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Preface

Books and Documents

THE MEDICAL DEPARTMENT OF THE UNITED STATES ARMY IN THE WORLD WAR.

PREFACE TO THE SERIES
(from Volume I: The Surgeon General's Office)

It is proposed in the history of the Medical Department of the United States Army in the World War to discuss the subject from both administrative and scientific standpoints. In addition, elaborate statistics of professional interest will be included. Illustrations, maps, and charts, so far as may be necessary to a clear understanding of the text, will be found in its pages. Fifteen volumes are contemplated for the history and some of these volumes will be published in parts. The subjects of the various volumes will be essentially as follows:  Volume I, The Surgeon General's Office; Volume II, Administration, American Expeditionary Forces (Central Administration; Hospitalization); Volume III, Finance and Supply (United States; American Expeditionary Forces); Volume IV, Camps, Posts, and Ports; Volume V, Hospitals (United States); Volume VI, Sanitation (United States; American Expeditionary Forces); Volume VII, Instruction and Training; Volume VIII, Field Operations, American Expeditionary Forces; Volume IX, Communicable and Other Diseases; Volume X, Neuropsychiatry; Volume XI, Surgery (General Surgery; Empyema; Maxillofacial Surgery; Ophthalmology; Otolaryngology; Neurological Surgery; Orthopedic Surgery); Volume XII, Roentgenology; Volume XIII, Physical Reconstruction; Nursing Service; Volume XIV, Gas Poisoning; Volume XV, Statistics (Army Anthropology; Medical and Casualty Statistics).
 
In the interests of completeness, mention is made of certain other historical volumes, covering restricted activities of the Medical Department in the World War. These are: Air Service Medical, prepared by the Division of Military Aeronautics, War Department, and printed at the Government Printing Office, Washington, 1919; Defects Found in Drafted Men, prepared under the direction of the Surgeon General, United States Army, and printed at the Government Printing Office, Washington, 1920; and Psychological Examining in the United States Army, Memoirs of the National Academy of Sciences, Volume XV, printed at the Government Printing Office, Washington, 1921.

Work on the history was begun in the Surgeon General's Office in 1917, in compliance with War Department orders, issued in August of that year, which provided for the organization of an historical board. While all administrative details respecting its progress will be found in the account of the Historical Division, which appears in this volume, an important policy adopted at the start and pursued throughout should be mentioned here. It is essential, of course, in an official history, that every effort be made to insure the absolute correctness of all statements which are made. In order to effect this, in so far as possible, in all cases the subjects to be covered in the history were assigned to authors who had been intimately connected with the activities concerned during the war, and who, therefore, had first-hand knowledge of the facts.


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The general plan for War Department historical publications was announced on April 5, 1920, in a letter from The Adjutant General, addressed to the chiefs of all staff bureaus and to the Chief, Historical Branch, War Plans Division, General Staff, now the Historical Section of the Army War College. The subject of the letter in question was unification of historical publications. Paragraphs, in so far as they are of interest in the present connection, are quoted in full:

In order that historical publications prepared by the several services, departments, and corps may be unified and fit into some general scheme, and to prevent duplication and to assure that the important activities of every service during the World War are made of record, the following plan of historical publication is announced:

GENERAL PLAN, ALL SERVICES, DEPARTMENTS, AND CORPS OF THE WAR DEPARTMENT, FOR THE PREPARATION OF HISTORICAL PUBLICATIONS.

1.   Basic Principles of plan. -- All historical publications will be supervised by the Historical Branch, War Plans Division, General Staff.

Historical publications relating to the technical activities of a service from the point of view of the service itself will be prepared by the service historical officer. The Historical Branch in such cases will be concerned only with the selection of supporting documents and the form in which the necessary references to such documents appear.1

2. Service historical officers. -- Upon receipt of this general plan each chief of service, department, or corps contemplating the publication of historical matter will designate a qualified officer as historical officer, also the necessary clerical assistance. This officer will inform himself of the policy of his service as to historical publications. The names of these service historical officers will be communicated as soon as practicable by the chiefs of services to the Historical Branch, War Plans Division, General Staff Building "B", Washington Barracks.2

3. Conferences of service historical officers. -- After the designation of service historical officers, conferences will be held at such time as may hereafter be designated by the Historical Branch, War Plans Division, General Staff. At these conferences the policies and requirements of each service in the matter of historical publications will be presented and a special plan drawn up giving a detailed plan of publication for each service.

 * * * * *
7. Form of publication.  To insure accuracy, all publications will be based upon existing primary documents when practicable. That this care in the preparation of work has been taken should be evident on the face of publication itself by attaching to each paper prepared a list of documents constituting sources consulted and giving the location and brief description of these documents; and to facilitate further study of the subject, references should appear in the body of the work to the particular documents of the source list relied upon as a basis for every important statement of fact or conclusion.

 By order of the Secretary of War:

(Signed)  H. G. Learnard,
Adjutant General

This history is concerned only with the technical activities of the Medical Department from the point of view of that service itself and is therefore prepared under the direction of the service historical officer. Numerous conferences have been held, however, with the Chief of the Historical Branch, Army War College, who passes upon all manuscripts before they are sent to the Secretary of War for final approval for publication.

No further explanation is thought necessary regarding the military rules under which the history is published save in one respect. The General Staff


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has determined, according to general military practice, that "effort should be made to omit names from the text where this can be done without injury to the sense or to the historical value." The history of the Medical Department forms no exception to this rule.

In 1920 an appropriation to publish the history was obtained from Congress. The item covering this expenditure applied to the Surgeon General's Office and appeared in the sundry civil bill providing for the year ending June 30, 1921. It is as follows:

Medical and Surgical History of the War with Germany: toward the preparation for publication, under direction of the Secretary of War, of the Medical and Surgical History of the War with Germany, including printing and binding at the Government Printing Office, and the necessary engravings and illustrations, $50,000: Provided, That the cost of such history shall not exceed $150,000.

An additional appropriation of $50,000 was made the next year.

The scope of the present volume of the history has been changed to a considerable extent from that originally contemplated, and included in the tentative plan for the history as a whole outlined by Lieutenant Colonel Garrison, M. C., in The Military Surgeon for May 1919. It was intended that this volume be divided into two parts, the first to give the history of each of the administrative divisions of the Surgeon General's Office, the second to give a narrative account of the so- called correlated activities, including all agencies which assisted in carrying out the general purposes of the Medical Department as prescribed by law and regulations or established by custom. Further study indicated that this plan was not sufficiently comprehensive to give a clear idea of central Medical Department administration, which was the real purpose of the volume. Certain additions, therefore, have been made, as may be seen from the text.

During the earlier stages of the preparation of the volume Lieutenant Colonel Garrison, M.C., was in direct charge of the compilation of the administrative histories of the divisions of the Surgeon General's Office, as well as of editing the volume as a whole. Lieutenant Colonel Casey A. Wood, M.C., was charged with the preparation of the correlated activities. These officers did much valuable work on their respective assignments, but the exigencies of the military service resulted in their separation from the activities connected with the history, except as members of the Editorial Board. This separation occurred with Lieutenant Colonel Garrison in December, 1920, and with Lieutenant Colonel Wood in October, 1920. Since these dates all editorial work on the volume has been handled in the Historical Division.

The idea of preparing official medical and surgical histories of wars apparently originated with the Medical and Surgical History of the British Army which served in Turkey and the Crimea during the War against Russia in the years 1854-55-56, published by the British Army medical department in 1858. This history owed its inception to the fact that Andrew Smith, then director general of the British Army medical establishment, was unable to find in records of previous wars any data which might be of value in making plans for the care of the sick and wounded. He determined, therefore, that those who came after him should encounter no similar perplexities. Accordingly, he proposed to the Minister of State for War and to the commander in


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chief of the army that there be prepared a précis, or descriptive index, of all letters relating to the war, as well as an analysis of all professional documents sent from the front by medical officers. This précis was published in two volumes and was followed by the history proper in two volumes. Histories of French and Russian participation in the Crimean War, by J. C. Chenu, published by the French Government, and C. von Hübbenet, published in Berlin, appeared in 1865 and 1871, respectively. Thus the medical record of what, from the viewpoint of lack of medical preparedness, faulty sanitation, and disease incidence, was a most disastrous war, was amply preserved for future generations of medical officers, and undoubtedly had an important effect in hastening improvements in army reorganization after that event.

In acknowledging indebtedness to the British medical and surgical history of the Crimean War, Woodward, one of the principal editors of the Medical and Surgical History of the War of the Rebellion, said: "It had proved of great value in giving direction to our efforts. What was the direction these efforts took, what were the results obtained, why our soldiers die, and how this can be best and most economically prevented in future wars, are questions upon which the experience of the present struggle as recorded in the official reports and documents can throw 'a flood of light.' " Such a publication, therefore, in Woodward's opinion, "becomes one of the most important duties of the Medical Department of the Army; a duty the evasion or neglect of which would be a grave crime against the Army of the United States and against every American citizen who, in future wars, volunteers in the defense of his country." As it proved, the Civil War medical and surgical history fulfilled a much larger purpose than this, for the carefully gathered material which found permanent record in its pages was actually made use of as largely by the civilian as by the military practitioner of medicine, and, consequently, the civilian benefited no less than the soldier patient from what, as Woodward expressed it, was truly "a flood of light."

Very soon after his appointment steps were taken by the Surgeon General, William A. Hammond, to promote the preparation of a medical and surgical history of the Civil War. On May 21, 1862, he made provision, by modification in the returns from medical officers, for obtaining more exact and detailed reports of sick and wounded, announcing on the same day (Circular No. 2, Surgeon General's Office) that an Army Medical Museum would be established, with instructions to medical officers "diligently to collect and to forward to the Office of the Surgeon General all specimens of morbid anatomy, surgical or medical, which may be regarded as valuable, together with projectiles and foreign bodies removed, and such other matters as may prove of interest in the study of military medicine and surgery." On June 9, 1862, he published a circular to all medical officers announcing the intention of his department to prepare a medical and surgical history, Surgs. John H. Brinton and Joseph Janvier Woodward having been ordered to duty in his office for that purpose on June 4. On August 1, 1862, Brinton was made virtual curator of the Military Medical Museum. The order directing him to collect and arrange specimens in the museum terminates with the following significant sentence:  "Should any medical officer of the Army decline or neglect to furnish such preparations for the museum, you will report the name of such officer to this


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office." By July 1, 1863, Brinton had already prepared and published an interim consolidated statement of gunshot wounds, and on September 8, Woodward, then in charge of medical records, published a Report on Sickness and Mortality of the Army during the First Year of the War. Progress thereafter was rapid. The forms for returns of sick and wounded were revised and improved during 1863-64. The orders for return of statistical and clinical data, while not so preemptory as were those for collecting specimens for the museum, were of similar intention, and it is plain that the preparation of material for the history was regarded as a duty and was so announced by the Surgeon General. This should not be held to mean, however, that medical officers generally tried to escape doing their part in the preparation of the history. Quite the contrary was the fact; and the value of the medical history of the Civil War, as is true of every similar history, is due in equal measure to the work of the many medical officers in the field, and to that of the few who gathered their records together and finally published them as a history.

During 1865-66, medical directors of departments and of armies in the field were directed by [Assistant] Surg. Gen. Charles H. Crane to forward to his office all copies of divisional or field hospital reports, registers and records of sick and wounded, and individual case reports of gunshot wounds which might be available for historical purposes. Thus all the necessary material was ultimately assembled in the Surgeon General's Office. On September 29, 1864, Brinton was relieved by Asst. Surg. George A. Otis. On November 1, 1865, Circular No. 6, Surgeon General's Office, was issued, being "Reports on the Extent and Nature of the Materials Available for the Preparation of a Medical and Surgical History of the Rebellion," by Woodward. This was a quarto volume of 166 pages, issued and distributed in an edition of 7,500 copies. With this start, and through the influence of Secretary of War Stanton, who took the deepest interest in the work, a congressional appropriation was finally granted on June 6, 1868, for the preparation for publication of 5,000 copies of the first part of the history, and on March 3, a joint resolution of Congress authorized that these 5,000 copies be printed at the Government Printing Office. Subsequent appropriations were made for the remaining volumes. The history appeared during 1870-1888, in six massive quarto volumes, three medical and three surgical, of "family Bible" size and shape. Woodward died in 1884, and the third medical volume was completed by Col. Charles Smart, M.C., while the third surgical volume was completed by Otis and Col. David L. Huntington, M.C. The two series are preceded by masterly introductions by Woodward and Otis, and are arranged as follows: Medical Series:  Volume I (1870) gives statistics of sickness and mortality, followed by historical reports of medical officers on separate battles and military operations, arranged in chronological order; Volume II (1876) treats of the diarrheas and dysenteries ("Alvine fluxes"); Volume III (1888) gives an analysis of the medical statistics of the war, followed by chapters on the continued and eruptive fevers, respiratory, cardiac and other conditions affecting the soldiers during the war, ending with an important chapter on the general hospitals, including plans. Surgical Series:   Volume I (1870) begins with a chronological summary of Union and Confederate losses in killed, wounded, and missing, by battles and engagements, followed by sections on injuries of the head and neck; Volume II (1876) deals with injuries


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of the abdomen, pelvis, back, and upper extremities; Volume III (1883) deals with injuries of the lower extremities, and injuries and surgical diseases of all other parts of the body, concluding with important chapters on anesthetics, duties of the medical staff, surgical materiel, and modes of transportation of the wounded. Otis concludes his introduction to Volume I with a list of United States medical officers (Regular and Volunteer) killed in battle, died from wounds, and wounded in battle.

This work, with its wonderful array of bibliographic footnotes, its pioneer accounts of the effects of gunshot injuries of nerves (Weir Mitchell, Morehouse, Keen), irritable heart of soldiers (Da Costa), the ipecac treatment of dysentery (Woodhull), ambulance service (Letterman), trench nephritis, and venereal prevention, was at once received with enthusiasm by the medical profession of the entire world. In some respects it was the outstanding production of American medicine during the period, and was hailed as such by no less an authority than Virchow.3   The narratives by medical officers  of battles and campaigns were used by subsequent military historians, and the chapter on hospital construction afforded a valuable repository of information during the World War.

A unique feature of the Medical and Surgical History of the War of the Rebellion is that not only was the experience of the Army to which it pertained made of permanent record there, but, in the interest of completeness, a good deal of valuable scientific data from other sources was incorporated. Confederate methods for making medical records were very similar to those on the Federal side, and many of these records were finally secured. After the war former medical officers of the Confederate service gave considerable assistance by contributing histories of cases, pathological specimens, statistical data, and facts concerning the termination of major injuries and operations. Data were obtained from the pension examiners, from the surgeon generals, and adjutant generals of States; in fact, no possible source of information was overlooked.

Neither the British South African War nor our own Spanish-American War was chronicled in an official history, though a great deal of interest and value regarding them has appeared in print. Boards of inquiry in each case were appointed after the war to investigate the conduct of the medical departments of the respective countries, each having failed to measure up to the standard demanded by the public. The historical student may find a great mass of information in the proceedings of the boards in question. Fortunate, though, is the medical department which does not have to write its history in this way; and it is noteworthy that, notwithstanding the magnitude of the task and our lack of preparation for it, there has been no suggestion of such a board for the World War.


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Before concluding this preface, it is necessary to say a few words on how the march of events has irresistibly affected this history as compared with former histories of the same kind.

It should be noted that this is the first comprehensive official war history of medicine which has been published for many years. The only exceptions are the Japanese histories of the part their medical department played in the Chino-Japanese and in the Russo-Japanese Wars. That it did play a notable part is well known, but unfortunately the official histories in question have never been translated in their entirety so as to make them available to other than Japanese readers. Doubtless they have profited, but so far as almost all the readers of this history are concerned the historical standards of comparison date back so many years that in the meantime we have actually passed from one epoch to another, both from the military and from the medical standpoint.

War has been changed fundamentally by new methods of warfare, and these military changes have affected the story of the Medical Department. At the time of our Civil War and much later the organization of the Medical Department was a fairly simple one. Today it must be far more complicated in order to fit into the more intricate military machine.

Increased complexity in army organization is not solely responsible for this change. In the earlier days, as the possibilities of the effect on military efficiency of an efficient medical department were not understood, so no very serious attempt was made in any army to develop it from this  standpoint: today quite the contrary is the case. That is to say, in Civil War days and later, the subject of medical department organization and administration could be touched on lightly for there was comparatively little to tell. Nowadays volumes are required to cover all the complex details, rendered the more complex on account of the distance from our own shores at which the war was fought.

The space allotted in this history to organization and administration represents only the relative importance of these subjects, as shown in the World War records. It will have been well expended if it serves to show in detail to the medical administrator of the future what was done in these directions. With the increased and increasing complexity of modern warfare, it is certain that in the future medical department organization and administration will loom very large and that the officers charged with carrying on the medical service of a great army in campaign will need all possible aid in the way of historical records.

If, as has been the case, great changes have taken place on the military side since the earlier medical war histories were published, what has happened in the meantime on the medical side? Here an actual revolution has been effected. The wars represented by the earlier histories were carried on before modern medicine was born. For example, while the Medical and Surgical History of the War of the Rebellion is an inexhaustible mine of information regarding diseases and injuries, where often can be found facts available in the mass nowhere else, so far as its present value is concerned, it almost stops there, for medicine and surgery as practiced in that day are now discredited arts on account of the many scientific discoveries made in the interval. Then there


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was no bacteriology, there were no laboratories, there was no sanitation according to modern standards, nor was there, in fact, much of anything relating to the present practice of medicine, surgery, and sanitation. Nor did doctors specialize to any extent.

The work of the Civil War medical historians was a masterly achievement which resulted in the publication of a classic. On the other hand, the scope of their scientific activities was necessarily limited by the medical knowledge of their time. Medical knowledge has increased by leaps and bounds since then, and so a history of today must treat of many things not even within the realm of scientific dreams in Civil War days.

It would be unbecoming to conclude this preface without a general acknowledgment of the assistance given by literally hundreds of World War medical department officers. Each has been thanked individually so far as might be, but in the thousands of communications on the subject it is possible that some may have gone astray. It is desired nevertheless that every contributor realize from what is said here that his assistance is appreciated, that through it and through that of other contributors who played their important part in the war, and through this only, has it been possible to prepare this history. It is true that many contributors will not see in its pages exactly what they have prepared, very often, doubtless, in a busy professional life, at the sacrifice of a great deal of valuable tine. This does not mean that their material has not been used in the history or that their contributions have been lost and forgotten. The limits set upon the size of the printed history were as liberal as it was possible to make them. Material was received in such amount that ten times as many volumes would have been required to publish it all. It was not possible, therefore, to print in extenso a great deal that well deserved the light. All this material was used first to get together the history. Now, it has been carefully preserved and will be disposed of in such a manner as to be available in the future to historical and other students.....

FOOTNOTES

1.   The history of the Medical Department in the World War relates to its technical activities from the point of view of that service itself, and therefore falls in this class.

2.  The editor in chief of the Medical History was at once appointed by the Surgeon General as the historical officer of the Medical Service.

3.  Virchow, in an address on infectious diseases in the army (1879): That the French learned little or nothing in the Crimea and the North Americans so much in their Civil War, that from that date onward begins a new era of military medicine--this depends not on the magnitude of the necessity which the Americans had to undergo, which in truth was not greater than the French underwent in the Crimea. It was far mere the critical, genuinely scientific spirit, the open mind, the sound and practical intelligence, which in America penetrated step by step every department of army administration, and which under the wonderful cooperation of a whole nation reached the highest development that, relative to humane achievements, had hitherto been attained in a great war. Whoever takes up and looks into the comprehensive reports of the military medical staff will be again and again astonished at the richness of the experiences chronicled therein. The utmost accuracy of detail, painstaking statistics embracing the minutest particulars, an erudite exposition comprehending every aspect of the practice of medicine, are here united in order to preserve and transmit to contemporaries and to posterity, in the most thorough way possible, the wisdom purchased at so tremendous a price.