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Chapter XIII

Contents

CHAPTER XIII

THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES
(Continued)

SECTION OF WATER SUPPLIES; SECTION OF FOOD AND NUTRITION; MUSEUM AND ART SECTION; LABORATORY OF SURGICAL RESEARCH

SECTION OF WATER SUPPLIES

The entire question of water supply and purification in the American Expeditionary Forces is dealt with in Volume VI of this history. Therein reference is made to the fact that stationary laboratories were established in the Services of Supply, A. E. F., for water analysis in certain Medical Department general laboratories. One of these laboratories was the central Medical Department laboratory at Dijon.1

In addition to water analysis, a subject which is outside the scope of the present chapter, the necessity existed for supervising water supply activities in the zone of the advance, not otherwise cared for by the water supply service, A. E. F. This supervision centered in the central Medical Department laboratory at Dijon. Until the latter part of September, 1918 (except for a short period that is referred to below), the water supply activities of the division of laboratories were supervised by the section of infectious diseases.2 It was during May, 1918, that efforts were made to organize a definite section in the central laboratory for coordinating water supply. Such a section was established and charged with the coordination of Medical Department activities pertaining to water supplies in the zone of the advance. However, since the officer then assigned to the section was retained therein only a short time, it was not until the following early fall that water supply work of the Medical Department in the zone of the advance was definitely coordinated.2

On September 27, 1918, an officer of the Sanitary Corps, expert as regards water supply and analysis, was assigned to organize a section of the central laboratory having to do with control of such water supplies in the zone of the advance as come within the province of the Medical Department.2 Thereafter, that section was engaged in the supervision of water surveys in all training areas in the Advance Section, the assignment of proper Medical Department personnel, the instruction of divisional personnel in water survey work, including control of chlorination of water supplies, and coordination with the officer in charge of the laboratories in the water supply service.2 The chief of the water supply section in the division of laboratories and infectious diseases was the representative of the Medical Department, in its liaison with the water supply service, A. E. F. made; plans pertaining to Medical Department activities connected therewith, and distributed the laboratory facilities which were made available for water analyses.2


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SECTION OF FOOD AND NUTRITION

In August, 1917, there was organized in the Office of the Surgeon General a division of food and nutrition, whose officers were authorized by the Secretary of War on October 16, 1917, to inspect food supplies in camps, to endeavor to improve the mess conditions, and to study the suitability of the ration and the food requirements of the troops. Officers of this division were sent to camps in the United States where they gave instruction to cooks, mess officers, and unit commanders and also made extensive studies of ration suitability and requirement.3

On January 18, 1918, the chief surgeon, A. E. F., requested that suitable officers be sent to France for similar services in the American Expeditionary Forces,4 and one month later the commander in chief, A. E. F., made the same request by cable.5 Accordingly, six officers were selected for this purpose and on March 1, the Surgeon General wrote the chief surgeon, A. E. F., that they would report for service after having studied food conditions in England.6

The Surgeon General outlined the nature of the services these officers already had rendered and suggested that they be authorized to make a thorough inspection and study of all food supplies and mess conditions and report to General Pershing, through the chief surgeon, A. E. F., on the following subjects:7 The quality of all Army subsistence supplies; the adequacy of the field ration (permissible and desirable modifications of the ration from the standpoint of transportation difficulties); balancing of menus (the desirability from the standpoint of economy of simultaneous menus for entire divisions); improvement in mess conditions with a view to the greatest conservation of food consistent with adequate feeding; suitability of hospital dietaries; suitability of rations used in prison camps with a view to greater economy; correlation of practical experience of other armies with regard to rations and mess conditions and its application to our own forces.

This letter was accompanied by documents which described the work already performed by the food and nutrition service in Army camps in the United States.7

Among the members of this initial group and the personnel who reinforced it later were men who in civil life had been State food commissioners, experts in the Bureau of Chemistry, physiologists, biochemists, organic and analytical chemists, State and city food inspectors, and those who had had practical experience in the large packing houses in the United States.8 Members of the section throughout were selected because of their knowledge of its specialties, with the result that collectively they were qualified to solve the scientific and practical questions pertaining to its activities.8 The officers composing the first group sent overseas had received training from three to six months in the camps in the United States, and the others who came later received training during variable periods.8 Having been trained in the United States, where saving privileges on the garrison ration were permitted, members of this section were not as familiar as could have been desired with preparation of the garrison ration if it were not supplemented by purchases nor with the possibilities of the rolling kitchen-i. e., with basic conditions pertaining to the preparation of food in the American Expeditionary Forces.8


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The officers composing the initial group remained in England from March 16, to April 2, 1918, studying the British system of rationing and its administration and making a preliminary survey of the service of food in American rest camps.7 One officer who was detached to remain in England and to attempt correction of the nutritional defects there discovered in the American service remained on this duty until the end of November, 1918.7 The other members of the group proceeded to France, where they reported to the chief surgeon, A. E. F., April 12. The chief of this service was assigned to duty under the director of the division of laboratories and infectious diseases, with office at Dijon, and the other members to different sections of the Services of Supply, in order that they might conduct inspections therein concerning food and nutrition, make practical recommendation, and improve the subsistence of troops.7 When these assignments were made the chief surgeons of the sections concerned were notified of the nature of the work the officers would perform, and their cooperation was requested.9 After these inspections were completed the members of the group held a conference at Dijon, where they discussed the defects they had noted in food supply, its preparation and service.7

In order to promote the correction of these faults and to study nutritional requirements that would eventuate if it became necessary to reduce the quantity of the ration, the chief surgeon, A. E. F., directed that a food and nutrition section be established under the control of the director of the division of laboratories and infectious diseases.7 To this section the following duties were assigned:7 Representation of the chief surgeon, A. E. F., in matters pertaining to the nutrition of troops; investigation of Army food requirements and consumption; advisory service in the specification of rations and dietaries; inspection of food supplies and mess conditions with troops, hospitals, and prison camps; instruction in food inspection and handling, mess management, and other measures for the maintenance of nutrition and for the conservation of food.7 The organization of this section was announced in Circular No. 37, chief surgeon's office, in June, 1918, and in the following month its duties as noted above were published in Circular No. 40, chief surgeon's office, July 20, 1918. It acted on all matters of importance pertaining to the food supply of the American Expeditionary Forces, maintaining close liaison with the chief quartermaster, A. E. F., and with the fifth section of the general staff, A. E. F., which was charged with instruction and training.7

Based upon a survey which four officers of this service made in May and June, 1918, of the food conditions in six divisions in the advance section, finding it advisable that personnel qualified to give instruction be attached to these organizations for more or less permanent duty, moving with them in successive changes of station,10 the representative of the Medical Department with the fifth section of the general staff, on July 8, 1918, submitted the following memorandum to the acting chief of staff G-5:

Subject: Project for Instruction in Cooking and Food Conservation.

1. Cooking schools.-Instruction in food values, selection and balancing of the ration, mess management, cooking, use of the rolling kitchen and improvised cooking devices, arrangement, cleaning, and care of kitchen equipment, storage, preservation, and conservation of foods,


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and kitchen sanitation is given to selected replacements in the school for Army cooks in connection with the school for bakers at the base division, first corps. Similar schools are projected in other base divisions.

2. Field parties.-Officers of the food and nutrition section of the Medical Department have been visiting the various divisions and base sections in France for purposes of observation and instruction, and three are now on duty with the United States troops in England. Action has been taken to secure additional trained officers of the food and nutrition section from the United States in order to give sufficient personnel for extension of the work. Field parties (consisting of one officer of the food and nutrition section, one butcher, and two cooks) will be assigned to a certain area corresponding to that covered by the division of any army corps and will be kept moving from division to division within that area. They will observe the methods of distribution and handling of the ration, mess management, cooking, kitchen economy, serving and food conservation, and will establish temporary centers of instruction for mess sergeants and the methods and procedures adapted to the conditions found.

3. Source, control, and distribution.-Officers engaged in this work will come from the officers of the Sanitary Corps, food and nutrition section of the Medical Department. The butchers will be secured from the enlisted men of the Medical Department, Quartermaster Corps, and from replacements trained in the cooking schools. Control of field parties and personnel attached to base sections and various headquarters will lie in the sanitary section of the office of the chief surgeon in cooperation with G-5. Control of the instructors of the various schools will lie with the commandants of these schools, or the commanding officers of the base divisions in cooperation with G-5. Distribution will be tentatively as follows:

At Medical Department laboratory:

Officers

Officer in charge food and nutrition section (general supervision) 

1

Officer on duty in the food laboratory

2

Officers for emergency examination and instruction

2

On duty at base section in England

3

On duty at base sections in France

5

On duty at First Corps schools

2

On duty with hospitalization section, chief surgeon's office

1

On duty with chief quartermaster

1

On duty at cooking schools

2

 

19


 

Butchers

Cooks

Officers

Field parties:

For 5 army corps

 

5

 

10

 

5

Services of Supply troops

2

4

2

 

7

14

a26

aIncluding 19 from above.

Increases in personnel and parties will have to be made as necessity arises.

With the approval of the assistant chief of staff G-5 and the cooperation of the chief quartermaster, the section now organized field parties, each of which consisted of one officer from the food and nutrition section, one butcher, and two cooks, with the grade of noncommissioned officer, the last mentioned being drawn from the Medical Department, Quartermaster Department, and replacements.7 During the period of its greatest activity about 40 noncommissioned officers, cooks, and butchers were assigned to the nutrition service, most of them being incorporated into the field parties. These units were sent to divisions at the front training areas, military schools, and later to organizations in sections of the Services of Supply.7 Before a party reported to the organization


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to which it was temporarily assigned, the adjutant general, A. E. F., sent to the commanding officer concerned the following form letter:11

1. In compliance with instructions from these headquarters a field party of the food and nutrition section, Medical Department, has been assigned for temporary duty with the organizations of your command.

2. This field party is charged with the investigation of ration conditions as to transportation, handling, preparation, and conservation, and instruction of mess sergeants and cooks as to field mess management, field cooking, and conservation within these organizations.

3. It is desired that the officer in charge of the field party be given proper authority and support in order that he may carry out the duty to which assigned. The officers in charge of the field party have been directed to make reports to the director of the Medical Department central laboratory, A. E. F., and authorized to make reports to the division surgeon of the organization with which he is on duty, or as you may direct. Attached find a copy of "Duties of field food and nutrition officers," which will fully explain the duty required of this party.

DUTIES OF FIELD FOOD AND NUTRITION OFFICERS

PROCEDURE ON REPORTING TO THE ORGANIZATION

1. Report through adjutant to the commanding officer. Present to him your orders, with a statement of your duties, and request that local orders or authority be issued. Suggest that the local order authorize you to inspect all food materials from their receipt by the organization to their consumption by the men; to inspect condition of all kitchens and the efficiency of their administration; to give instruction to mess sergeants and cooks in mess administration and in the storage and preparation of food, and to make recommendations to organization commanders, mess officers, and to the commanding officer in matters affecting the proper feeding of the men and the conservation of food.

2. Report to the division surgeon or senior medical officer, explain your mission, present to him your instructions, request his advice, and follow his suggestions.

3. Consult with the railhead officer, division quartermaster, or subsistence officer and supply officers and examine food supplies to obtain information re the ration issued, the various components, their percentages, quality, period of issue, storage facilities, and method of distribution.

4. Visit all kitchens in the organization; note and record in each the points covered in the outline of the reports. Give individual instruction personally, and through noncommissioned officers of the field party, to mess sergeants and cooks for the improvement of the mess and avoidance of waste. See that they know what the ration is and whether they get all of it. Consult organization commanding officers and make recommendations to them where desirable.

5. Choose one or more centrally located kitchens illustrating conditions in the area and develop them as models for the practical instruction in cooking, mess administration, and avoidance of food waste. Build here model bread boxes, shelves, meat safes, work tables, grease traps, and any other devices which can be made of the materials at hand or obtainable. Assemble here, with the permission of the proper authorities, the officers, mess sergeants, cooks, and men of different units and demonstrate the advantages of your devices, the importance of good meals, and the necessity of avoiding waste. Accept and stimulate suggestion and criticism. Devise a system of competition between messes, involving the recognition and public mention of excellence.

6. If accompanied by the noncommissioned officers, cooks, mess sergeants, or butchers, distribute them at various points in the area so as to give the necessary practical distribution over the whole organization as quickly as possible.

7. Your first duty is to improve the food as served to the men. Food conservation is merely giving the men more and better food and putting less in the garbage pail and extracting or saving for mess consumption or commercial use all material of value. In training areas and in positions not exposed to shell fire there should be no food waste; material not used should be deducted from the following issue, with corresponding reduction in transportation, tonnage, and drain upon resources at home.


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With troops occupying trenches or positions under shell fire there will be frequent and inevitable waste of food as well as of other material. Your duty under such conditions is to urge that such food be allowed and delivered as will make possible the proper feeding of the men in spite of unavoidable waste. Study the food needs of the men and take steps to insure that the needs are complied with.

Report on any unusual requirements of particular troops.

8. Make reports weekly to the food and nutrition section, A. P. O. 721.

9. Notify the food and nutrition section one week in advance of the time that your work within a division is to be completed, requesting orders to move to another organization.

REPORTS

1. Officers will make oral or written reports to commanding officers through division surgeons or other officers under whose direction they work. These reports should contain a brief statement of conditions found and specific recommendations for their improvement. Avoid long reports. Don't criticise unless you are able to have the fault corrected. Be sure that your recommendations are practicable-otherwise don't make them. Correct faults by informal conference and suggestion or by your own efforts before writing reports about them. Always pay due respect to military courtesy and the limitations of your authority, which is only advisory.

2. In addition to reports within the organization, officers will make regular reports weekly by mail to the director of laboratories, food and nutrition section, A. P. O. 721, and special reports by telegraph whenever necessary. Officers in the various sections of the Services of Supply will similarly report to the chief surgeon in that section.

3. The outline below will serve as a guide in inspections and in the preparation of weekly reports. Adhere to the numbers as stated and it will permit considerable abbreviation. In reports after the first, from each division it will usually not be necessary to repeat items under A. B., etc., covered in the first report.

    To: Director of laboratories, food and nutrition section

    Heading: Organization; date covered by report

    Party No.: Number of report

    Contents:

    A. Information obtained at the railhead or chief supply point

    1. Storage facilities

    2. Amount of reserve food on hand, (1) garrison ration, (2) field ration, (3) reserve ration (4) trench reserve ration, (5) travel ration

    3. Wastage at railhead or in reserve storage

    4. Ration being issued with proportion of each component and substitute

    5. Period of issue; system of issue

    6. Quality of food material

    7. Desirable ration changes

    8. Arrangements for food salvage

    9. Faults requiring correction

    10. General comments

    B. Transportation of food

    C. Conditions at regimental food dumps or similar food supply points (Nos. 1 to 10, as under A)

    D. Report on mess inspections

(1) Name of organizations; (2) commanding officer; (3) mess officer; (4) mess sergeant with his knowledge of ration efficiency; (5) number of men fed; (6) number of cooks and efficiency; (7) general appearance of kitchen (good, fair, poor, excellent); (8) stove facilities roller kitchens, fuel; (9) cooking utensils; (10) storage facilities; (11) sanitation-kitchen surroundings, personnel; (12) waste, garbage, amount, character, disposal, reasons; (13) menus-character; (14) water supply; (15) arrangements for washing mess kits and dishes; (16) character of service-mess hall, tables, line system, billets, dugouts, trenches, marmites; (17) is food good and are men satisfied; (18) shortage or overdraft shown on ration slips; (19) conditions requiring correction and your action; (20) where possible


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calculate or estimate the gross and net food consumption. Record any significant facts not covered above, such as weather conditions, activity of the men, etc., which affect the food consumption; remarks; (21) estimate the amount of food purchased by individual men from data obtained from the canteens, from inquiry from the men or from stores in the vicinity; (22) estimate the amount of food purchased by the organization to supplement the ration; its source; (23) estimate of wine consumption.

E. Give in detail such methods of instruction and demonstration as you have used, with comment on their success.

A field party under the immediate direction of the division surgeon and the sanitary inspector of the organization to which it was assigned (or corresponding officers in other commands) inspected the food supply from its receipt at railhead to its consumption; investigated mess management and mess sanitation; studied the methods of issuing and distributing rations, food preparation, and service, and, by informal conference with those concerned and by practical demonstration, corrected as far as possible any faults in supply, preparation, or conservation of food.7 The parties were given a degree of independence which enabled them to develop their own resourcefulness and to adapt their activities to the conditions which the immediate occasion demanded.7 These parties worked in close conjunction with divisional agencies, especially the first section of its general staff, the sanitary inspector, the inspector general, the quartermaster, and the several organization commanders.10 They made detailed inspections of kitchens and instructed personnel, either individually or in groups, gave demonstrations and lectures, and distributed circulars. From January to June, 1919, they gave most of their time to schools which they conducted for mess sergeants and cooks.10 The program which these parties sought to follow was one which they believed would insure, under mutable conditions, that food was regularly provided and handled to the best advantage in so far as storage, preparation of menus, cooking, serving, sanitation, and economy were concerned.10

The field parties did not follow inspections by elaborate reports, for they were primarily engaged in constructive criticism and instruction at each mess inspected, but such reports as were necessary and required were made to organization commanders and to supply officers.7 Weekly reports were sent by these parties to the food and nutrition section in Dijon in order that it might be kept apprised concerning the suitability of the ration under changing conditions, the quality of supplies, defects detected, progress being made, and other matters.7 These reports formed the basis for recommendations pertaining to the ration which this section submitted. It wrote, for example, an order which was adopted with but few changes by the chief quartermaster, A. E. F., and which was published as General Orders, No. 176, General Headquarters, A. E. F., 1918.3

Until September, 1918, when 20 additional officers pertaining to this service arrived from the United States, and two others were assigned thereto from other duties, only the five officers of this section originally serving in France were available there for the service of this section.7 One officer of the group first sent, had remained as stated above, in base section 3 (England); two, at Dijon, were engaged in development of the organization of the section, solution of problems referred to its headquarters and in special investigations, while the other three served with field parties which visited different divisions.7 As but


220

few organizations could be given attention for any considerable period a readjustment and concentration of effort became necessary in the armies, and a plan was adopted which contemplated that the field parties be sent to headquarters of different corps in order that they might serve their constituent divisions, but until troops returned to billeting areas after the signing of armistice, the shifting of troops was so frequent that this method proved unsatisfactory. Thereafter it was the reverse.7

After the group of 20 officers above mentioned had joined the section, September 1, 1918, others gradually were added, until 43 were on duty with it when the armistice was signed.7 Of this total, four officers belonged to the Medical Corps and all others to the Sanitary Corps.7 Seventy-three enlisted men, most of whom were serving in the field parties, also were serving in this section at that time. By December, 1918, parties had been attached to 18 divisions for periods varying from a few weeks to several months; and with five of these, two or more parties had been on duty at different times. After January 1, 1919, field parties assigned to army corps served six other divisions and eventually they had served 8 corps and 26 divisions.7

After October 18, 1918, when the director of laboratories and infectious diseases was authorized to issue travel orders for the movement of these groups their mobility and value in meeting emergencies was greatly increased.7 Such orders were issued for specific purposes only; e. g., investigation of epidemics of food poisoning, inspection and prompt recommendation concerning the preservation of food, and similar purposes.7

After the strength of the food and nutrition service was increased in September, 1918, additional field parties were organized, and soon thereafter it became possible to provide officers for base sections Nos. 1, 2, 5, and 7 (in addition to base section No. 3, provided for at the outset) and for the intermediate section.7 Officers or parties also were stationed at 10 large camps for considerable periods, and repeated inspections were made of supply, preparation, service and conservation of food as well as other matters pertaining to the mess service at practically all camps in base sections. Many other inspections which sought to be of constructive value were made of other organizations including hospitals in the base and intermediate sections. In base section No. 3 where four officers were on duty for more than five months, practically all organizations were inspected, many of them repeatedly.7

The most important problems which confronted the section of food and nutrition during the winter of 1918-19 were the following:7 (a) Inspection and report upon needs of labor organizations requesting increases in the ration in accordance with General Orders No. 176; (b) continuation of the inspection and instruction work in base sections with added emphasis on the messing conditions in the embarkation camps; (c) continuance of instruction to divisional troops in the first, second, and third Armies and the development of instruction concerning cooking in their component units; (d) the appointment of special inspectors to safeguard the nutritional interests of our troops on returning commercial liners; and (e) assistance in solving the food problems of the section of civil government in the occupied territory in Germany.7 The food and nutrition section also provided a representative for investigation and advice


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concerning matters pertaining to his specialty in the Third Army and another who supervised messing conditions in the district of Paris, and investigated questions of factory sanitation that were of interest to the Quartermaster Corps.7

From November to May the following new features developed in the work of the section:3 The supervision and assistance in the organization of the large embarkation messes at the base port. This covered base sections Nos. 1, 2, 5, 6, and the embarkation center at Le Mans. At these same base ports a member of this section in each base served officially on the boards which inspected transports to determine the proper food equipment of the same. At advanced general headquarters one of our officers served as food and nutrition consultant on the staff of the officer in charge of civil affairs and there rendered valuable service in determining the food supply of the occupied territory.

From January to June, 1919, the officers assigned to army corps (where they were attached either to the corps surgeon's office, to G-1 or G-3 of the corps) exercised general supervision over the nutritional service of divisions and devoted much of their time to the development of schools for mess sergeants and cooks.7

Of the numerous investigationsa which this section conducted the following were practically noteworthy, viz, food conditions in the zone of the armies, on the Murman coast, and in the sections of the Services of Supply; food service in hospitals; caloric value of the ration; laboratory examinations and analyses of food; inspection of factory conditions pertaining to food supplies; special problems regarding bread and meat issues; rations for later troops and food supply and its service on transports, especially on commercial liners hired for transport purposes by the United States.7

The services of the food and nutrition section for the American Expeditionary Forces as a whole was terminated May 26, 1919, but was continued so long as circumstances required in the administrative sections of the Services of Supply and in the remaining army corps, the work being so arranged that officers employed therein could automatically be released when their services were no longer necessary.7

MUSEUM AND ART SECTION

For the purpose of collecting suitable medical museum specimens, the Surgeon General, in January, 1918, requested authorization from the commanding general, A. E. F., to send to France a medical museum unit with a designated director.12 After receipt of the authorization, and a period of two months spent in planning for the collection of museum material in the camps and cantonments of the United States, the director of this unit was ordered to England in order that he might study both the collections made and methods of collecting employed by the British Army, and was then sent to France for further duty.12 In the meantime Circular No. 17 had been issued by the chief surgeon, A. E. F., calling attention to the importance of collecting museum specimens and giving brief directions for their preservation.12

    aFor details concerning these investigations, consult Chap. VI, Sec. II, Volume VI, of this history.


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The collection of museum and art material in France was made a responsibility of the division of laboratories, for it early became apparent that the procurement of pathologic material would be wholly dependent on the efficiency and activity of the officers who performed autopsies.12 The first task, therefore, was the improvement of the necropsy service in the American Expeditionary Forces, which at that time, because of lack of personnel for such service, was very inadequate. During the summer of 1918 it became evident that there existed a great need for a routine service of this character which would afford a means of professional inspection of the measures which medical officers employed in their care of patients.12 This inspectorial need was filled in satisfactorily, and, although the number of pathologists was constantly so limited that they could not give more than incidental attention to the collection and preservation of pathologic material, their collections were more extensive than could have been hoped for under the circumstances.12

Since General Orders, No. 15, H., A. E. F., January 24, 1918, limited the practice of photography in the American Expeditionary Forces, in so far as obtaining a pictorial history of the war was concerned, to the Signal Corps, the chief surgeon, A. E. F., in March, 1918, approved an elaborate schedule for the taking of photographs by that corps for the purpose of illustrating the medical history of the war.12 In order that other technical photographs might be procured, a request was made early in May for the privilege of cabling for photographers and artists who were then in readiness to proceed from the Army Medical Museum in Washington, but this was disapproved by the general staff, A. E. F., in view of the existing tonnage situation, and in the belief that the requirements of the Medical Corps could be met successfully in this particular by the personnel and facilities already available, in both the Signal and Engineer Corps.12

On May 3, 1918, the director of laboratories notified the chief surgeon that provision was contemplated for photographic work on anatomical material in the advance section and in the central Medical Department and base laboratories.13 It was believed that a sufficient number of men for this purpose could be found in the American Expeditionary Forces, and it was planned to train them, at the central laboratory, in the simple laboratory procedures so that they could serve both as laboratory assistants and as photographers.13 Another acquisition desired by the museum and art service of the division of laboratories was a number of artists who could make sketches of anatomical specimens and of medical and surgical procedures.13

In July, the division of laboratories reported to the chief surgeon, A. E. F., the lack of men in the Signal and Engineer Corps who had special training in preparing medical illustrations and urged the necessity for special training along such lines in order that good results might be procured.12 As a result, a cabled request was made to the War Department that a museum unit, consisting of a cinematographer, a photographer, and four artists, with complete equipment and supplies for six months, be sent to France. One officer and seven enlisted men, equipped for making moving pictures, arrived in France September 14, 1918, pursuant to this cablegram.12

General Orders, No. 78, G. H. Q., A. E. F., May 25, 1918, amended previous orders on the use of cameras in the American Expeditionary Forces, and


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charged the Medical Department with making technical photographs of surgical and pathological interest. To carry out this responsibility, the officer in charge of the museum and art section made a survey of the Medical Department personnel and pertinent equipment in the American Expeditionary Forces. Several men were found who had been trained in photographing medical subjects, but because of the order previously issued concerning the taking of photographs, almost no hospitals were found equipped with photographic apparatus.12 Those that were so equipped were authorized to place their equipment in use.12 A few cameras were procured from French sources, 3 were borrowed from the Signal Corps, and 24 from the Roentgenologic department of the professional services.12 A limited amount of photographic supplies was obtained from French sources.12

An examination of the feasible sources of supply-American, French, and British-revealed the fact that nothing but formalin was obtainable for the fixation of pathologic specimens, except in a few base hospitals which had first arrived in France and which had brought with them a small supply of alcohol.12 The only materials available for color preservation were sodium or potassium acetate and nitrate, one or the other of which was obtained after long delay from the French. These materials, photographic and pathologic, were placed in the central medical supply depot, but the facilities there for distribution either of these or of the other Medical Department supplies used in the museum and art service were inadequate.12

After a careful survey of the situation, Circular No. 42 was issued by the chief surgeon's office.12 This circular, which gave technical instruction concerning the collection and preservation of specimens, is reproduced in the appendix to this volume.

As a result of these efforts, the increase in the total number of pathologists, their assignment at advantageous points, and personal appeals while inspecting laboratories, much interest in the collection of museum material was developed.12 But the battle activities in June and July so overwhelmed the laboratory division that very few pathologic specimens were collected at that time.12

On September 15, 1918, the director of laboratories wrote, through the chief surgeon, to the chief quartermaster under whom the officer in charge of salvage was operating, stating that it was important that certain articles of interest to it, which were employed in allied armies or in that of the enemy, be collected and transferred to the Medical Department.14 These articles included drugs, sera, chemicals, apparatus, instruments, etc., and ordnance. He stated that the Army Medical Museum was charged with the collection of such material and the provision of arrangements whereby it would be made available for future studies and requested that such articles of the character mentioned as had been selected by a medical officer be transferred to the division of laboratories for shipment to the Army Medical Museum in Washington.14

In October and November the epidemic of influenza, coinciding as it did with the Meuse-Argonne operation, the period of greatest battle activity in the American Expeditionary Forces, again overwhelmed the pathologists, though by this time their number had materially increased.12 By this time,


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also, an excellent necropsy service had been developed, but only relatively slight attention could be given to the collection of specimens.12 Nevertheless, despite the limited personnel and the lack of equipment, of supplies, of containers, of transportation, of time, and in fact of everything except a multitude of specimens, upward of 6,000 pathologic specimens were collected, preserved, and shipped to the Army Medical Museum.12 Most of these related chiefly to war wounds and to gas poisoning.12

Early lesions of war gas poisoning were especially difficult to obtain, owing to lack of transportation facilities and of pathologists, and to the necessity for the collection of specimens for immediate study at the pathologic laboratory in the Chemical Warfare Service, with which the Medical Department attempted to cooperate in every possible manner.12 However, a small but a fairly representative collection of these lesions was assembled. By December 26, 1918, most of the pathologic specimens from gas-poisoning cases had been forwarded to the laboratory of the Chemical Warfare Service for study, and the others, which had been held at the central laboratory, had been shipped to the Army Medical Museum.15 A number of good specimens illustrating the more striking types of lung lesions occurring during the epidemic of influenza in the fall of 1918 were preserved.12 Lesions illustrating the often unique course of typhoid and paratyphoid fever in men who had received specific prophylaxis also were collected in considerable numbers during the fall and winter of 1918-19. Fairly good collections were made of specimens illustrating lesions of the brain, and of peripheral nerves and certain other conditions.12

About 2,000 microscopic slides of tissue were collected and shipped to the United States.12

A small collection of missiles which had caused injuries and which had been removed at surgical operations was preserved, but most of these were returned to wounded soldiers, pursuant to Circular No. 42, Chief Surgeon's office. A fairly complete collection of unused small-arms missiles and fixed ammunition of the several belligerent nations, a few specimens of heavy ordnance missiles and of their fragments, and a representative collection of rifles, pistols, bayonets, trench knives, and other weapons were forwarded to the Army Medical Museum.12

On January 13, 1919, the commander in chief instructed army commanders and the chiefs of all technical and supply divisions concerning the collection of material for historical and exhibition purposes.16

A large collection of helmets, which showed evidence that they had either warded off missiles or been penetrated by them, a small number of pieces of body armor, and other metal objects such as canteens, mess kits, trench mirrors etc., which also showed they had been struck by missiles, were collected and shipped to the museum.2 A number of surgical instruments and other items in Medical Department armamentarium, which had been developed or materially modified in our service, or in those of our allies, or in that of the enemy during the progress of the war were collected and shipped.12

In September, 1918, several artists (medical illustrators, wax modelers, and others) had arrived in France attached to Base Hospital No. 115, which was stationed at Vichy.12 An art and photographic section was therefore established in Vichy in the center laboratory of the hospital center, using this personnel


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and its equipment.12 Other artists were assigned from to time to time to this art section and were ordered out therefrom to various hospitals in the American Expeditionary Forces where opportunities afforded making illustrations of medical or surgical subjects. This group produced 35 casts of surgical cases, about 200 drawings and paintings, and more than 1,000 photographs of technical subjects.12 In addition to these illustrations and photographs, which were centered at Vichy, a number of other drawings, paintings, and photographs of technical subjects were made in other hospital centers, particularly at Allerey, Beaune, Chateauroux, and Paris.12

The cinematographer, photographers, and artists cabled for in August, 1918, reported for duty to the director of laboratories in the following month.12 This personnel was distributed as advantageously as possible, principally to cover the activities of combat divisions. Here they remained on duty until the signing of the armistice.12 Late in September, 1918, the museum section of the division of laboratories had been charged with the duty of cooperating with the Signal Corps in making photographs for the medical and surgical history of the war.12 The Signal Corps, though it had been authorized in March, 1918, to prepare such photographs, had been able to cover but little of the medical activities of the American Expeditionary Forces except the more popular subjects which were needed for propaganda purposes.12 After the signing of the armistice and as soon as the general photographers of the Medical Department could be released from their duties with combat divisions, a photographic bureau of the Medical Department was established in Paris for making and collecting photographs and moving pictures illustrative of the medical activities in the war.12 Personnel of both the Medical Department and of the Signal Corps were assigned to this duty.12

The negatives of the medical pictures taken by the Signal Corps photographers were developed by them and two prints of each made for the Medical Department bureau, the negatives being retained by the Signal Corps.12 The negatives made by medical personnel were developed, printed, and filed in the Medical Department bureau. This bureau filed more than 10,000 still pictures, titled and cross indexed, supplied about 5,000 proof copies to hospital organizations for use in their several histories, and furnished 1,500 prints for medical officers of the general staff of general headquarters.12 The bureau also photographed about 350 dental specimens. It made about 40,000 feet of moving-picture film of surgical and medical subjects, such as activities in and around hospitals, rehabilitation of convalescent patients, care of psychiatric cases, etc., and filed about 20,000 feet of other motion pictures made by Signal Corps photographers. Nineteen copies of the motion picture, "Fit to fight," were made for circulation in the American Expeditionary Forces.12 Two other propaganda pictures-"Fit for America" and "How to avoid typhoid fever"-and six copies of a two-reel anatomic picture concerning venereal diseases were also made.12

The Roentgenologic division of the professional services, on request from the division of laboratories, packed and shipped about 2,000 selected X-ray plates from their point of origin directly to the Army Medical Museum.12 These were selected for their technical quality as well as for their scientific interest and


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covered in a number of instances special series of cases or series which showed different stages in the treatment and healing of the same case.12

Immediately on the signing of the armistice it became obvious that transportation facilities for specimens, not only within the American Expeditionary Forces but also from base ports to the United States, would be exceedingly limited.12 A supplemental museum circular (No. 58) was therefore issued from the chief surgeon's office December 2, giving directions for expediting transportation and calling attention to the desirability of obtaining material showing stages of healing, etc.12 As a result of this circular the transportation of pathologic specimens directly to base ports from their points of origin instead of through collection centers was materially expedited, as this procedure required that dependence be placed on a large number of shippers for report of details concerning the individual specimens they forwarded, there eventuated in some instances a lack of the detailed information desired.12 The shipment of museum material to the United States was greatly hampered by the inevitable confusion incident to general shipping conditions in France and to the lack of tonnage at the close of the war. All the specimens, however, were carefully packed, and it was believed they would not materially deteriorate even if delayed one or two years in transit.12
 LABORATORY OF SURGICAL RESEARCH

In order that use might be made of the unusual opportunities which the World War afforded for the study of certain conditions, such as shock and hemorrhage, which occur both in military and civil practice, and in order to obtain information wherewith to meet new experiences in war surgery, as these arose, a laboratory for surgical research was established at Dijon.17 This organization was established on the initiative of the chief surgical consultant and connected with the central Medical Department laboratory. Plans for carrying on the research work were perfected in January, 1918, but it was not until May 1 of that year that active work was begun.17 Two divisions of the unit were established, physiological and surgical, the former being staffed by 4 officers and 3 enlisted men and the latter by 6 officers, 2 nurses, and 2 enlisted men. Investigations of problems connected with shock and hemorrhage and the development of a satisfactory technique in the treatment of chest wounds were the first studies undertaken.17 Studies concerning shock and hemorrhage progressed in such a favorable manner that late in May instruction was begun of classes in resuscitation, and thereafter teaching and investigation were closely associated in this service. With a few interruptions, classes of from 6 to 21 officers were instructed each week until November 1, 1918, the successive courses of lectures and demonstrations being gradually amplified and improved.17 Members of the classes drawn from the surgical staffs of base hospitals, were organized in resuscitation teams, and when needed they were to be ordered to hospitals at or near the front. This plan was not altogether satisfactory. In many cases the personnel in question could not be released from their units for this purpose and as a result some of the resuscitation teams in forward hospitals had not received the instruction referred to.17 The teaching staff of the surgical research laboratory also gave instruction monthly to the classes in the sanitary school at Langres.17


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Meanwhile surgical research was prosecuted, some studies of this character being conducted in British hospitals. Research in the treatment of chest wounds was conducted by a team of 6 officers, 2 nurses, and 2 enlisted men.17 These studies were not completed but certain principles apparently were established and surgical operations simplified accordingly.17 A project to establish an advance surgical research laboratory where observations could be made on recently wounded men was contemplated but never materialized.17
 REFERENCES

(1) Report of the activities of the water analysis laboratories, to January, 1919, by Lieut. Col. Edward Bartow, S. C. On file, Historical Division, S. G. O.

(2) Report of water analysis work at the central Medical Department laboratory, Dijon, France, January 25, 1919, by Captain H. B. Hommon, S. C. On file, Historical Division, S. G. O.

(3) 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 to May 1, 1919. On file, Historical Division, S. G. O.

(4) Letter from the chief surgeon, A. E. F., to the Surgeon General, January 18, 1918. Subject: Recommendation for food division. On file, A. G. O., World War Division, chief surgeon's files (720.1).

(5) Cablegram No. 614, par. A, from General Pershing to The Adjutant General, February 18, 1918.

(6) Memorandum from the Surgeon General to the chief surgeon, A. E. F., March 1, 1918. Subject: Officers reporting for duty. On file, A. G. O., World War Division, chief surgeon's files (720.1).

(7) Letter from Maj. P. A. Shaffer, San. Corps, December 6, 1918, to the director of laboratories, A. E. F. Subject: General report from the food and nutrition section, from its establishment to December 1, 1918. On file, Historical Division, S. G. O.

(8) Report on the section of food and nutrition, personnel, August 8, 1919, by Maj. Walter H. Eddy, S. C. On file, Historical Division, S. G. O.

(9) Letter from the chief surgeon, A. E. F., to chief surgeons of sections concerned, April 12, 1918. Subject: Duties and cooperation of food and nutritional officers. On file, A. G. O., World War Division, chief surgeon's files (720.1).

(10) Report on the section of food and nutrition, food problems with combat troops in France, August 8, 1919, by Capt. C. C. Mason, S. C., and Lieut. A. T. Shohl, M. C. On file, Historical Division, S. G. O.

(11) Letter from the adjutant general, A. E. F., to commanding officer of the organization concerned, September 20, 1918. Subject: Assignment of field party, food and nutrition section. Copy on file, Historical Division, S. G. O.

(12) Report on the museum and art service of the American Expeditionary Forces (undated), by Col. Louis B. Wilson, M. C. On file, Historical Division, S. G. O.

(13) Letter from Lieut. Col. J. F. Siler, M. C., director of laboratories, A. E. F., to the chief surgeon, A. E. F., May 3, 1918. Subject: Photographic work in laboratory service. On file, A. G. O., World War Division, chief surgeon's files (321.630).

(14) Letter from Lieut. Col. J. F. Siler, M. C., director of laboratories, A. E. F., to the chief quartermaster, A. E. F., September 15, 1918. Subject: Transfer of certain material to the Medical Department. On file, A. G. O., World War Division, chief surgeon's files (700.6).

(15) Fourth indorsement from director of laboratories, A. E. F., to the Surgeon General, U. S. Army, December 26, 1918, on letter from Major M. C. Winternitz, M. C., to director of Chemical Warfare Service, November 7, 1918. Subject: Study of human pathology of poison war gases. On file, World War Division, chief surgeon's files (321.630).


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(16) Letter from commander in chief, A. E. F., to army commanders and all technical and supply divisions, January 13, 1919. Subject: Collections of materials of historic value. Copy on file, Historical Division, S. G. O.

(17) Report on the services of the laboratory of surgical research, American Expeditionary Forces, at Dijon, December 7, 1918, by Lieut. Col. W. B. Cannon, M. C., and Lieut. Col. J. L. Yates, M. C. On file, Historical Division, S. G. O.

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