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Chapter X

Contents

CHAPTER X

THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)

THE CENTRAL MEDICAL DEPARTMENT LABORATORY

HOUSING FACILITIES

A building, loaned for the purpose by the University of Dijon, was utilized by the central laboratory, established at Dijon on January 1, 1918. When taken over the building was not equipped but early in February it was reconstructed as a modern laboratory and completely equipped with material brought from the United States for work of general and special character.1
 FIG. 7.-Central Medical Department laboratory, Dijon. The main building is in the center of the background

By March, 1918, the buildings consisted of the initial large laboratory structure, four barracks donated by the American Red Cross which housed the office of the director of laboratories, a large laboratory for instruction of student officers, five well-equipped research laboratories, an operating room for experimental surgical research on animals, a complete X-ray installation with photographic dark room, space for the art and museum section, and messing facilities and quarters for the enlisted personnel.1 Fixtures for gas, water, and electricity, a very complete plumbing and sewerage system, and equipment


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for general and special laboratory activities were installed in the buildings used for laboratory purposes. Later, four small Abincourt barracks were added to provide animal houses and a carpenter shop, and four additional barracks were erected for accommodation of enlisted personnel and storage of supplies.1 The laboratory also secured two buildings for garage space and operated a breeding farm for laboratory animals, on funds privately donated for special research. The entire plant eventually occupied 18 large and small buildings.1

PERSONNEL

When established at Dijon, the central laboratory was staffed by officers from Army Laboratory No. 1, at Neufchateau. By March, 1918, the staff consisted of 16 officers, 35 enlisted men, and 12 civilian employees.1 The average personnel on duty at the central laboratory between June and November, 1918, was 24 officers, 93 enlisted men, and 23 civilian employees. From November, 1918, to May, 1919, the average personnel remained approximately the same.1

LABORATORY EQUIPMENT AND SUPPLIES
 One of the greatest difficulties that confronted the laboratory service in the early months of the war was a shortage of equipment and supplies.1 Before the war many essential technical items, notably of apparatus, glassware, dyes, and chemicals, had been imported from Germany. American industries that had begun to manufacture these articles were still lacking in quantity production in many essentials.1 Furthermore, the normal peace-time stocks of dealers in scientific apparatus and supplies were just sufficient to meet the comparatively meger demands for the upkeep of established institutions and the initial equipment of an occasional new one.1 Demands such as were made by the Army in the earlier months of the war were unheard of and they could not be met until American scientific industries became organized for quantity production. The situation was further complicated by priority schedules on raw materials, many chemicals, and skilled labor, which diverted these to other war industries; and a priority on shipping and tonnage that made the floating of supplies secondary to the transportation of troops. The congestion at base ports, American Expeditionary Forces, and shortage of transportation in France militated against prompt handling of supplies after their arrival in France.1

With the exception of the initial equipment of three of the larger laboratories and the laboratory equipment of a few base hospitals, laboratory supplies from the United States were not available for issue in appreciable quantities until about a month before the armistice. Furthermore, laboratory supplies in large quantities were never available by purchase by us in France.1 When it became apparent that months would elapse before the automatic supply of apparatus from the United States would become available, an attempt was made to reduce equipment and supplies to the absolute minimum consistent with efficiency, and to standardize the equipment of laboratory field units.2 On August 19, 1917, an order for two motor bacteriological laboratories, each to consist of a small but well-equipped outfit mounted on a 3-ton chassis, was placed with a British manufacturing firm. This order contemplated the first use of such a unit in our service and was frankly experimental.3


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The supply division of the chief surgeon's office, A. E. F., had made provision for the shipment from the United States of such laboratory supplies as appeared on the supply table of the Manual for the Medical Department, 1916, but this list included only 84 items, which were quite inadequate to meet even the simplest requirements.2 To meet the existing emergency, such supplies as were available were purchased in France and contracts made by the supply division for the continuous supply by French manufacturers of certain bulky items requiring a very considerable amount of cargo space.2 In coordination with the supply division of the chief surgeon's office, requisitions were prepared covering estimated future requirements with a view to their inclusion among supplies shipped automatically from the United States.2 The shipment of laboratory equipment according to this revised list did not begin until April, 1918, and did not become available for issue in France in quantity until October, 1918.2

On January 12, 1918, the director was authorized to place direct with the purchasing agent for the Medical Department in Paris, orders for the purchase of standard laboratory equipment and supplies, except in the case of special supplies desired in large quantity, or when the expense involved was large.4 Requisitions were also placed in England and some supplies obtained from the American Red Cross.2

In the detailed plan for the organization of the division of laboratories submitted to the chief surgeon, A. E. F., on January 11, 1918, the director of that division recommended that special motorized and transportable units be provided.5 The motorized units were to be installed in their own cars while the transportable units, packed in chests, were to be moved by any transportation available.5 This plan, which was approved, provided for motorized laboratories of two classes: Bacteriological cars and meningitis cars.5

On the same date the director of laboratories wrote that several completely equipped motorized laboratories were urgently needed.6 The next day the chief surgeon, A. E. F., authorized the purchase of a "cerebrospinal" bacteriological car to cost £1,892, exclusive of the chassis,4 and on January 14 he authorized the purchase from the French Medical Department of one motorized bacteriological laboratory to cost approximately $8,000.7

In order both to conserve and standardize the equipment of field units, the commanding officer of the central Medical Department laboratory undertook to design a transportable laboratory in which the necessary equipment and supplies would be reduced to approximately 150 items.2 These items were to be packed in eight chests so designed as to be capable of expansion in numerous ways if necessary, to meet the essential needs of any type of laboratory. The selection of equipment for a set of these chests which would constitute a division laboratory, also was undertaken.2 In reply to a query from chief of staff, G. H. Q., A. E. F., concerning transportation which the division of laboratories would
require, the chief surgeon replied, on February 4, 1918, in part, as follows:8 "The increase of the forces and the prevalence of epidemics would require that the laboratory service be furnished among other vehicles with 6 motor trucks and 10 special bacteriological cars." On February 11, the chief surgeon initiated a cable-


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gram to the War Department asking that personnel requested for divisional laboratories be sent in accordance with the priority schedule, but that portable field laboratories be substituted for laboratory cars.9 On March 1, 1918, the director, division of laboratories, reported that two motorized laboratories each mounted on a 3-ton chassis were en route from England, but that it was anticipated that eight more of these outfits would eventually be required.10 While most movable laboratories were to be of the type which utilized chests, it was planned that a relatively small number of motorized laboratories would also be employed. Under this plan the equipment for a divisional laboratory would be contained in a set of three chests and a ¾-ton truck would be required for its movement. The laboratory for an evacuation or mobile hospital would consist of a complete set of eight chests transportable on a 1½-ton truck.2, 1, 11

Toward the end of March, 1918, the commanding officer of the central laboratory visited England with a view of determining the possibility of purchasing laboratory material to equip the series of chests which he had devised, and other assemblages of material.2

On April 29, he telegraphed the chief surgeon, requesting him to authorize the purchasing officer of the American Expeditionary Forces in London to purchase 100 transportable laboratory units at approximately $1,000 each. The average cost of the truck on which one complete set could be transported, he added, would be $3,400.12 The chief surgeon complied with this request.2 Deliveries of the units which began on May 8, were completed October 24, 1918, so each division and each mobile or evacuation hospital which arrived in France after the former date, was given its equipment before it entered the advance zone.2 Such transportable laboratory units, attached to mobile and evacuation hospitals, were equipped adequately for the performance of all types of clinical and bacteriological work. Those attached to divisions were equipped for the chemical and bacteriological examination of water supplies, the performance of routine clinical examinations and the bacteriological examinations necessary for the control of epidemics.2 This transportable equipment was also utilized with very satisfactory results in many camp and base hospitals, and in some hospital centers and base laboratories, pending the arrival of the equipment for stationary units.2

As noted in the preceding chapter, on May 2, 1918, the director of laboratories submitted a complete schedule of the transportation which would be required by the division of laboratories and requested that this be furnished. He also asked that motor cycles with side cars be issued to the laboratories assigned to divisions, for these vehicles already had facilitated collection of water samples and the prosecution of investigations in outbreaks of infectious diseases.13 This transportation schedule in so far as it pertained to movable laboratories was approved by the chief surgeon and was forwarded by him for approval to the general staff, general headquarters,14 but despite repeated subsequent requests, approved by the chief surgeon, transportation for the laboratory units in question was procured with the greatest difficulty and only to a partial degree with the results noted below in the consideration of divisional laboratories.2


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On July 8, the director of laboratories reported to the chief surgeon, A. E. F., that the earlier divisions arriving overseas had brought with them their laboratory personnel and equipment, that since that time it had been learned that equipment could be simplified and that tonnage requirements could be reduced by the purchase of all the materials required in England, but that field transportation was essential if these units were to be of value.15 Similarly, on the 16th of the same month, he reported that the laboratories with mobile and evacuation hospitals had already rendered invaluable service, but that neither the laboratories of the hospitals mentioned nor those of divisions could function properly without transportation, and he urged its provision. Other pleas and arguments for transportation were forwarded, but because of the general shortage of transportation throughout the American Expeditionary Forces, they were only partially successful.16

Because of the considerations mentioned in the letter of May 22, 1918, quoted in the preceding chapter,17 and the further fact that the laboratory cars being of special design and equipment, could be manufactured in limited numbers, none other than the four above mentioned were procured.18

On November 4, the chief surgeon wrote the director of the Motor Transport Corps that the time consumed in the manufacture of specially constructed laboratory trucks and bacteriological cars had been so protracted, and the difficulty of their transport to France so great, that ordinary cargo trucks had been substituted for them and that the specially constructed laboratory trucks were not needed.19

When the Armistice was signed two of these motorized laboratory units were attached to the general laboratory, one was with Army laboratory No. 1 at Neufchateau, and one with the Second Army.2 Motorized laboratories, or field laboratory cars, as they were officially designated, are further discussed under Army laboratories below.

Circular No. 40 of the chief surgeon's office published July 20, 1918, provided that the laboratories of the American Expeditionary Forces would be of two general types, stationary and transportable. The latter were to serve evacuation and mobile hospitals and divisions, and their equipment was to consist of standardized, expendable units in chests.

In the period from July to November, 1918, a large number of hospital centers were established and the equipment and organization of these were expedited.

In September, 1918, a bulletin was prepared by the commanding officer of the central laboratory, which covered in detail all matters relating to the procurement of laboratory supplies by Medical Department units, A. E. F.2 This bulletin which provided for a standardization of equipment was distributed to all units. It is reproduced in the appendix.

On September 19, 1918, the Surgeon General wrote that he desired that the field laboratories be numbered, and he allotted to the chief surgeon numbers from 1 to 45, inclusive, for such of these formations as already were overseas or en route. Records of the Surgeon General's office at that time showed that laboratories had been sent to France with 31 divisions, but had not accompanied 6 others.20 In reference to this record the director of laboratories stated that


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in point of fact many of these units had not actually accompanied their divisions from the United States; that some had come after them, and that in all instances it had been necessary for the director of laboratories to find personnel in the American Expeditionary Forces who could be trained and assigned to this service.21 In view of the signing of the armistice the proposed enumeration of laboratories engaged in field service never became effective.22

ACTIVITIES

As soon as the central laboratory was thoroughly organized the development was begun of those phases of its activities which related more particularly to the general activities of the laboratory service throughout France.2

The central laboratory came into more intimate contact with the American Expeditionary Forces in general than did any other section of the division of laboratories.2 It was planned that the officer commanding this institution would, with those at the head of other sections of the division, have his main office in that of the director of laboratories where he would be engaged only in larger problems affecting the service of the laboratory to the entire American Expeditionary Forces and that his adjutant would care for the administrative details intrinsic to the central laboratory itself.2 But because of shortage of personnel, this plan was not practicable and the commanding officer of the central laboratory, in addition to supervising its professional work, and conforming its general activities to the plans of the director of the division, discharged in great detail many administrative duties connected with its organization, equipment, and operation.2

The central laboratory at Dijon and the other laboratories in the division of laboratories were highly coordinated, and except as specified below, their activities were developed concurrently.2 These common interests included technical advice on general bacteriology, immunology, serology and other laboratory procedures, control of epidemics, bacteriology of war wounds, special instruction, personnel, laboratory equipment and supplies, gross and histopathology, museum and art service, photographic history of Medical Department activities, inspections, medical and surgical research, and liaison with other services.2

The activities of the central Medical Department laboratory which was in reality the headquarters laboratory for the American Expeditionary Forces conformed to those itemized on the project submitted January 11, 1918, which is quoted in the preceding chapter. These activities may be summarized as follows:1

Bacteriology.-The work consisted in the standardization of technical bacteriologic methods; the investigation of new technical methods; the preparation of all culture media for stocking transportable laboratory units and mobile laboratories in the zone of the advance; laboratory studies on the incidence of communicable diseases, notably influenza, pneumonia, diphtheria, meningitis, and intestinal diseases; the isolation, intensive study, and classification of the aerobic and anaerobic bacteria concerned in wound infections and gas gangrene; experimental and practical tests of the efficacy of antitoxic sera in the prophylaxis and therapy of gas gangrene; the identification of cul-


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tures of microorganisms received from other laboratories; the preparation of bacterial antigens and vaccines; the propagation and study of lice concerned with the transmission of trench fever. These activities were carried on in addition to the ordinary routine bacteriologic examinations.1

Serology.-This included standardization of the Wassermann test and manufacture and supply of amboceptor and antigen to all laboratories performing the test. The diagnostic sera furnished the laboratories of the American Expeditionary Forces for the identification of pathogenic microorganisms, as well as human sera for typing donors and recipients for blood transfusion, were prepared in this division. A considerable volume of routine serologic work, notably Wassermann tests, was also accomplished.1

Pathology.-Pathology was concerned with the performance of all autopsies at Base Hospital No. 17, at Dijon, the gross examination and histologic study of operative and autopsy tissues; the collection and preparation of specimens for the Army Medical Museum, and the review of the protocols of all autopsies performed in the American Expeditionary Forces. The latter activity was of value in checking errors in diagnosis. A collection of photographs, moving-picture films, paintings, charts, etc., was prepared for the Army Medical Museum.1 The administration of the pathological service is considered at greater length elsewhere in this volume.

Chemistry.-The activities of the chemical laboratory covered routine medical chemistry, the examination of foods for the Food and Nutrition Section and the Quartermaster Department, toxicological examinations, investigations of the medical properties of mustard gas, examination of drugs and other supplies furnished the Medical Department, and sanitary and industrial water analyses.1 During battle activities this division manufactured many thousand liters of gum-salt solution for intravenous use in the resuscitation of the seriously wounded.1 The laboratory also prepared standard solutions and reagents for transportable laboratories and such other laboratories as were not equipped to prepare their own.1 So much of the chemical service as pertained to the water supply or food and nutrition sections is discussed with those subjects elsewhere in
this volume.

Surgical research.-In the laboratory of surgical research experimental studies on animals were fruitful in their bearing on the prevention of wastage from battle casualties. The cause, prevention, and treatment of surgical shock were studied experimentally here and the results applied practically at the front during the Chateau Thierry and subsequent military operations. Experimental attempts to place wounds of the chest in the category of those amenable to treatment by "débridement," and studies of the relation of various anesthetics and methods of anesthesia to the production of shock were also made.1

Epidemiological investigation.-Perhaps the most important work of the laboratory from the practical point of view was that concerned with the laboratory and epidemiologic investigation and control of communicable diseases.1 Specially trained commissioned and enlisted personnel with mobile equipment were held in reserve at this laboratory for the prompt investigation of epidemics or threatened epidemics anywhere in the American Expeditionary Forces. By bacteriologic detection of early cases of communicable diseases, mild cases


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missed clinically, and carriers, this laboratory did much to prevent the spread of influenza, pneumonia, diphtheria, meningitis, and enteric infections, and thus decreased the wastage concomitant with outbreaks of these diseases when not detected early and effectually controlled.1

Supplies.-The supply division of this laboratory was charged with assembling, equipping, and issuing transportable laboratory equipment to mobile units; replenishing expendable items and replacing those that had become unserviceable; issuing to mobile laboratory units and to camp hospitals various culture media and reagents required for bacteriologic work in the field; and issuing to all Medical Department units in the geographic region served by the central Medical Department laboratory, the various biologic products used in the diagnosis, prevention, and treatment of infectious diseases.1 During the period of active participation of our troops at the front, the greater portion of these supplies was delivered by courier service, necessitating the constant operation of numerous motor trucks and motor cycles.1

Courses of instruction.-From its inception this laboratory conducted courses of instruction in professional subjects.1 One hundred and fifty-eight student officers were given two-week courses of instruction in the bacteriology of war wounds; while in the laboratory of surgical research a six-day course, repeated weekly, was given to prospective members of shock teams. This course covered the experimental evidence that had been gathered concerning the cause, prevention, and treatment of surgical shock, and its practical application to the resuscitation of the seriously wounded. Selected student officers in lesser numbers were also given special courses in epidemiologic laboratory methods, in serologic work, and other laboratory procedures.1

Cooperation with Chemical Warfare Service.-In August, 1918, close contact was established with the consulting pathologist of the Chemical Warfare Service, A. E. F., and arrangements were completed for study of the effects produced on human beings by known and unknown types of gases.23

REFERENCES

(1) Report from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, May 1, 1919. Subject: Activities of the chief surgeon's office, A. E. F., to May 1, 1919. On file, Historical Division, S. G. O.

(2) Report from Col. J. F. Siler, M. C., director of laboratories and infectious diseases, A. E. F., to chief surgeon, A. E. F. (not dated). Subject: Activities of division of laboratories and infectious diseases, from August, 1917, to July, 1919. On file, Historical Division, S. G. O.

(3) Letter from the general purchasing officer, A. E. F., to Daird and Tatlock (Ltd.) London, August 19, 1917. Subject: Motor bacteriological laboratories. On file A. G. O., World War Division, chief surgeon's files (322.3271).

(4) First indorsement, Hdqrs., A. E. F., chief surgeon's office, to director of laboratories, A. E. F., January 12, 1918, on letter from director of laboratories, A. E. F., to the chief surgeon, A. E. F., January 7, 1918. Subject: Purchase of laboratory equipment. On file, A. G. O., World War Division, chief surgeon's files (322.3271).

(5) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., January 11, 1918. Subject: Organization of the division of laboratories and infectious diseases. On file, A. G. O., World War Division, chief surgeon's files (321.630).

(6) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., January 11, 1918. Subject: Mobile motor bacteriological laboratory. On file, A. G. O., World War Division, chief surgeon's files (322.3271).


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(7) First indorsement from the chief surgeon, A. E. F., to the director of laboratories, A. E. F., January 14, 1918, on letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., January 11, 1918. Subject: Mobile motor bacteriological laboratory. On file, A. G. O., World War Division, chief surgeon's files (322.3271).

(8) Memorandum from the chief surgeon, A. E. F., to the chief of staff, A. E. F., February 4, 1918. Subject: Expansion of transportation for laboratories. On file, A. G. O., World War Division, chief surgeon's files (321.630).

(9) Cablegram from General Pershing, A. E. F., to The Adjutant General and to the Surgeon General, U. S. Army, February 11, 1918. Copy on file, A. G. O., World War Division, chief surgeon's files (322.3271).

(10) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., March 1, 1918. Subject: Motor laboratories. On file, A. G. O., World War Division, chief surgeon's files (322.3271).

(11) Report of the chief surgeon, A. E. F., to the commanding general, S. O. S., A. E. F., April 17, 1919. Subject: The Medical Department, A. E. F., to November 11, 1918. On file, Historical Division, S. G. O.

(12) Telegram from Maj. George B. Foster, M. C., to the chief surgeon, A. E. F., April 29, 1918. On file, A. G. O., World War Division, chief surgeon's files (322.3271).

(13) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., May 2, 1918. Subject: Schedule of transportation. On file, A. G. O., World War Division, chief surgeon's files (451).

(14) First indorsement from the chief surgeon, A. E. F., to the director of laboratories, A. E. F., May 6, 1918, on letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., May 2, 1918. On file, A. G. O., World War Division, chief surgeon's files (451).

(15) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., July 8, 1918. Subject: Transportation. On file, A. G. O., World War Division, chief surgeon's files (322.3271).

(16) Letter from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., July 16, 1918. Subject: Transportation. On file, A. G. O., World War Division, chief surgeon's files (322.3271).

(17) Letter from Lieut. Col. J. F. Siler, M. C., director of laboratories, A. E. F., to the chief surgeon, A. E. F., May 22, 1918. Subject: Table of organization for laboratory units. On file, A. G. O., World War Division, chief surgeon's files (321.6).

(18) Report on mobile laboratories by Capt. C. O. Rinder, M. C., (not dated). On file, Historical Division, S. G. O.

(19) Letter from the chief surgeon, A. E. F., to the director of laboratories, A. E. F., November 4, 1918. Subject: Bacteriological cars. On file,
A. G. O., World War Division, chief surgeon's files (322.3271).

(20) Letter from the Surgeon General, U. S. Army, to the chief surgeon, A. E. F., September 19, 1918. Subject: Mobile laboratories. On file,
A. G. O., World War Division, chief surgeon's files (322.3271).

(21) Second indorsement from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., October 24, 1918, on letter from the Surgeon General, U. S. Army, to the chief surgeon, A. E. F., September 19, 1918. Subject: Mobile laboratories. On file, A. G. O., World War Division, chief surgeon's files (322.3271).

(22) Sixth indorsement from the director of laboratories, A. E. F., to the chief surgeon, A. E. F., November 21, 1918, on letter from the Surgeon General, U. S. Army, to the chief surgeon, A. E. F., September 19, 1918. Subject: Mobile laboratories. On file, A. G. O., World War Division, chief surgeon's files (322.3271).

(23) Letter from pathologist of Chemical Warfare Service to Maj. William Elser, M. O. R. C., through director of laboratories, A. E. F., August 5, 1918. Subject: Instruction to pathologists, cooperating with Chemical Warfare Service. On file, Historical Division, S. G. O.

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