, 25 more students arrived. These young women had been helping, during the influenza epidemic, at Camp Humphreys, Va. To this group, 26 probationers were added, making a class of 51. At  the beginning of January, 1919, there was a total enrollment of 66 student nurses in training. During February and March following, the students were accepted as regular members of the Army School of Nursing, upon completion of their four months of prohati onary training. In March and April, all student

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nurses who had entered the Army for service during the emergency period were released from the rapidly closing camps. Students who desired to complete the three-year period of training were, in many instances, transferred to Walter Reed General Hospital. This policy of concentration continued uninterruptedly throughout the year 1919, toward the end of which the total enrollment was 112; and in this number were represented students from practically all the units of the Army School of Nursing, formerly connected with eastern military hospitals.

    The theoretical and practical work given the student nurses was in strict compliance with the standard curriculum for schools of nursing as authorized by the National League of Nursing Education, 1918. In Circular Letter No. 301, Surgeon General’s Office, 1919, authorization for allowance of from three to nine months was given for students with college credits or with credits from approved technical schools.
                
    By means of affiliation with civil hospitals, students were given adequate training in pediatrics, gynecology, obstetrics, psychiatry, and public health nursing. The time allowed for affiliation work was one year.

    The daily routine was eight hours of work in the wards, one hour of class work, and one hour of study. In addition to being placed in surgical and medical wards, the students were also placed on duty in the general operating room, the eye clinic, the ear, nose, and throat clinic, the dental clinic, the various diet kitchens, and the surgical dressing room. Each student was given a service of eight weeks in each department.

    A course of occupational therapy was given to the student nurses in the occupational therapy department. This course included the teaching of all  forms of invalid occupation.
         
COURSE OF SURGERY FOR MEDICAL OFFICERS.
         
    Due to the fact that demobilization had separated a great many competent surgeons from the service, and also to the fact that hospitals contained many cases requiring surgical intervention, it became necessary to train officers of the Regular Medical Corps in surgical technique, to enable them to cope with the situation confronting the Medical Department after the cessation of hostilities. Because of the unusual number and variety of surgical cases at Walter
Reed General Hospital, a three months’ course of surgical instruction for Regular Medical Officers was begun the latter part of June, 1919. The course comprised a series of lectures by the different section chiefs of the surgical service, the assignment of each officer to each section for one week’s practical instruction in the wards, his assignment as an assistant in operations performed on patients in the section to which he had been detailed, and his designation as principal operator in certain types of ordinary surgical operations (particularly herniotomies and appendectomies).
         
PATIENTS.
         
    The work of the hospital during 1917, the first year of the war period more than doubled. There were 4,256 patients admitted during the year, an increase of 2,906 over the preceding year. A table prepared for the Walter Reed General Hospital Annual Report for 1917, to show the average number

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of days in hospital for each patient, also indicates the range of cases and their distribution in the various services of the Army. This table follows:

    TABLE 15.—Average number of days lost in hospital, Walter Reed General hospital, 1917.

    In the surgical clinic, 974 operations were performed during 1917. A condensed tabular statement furnishes an admirable projection of the surgical experience of the hospital during that year, when the massing of troops had concentrated the demands upon the surgeons but before the overseas cases, with their more complicated problems, had arrived.

    TABLE 16.—Surgical operations performed at Walter Reed General Hospital, 1917.

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    During 1918, 13,752 patients were admitted to the hospital, an increase of 9,496 over the preceding year. The average number of days for each case was as follows:                                      
         
    TABLE 17.—Admissions to Walter Reed General hospital, 1918.
         
    The surgical operations performed during 1918, are shown by the following table:

    TABLE 18.—Surgical operations performed at Walter Reed General hospital, 1918.
         
    The following is a summary of patients admitted to and disposed of from January 1, 1919, to December 31, 1919, inclusive.
         
    TABLE 19.—Admissions and dispositions, Walter Reed General Hospital, 1919.

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    During the year 1919 over 1,200 cases of mental conditions were treated by the neuropsychiatric division. This statement does not accurately estimate the work of the section because there were many cases where the nervous condition was secondary, or the mental state, while abnormal, could not be classed as a definite psychosis and hence would not appear in these tables as such.
         
PROFESSIONAL ACTIVITIES OF THE HOSPITAL DEPARTMENTS.

SURGICAL SERVICE.
         
    The chief of the surgical service held a daily conference with all chiefs of sections, and a Saturday meeting at which all officers on duty in the surgical service attended. At the Saturday meeting, hospital orders, memoranda, and other pertinent matters, or irregularities of the service, were brought to the attention of the officers attending. A surgical conference of one hour’s duration was held weekly for all officers of the surgical service, the various section chiefs, in turn, presenting interesting clinical cases from their respective services.

    The chief of the surgical service and his assistant daily inspected a group of surgical wards. During this inspection the chief of the service was consulted as to diagnosis and suitable treatment of unusual developments and complications arising in eases of the service. At least twice weekly he surveyed every case of the surgical section.

    Requests for consultation between the sections for cases of the surgical service as well as those from other services for surgical conditions, were all referred through the chief of the surgical service to the special section concerned.

    Amputation section.—A large number of amputation cases during the early part of 1919 were received from overseas. At least 90 per cent of these cases required operative treatment of some character before they could be fitted with artificial limbs. Postoperative infection, low grade, was frequently encountered, but the percentage of cases requiting re-operation was very small. The shop for fitting artificial appliances fitted as many as 156 cases in one month. The work of this shop improved in grade and amount after the soldier labor was replaced by skilled leg fitters. Noninfected stumps were fitted  routinely six weeks after operation; others three weeks after healing. Numerous makes and types of buckets f or thigh and leg fitting were purchased and tried. Some could never be used owing to improper molding. The physiotherapy department assisted in the massage of stumps and the application of elastic bandages to improve circulation and age shrinkage, and to make stiff joints mobile, and gave instruction in the use of appliances. Patients, after being fitted, were assigned to working classes for one hour’s instruction daily. They usually became proficient in the use of the appliance in from three to four weeks and were then ready f or discharge. All were instructed in the care of the stump, adjustments being made in the appliance as shrinkage occurred; and all were examined by the chief of section prior to discharge, for final instruction to determine the correctness of the fitting and the condition of the stump. All amputations, after fitting, were assigned to the occupational shop for instruction in the use of the appliance. Fittings for hip disarticulation and certain other stumps, which could not be properly fitted from stock, were ordered from outside artificial limb makers.

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    Dental section.—The dental service was divided into five subsections: Dental hygiene; X-ray; operative; prosthetic and oral surgery; and one dental officer for the survey of patients. The completion of the new dental building in August, 118, and its immediate occupancy facilitated the successful detachment of the dental department. The new building consisted of a large operating room, adequate for nine operators, an oral surgery department, including an operating room, and an extracting and record room, and quarters for the officer of the day and sergeant in charge, together with necessary storage space. A dental X-ray laboratory and developing room were provided and an officer was detailed to care for this work. From three dental surgeons in 1918,  the personnel of the department increased to nine dental officers, one of whom  was on duty to render emergency treatment at all hours of the day and night. In January, 1919, the prosthetic department was organized for the construction of splints for maxillofacial cases and prosthetic restoration of all kinds. Five female technicians were on duty in the hygienic department of the clinic. This permitted the dental officers to spend their entire time operating.

    Eye, ear, nose, and throat section.—In April, 1917, the eye, ear, nose, and throat section had a personnel of two officers. This was gradually increased to seven officers by the end of 1918. A division of the department into the eye section and the ear, nose, and throat section was made in July, 1918, to promote a more efficient service. At that time the number of patients had increased from 15 to 170, and it could be seen that better results could be obtained from a more complete specialization. Originally the section operated in the main building of the hospital, but soon outgrew the space allotted and was assigned to two temporary wards. In August, 1918, a special building had been constructed for the section, known as the eye, ear, nose, and throat building.

    Empyema section.—In March, 1919, Walter Reed General Hospital was designated as one of the concentration points for chronic empyema. Most cases were primarily chronic, relatively few being acute, and those few practically all from the influenza epidemic of 1918-19. It is noted that no case on which a primary operation was done during the calendar year 1919 became a chronic case.

    Maxillofacial section.—The first maxillofacial patients arrived at the hospital on January 15, 1919, at which time Walter Reed General Hospital was one of the three hospitals designated by the Surgeon General’s Office to receive this class of patients. They were scattered throughout the surgical wards at first, until a chief of section was detailed to care for them, in February, when they were all assembled in three wards. Prior to March very little surgical operative work was done. On February 21, in compliance with instructions received from the Surgeon General, a thorough system of recording these cases was begun. At the end of the year over 800 photographs, a large number of wax models, drawings, and descriptions were made, illustrating all cases of interest from a scientific point of view. In addition, the dental splints made overseas or in the United States were mounted, with a view to their scientific interest, as there is no type of jaw fracture which is not represented in the series. Diagrammatic sketches of operations performed were made in many instances to supplement photographs and models. Cases were photographed in four classes, bone graft, scar excision, superficial plastics, and deep plastics.

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Coordination with the dental surgeon, necessary in the treatment of most of the cases, was early established.

    Neurosurgical section.—The majority of the cases of this service were the result of gunshot wounds incurred in action, while less than 5 per cent were the result of accident or disease. Peripheral nerve injuries constituted a large number of cases; 30 per cent were operated upon, 20 per cent of which showed the nerve to be divided. In suitable cases indicating the use of nerve grafts, two-stage or three-stage operations were done, the neuromata being approximated by tension sutures until resection of the nerve ends and neurorrhaphy could be accomplished.

    Orthopedic section.—Prior to June 25, 1918, there had been no true subdivision of this section from the general surgical service, although in November, 1917, an officer was placed in charge of two wards in which there were some cases of an orthopedic nature, mainly foot, back, and joint injuries, from the surrounding camps. From June to December 31, 1918, the section materially increased in size, and on the latter date occupied 21 active wards. Toward the latter part of July, 1918, the first contingent of wounded from overseas was admitted to the orthopedic section, and by the end of the year the admissions averaged 300 monthly. The majority of these cases were deformities resulting from gunshot wounds received in action overseas, plus a large number of orthopedic conditions unsuccessfully treated at other general hospitals.

    Roentgenological section.—A notable development of the hospital service during 1918 was in the X-ray department. In March, 1918, the new X-ray laboratory situated in the east wing of the third floor of the administration building was completed and ample facilities were then available for conducting every conceivable method of X-ray examination. The installation included the equipment for administering deep therapy.

    The commissioned personnel of this department was increased to five, and the enlisted personnel was increased proportionately.

    During December, 1918, three of the largest type of X-ray transformers were in daily use, and, in addition, six United States Army standard bedside X-ray units were in constant demand to execute numerous requests for examination of patients too ill to be moved.

    An auxiliary X-ray laboratory was opened in Ward No. 61 to expedite the handling of overseas patients in the orthopedic department. A second auxiliary laboratory was opened in the dental infirmary.

    The influenza epidemic which became alarming the early part of October, 1918, was made a subject of extensive study by means of X-ray investigation. More than 3,000 X-ray films of the pulmonary complications were made with the bedside machine, and in no instance was the patient removed from the bed.

    The investigation of focal infection, which was begun in 1917, was continued throughout the year 1918. In certain types of patients the examinations were done as a routine on the teeth, accessory sinuses, genitourinary tract, gall-bladder, and the gastrointestinal tract.

    All amputations and bone-injury cases from overseas were examined on admission.

    During 1919, the character of work done varied from month to month. The number of cases with purely battle casualties decreased and the of more or less civil injuries and disease increased gradually. During the year

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there was a considerable increase in the relative number of gastrointestinal examinations over 1918. No X-ray burns or other untoward effects, were noted. A separate room for roentgenotherapy was maintained and proved of considerable value in certain selected cases.

    Septic-surgery section.— The work of this service was concerned mostly with old war injuries from overseas and those unsuccessfully treated at other general hospitals, involving bones, and complicated by chronic suppurative osteomyelitis. In addition there were domestic and local septic cases, both bone and soft parts. The standardized Carrel-Dakin technique was closely followed in the treatment of these cases, and the results obtained fulfilled all expectations.
                              
GENERAL MEDICAL SERVICE.
         
    The general medical service was divided into the medical service, the neuropsychiatric service, and the receiving ward. The medical service comprised the officers’ section, including examinations, ward, contagious or infectious disease section, and the noninfectious disease section. There was a chief of medical service, one assistant chief, two chiefs of sections, and nine ward surgeons or assistant ward surgeons. The neuropsychiatric section comprised one chief of section and five assistants. The medical service conducted the physical examination and furnished medical attendance for the Medical Department and civilian personnel at the hospital, a population in the neighborhood of 2,000. It also furnished a consultation service covering medical conditions in other services at the hospital. An officer of the medical service, at the receiving ward, admitted all patients to the hospital.

    The scheme for operating the neuropsychiatric service comprised the professional staff and four specialized corps: The female nurses; the enlisted men, Medical Department; social welfare workers; and reconstruction aides. The nurses looked after the medications and those physically ill; the corps men cared for the physical comfort and material welfare of the patients; the social workers acted as liaison officers, securing touch with the patient’s relatives, the study of former environments, and followed these features up so that the service would know how former patients progressed, and assisted in arrangements for the food; the reconstruction aides had charge of the vocational therapeutics, the principal aim being to keep the patients’ minds along normal channels, assisting them in utilizing their resources and outlining the business side of life. The work of these corps naturally overlapped or dovetailed in the great effort to restore the patient to mental health by all possible means. The professional staff was in charge of the patients and directed all matters professional and otherwise having to do with their diagnoses, care, treatment, and environment. The service was also called upon to make careful examinations and render conclusions in cases of legal and moral responsibility. This brought the neuropsychiatric service in close touch with the Judge Advocate General’s Department.

LABORATORY SERVICE.
         
    At the beginning of the war the general laboratory of the hospital occupied two small rooms on the first floor of the main or administration building. As the hospital, at that time, was located entirely in this building and had not

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more than 200 beds, the laboratory facilities were adequate. No commissioned officers were in charge of the laboratory, the personnel consisting of one sergeant and two privates, one of the latter being a chemist of considerable ability.

    In August, 1917, one captain was assigned to duty in the laboratory, and in September following, two lieutenants were added to the commissioned personnel. At this time the laboratory was not equipped for cultural bacteriology, tissue work, or complement fixation tests. Work of that character was sent to the well-equipped laboratory of the Army Medical School in Washington. Following the detail of commissioned officers to the laboratory, bacteriological apparatus was installed and the space allotted became overcrowded; and provisions for the care of a few animals had to be made beneath the tables in the laboratory. Plans were accordingly drawn up for what appeared then to be a spacious and commodious laboratory building. During the period 1917-18, the enlisted personnel was increased to six men. These men, together with three officers in the laboratory, made a very crowded place, but in spite of insufficient room and apparatus a great deal of routine and other work was accomplished, particularly along the line of investigations in pneumonia, empyema, and meningitis.

    In March, 1918, the new laboratory, located just to the rear of the main building, although not entirely complete, was so far finished as to be in a usable condition, and the apparatus was removed from the main building to the special laboratory building. The personnel at this time was increased by the addition of two sergeants; and in April the enlisted personnel was much increased, the number varying from 18 to 30.

    On moving into the new building, apparatus for the microscopic examination of tissues was installed, and subsequent to that time the laboratory did its own diagnostic tissue work instead of sending it to the Army Medical School. In the latter part of June, 1918, the Wassermann reaction was undertaken, and in addition there was subsequently established a complement fixation for tuberculosis. One room was devoted to clinical work, and a considerable amount of modern apparatus for the examination of blood and other body fluids was installed.

    After the hospital had increased in size to nearly 2,000 beds, several expansions occurred in the laboratory service, and three ward laboratories were created. One of these, in ward 15, the admitting ward for the medical service, proved especially valuable; another in the genitourinary ward relieved the main laboratory of much routine work; and a third was established in the psychiatric ward. Female technicians were employed, one in April, 1918, one in the middle of August, and two in September following. They efficiently performed the work which otherwise would have required extra men. One was assigned to chemistry, one to serology, one to tissue work, and one to routine sputum and feces examinations.

    The work of the laboratory increased with such rapidity during 1918 that it outgrew its new quarters in a few months, and in October it became necessary to turn over to the laboratory service a second frame structure near by, which had previously been used as a hospital storehouse. This was connected by a corridor with the main laboratory building.

    Special attention was paid by the laboratory service to post-mortem examinations, and an effort was made to examine each case of death and to

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make a survey of the clinical record as compared with post-mortem findings. Many of the specimens were sent to the Army Medical Museum. The autopsy reports were so made as to give a brief clinical record of the cases; and sufficient copies were made to file one in the record office, keep a serial file in the laboratory, and transmit a copy to the Army Medical Museum with material sent there. Because of the policy established by the Surgeon General’s Office of sending all known typhoid carriers to Walter Reed General Hospital, considerable work was done on this type of patient. Much work was done on the hemolytic streptococcus problem; and during the year 1919, 100 cultures of empyema, tonsils, throats, etc., were tested for sugar reaction. During the epidemic of influenza, 50 autopsies were performed and cultures made from various organs. A great deal of available pathological and bacteriological data was secured. With the establishment of a training school for nurses at the hospital, members of the laboratory staff gave instruction to student nurses in bacteriology, chemistry, etc. This work took the form of a course of lectures to the class as a whole, supplemented by laboratory exercises to the class in sections.

RECONSTRUCTION.
         
    The first systematic trial of occupational therapy at Walter Reed General Hospital was initiated in February, 1918. Experiments were started in a  workshop to determine the value of handicrafts in the cure of patients’ who needed definite functional treatment. To begin this experiment a single room was secured in what was originally the Lay homestead, dating from Civil War days, and tenanted by the post carpenter and his family. The work was necessarily limited to the simplest kind of carpentry, since the only tools available were portions of a set which the post carpenter had discarded.

    After a preliminary trial it was found that such treatment of functional defects as had been planned was impossible without adequate equipment. The work which had been started proved of very definite value in keeping cheerful and contented and physically well the patients who were engaged in it. With this value in mind, the shop was continued for patients who cared to work in it.

    About the 1st of March, 1918, the Division of Physical Reconstruction of  the Surgeon General’s Office instituted a survey of the various types of cases at Walter Reed General Hospital to lay the foundation for the establishment of a well-equipped shop and school. In April, 1918, an expenditure of $3,000 was authorized to equip the shops with the necessary tools, and expert educational directors were assigned to the work.

    The fundamental aim of the work in the department of occupational therapy was curative. Specifically, its purpose was to help each patient to find himself and function again as a whole man—physically, socially, educationally, and economically. It sought to restore him physically by helping to restore his body, so far as possible, to its normal condition; socially, by enabling him to feel that despite his physical handicap he might still be a self-reliant and self-respecting member of the community; educationally, by furnishing him with such training as would increase his personal efficiency; and economically, by providing him with a means of earning a comfortable livelihood so that with his return to civil life he might be an economic asset instead of a liability. The  problem thus broadly outlined was a new one. Upon each instructor in the department there fell a share of the responsibility for working out a solution,

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and this meant that he must get in closest personal touch with his patients. The activities of the organization of the department were therefore the outgrowth of many conferences at which were discussed the observations of the various instructors, and their significance.

    At the close of the year 1918 the scope of the work included:
 
        Academic.
         
         English, French, Spanish.
         Arithmetic, geometry, algebra, trigonometry.
         Penmanship, left-hand writing.
         Civil Service preparation.
         Physics, chemistry.
         History.
                                  
         Commercial.
         
         Commercial arithmetic and English.
         Shorthand, stenotype.
         Filing and recording.
         Bookkeeping.
         Commercial law.


         Agricultural.

         Truck farming out of doors.
         Vegetable forcing under glass.
         Growing of flowers.
         Textbook studies.

        Printing.

         Hand composition.
         Linotype operation.
         Presswork.

        Mechanical and electrical.

         Automobile repairing.
         Oxyacetylene welding.
         Wiring for bells, lights, and motors.
         Telegraphy, radio operation.
         Motion-picture machine operation.
         Machine-shop practice.
         Electrical studies.
         Mechanical studies.

        Drafting.
         
         Shop drawings, details and assembly.
         Tracing and blue prints.
         Architectural drawings.
         Topographical drawings.
         Freehand sketching.
         
        Woodworking.
         
         General carpentry.
         Framing, cabinet work.
         Pattern making.
        
        Display painting.

         Lettering.
         Sign painting.
         Poster making.

        Arts and crafts.

         Wood carving.
         Jewelry making and repairing.
         Silver smithing
         Watch and clock repairing.
         Engraving.

        Leather work.

         Shoe repairing.
       
        Physical education.
        
         Athletic sport.
         Calisthenics.
         Gymnastics.
         

       Rug weaving.
         
         Fundamentals of rug weaving.
         Rug repair.
         Loom work.
         Dyeing.

    The department of occupational therapy was divided into five sections: Administrative, psychological and statistical, general or academic, technical, and recreational.

    The administrative section was charged with the ordinary duties of a record and property office. A large staff of clerks was required because of the rapidity of the growth of the department, the large “turnover” of patients, and the compilation of reports and data f-or the Surgeon General’s Office.

    The psychological and statistical section was primarily responsible for the psychological and educational surveys of individual patients. In this section an extensive study was made of the learning problems encountered under the curative workshop schedule, the adaptation of curative methods to particular patients and specific disabilities, the application of trade tests and  vocational guidance, and the measuring of intelligence by approved methods.

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The section was especially successful in measuring the increase and strength of the movement of ankylosed joints and stump limbs, such measurements serving the double purpose of furnishing an incentive and encouragement to the patient, and of informing the surgeon and physiotherapist as to the rate and focus of improvement.

    The academic section offered a curriculum which covered a fairly wide range of subjects, from the most elementary to those of high-school grade. This section succeeded in reaching large numbers of patients who had been denied the advantage of courses which required some academic background.

    The technical section worked out a broad program which offered valuable instruction to the men who were mechanically inclined. The automobile department early seized upon the idea of doing practical work repairing cars. This gave the men the opportunity to put into practice what they had learned in class discussions. The work in the machine shop was at first hampered by lack of facilities and rooms for the proper conduct of work, but with the construction of new shops, the purchase of machinery, and, with the settlement of the type of power, this work became a valuable part of the curative program. The drafting division aroused the interest of the men, and gratifying results were obtained along that line. The farm and the greenhouse proved profitable. The woodworking division in addition to making a good record as a curative agency did a good deal of post repair work and made possible many conveniences in the new shops. The rug-weaving division always made an appeal to the patients, and it developed a number of new types of curative exercises. The men were interested also in the jewelry division and produced some particularly fine work of this character. The modeling developed the artistic temperaments of some men and provided them with a pleasing occupation while in the hospital.

    The recreational section handled the formal exercises and play hours of the patients, and under skilled instructors offered the following work:

    (1)   Daily lectures on personal and community hygiene.
    (2)   Classes in general calisthenics, using largely natural movements
    (3)   Special instruction for amputation cases and special classes for disabled groups.
    (4)   Classes in athletic and folk dancing.
    (5)   Instruction in boxing, fencing, wrestling, bag punching, swimming, jin-jitsu, and target shooting.
    (6)   Games—volley ball, handball, tennis, indoor baseball, basket shooting, and competitive group games.
    (7)   Course in military drill and Army regulations for men returning to duty.
         
    On February 15, 1918, the first aides were employed by the hospital. They began by teaching some of the bed patients in the orthopedic wards to knit colored wool squares for blankets, and the men welcomed the opportunity to do something. Gradually the work spread through the different wards; and with the increase of facilities and enlargement of personnel, a variety of activities broadened the occupational interests of the wards and results were both  remedial and palliative.

    To train the aides adequately for their work, a school for reconstruction aides was started late in the fall of 1918, and continued until after the signing of the armistice. The course of training consisted of practical work with the patients under the supervision of experienced aides, and of lectures of both a general and a professional nature.

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    In the latter part of the summer of 1918, the department of occupational therapy instituted weekly meetings of the staff and patients, which were held in the Red Cross house or the post auditorium. The purpose of these meetings was to present to the patients the advantages of taking work with the department of occupational therapy, and attractive as well as instructive programs were offered. This particular department was a training and demonstration school for other hospitals and an experimental laboratory for trying out methods of teaching, outlines of subject matter, types of equipment, and the selection and training of personnel. To Walter Reed General Hospital belongs the distinction of being the first American hospital to have a professional psychologist on its staff.

    The rapidity with which the personnel and work of the department of occupational therapy expanded is evidenced by the erection, during 1918, of five curative occupational buildings.

    The apparatus in use in the hydrotherapy, electrotherapy, gymnasium, and baking departments of the hospital during 1917-18 occupied four rooms.

    The activities of the department of occupational therapy continued throughout the year 1919, and in September the first classes of nonpatients (detachment, Medical Department, and detachment, Quartermaster Corps, and nurses) were organized. Approximately 6 educational and 13 vocational subjects were offered in these classes. The total attendance ranged from 160 to 170.

In the department of physiotherapy about 265,000 treatments were given to approximately 3,000 patients during the year 1919.
         
RECREATION.
         
    Recreation at the hospital was in general under the charge of the educational and recreation officer, who had under his immediate supervision the recreational work for patients provided by the Red Cross, and activities for the hospital staff and personnel provided from various sources. This included the recreational activities of the Young Men’s Christian Association, the Knights of Columbus, the Jewish Welfare Board, and the War Camp Community Service, while they functioned on the post.

    Practically all indoor recreation for patients was provided in the Red Cross Convalescent House and in Service Club No. 1; entertainments for officers, nurses, aides, and enlisted men were provided in the Service Club, gymnasium, post auditorium, in the Young Men’s Christian Association, and Knights of Columbus buildings on Dogwood Street.

    From 3 p. m. to 10.30 p. m. on Monday, Tuesday, Thursday, and Friday of each week, and from 1 p. m. to 10.30 p. m. on Wednesday and Saturday, a program of recreation was arranged wherein all groups in the hospital—patients, officers, enlisted men, nurses, and aides—were offered the opportunity of some form of entertainment. Every night in the week moving pictures made up a portion of the program; other activities included dances, musicales, classes in dancing, community sings, lectures, addresses by men and women prominent in their special fields, sightseeing trips; and, in season, excursions to important places of interest like Mount Vernon and Great Falls; corn roasts, picnics, theater parties, with supper at the Red Cross canteen, athletic games by post

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teams, free trips to the ball park of the American League, dramatics, masquerades, and the like.

    The nurses had a weekly program of activities in their recreation house;  the aides provided for themselves a clubhouse near the post; and the service club and the recreation room of the enlisted men’s barracks offered additional places for unscheduled- recreation.
         
ATHLETICS.
         
    Opportunities were offered in the appropriate seasons for baseball, basketball, tennis, handball, quoits, track sports, volley ball, indoor baseball, and other gymnasium games, boxing, wrestling, bowling, and swimming. Two organized baseball teams from the Medical Department played regular schedules during the baseball season, both at the post and at neighboring posts, and
         
        
           FIG. 97.—Hospital swimming pool, Walter Reed General Hospital.
         
         
several teams of patients were organized for special games. A basketball team was organized and played an unusual number of successful games. Tennis tournaments for patients, nurses, aides, officers, and detachment men were conducted. Three special days for meets were held, with events and prizes for detachment men and patients.

    A baseball and athletic field was made on a plot of ground opposite the reconstruction buildings. Bleachers were conveniently placed in the shade of tall trees. Two tennis courts were constructed for the nurses near their quarters, and two for general use were constructed, one outside of building 76, the other at Fourteenth and Dahlia Streets; and three other courts were built by the welfare organizations. These were freely available for the use of the patients and enlisted personnel.

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    Through the generosity of a former field director of the Red Cross at the hospital, a modern outdoor cement swimming pool, 33 by 85 feet, with dressing rooms, showers, etc., was built and presented to the hospital.        

    Two bowling alleys were constructed in the recreation room of the enlisted men’s barracks.
                              
WELFARE ORGANIZATIONS.
         
THE RED CROSS.
         
    The welfare organizations functioned under the direction of the commanding officer and under the supervision of the Red Cross, as prescribed in regulations. The American Red Cross utilized its building for all of the activities authorized for this society by the Secretary of War; and carried out its program with a personnel staff of 93, consisting of the field director, assistant field director, three home service men, three entertainment men, one accountant, four stenographers, and 80 ward workers and house entertainers.

    Great effort was made to see that all the patients admitted to the hospital were given every possible attention and service within the jurisdiction of this organization. The home service department rendered a most valuable service. Their record shows that more than 7,556 file cases were taken care of, besides the hundreds of dollars worth of Liberty bonds and State bonuses secured and the thousands of miscellaneous matters taken up and straightened out for the men.

    The entertainment department entertained over 30,000 patients. Theater parties were conducted on three days a week for all able patients, and vaudeville acts were secured and brought out to the Red Cross house on Wednesday afternoons for the entertainment of those who were in wheel chairs, or who were too invalided to go out of the hospital. World-famous entertainers were brought to the Red Cross House from time to time. This building was open every day from10.30 a. m. to l0 p. m. Two dances were given each week, and a regular moving-picture program operated weekly. Entertainments of every conceivable kind which would have a good effect on the morale of the men were secured and given in the wards and in the convalescent house. Victrolas were placed in the wards where it was permissible, and were adequately supplied with records. Games of various kinds were provided for use in the wards and in the convalescent house.

    Letter writing was stimulated to such an extent that 800,000 sheets of paper and 500,000 envelopes were given out to the men. Quantities of approved supplies were distributed to the patients for their comfort and pleasure. A diet kitchen was established by the Red Cross in which were served extra supplies.

YOUNG MEN’S CHRISTIAN ASSOCIATION.
         
    In 1918, the Young Men’s Christian Association began its activities at Walter Reed General Hospital in a room in the basement of the main building. When the Red Cross building was completed the Young Men’s Christian Association was given the end of the main room of that building where they remained until the completion of the “Y” hut on Dogwood Street, just across from the hospital reservation.

317
         
    On Christmas Eve, 1918, the “Y” hut on Dogwood Street was formally dedicated and the greatly enlarged activities of the Young Men’s Christian Association were begun and continued until the end of the war period.

    The social work of the Young Men’s Christian Association was an important factor in the life of the post. Every Thursday a vaudeville performance was given in the post auditorium with the aid and cooperation of the War Camp Community Service. Many prominent actors and actresses, as well as local talent, appeared. From time to time special concerts were put on in the auditorium and in the “Y” hut. Every Saturday night moving pictures were shown in the post auditorium, or, when the weather permitted, on the lawn near the main hospital building.

    The hut, however, was the real social center of the “Y” activities. It was open from 8 o’clock in the morning until 10.30 at night, during which time an average of over 600 men made use of its advantages daily. One or more dances were given each week. One of these each month was for officers, nurses, and aides, the others being for enlisted men. Two women members of the Young Women’s Christian Association who were assigned to the hut served light refreshments several nights each week in the social room.      

    During 1919, one secretary divided his time between work in the wards, visiting the men and distributing such articles as paper, cigarettes, matches, and candy.

    In religious work the Young Men’s Christian Association and the chaplain cooperated in conducting services Sunday mornings and evenings, with special music and nationally prominent speakers.

    The gymnasium in the “Y” hut was the largest on the post, being 50 by 110 feet and 16 feet high. The Young Men’s Christian Association played a large part in the athletic program at the Walter Reed General Hospital. At all times there was at least one physical director, and during the summer months two, one working at the hut and in the outdoor activities and the other in the physiotherapy section of the hospital. The Young Men’s Christian Association used and gave away more than $3,000 worth of athletic equipment. The result of this ample equipment was that the gymnasium was kept busy all the while during the winter months, and the diamonds, courts, and vacant spaces near the post showed great activity in good weather.

    In its educational work 15 different subjects were taught in the night classes.

KNIGHTS OF COLUMBUS.

    The Knights of Columbus hut opened November 24, 1918, and soon became a scene of a great number of recreational activities, amusements, and pleasures for the many service men and women stationed at the hospital. Arrangements were made whereby three moving-picture shows, an enlisted men’s dance, and officers’ and nurses’ dance were given for entertainment nearly every week. At frequent intervals boxing and wrestling matches were staged by some of the best talent obtainable. Vaudeville shows were also a feature of the activities at the hut.

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JEWISH WELFARE BOARD.
         
    The Jewish Welfare Board maintained headquarters in a house on Butternut Street, one-half block from the main entrance to the hospital. This was fitted for a clubhouse especially for the Jewish men. The secretary in charge maintained an excellent program of activities, including both social events and religious services. The secretary of the Jewish Welfare Board visited all wards at regular intervals and contributed to the comfort of patients whenever possible.
         
 SERVICE CLUB NO. 1.
         
    Service Club No. 1 was opened December 15, 1919, in a building provided by the National Catholic War Council. The construction work on the building         

        
    FIG. 98.—Service Club, No. 1, Walter Reed General Hospital.
         
began about the 1st of September. It included a cafeteria service on the lower floor, with a dining room seating 125 persons. The main floor was used for general purposes as a visitors’ house. The upper floor had 11 rooms, rented to transient visitors, particularly to friends and relatives of patients in the hospital. A regular program of entertainments and socials was held in the club.
         
HOSPITAL NEWSPAPER.
         
    The hospital newspaper, The Come-Back, published its first number on December 4, 1918. It was frankly aimed to be the spokesman of the patients in the hospital, to be a medium of news for these men, and to present to America the picture of the soldier who, having performed his service, asks nothing of the world but the chance to get back, and who, in spite of wounds and the
             

319
         
heartbreak of absence from home, resolves to put on a brave and contented front. The words of the first editorial, “This is going to be a cheerful sheet—or bust!” sum up the policy that was maintained throughout. It was through the constant good cheer of this paper that the patient-soldiers took their cue of self-discipline and good humor.

    Journalistic features were listed in the achievements of the little paper: It originated the “Port of Missing Men,” by which lost men were advertised widely among their old comrades; it led the fight for the abolition of the street salesman in uniform; in its column “The Army in Congress,” it presented an authentic digest of activities relating to the Army; and it inaugurated a series of illuminating articles on insurance and compensation.

    Two thousand copies of the The Come-Back were distributed free to the patients and personnel of the hospital through the generosity of the American Red Cross. Eventually The Come-Back ran an outside circulation of 30,000 copies.

    All of the work on the paper was volunteered; no salaries or commissions were paid to the enlisted men, patients, or officers who cooperated in putting the paper together.

    The profits from the paper were presented to the donation fund in the Surgeon General’s Office. One of the contributions to the Walter Reed General Hospital from these profits was a cylinder press and a printing outfit valued at $13,000.

THE LIBRARY SERVICE.
         
    The American Library Association founded, equipped, and maintained a library at the Walter Reed General Hospital for the purpose of providing with reading matter all persons connected with the institution. This service had a twofold work: That done in the main library and that done in the wards. The main library, situated in the Red Cross convalescent house, contained about 6,500 books, a large percentage of these being foreign works and up-to-date business and technical books. On the reading tables were most of the popular magazines, besides a large number of scientific and technical periodicals. In addition to books and magazines, were home newspapers from all over the country. This main library was for the use of all and was used by patients, officers, enlisted ,men, nurses, aides, and the instructors in the vocational school. It was open every day, Sundays and holidays included, from 9 a. m. to 9 p. m., with a trained librarian in charge. From this main library collections were sent to the Young Men’s Christian Association, Knights of Columbus, Jewish Welfare Board, and to the nurses’ Red Cross home, and the reconstruction aides’ club. Separate wards asking for small collections for their sun parlors were also supplied. The American Library Association also subscribed for magazines for the three welfare organizations, the Young Men’s Christian Association, Knights of Columbus, and the Jewish Welfare Board, for use in their houses, and the reconstruction aides’ club.

    The ward work was the part of the service most carefully planned. Every ward was visited at least twice a week by one of the librarians with a truck of books and magazines from which a man who could not leave his ward or could not carry a book home from the main library could choose the reading he

320                       
         
wished. During these visits the men had a chance to ask for any particular books they desired, or the librarian suggested one as helpful to a man in his chosen profession. The isolation wards were also visited, but the books and magazines left there were later destroyed, so some care was taken in the choice of books carried to these wards.

    There was a close cooperation of the aides and instructors of the schools of the reconstruction department. Many textbooks were furnished, especially where the classes were small and only a few copies were needed, or when a man showed a sudden interest in a particular course and the school text had not arrived. Many men became interested in some subject through a book read and were thus led to study further in the schools or came to the library for supplementary reading after taking a course in the schools.

    On November 1, 1919, the Army assumed charge of the work of the American Library Association in the Army hospitals, and the library was placed under the educational and recreational branch of the War Department.
         
DEMOBILIZATION.
         
    At the beginning of 1919, 1,090 enlisted men were on duty in the hospital,  practically all of whom were emergency men. The discharge of these men proceeded slowly, depending upon replacement. Frequently during the year emergency men from other hospitals that had been closed were sent to Walter Reed General Hospital for duty. Hence, the number of men actually discharged, as shown in the table below, is greater than the number of men on duty on January 1.

    Number of men discharged each month.

            January                               32         
            February                            46
             March                               60
             April                                  61
             May                                  59
             June                                188
             July                                 193
             August                            200
             September                      110
            October                           152
            November                        194
            December                          83

            Total                            1, 378

    For the purpose of determining the urgency of the various claims for discharge on the part of the enlisted men and the needs of the hospital, a  board of officers appointed to consider claims for discharge met from time to time, and, in the latter part of the year, weekly. This board ascertained the needs of each case as presented by the application and supporting affidavits,  and placed the names of the approved applications on a priority list in the order of the emergency of the case presented. All men were discharged in the order indicated on that list. This order was deviated from only in very exceptional cases where retention in the service would have caused manifest hardship to the applicant and immediate discharge was essential. At the end of the year there were 90 emergency men remaining. Of these about 20 elected to remain in the service.

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         Statistical data, Walter Reed General Hospital, Takoma Park, D. C., April, 1917, to December, 1919, inclusive. a
      
         ^a Compiled from monthly returns and sick and wounded reports (Form 52) to the Office of the Surgeon General, on file, Medical Records Section, Adjutant General’s Office; and monthly statistical returns made to the Office of The Adjutant General, on file, Statistical Division, Adjutant General’s Office (name of hospital).
        

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         Statistical data. Walter Reed General hospital, Takoma Park, D. C., April, 1917, to December, 1919, inclusive—Continued.