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Chapter IX

Contents

CHAPTER IX

THE DIVISION OF LABORATORIES AND INFECTIOUS DISEASES

GENERAL ORGANIZATION

When the United States entered the war, practically no information was available to us relative to the laboratory organization and activities of the nations engaged. Therefore, it was not possible for the Medical Department to formulate at that time any definite plan of organization based on their experience; however, as a preliminary measure to the provision of a laboratory service for the American Expeditionary Forces, the officers in charge of the laboratory division, Surgeon General's office, assembled the personnel for an initial laboratory and dispatched it to France.1 This unit which sailed on July 26, 1917, and arrived in France on August 5, consisted of five officers and six enlisted men under command of a major of the Medical Corps. Designated as Army Laboratory No. 1, it was assigned to station at Neufchateau about 35 miles north of Chaumont.1 As the officer in charge of the laboratory division, Surgeon General's office, had believed that general laboratory supplies would be available in France, this unit brought with it only a few special items and procured from the Pasteur Institute in Paris an emergency equipment consisting of one French Army model field laboratory packed in chests.1 This equipment provided very limited material for clinical pathology and general bacteriology, and only with the greatest difficulty was a very incomplete equipment for neurologic and pathologic work procured.1 A small requisition had been placed with the supply division of the Surgeon General's office before this unit left the United States, but much of this never reached the laboratory in France.1 A requisition was placed for the limited number of items of laboratory equipment on the Medical Department supply table, and provision was made for the supply of a standard cantonment laboratory to corps laboratories, and the Army standard field laboratory equipment (plus a poison detection chest) to mobile laboratory units, as they were ordered overseas.1 Army Laboratory No. 1 was obliged to occupy a building altogether unsuitable for its purposes, where necessary alterations were made under almost insurmountable difficulties. Neither gas nor electricity was available with sufficient constancy to permit their use.1

The commanding officer of this unit, who was also the adviser of the chief surgeon, A. E. F., in all matters pertaining to laboratory service,1 formulated a tentative plan for the laboratory organizations of the American Expeditionary Forces, which was submitted to the Surgeon General in the following letter:2

1. This letter * * * is intended to furnish your office with an approximate idea of the officers, men, and supplies needed in France for the laboratory work of an army on the basis of five corps of six divisions each-a total of approximately 1,000,000 men.

PERSONNEL

(a) It is planned to establish one army laboratory with a personnel of 8 officers and 16 men, which will be the central laboratory, fully equipped for all kinds of routine special work, including research. The laboratory detachment and supplies brought over by Major Nichols will serve as the nucleus for this laboratory.


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(b) This office has recommended the establishment of five corps laboratories with a personnel of 4 officers and 8 men each. These laboratories will be stationary and will need to have an equipment less complete than that of the central army laboratory, but sufficient for all routine work. They may be specialized under direction of the army laboratory, if the routine work of the corps permits.

(c) A field laboratory with two officers and four men each will be provided and attached to each division. The field laboratory will be mobile and its principal work will be the bacteriological and chemical examination of water, the taking of cultures and specimens for examination in the corps or army laboratory, the examination of smears, etc. The field laboratories will depend upon and look to the corps and army laboratories for supplies and supervision of technique, etc.

(d) Summary of personnel-

 

Number

Officers

Men

Army laboratory (8 officers, 16 men)

1

8

16

Corps laboratories (4 officers, 8 men)

5

20

40

Field laboratories (2 officers, 4 men)

30

60

120

Total

---

88

176

(e) Chemist.-It is planned to include in the work of the organization given above, all chemical work which is of great importance in this war and which in the English and French services is done by separate organizations. It is believed that all laboratory work can be combined to advantage in our service. For this work officers and men, chemists of the Sanitary Corps, can be used as follows:

 

Number

Officers

Men

Army laboratory

1

2

4

Corps laboratories

5

5

10

Field laboratories

30

30

30

Total

---

37

44


SUPPLIES

(a) The supplies for the army laboratory have already been partly arranged for by a requisition prepared by Major Nichols and submitted before his departure from the United States. Further requisitions will be made on Washington for this laboratory later.

(b) At present, as our own laboratory supplies will not be available for issue for some time, work will be started near the established training camp with a laboratory outfit which has been obtained by purchase from the Pasteur Institute. Emergency items, as they may be needed, will be obtained here by purchase from the Pasteur Institute or elsewhere.

(c) It is desired that the equipment of the corps laboratories shall be the same as that already adopted for the cantonment laboratories in the United States. It is believed that the simplest method of requisition is to ask for five of these outfits.

(d) The standard field laboratory equipment can be used for the field laboratories with the addition of a chest for the detection of mineral poisons. It might be possible to obtain these here, but it is preferable to have them sent from the United States. It is planned to purchase here two motor laboratories, similar to those used in the English service, * * * for trial; but it is believed that our field laboratory can be used without a special car by transporting it on a light truck or ambulance.

(e) Laboratory supplies to replace those expended will be asked for by the medical supply officer from time to time according to strength as authorized by the supply table.

2. To recapitulate: For the whole laboratory organization there will be required about 50 medical officers and 130 men capable of doing routine laboratory work, and 35 officers and 45 men of the Sanitary Corps capable of doing chemical work. These should


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be sent to France so that the required personnel for each division field laboratory will accompany each division. The army laboratory, Major Nichols in charge, will do the work of the corps laboratories until the latter can be established. There is immediate need for two chemists to start their part of the central army laboratory organization.

(a) Advance notice of all arrivals should be sent, to facilitate the assignment of laboratory personnel.

3. In regard to supplies, there will be needed 30 more field laboratories each with a small, suitable chemical chest for qualitative analysis for mineral poisons, to be provided in the United States.

(a) The question of the transportation of field laboratories will be made the subject of a later communication.

(b) There will be required five corps laboratory equipments similar to those now used in the cantonments established in the United States.

(c) Additional equipment which will be required for the army laboratory will be covered by requisitions from France from time to time.

4. Résumé:

(a) Required at once: 2 chemists, Sanitary Corps.

(b) Required with each new division which may come to France: 2 officers (1 a chemist), 4 men (1 a chemist), 1 field laboratory equipment, to which there must be added 1 chest, chemical (for the detection of mineral poisons, etc.).

(c) Required before November 15, 1917: 1 cantonment laboratory (4 others to follow before January 15, 1918).

(d) The personnel for corps laboratories should be sent from time to time as indicated by the divisions which are dispatched.

5. For the purpose of supply it is requested that this letter be taken as a requisition.

This letter indicates, among other things, that the chief surgeon's office desired three special types of laboratories not previously authorized in War Department Tables of Organization. A representative of one of these types, an army laboratory, was already provided, so far as nomenclature was concerned, in army laboratory No. 1, but in addition to its other services this unit operated as the headquarters laboratory for the entire American Expeditionary Forces until the central medical department laboratory was established at Dijon, January 1, 1918.1 Thereafter in addition to serving the troops in the combat zone, it also served the advance section.1 A second type of unit desired was the corps laboratory, to be organized and dispatched to France in the proportion of one for each corps.1 The plans accepted at this time provided that each of these units should be of a stationary character, and well equipped for the service of corps troops, but events proved that their employment as contemplated was not practicable.1 Therefore, on arrival, the corps laboratories were diverted from their original purpose and operated as base laboratories in the different sections of the Services of Supply. The third type of special laboratory desired was the field or divisional laboratory unit, one of which was to be provided for each division. These units were to be supplied with the standard field laboratory equipment already authorized by the Medical Department. As the situation later developed, these divisional units were retained in the final plan of organization, but their equipment was changed.1

In addition to the special types of laboratories mentioned above, Tables of Organization already provided for a laboratory as a part of each base hospital and specified its personnel and equipment.3 Though none of the corps or divisional laboratories reached France before November 1, 1917, several base hospital laboratories (Nos. 6, 101, 15, 18, 17, 8, 9, and 27) arrived and began


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operating.3 These base hospital laboratories had fairly complete equipments and supplies at this time, but much of it was useless, since neither sufficient gas nor usable electric current was then obtainable.3

Before November 1, 1917, the personnel of the laboratory service in France consisted, in addition to the staff of army laboratory No. 1, of two commissioned officers and a varying number of enlisted technicians with the laboratory of each base hospital then in France.3

A considerable amount of routine clinical pathology was performed during this early period and an autopsy service of practical value conducted. The bacteriologic work done at this time consisted mainly of a study of the organisms concerned in the prevalent infections of the respiratory tract.3 The service for conducting Wassermann reactions was begun in September, 1917. The difficulties to be overcome were many. Little equipment was available, all reagents had to be prepared and standardized, only with the greatest difficulty could guinea pigs be secured, only a low-speed hand centrifuge was available, and it was necessary to use some very primitive equipment.3 At that time it was planned that the Wassermann work for the entire American Expeditionary Forces would be done at army laboratory No. 1, but this proved impractical because of delays in transmitting specimens and reports.3

In the latter part of October, 1917, a division charged with the supervision of the laboratory service of the American Expeditionary Forces was created as a part of the office of the chief surgeon, and Circular No. 2, chief surgeon's office, dated November 9, 1917 (quoted in the appendix), which announced the creation of professional divisions in that office, included among others the division of laboratories. Later in the same month a section of infectious diseases was added to this division.3

The chief surgeon on November 11, 1917, instructed the director of laboratories, A. E. F., to submit plans to organize a division of laboratories and infectious diseases.3 Some information was then available concerning the organization of the laboratory services in the British and French Armies, but it seemed advisable to plan for a somewhat more comprehensive organization with greater centralization and more definite administrative control and coordination than existed in those forces.3 The general projects of organization and phases of development for the American Expeditionary Forces as worked out by the general staff were reviewed, the plans of the hospitalization division of the office of the chief surgeon, including geographic location of hospitals present and prospective (i. e., those leased, under construction, or projected) were studied, and as much relevant information as possible was obtained, concerning the proposed lines of railway communication.3 By means of this information, and the employment as a basis of the preliminary plans for the laboratory service already adopted, a highly developed project for the organization of this division was formulated.1 On December 29, 1917, a general outline of the proposed organization was submitted to the chief surgeon, and on January 11, 1918, a detailed outline with the statement that plans were already being formulated to effect a number of the features it prescribed.1 This latter project, which was approved by the chief surgeon, was as follows:1


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ACTIVITIES-DIVISION OF LABORATORIES AND INFECTIOUS DISEASES

SECTION OF LABORATORIES

1. Representative of chief surgeon in all matters relating to laboratory service.

2. General supervision of all laboratories and the assignment of special personnel.

3. Direct supervision of purchase and distribution of laboratory equipment and supplies.

4. Publication of circulars relating to standardization of technical methods, collection of specimens and other matters of technical interest to the laboratory service.

5. Collection and distribution of literature relating to practicable and definite advances in laboratory methods.

6. General supervision of research.

7. Supervision and action on manuscripts of laboratory personnel to be presented to chief surgeon for publication.

8. Cooperation and coordination with the directors of all the professional divisions, in order that medical and surgical problems arising during the war may be most effectively handled from the laboratory point of view.

SECTION OF INFECTIOUS DISEASES

1. Representative (advisory) of chief surgeon in matters relating to the prevention and control of transmissible diseases.

2. Collection and distribution of literature pertaining to practical advances in methods of prevention and control.

3. Preparation of circulars relating to prevention and control.

4. Detail of specially trained units with personnel and mobile material, on request from the division of sanitation, for the investigation of epidemics or threatened epidemics.

5. Experimental investigations of suggested prophylactic methods for the prevention of infectious diseases and recommendations relative to their general adoption.

6. Collection of statistics and epidemiological data on infectious diseases.

A. CENTRAL ORGANIZATION

1. Central offices.

Personnel:

Director of division of laboratories and infectious diseases-

(a) Assistant director (section of laboratories).
(b) Assistant director (section of infectious diseases).
(c) Adjutant; 2 secretaries, 2 clerks, chauffeur and orderly.

2. Central medical department laboratory, A. E. F.

Divisions:

(a)  Bacteriology.
(b)  Serology.
(c)  Pathological anatomy.
(d)  Chemistry (sanitary-medical).
(e)  Medical biology
(f)  Supplies (diagnostic and therapeutic sera, vaccines, culture media, stains, standard   solutions,  portable laboratory units, ect.).

Activities:

(a) Standardization of technical methods.
(b) Manufacture and distribution of culture media, stains, agglutinating sera, amboceptor, antigen, etc.
(c) Distribution of diagnostic and therapeutic sera, vaccines, etc., to base, camp hospital, army, evacuation hospital, and divisional laboratory units and to troops.
(d) Supply of complete transportable and other mobile laboratories for units in the field and for special investigations. (Meningitis, diphtheria, pneumonia, enteric fevers, etc.)
(e) Supply of laboratory animals.
(f) Special highly technical chemical and other laboratory work as required.


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Central medical department laboratory, A. E. F.-Continued.

Divisions-Continued.

Activities-Continued.

(g) Standardization of technique and records of post-mortem examinations and supervision of collection of museum specimens to be forwarded to the Army Medical museum.
(h) Special work on insects (lice, etc.).
(i) Special research work.
(j) Instruction of laboratory personnel in technical methods (wound bacteriology, etc.).
(k) Supply of special personnel and material for the investigation of epidemics.

Personnel:

Commissioned-

Commanding officer.
Adjutant.
Quartermaster.
Chief, division of bacteriology.
Assistant, division of bacteriology.
Chief, division of serology.
Assistant, division of serology.
Chief, division of pathological anatomy.
Chief, division of chemistry.
Chief, division of medical biology.

Enlisted and civilians (43)-

2 secretaries.
3 clerks.
10 technicians.
1 electrician.
1 plumber.
1 cabinetmaker.
1 general carpenter.
1 packer.
6 chauffeurs.
1 mechanic, having general knowledge of autos.
1 motor-cycle driver.
5 general utility men.
10 civilian laborers.

NOTE.-Both commissioned and enlisted personnel will be attached temporarily to this laboratory from time to time, for purpose of instruction. Special mobile units for special investigations and reinforcements will be held in reserve at this laboratory.

The central laboratory will supply culture media, stains, therapeutic sera, standard solutions, and other expendable laboratory items to laboratory units in the intermediate and advance section, line of communications, and the zone of the advance. It will equip, distribute, and replenish the transportable laboratory units for camp hospital laboratories. It will stock and replenish all transportable laboratories (in chests) for special investigations (meningitis, pneumonia, diphtheria, typhoid, dysentery, etc.), and all motorized corps and special mobile laboratories functioning in the intermediate and advance sections, line of communications, and the zone of the advance. In the investigation and control of epidemics and threatened epidemics, it is of the utmost importance that the existence of suspected disease be recognized promptly, in order that measures for its control and prevention may be instituted without delay. Experience has demonstrated already that railway transportation fails absolutely to meet the necessary requirements. All parts of the area served by the central Medical Department laboratory can be reached by motor transportation in from two to eight hours and an adequate motor transportation will be urgently required. The following transportation will be necessary:

1 1½-ton truck.
1 passenger car (Ford).
2 light Ford trucks.
2 motor cycles with side cars.
2 Ford ambulances.
6 motorized bacteriological laboratories (reserve).
1 passenger car closed (Dodge).


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B. GENERAL ORGANIZATION

(Division of Laboratories)

1. Base laboratories:

(These laboratories will be of two general types: Those functioning directly under the headquarters of the different sections of the Services of Supply and those functioning as base laboratories for single base hospitals or for groups of base hospitals.)

(1) Base laboratories, Services of Supply-

Divisions-

(a) Bacteriology.
(b) Serology.
(c) Pathological anatomy.
(d) Chemistry (sanitary and medical).
(e) Supplies (diagnostic and therapeutic sera, vaccines, culture media, stains, standard solutions, etc.).

Activities-

(a) Manufacture of culture media.
(b) Distribution of culture media, stains, diagnostic and therapeutic sera, etc., to camp hospital laboratories and base laboratories, base hospitals, in their section.
(c) Stocking and replenishing special transportable and motorized mobile units functioning in their section.
(d) Supply of laboratory animals.
(e) Special research.
(f) Investigation of epidemics and threatened epidemics in their section by means of special personnel and material attached. (Transportable units in chests for investigation meningitis, diphtheria, pneumonia, dysentery, etc., and motorized bacteriological laboratory for special investigation.)
(g) Serological and special bacteriological work for camp hospitals, base hospitals, and for troops.

Personnel-

Commanding officer.
2 commissioned assistants permanently attached.
2 commissioned assistants to be available for special duty in investigating epidemics.
The necessary enlisted and civilian personnel.

Transportation-

1 passenger car and 1 motor cycle with side car.
1 motorized bacteriological laboratory.

(2) Base laboratories, base hospitals-

(These laboratories will be organized for single base hospitals (1,000 beds) and base hospital groups (5,000 to 10,000 beds). They will be well equipped as to personnel and material and capable of doing any work ordinarily carried on in a good laboratory.)

Activities-

(a) Bacteriological, serological and gross and histopathological work for base hospitals or for groups of base hospitals.

(b) When necessary, they will be charged with the serological and specialized bacteriological work for camp hospitals in their vicinity.

(c) Supply of therapeutic sera, vaccines, etc.

NOTE.-The routine pathological work (blood counts, urines, smears, etc.) in base hospital groups will be done by a special personnel in small laboratories in close proximity to the wards. Special base laboratory buildings with adequate space are being provided for in the plans for the construction of groups of base hospitals (5,000 to 10,000 beds).

Transportation-1 motor cycle with side car.


144

Base laboratories-Continued.

(3) Camp hospital laboratories-

Activities-

(a) Routine clinical pathological work for camp hospitals (300 beds) and regimental infirmaries (urines, sputum, blood counts, dark field, diphtheria cultures, etc.)

(b) Collection of specimens from regimental infirmaries (blood for Wassermann, etc.) to be forwarded to base and army laboratories.

(c) Distribution of reports to regimental infirmaries.

Personnel-

1 bacteriologist.
3 enlisted technicians.
1 motor-cycle driver.

Transportation-1 motor cycle with side car.

Equipment-Transportable expandable units in chests.

(4) Evacuation hospital laboratories-

(These units will be assigned to evacuation hospitals and will have the necessary equipment to do the routine clinical ward work and special work in wound bacteriology for evacuation hospitals).

(5)                     Army laboratories-          

(Stationary units. Located in permanent buildings in the zone of the advance or in the advance section, line of communications, immobilized well equipped. Directly under the chief surgeon, A. E. F., for administrative purposes. Designated as army laboratories but will not be mobile in the sense of being attached to any particular army and following it as it moves. These laboratories will be organized as necessity for them arises and will be numbered serially.)

Activities-Similar to the activities of base laboratories.

Personnel-

4 commissioned.
10 enlisted.

Transportation-

1 passenger car (closed).
1 Ford truck or ambulance.
1 motor cycle.

(6)                     Corps laboratories-          

These laboratories will be motorized, mobile units, completely equipped for general bacteriological and epidemiological investigations. They will be numbered serially.    They will not be assigned definitely to corps but will be attached to armies, corps, or other units when their services are required. For administrative purposes and purposes of mobility, they will be controlled directly by the chief surgeon.

Activities-Investigation of special problems, epidemics, reinforcement of laboratory  units in the zone of the advance, etc.

Personnel-

1 commissioned.
2 enlisted.

Transportation-1 motorized bacteriological laboratory.

(7) Division laboratories-

(These units will be assigned definitely to divisions and will be under the order of the division surgeon.)

Activities-General routine pathological work for the division, including bacteriological  and chemical examinations of water supplies. When the division is in training, the laboratory unit should be attached to the camp hospital in its particular area. When serving at the front, one bacteriologist and technical assistant will be detached for service in wound bacteriology at evacuation hospitals or special surgical units near the front.


145

Base laboratories-Continued.

          (7) Division laboratories-Continued.

Personnel-

1 medical officer.
1 officer, Sanitary Corps (water).
4 enlisted.

Transportation-

The portable laboratory is to be transported on the sanitary train of the division.  1 motor cycle with side car.

Equipment-In chests, each chest containing a complete unit for a definite purpose. Number of units assigned dependent on character of work anticipated. Ordinarily the equipment furnished will meet the requirements for routine clinical examinations (chemical and bacteriological), examinations of water supplies, and wound bacteriology.

(8) Special units-

Motorized mobile units.

(a) Bacteriological cars.
(b) Meningitis cars.

Transportable mobile units (in chests)-

(a) Meningitis units.
(b) Diphtheria units.
(c) Pneumonia units.
(d) Typhoid group, dysentery units.
(e) Wound bacteriology units.
(f) Water supply units.
(g) General bacteriological units.
(h) Camp hospital laboratory units.
(i) Division laboratory units.

NOTE.-These special units will be assembled at the central Medical Department laboratory and sent where required. Their expendable supplies (culture media, stains, etc.) will be replenished at the central and base laboratories.

In addition to the functions outlined in this plan, the division of laboratories assumed certain others also; e. g., the collection of statistics on routine and special work done in laboratories, cooperation and coordination with the Chemical Warfare Service, supervision of the collection of museum and photographic records of the Medical Department, and research in a number of medical problems. Furthermore, additional sections later were added to the division, viz., that of food and nutrition, and that charged with supervision of purification of water supplies.1

Some other modifications of this original plan also proved necessary, the more important being the following:1 Army laboratories of a stationary type were not organized, and mobile units were assigned to the headquarters of field armies for use in investigations of epidemic disease in the field; corps laboratories were not organized, for only exceptionally could highly specialized, technical, bacteriological work, such as wound bacteriology, be done in evacuation and mobile hospitals during active military operations; the divisional laboratory units usually were unable to function, from the purely laboratory point of view, during combat, and furthermore they required additional equipment when in rest or training areas.1


146

However, after the chief surgeon's approval of the plan detailed above, efforts were immediately begun by the director of laboratories to carry it into effect, the organization of the laboratory section and more particularly the establishment of a central (headquarters) laboratory being given first consideration.1 After a thorough study of the projected line of communications it was decided that the central laboratory should be located at Dijon, which situation presented many natural advantages. The chief reason for selection of this locality was its proximity to the American front and training areas and to the main line of communications.1 On a visit of inspection to that city by the director of laboratories on December 15, 1917, a modern laboratory building was found which constituted a part of the plant belonging to the University of Dijon. Late in the same month arrangements were completed for taking over this structure and here the central Medical Department laboratory was established on January 1, 1918.1 On the same date the director of laboratories moved his office to the same point from Neufchateau, where it had been located first in the office of the commanding officer of Army laboratory No. 1, and then in a hut erected beside the laboratory.1

At Dijon the director's office was first established in the central Medical Department laboratory, but in April, 1918, a temporary wooden office building 100 feet long and 20 feet wide, located on the grounds of the laboratory, was completed and occupied by the director.1

The preliminary plans for the office provided that only two-thirds of the building would be used for office purposes, the remainder being reserved for storage and expansion if necessary, but even before this plan could be applied the volume of work had so greatly increased that the entire building was arranged for office purposes. One large room served as a combined office and library, partitions dividing the remainder into small offices with connecting doors.1 The structure was well lighted by electricity and was heated by stoves during the winter months; telephone connections through a local switchboard provided communication both with local and distant offices. Eventually satisfactory telephone connections could be made with places as far distant as Bordeaux, St. Nazaire, and Brest.1 The director's office remained in this building until it was transferred to the office of the chief surgeon at Tours in June, 1919.1

The general arrangement of the offices and the relationship of the office buildings to the central Medical Department laboratory are shown in Figure 5.

Until February the director's office force was still limited to one stenographer, but efficient office and other personnel was then procured, adequate to requirements.1

On February 6, 1918, the director of laboratories was directed to make such journeys as were necessary in matters pertaining to the service of that specialty.1 Prior to January the urgent necessity for completion of plans for the organization of this division had been such that but little time could be devoted to inspections.1

During the period from August to December, 1917, inclusive, the plans of organization of the division were elaborated, definitely formulated and adopted; from January to June, 1918, inclusive, the laboratory service underwent active


147

development; from July to November, 1918, inclusive, it worked under stress; and from December, 1918 to July, 1919, inclusive it underwent demobilization.1

In the spring and early summer of 1918, a considerable number of additional activities were assigned to the division and new sections were established as mentioned above.1

On May 22, 1918, the director of laboratories forwarded to the chief surgeon the following letter,4 which gave a general summary of organization then effected and projected, and especially stressed the transportation needs of the laboratory service.4 Such needs became of very urgent importance later.1
 FIG. 5.-Ground plan, headquarters, division of laboratories, A. E. F., and central Medical Department laboratory, Dijon

1. I am inclosing herewith a table of organization for laboratory units that this office considers necessary for the American Expeditionary Forces; as will be noted the laboratories are divided into two basic types: Stationary and transportable.

STATIONARY LABORATORIES

2. Central Medical Department laboratory.-This laboratory is situated in the advance section and is thoroughly equipped to do any work that may come up. It is estimated that it will eventually require 25 officers and 50 enlisted men. So far as is possible we are cutting down the enlisted personnel by the employment of civilian technicians and laboratory assistants, thus releasing male personnel for more urgent field duties. The civilian personnel is quite satisfactory and is in reality cheaper than enlisted personnel.

This laboratory, in addition to its permanent personnel, has established laboratories equipped for special investigations. At the present time surgical shock and chest surgery are the subjects of special investigation in special laboratories. The water-supply service, A. E. F., is provided with special laboratories here. We have arranged with the intelligence section, general staff, to organize a special chemical section here for the investigation of


148

correspondence and the development of invisible inks. Special problems will come up from time to time and this laboratory will be prepared to handle them.

Referring to transportation required for this particular laboratory, it will be necessary to send laboratory personnel out from this center to various parts of the Advance Section and Zone of Advance for investigation of epidemic diseases. The motor cars, light, are required for this particular purpose. It will also be necessary to deliver standardized laboratory units and replenishment supplies to mobile units in the zone of advance, and three motor trucks, medium, and three motor trucks, light, will be required to meet these needs. We have adopted a standard expandable laboratory unit system in chests with the idea that when a special investigation of epidemic diseases is to be undertaken, one of these transportable laboratory outfits can be placed on a motor truck, medium, size 1½ tons capacity, proceed to the area to be investigated, unpack the chests and organize the laboratory in a vacant room. On completion of work of this character the laboratory can be repacked within an hour's time and returned to its station with its own transportation.

Laboratory supplies and sera of various kinds will be required in the front areas, and these can be taken care of (when railroad facilities are not direct or possible) by the light motor trucks and by motor cycle with side car. The two bicycles can be used for messenger work in the city. This laboratory has at the present time three bacteriological cars, motor, and these cars will be used for investigation of special epidemics.

3. Base laboratories, sections Services of Supply.-Base laboratories are being organized in each of the sections on the lines of communication. Already one has been established for base section No. 1, base section No. 2, and intermediate section, Services of Supply, and stationary laboratories are now en route from the United States for base section No. 3 and base section No. 5. These laboratories will handle the general laboratory work and laboratory work concerned with the prevention of infectious diseases in their respective sections. To carry out this work efficiently and effectively, transportation will be necessary. One light motor car, passenger, is asked for; one motor cycle with side car; one bicycle; and one motor truck, medium. To each of these laboratories one transportable laboratory outfit will be supplied and one 1½-ton motor truck will be required to transport this laboratory from place to place for the investigation of epidemics.

FIG. 6.-Floor plan of the office of the director, division of laboratories, A. E. F.

4. Base hospital laboratories at base hospital centers.-We have organized at each base hospital center one laboratory well provided as to personnel and equipment. This laboratory will serve as a central laboratory for the entire group of hospitals, and in this laboratory it is proposed that all highly technical bacteriological and serological work will be done. In addition to this it is the intention to establish a certain number of small clinical ward laboratories in connection with a certain number of wards. By carrying out this arrangement we will conserve building space, equipment and personnel. The only transportation necessary for such a unit is a motor cycle with side car and one bicycle.

5. Base hospital laboratories at base hospitals.-These laboratories will be provided for base hospitals of from 1,000 to 1,500 beds. No transportation will be required for such units.

6. Army laboratories.-We are organizing in the advance section, or zone of the advance, laboratory units that will be of a fixed character and will be known as Army laboratories. These laboratories will be so located that they will be closely in touch with troops in the line, and it is proposed that all highly technical bacteriological and serological work for divisions in the field be done by these units. They will also be provided with a transportable labora-


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tory unit for the investigation of epidemics and will care for epidemics in their particular section. In order to carry out work on epidemics effectively, it will be necessary to supply them with a 1½-ton motor truck for the transportation of the transportable laboratory.

TRANSPORTABLE OR MOBILE UNITS

7. Camp hospital laboratories.-We have arranged to supply camp hospitals with transportable units in chests, but as these units are permanent or semipermanent, no transportation for carrying their transportable units will be necessary. They should be provided, however, with a motor cycle with side car, in order that they may be in close touch with infirmaries and other units for which special work will be done.

8. Evacuation hospital laboratories.-These units are made up of the standard transportable outfits and consists of eight chests. They should be provided with a 1½-ton motor truck to carry their equipment. This truck will be used constantly by the pathological and museum units attached to the laboratory of evacuation hospitals when not in use.

9. Mobile hospital laboratories.-A transportable laboratory unit consisting of eight chests is required for each mobile hospital, and in order that it may be transported one truck, motor, medium, will be required.

10. Divisional laboratories.-This laboratory unit is attached to each division, and its equipment consists of three of the chests of the standardized transportable outfits. To make this unit mobile it will be necessary to supply one light motor truck capable of carrying these three chests. This unit will also require one motor cycle with side car.

11. In connection with the transportation provided for in this T. of O., this office is convinced that the laboratory service will not and can not perform its functions properly unless provided with transportation. In working out the organization of supplies for mobile and semimobile units, we have endeavored to standardize equipments, and this has been accomplished by providing an expandable unit laboratory system in chests. These chests are so arranged that a given number of chests will care for the work of camp hospitals and divisions, while the evacuation hospitals and mobile hospitals will require the full number-eight. The British system has been somewhat different. They have organized a unit system consisting of a bacteriological motor car, with the idea that the necessary work would be done in this car. As a matter of practice it has been found that usually the equipment would be taken out of the car and placed in a vacant room provided the unit remained at one place for any great length of time. These cars cost approximately $7,000. We feel that the system adopted by us will be more satisfactory and will be much cheaper, provided the necessary transportation is furnished. A standardized laboratory unit of chests costs, complete, about $1,200, and a motor truck of 1½-ton capacity will probably cost in the neighborhood of $2,000. This makes about $3,500, while the British units cost from $6,000 to $7,000.

12. It will be necessary that the truck transportation allowed for these mobile units be assigned very definitely to these particular laboratory units; otherwise they lose their mobility. Laboratory supplies are difficult to secure. We have heard that during a recent German offensive on the Western Front the laboratory service for the British Army in France were able to save their entire equipment. This was possible by reason of the fact that they had transportation definitely assigned to them.

                            J. F. SILER,
                          Lieutenant Colonel, Medical Corps, United States Army.

As mentioned above, the division of laboratories had been included among the professional services prescribed in Circular No. 2, chief surgeon's office, A. E. F., November 9, 1917.3 But that division, being a part of the division of sanitation in the chief surgeon's office, and therefore in a somewhat different administrative position from the other professional services which were under control of the hospitalization division, was not grouped with these when they were reorganized by Circular No. 25, chief surgeon's office, A. E. F., May 5, 1918, and by General Orders, No. 88, G. H. Q., A. E. F., June 6, 1918.


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The director of the division of laboratories enjoyed entire freedom in the organization and development of his department except that all matters of policy and those affecting the service in general were submitted to the chief of the division of sanitation for final decision.1 The director was authorized to issue circulars, memoranda, and special letters of instructions concerning matters of interest in the laboratory service. Memoranda which were of interest to the Medical Department at large were submitted to the chief surgeon and issued as circulars from his office.1

At the time the office of the director of the division was established at Dijon, that of the chief surgeon was located at Chaumont, and because of their proximity there were then no great difficulties of coordination. But after the chief surgeon's office was transferred to Tours, in March, 1918, the unavoidable congestion of telegraph and telephone lines, necessary censorship regulations, and irregular mail facilities often caused considerable delay in receipt of orders affecting transfer of personnel.1 This situation was remedied by granting to the director of the division in August, 1918, authority to issue suitable orders to personnel under his control whereby he could meet emergencies and fill existing vacancies from the reserve staff on duty at the central medical department laboratory.1 Thereafter the efficiency of the laboratory service was greatly increased, particularly by promoting both the early investigation of epidemic diseases and quick response to emergencies that developed during combat. Better coordination would have been secured if the director's office had been located in the office of the chief surgeon, for delays which occurred at time in communication would have been obviated.1 But many and greater office advantages accrued from maintenance of close contact between the director's and the central Medical Department laboratory at Dijon.1 The laboratory was so located that it was less than six hours distant from 1,500,000 troops and from hospitals with a total capacity of more than 100,000 beds. Request was made of the hospitalization division of the chief surgeon's office that the director be promptly apprised of the arrival and location of all hospital units arriving overseas.1

GENERAL CORRELATION AND ACTIVITIES

In order to correlate the work of the division with the activities of the Medical Department in general, the following methods were employed:1

Letters covering the progress of the work and plans for the future were written at frequent intervals to the chief of the division of laboratories in the office of the Surgeon General at Washington, and in July, 1918, an officer was sent to Washington in order to give more definite information concerning the various problems confronting the laboratory service of the American Expeditionary Forces.1

The director had frequent conferences with the head of the division of sanitation in the chief surgeon's office, the progress of the work being reviewed and special matters brought up for final action.1

Weekly reports, covering the general activities of the division were submitted to the chief surgeon and copies forwarded to the Surgeon General.1

Copies of all reports on investigations of epidemics as well as reports that were considered of sufficient interest were transmitted to the chief surgeon for his information.1


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When general or technical circulars involving action by some other division or service were contemplated, that division or service was consulted, and approval and cooperation secured before the circular was published.

A special mailing list was prepared, including divisions of the chief surgeon's office, the professional divisions, the sanitary school, the Pasteur Institute, the adviser in pathology to the British Expeditionary Force, the secretary of the British research committee, the secretary of the research committee of the American Red Cross, and individual officers on duty with the American Army, the French Army, the British Army, and the Italian Army, to all of whom special memoranda, etc., were forwarded.1

Officers of the division represented it at the meetings of the Inter-Allied Surgical Congress.1 The director of the division attended sessions of the research committee organized by the American Red Cross, of which committee he was a member.1

Matters affecting the medical and surgical services were taken up through liaison officers appointed for this purpose by the chiefs of those services. These matters, in so far as the medical service was concerned, included, among others, control of epidemic diseases.1

All matters relating to water supplies were taken up with the senior representative of the Medical Department with the water supply service, A. E. F.1

In the summer of 1918, it was planned to initiate conferences of special groups of officers at stated intervals for the purpose of discussing special features of their work and the local problems with which they had to contend.1 These meetings were to be held every month or six weeks, at the central Medical Department laboratory, and were to be limited to groups of officers engaged in identical lines of work.1 One meeting was to include the commanding officers of base laboratories operating in the different sections of the Services of Supply, and the officers engaged in disease control; one was to include the commanding officers of base laboratories in hospital centers; another the laboratory officers of evacuation and mobile hospitals; another the officers in charge of division laboratories, etc.1 But because of combat activities it was not possible to call the first conference until November 1 and 2, 1918.1 This was attended by the chief of the division of sanitation, chief surgeon's office and his assistant, by the commanding officers of the base laboratories functioning in the sections of the Services of Supply, by sanitary inspectors of the sections of the Services of Supply, and others.1

After the signing of the armistice, conditions became so unsettled that it was not practicable to continue these conferences.1
 

DIRECTOR'S OFFICE

ADMINISTRATIVE DETAILS

For administrative purposes the office of the director, division of laboratories and infectious diseases, was divided into six general sections with one or more officers on duty in each as assistants to the director. These sections were: (1) Executive office and records, (2) central Medical Department laboratory, (3) section of laboratories, (4) section of infectious diseases, (5) food and nutrition section, and (6) water supply section.1


152

The offices of the director and those of the chiefs of all the sections were located in the same building except that the commanding officer of the central Medical Department laboratory had his office in an adjoining structure.1

While the ensuing text attempts, for the purpose of clarity, to discuss separately the several sections of the division of laboratories and infectious diseases, there was such close coordination and overlapping of several of these that note should be made of that fact.1 Certain officers on duty at headquarters of this division at Dijon were also on the staff of the central laboratory or on that of the laboratory section.1 The central laboratory while a part of the general laboratory system, was highly individualized, and from an administrative point of view was differentiated from the section of laboratories in this division, but the activities of the latter were often supplemented by those of the former, as in the solution of special problems and in other matters noted below.1

The records pertaining to all sections of the office of the director, except autopsy protocols and statistical reports, were centralized in a single file, controlled by the same decimal filing system which was in use throughout the Army.1 Incoming mail was classified by the adjutant and distributed directly to the officers concerned. Reports and documents of general interest went first to the desk of the director and were then circulated in the office before going to file.1 Correspondence and other matters requiring routine action were acted on by the officer directly concerned and only such matters were brought to the attention of the director as were considered to be of interest to him, or concerning which his decision was required.1

Matters of general policy were taken up by the director with the officer or officers directly concerned and if considered desirable, with all members of the staff who might have special knowledge of the subject or from whom advice would be of value.1

Special memoranda, circulars and forms were prepared ordinarily by the section most directly concerned, but those of special importance were reviewed by several members of the staff. These memoranda and circulars were of two general types: Those covering subjects of general interest to the entire Medical Department, and those covering technical matters pertaining to the laboratory service.1 The former were forwarded to the chief surgeon for incorporation in official circulars issued by his office, while the latter were issued and distributed directly from the office of the director as "office letters," "memoranda," or "forms," those in each class being given serial numbers.1 A general idea of the material forming the subject matter of circulars and memoranda may be gained from the lists given in the appendix.

The commissioned personnel of the division of laboratories was distributed and assigned mainly by the officer at the head of the laboratory section, with suggestions, in some instances, from the director.1 The distribution of the special personnel on duty in the sections of food and nutrition, of water supply, and of infectious diseases were assigned on the recommendation of the officer in charge of those sections, respectively.1

The personnel of this division consisted of officers of the Medical Corps with special training in laboratory procedures, sanitation, and epidemiology, or


153

other special qualifications; officers of the Sanitary Corps who were sanitary engineers, had special knowledge of food and nutritional problems, were competent to make field surveys and laboratory examinations of water supplies, had general or special qualifications in laboratory procedure, were artists, photographers, executives, or possessed other special qualifications; and enlisted men, many of whom had a special technical training.3

Not more than 12 officers of the Regular Medical Corps and of the Sanitary Corps, who served with the division of laboratories, had any service in the Army prior to the war.3 Two of these medical officers and one officer of the Sanitary Corps were on duty in the office of the director, the others being assigned to laboratory administrative positions elsewhere in the American Expeditionary Forces.3 The remaining personnel, consisting of approximately 670 officers, was drawn chiefly from civil laboratories.3 Many of the enlisted personnel were college graduates, undergraduate students, or men with special technical training in laboratory work of various kinds. As with the Medical Department generally, there was always a shortage both of total personnel and of those competently trained.3

The personnel to carry on the activities of the division of laboratories was acquired from various sources, mainly the following:3 (1) Base hospitals and a considerable number of evacuation hospitals, for the prescribed organization of both those types of units included laboratory personnel; (2) stationary laboratory units, of which 5 were sent to France, each consisting of 6 officers and 12 enlisted men; (3) special units sent to France for special, highly technical activities; (4) divisional laboratory units automatically dispatched to France for service with divisions; (5) detachments of casuals sent to France on cable requests from general headquarters. (6) The general medical service of the American Expeditionary Forces whence a considerable number of specially trained officers were drawn and assigned to duty with this division.3

All casual personnel and special units arriving in France for service in this division were automatically ordered to the central medical department laboratory, where their special qualifications were investigated and any necessary special instruction given.1

The individual qualification cards of officers of the Medical Department on file in the headquarters office of the division permitted a broad general classification of qualifications, but for the highly technical activities in which the division of laboratories was engaged it was necessary to have a much fuller knowledge of the special qualifications of each officer.3 A questionnaire, covering in detail the information desired, was therefore filled in by each officer on duty in the division of laboratories and filed in the office of the director.3 A still better conception of the special qualifications of the individuals was gained by direct observation of from 300 to 400 of these officers who served on temporary duty at the central Medical Department laboratory either as casuals or as students, taking courses of instruction.3 These officers were interviewed by the personnel officer on duty in the office of the director of the division, and ratings of those undergoing instruction were submitted to him. From these sources of information and from inspections of the work being done in the different laboratories an effort was made so to classify and dis-


154

tribute the personnel that the necessary activities might be more efficiently performed and elimination of the incompetent effected.3 The laboratory personnel sent to France with the earlier base hospitals was made up, as a rule, of highly trained and competent men. This statement also applies to many of the special units.3 The special laboratory training of a considerable percentage of the officers, however, consisted only of the training ordinarily acquired in medical schools plus a short course of training at the Army Medical School, at the Yale Army Medical School, at the Rockefeller Institute, or at more than one of these institutions.3 Therefore, special courses of instruction in the bacteriology of epidemic diseases and in the bacteriology of war wounds were given at the central Medical Department laboratory, approximately 250 officers taking one or the other of these courses.3 Because of the scarcity of trained administrative personnel it was not practicable to form two detachments, one consisting of casuals under the administrative control of the director's office, and the other of permanent personnel assigned to the central Medical Department laboratory.1 Therefore, both permanent personnel and casuals were carried on the records of the detachment at the central Medical Department laboratory as of a duty status, for rations, quarters, personal equipment and for statistical and other matters pertaining to the interior administration of a detachment.1 A list of the permanent personnel on duty at the central Medical Department laboratory was kept by the adjutant in the director's office. It was understood that all other personnel was to be considered as casual and subject to assignment by the director without previous consultation with the commanding officer, central Medical Department laboratory.1 After investigation of their qualifications and any necessary special instruction, officers of this division were assigned to appropriate stations.1

The division of laboratories was charged with the organization of new laboratory units and the distribution of personnel under its supervision. All requests for laboratory personnel were referred to it, and assignments and changes in station made on recommendation of the director.3

While in May, 1918, less than 140 commissioned officers were engaged in activities under the supervision of this division, by November, 1918, this number had increased to 683.3 Their distribution, by corps, grade, and general duties, is shown in the following table:3
 Personnel on duty in division of laboratories and infectious diseases in November, 1918 

 

Colonels

Lieutenant Colonels

Majors

Captains

First lieutenants

Second lieutenants

Totals

Section of laboratories and infectious diseases:

 

 

 

 

 

 

 

Medical Corps

1

10

20

124

317

---

472

Sanitary Corps

---

---

2

6

64

76

148

Section of food and nutrition: Sanitary Corps

---

---

4

11

15

2

32

Section of water supplies: Sanitary Corps

---

1

---

5

15

10

31

 

1

11

26

146

411

88

683


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PERSONNELa

    Col. Joseph F. Siler, M. C., chief.
 SECTION OF LABORATORIES

   Col. George B. Foster, Jr., M. C., chief.
        Lieut. Col. William J. Elser, M. C.
        Maj. Ward J. McNeal, M. C.
 SECTION OF INFECTIOUS DISEASES

    Col. Richard P. Strong, M. C., chief.
        Col. Hans. Zinsser, M. C., chief.
        Maj. Ward J. McNeal, M. C., chief.
        Maj. Richard M. Taylor, M. C., chief.
 SECTION OF WOUND BACTERIOLOGY

    Lieut. Col. William J. Elser, M. C., chief.
        Maj. Benjamin Jablons, M. C.

SECTION OF WATER SUPPLIES

    Maj. Harry B. Hommon, San. Corps, chief.
        Capt. Machael J. Blew, San. Corps.
        Capt. Alvin R. Harnes, San. Corps.
        Capt. Walter C. Russell, San. Corps.
        Capt. Emery J. Theriault, San. Corps.
        First Lieut. Henri E. St. Pierre, San. Corps.
 SECTION OF FOOD AND NUTRITION

    Maj. Walter H. Eddy, San Corps, chief.
        Maj. Phillip A. Shaffer, San. Corps, chief.
        Maj. David Klein, San. Corps.
        Capt. Fred F. Flanders, San. Corps.
        First Lieut. S. C. Dinsmore, San. Corps.
 MUSEUM AND ART SECTION

    Col. Louis B. Wilson, M. C., chief.
        Maj. Henry W. Cattell, M. C.

LABORATORY OF SURGICAL RESEARCH

    Lieut. Col. Walter. Cannon, M. C., chief.
        Lieut. Col. J. L. Yates, M. C.

aIn this list have been included the names of those who at one time or another were assigned to the division during the period July 28, 1917, to July 15, 1919.
There are two primary groups-the heads of the division or the section and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.


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REFERENCES

(1) Report from Col. J. F. Siler, M. C., director of laboratories and infectious diseases, A. E. F., to the chief surgeon, A. E. F., undated. Subject: Activities of division of laboratories and infectious diseases, from August, 1917, to July, 1919. On file, Historical Division, S. G. O.

(2) Letter from the chief surgeon, A. E. F., to the Surgeon General, U. S. Army, August 12, 1917. Subject: Outline of laboratory organization,
A. E. F. On file, Record Room, S. G. O., 322.15-16 (A. E. F.) (Y).

(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,
A. E. F., to May 1, 1919. On file, Historical Division, S. G. O.

(4) 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, 451.

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