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Chapter VI

Contents

CHAPTER VI

PORT OF EMBARKATION, HOBOKEN, N. J.a

Medical activities of the port of embarkation, Hoboken, were mainly confined to the area comprised in a circle approximately 50 miles in diameter, centering on Manhattan Island. The embarkation of troops at the ports of Baltimore, Philadelphia, New York City, Boston, and Portland, Me., was supervised by medical officers sent from Hoboken as occasion arose. Permanent medical detachments stationed at Quebec, Montreal, and Halifax, but subsidiary to Hoboken, performed similar duties at those ports. Within the main area were embarkation camps, camp, base, general, and debarkation hospitals, 13 in all; medical supply depots; concentration centers for nurses; ambulance services; inspection services for camps, hospitals, ships, and men; office of the surgeon of the port, etc.

This vast machinery was of gradual growth. The first medical officer in charge of the work was detailed temporarily from the New York Medical Supply Depot, with one commissioned assistant, and his duties were limited to supplying medical equipment and medical personnel to the few transports available. The office of surgeon of the port was created in July, 1917, and the officer assigned to that duty remained as port surgeon until the main period of activity of the port had passed and his command had grown to 1,000 officers and 6,000 enlisted men.

The main purpose of this port, from the medical point of view, was the embarkation, and later, debarkation, of troops, and this implied activities at three points-in the embarkation camp (debarkation camp during the Armistice), in the harbor, and in hospitals.

No embarkation camp was available during the summer and early fall of 1917, arriving troops being embarked more or less directly from the trains. The necessity for such a camp was realized and Camp Merritt was under construction, and was first used in October, 1917. Camp Mills also was designated as an embarkation camp in April, 1918, and a portion of Camp Upton was used for a similar purpose.  Such camps became absolute necessities as the flow of troops through the port increased.  Their prime function originally was to provide a place where troops could be retained until transports were

available, and to furnish reliable information as to the number of troops for which transportation was necessary. While not originally intended as such, their function in completing the equipment of troops and in their preembarkation medical inspection soon became of vital importance.

Medical activities in the harbor consisted of two main parts the preparation of ships by inspection and by supplying medical personnel and equipment, and inspections of men at the gangplank in order to prevent the embarkation of those physically unfit. The latter activity was at first merely the exclusion

aThe statements of fact appearing herein are based on the History of the Office of the Surgeon, Port of Embarkation, Hoboken, N. J., prepared by the staff of that office. The history is on file in the Historical Division, Surgeon General's Office, Washington, D. C.-Ed.


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of those whose unfitness was more or less evident. Reports from overseas led to examinations for vermin, to the exclusion of those with acute venereal disease, and finally to contacts of acute infectious diseases. These advances in the scope of the examinations necessitated the completion of the routine examinations at the embarkation camp, the dock inspections still being made in order to retain those taken sick at the last minutes.

Hospitals were necessary to care for the men who became ill or who were retained before embarkation. Later, when the tide was reversed and the port became a place of debarkation, hospitalization became the most important medical activity. Evacuation was the key to successful hospitalization during the debarkation period. Had evacuation faltered even momentarily, the limited bed capacity in the port area would have been overwhelmed. Disinfestation of individuals and of their clothing and equipment largely replaced the physical inspections of the embarkation period in estimating work done.

PERSONNEL DIVISION

PERSONNEL AT THE PORT

The United States Army Transport Service was under the control of the Quartermaster Department at the outbreak of the World War, and the officer in immediate charge of the transports was the depot or the Atlantic quartermaster, New York City, who was the general superintendent. As stated above, the medical superintendent was an officer on duty in the medical supply depot in that city, and this officer made the first assignments of medical personnel to troop transports bound from New York for Europe.

Until the office of the surgeon of the port was established, the only duties of the medical superintendent were in connection with the Army Transport Service. The duties relating to personnel were then divided into two sections, one concerning permanent personnel of the office and the other concerning personnel more or less casually in the port. A commissioned officer in charge and a noncommissioned officer for each section constituted the entire personnel. Additional sections for nurses and civilian employees and for mail had been added by June, 1918, when the duties of the various sections were as follows:

Permanent personnel.-Assignment to duty and provision of a sufficient number of officers to meet the requirements of the office. Provision and detail of enlisted men for duty in the office, rendition of detachment reports, and maintenance of discipline.

Casual personnel.-Maintenance of correct lists of commissioned and enlisted personnel on transports; rendition of reports and returns of medical officers within the port area; verification and forwarding of reports and returns of enlisted personnel under the control of the office, and the registration of Medical, Dental, Veterinary, and Sanitary Corps officers passing through the port.

Nurses and civilian employees.-Supervision of mobilization stations for nurses, and the vaccination, equipment and other preparation of nurses for overseas service; preparation of reports; care of returned money, papers, and correspondence relative to nurses and civilian employees.


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Mail.-Receipt and distribution of personal mail; maintenance of a correct list of forwarding addresses of officers and men who had previously been on duty in the port.

The history of the personnel division is one of expansion and contraction, as the needs of the service required; of endless, unremitting effort during the period of expansion to obtain a sufficient personnel to properly carry on the work of the Medical Department at the port, and of equally endless and unremitting effort during the period of contraction to retain a sufficient personnel in the service until the work was finished. The period of expansion continued from the organization of the port until the month of January, 1919, and the period of contraction from the latter date to the close of the war period.

For six months before the beginning of the armistice, endeavor was made to provide a personnel sufficient for the needs of the embarkation hospitals and other medical work at the port and, in addition, a surplus personnel who could be assigned to the embarkation hospitals for training, so that, on the opening of the debarkation hospitals then being prepared and equipped, there could be transferred thereto at least a nucleus of officers and men trained for the service of a military hospital. A moderate degree of success was attained so far as officers were concerned, but it was not possible to secure a sufficient number of enlisted men and, in general, the debarkation hospitals were opened with an untrained and inadequate enlisted personnel. This enlisted personnel was received, in the main, from training camps, especially Camp Greenleaf, Ga.

The following communication from the port surgeon, dated September 12, 1918, sums up the personnel situation on that date and is typical of many other communications along the same lines:

1. The port of embarkation, as far as the Medical Department pertains, is roughly divided into embarkation and debarkation service. Its organization has been built up in the handling of embarkation work, and for that purpose it is fairly satisfactory.

2. On September 4, 1918, a communication was addressed to the commanding general stating that the embarkation hospitals were filled to overflowing, that there were then between 200 and 300 patients with venereal diseases at Camp Merritt for whom there was no available hospital space, and that men with venereal disease were being detained from embarking troops at the rate of two to three hundred daily.

3. The medical units for embarkation work all have a personnel sufficient to give a fairly satisfactory service, but not a service so exacting as the War Department demands. For the men now detained at Camp Merritt who are not in hospital, and for others who may be added to them, there is no available enlisted medical personnel.

4. For the debarkation service there are now 2 hospitals having an aggregate accommodation for 3,000 patients. These hospitals have an adequate personnel. Patients upon arrival in these hospitals from abroad must be immediately transferred to reconstruction hospitals in the interior in order to maintain a sufficient number of vacant hospital beds for the reception of incoming patients. In making the transfer from transport to debarkation hospital, an enlisted medical personnel is necessary; in making the transfer from debarkation hospital to a reconstruction base hospital, of the interior, an enlisted medical personnel is necessary for the care and the feeding of patients en route. For these transfers there is no available enlisted medical personnel.

5. Recent instructions from the War Department direct that a permanent medical personnel be assigned to duty on each troop ship for the care of the sick and wounded returning from abroad. This personnel is to consist of one medical officer, one dental surgeon, and a sufficient number of enlisted men. For this service there is no enlisted medical personnel available.


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The number of troop ships leaving ports under the control of these headquarters is approximately 200, and when this personnel is assigned not less than 1,000 men will be required for this work.

6. Recently there have been several places leased for use by the Medical Department for hospital purposes which, when necessary alterations are completed, will accommodate in the aggregate 7,000 patients. Two of these buildings have already been turned over to the care of the surgeon, and for them there is no medical personnel available. When put into operation they will require not less than 1,500 men.

7. It appears that it is now contemplated that men for service in this department are to be assigned from among those of whom many are malingerers, some cripples, all decrepit, more or less, in body or soul, and none trained. The character of the work they are to be called upon to perform is such as requires, for the most part, highly trained men, schooled in the care and management of the sick, and for that reason the enlisted personnel required now and for the near future should be sent here with the least possible delay.

Efforts to obtain an adequate personnel for the debarkation hospitals continued during the first part of the armistice. The return movement of sick and wounded from Europe was initiated on a large scale shortly after the signing of the armistice and continued until the summer of 1919. The demobilization of officers and men began soon after the beginning of the armistice. The period following this, about six months in duration, was one of great activity for the Medical Department, and, needless to say, there was no thought of a reduction in the medical force during that period, since there had never been

a time when medical personnel was in greater need. Nevertheless, many officers and men were discharged and others obtained to replace them. It was during this period that pressure from all sides, from among the highest to the lowest in the land, was brought to bear to effect the discharge of individual officers and men.

The following memorandum, dated February 9, 1919, from the officer in charge of the personnel division of the port surgeon's office to the port surgeon and the latter's indorsement thereon conveys a very fair idea of the personnel situation on that date.

I wish to call your attention to the fact that the service of the hospitals, under the control of this office, is likely to become seriously embarrassed in the immediate future as a result of the policy of discharging trained enlisted men under the provisions of Circular No. 77, War Department, 1918, and the later revisions and amendments thereto, each of which seems progressively more detrimental to the service here.

Never before have the services of trained men been so greatly needed as at present. We must maintain the service at the highest standard or meet the severest criticism, and we are not permitted to retain the services of the men on whom we depend to maintain a high standard. Trained men are being discharged everywhere, untrained men are taking their places only to be discharged in their turn before they have attained even a moderate degree of efficiency.

If all requisitions for enlisted personnel now on file were immediately filled, the reserve at Camp Merritt would be entirely exhausted and replacement wholly out of the question.

In a very short time it will be necessary to recommend the disapproval of every application for the discharge of a soldier where replacement is requested on the ground that replacement can not be made.

In my judgment the matter should be immediately brought to the attention of the higher authorities in order that ports of debarkation (this port, at any rate) may be exempted from the provisions of the circulars referred to above, so that the discharge of men of the Medical Department may be left to the discretion of the authorities at the port, who, I think, may be depended upon to act with fairness and justice to all concerned.


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The period of high tension can last but a few months longer, and a prolongation of their services by a few months will jeopardize the future of but a very limited number of men now here, even though a very large percentage are able to produce affidavits in great number to the contrary.

The alternative seems to be repeated requisitions for replacements from outside sources, a constant stream of new men untrained in, and unfamiliar with, the work of the large debarkation hospitals, an enormous mass of paper work resulting from the individual application of these men for discharge, and, worst of all, the entrusting of a large part of the care of returning sick and wounded to this stream of untrained transients. The result of this policy will be to favor the well at the expense of the sick, and I am sure this result was not intended by the War Department.

The least that should be expected of soldiers who have served, however unwillingly, on this side during the war, is to remain in the service long enough to properly care for their comrades who went abroad, and it seems to me that their wives, fathers, mothers, sisters, Congressmen, and employers should be so informed.

If it were practicable to convey this information from some authoritative source through the medium of the public press, it is probable that the situation would be accepted in the proper spirit by the fair-minded and loyal. The others are not worthy of consideration

*  *  *  *  *  *  *

[Indorsement ] 

1. Attention is invited to memorandum herewith, for which careful consideration with appropriate action is recommended.

2. The work of the Medical Department at the port is now as heavy as it has been at any time since its establishment, and the prospects for the next several months promise a continuance of this condition.

3. These prospects are somewhat as follows: Published statements from the War Department indicate that the troops from overseas will be returned by September 1, 1919, and that they will be returning at the rate of about 300,000 a month; they also indicate that there are now sick in hospital in Europe approximately 100,000 men, which will make an average of 15,000 sick returning per month.

4. The experience of the past two months would indicate that the base hospitals at Camp Mills and Camp Merritt will be kept full to overflowing by the admission of sick from the troops arriving in those camps when the return is speeded up to the figures above mentioned, leaving the hospitals at the port to take care of the sick as they return, and their dispatch to hospitals in the interior, and to take care of the sick incident to the troops on duty at the port. The work of the Medical Department in the embarkation camps will be extensive in proportion to the troops arriving, in looking after the general sanitation of the camps, the sterilization of the troops, and providing medical attendants, not otherwise provided for troops shipped to demobilization camps.

5. There are now approximately 17,000 beds in hospitals under the jurisdiction of the port. The work of clearing these hospitals by transfer of the sick to interior hospitals must be sufficiently speedy to maintain always a sufficient number of vacant beds for the reception of the sick as they arrive This transfer involves a large personnel for the attendance of the sick on the trains, which are in reality travelling hospitals, until they reach the designated hospitals, and this number will amount to, perhaps, not less than 15,000 men monthly being moved on the train.

6. For this and all other work pertaining to the port, there are now present approximately 6,500 enlisted men of the Medical Department. Applications for discharge are being received at the rate of about 1,000 per month. When requisitions now in the office have been filled the reserve of 300 enlisted men at Camp Merritt will have disappeared. 

The officers and enlisted men who finally arrived for the relief of this situation were untrained in the work. Many of the enlisted men were in the limited service class, malingerers, unhealthy in body or mind, or lacking in desire as well as in training.


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PERSONNEL ON TRANSPORTS

The difficulties that the medical personnel assigned to transports encountered increased as time progressed and as various factors, which will be considered in detail later, entered into consideration, so that at no time in the history of the organization could it be said that matters were satisfactory. The history of this service was similar to that of others in the opening and closing of all ports of embarkation and debarkation, both at home and abroad. It can best be considered in three periods, each of which had problems of its own.

Until April, 1918, the transports used were all United States Army chartered transports and were entirely under the control of Army authorities, while in port and at sea, except in matters of navigation and convoy.

Commissioned and enlisted personnel for transport duty were provided by the Eastern Department early in June, 1917, reporting at Hoboken, where they were assigned to their respective vessels by the acting medical superintendent of the port. The personnel of each transport consisted of a transport surgeon and 1 sergeant and 4 privates of the Medical Department. The privates were raw recruits, as a rule, with little knowledge of the Army and less of medicine. The first convoy of troops carried its quota of the original assignment. Similar personnel was assigned as fast as other transports were added to the service, so that by the end of this period the original number of 5 officers had grown to 50.

With the establishment of the port of embarkation, the assignment of personnel was placed upon a more rational basis, for the type of vessel was thereafter taken into consideration. One surgeon and an enlisted assistant were deemed sufficient for vessels sailing under the direction of the United States Army Transport Service to which an armed guard of the United States Navy had been assigned and where the total of crew, guard, and troops was about 100. Additional enlisted personnel were assigned in sufficient numbers properly to care for any emergency that might arise on vessels which carried large numbers of troops and which were known as troop transports in contradistinction to cargo transports.

The permanent enlisted personnel was divided as follows: One man was assigned to take care of the dispensary, one to the messing of patients, two as ward masters, the others acting as assistants. The sergeant in charge was held responsible for the proper execution of all orders and the preparation of all records, under the supervision of the transport surgeon.

All medical personnel with troops, including commissioned and enlisted personnel, casual medical officers, and members of the Army Nurse Corps, were available for assignment to duty. Medical attention, other than that requiring hospital care, was given to the troops by the members of their own medical organizations, but under the supervision of the transport surgeon.

There was some difficulty at first regarding the status of the enlisted men of the Medical Department in relation to guard duty while in the war zone, but later this was satisfactorily arranged by a port order which stated that they were to be used only in emergencies. The minor difficulties that arose from time to time during this period were due more to an untrained personnel, with but little understanding of the correct interpretation of transport regulations than to any defect in the regulations. Officers and men whose services were


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unsatisfactory were weeded out and replaced. It was due, in all probability, to this preliminary course in transport work on Army transports that there was less friction later when large numbers of troops were carried on commercial liners under adverse circumstances.

This period was the most satisfactory of all, due to the fact that everything was under direct control of the Army and the transport surgeon was in charge of all medical affairs aboard the vessel. It resulted in a cooperation that could not have been attained otherwise, both while in the various ports of embarkation and debarkation and, what was more important, while at sea.

During the period which began about the middle of April, 1918, and continued to the signing of the armistice, troops were transported by three classes of vessels, viz, United States Army transports, United States Navy transports, and commercial vessels of the allied countries. The United States Army transports, however, were not used as such for long. The Navy commenced taking them over about the middle of April, particularly those which were most suitable for carrying troops. Since no Army personnel were assigned to Navy transports, not only were all Army personnel removed but equipment was removed also, so that toward the end of this period not more than three or four of the original vessels remained under Army control. Two of these were vessels that the Army owned prior to 1917 and the others were cargo vessels. Their administration was the same as in the first period. As regards vessels of the allied countries used as transports, the countries concerned were England, France, and Italy, each of which allotted all available shipping for this work. These vessels were divided in turn into three classes-those regularly assigned to American convoy, those sailing under the jurisdiction of the ministry of shipping or similar organizations of each country, and those in the status of war vessels of the respective countries.

ON VESSELS ASSIGNED TO AMERICAN CONVOY

This group consisted of about 12 vessels, mostly French and Italian. There was assigned to them in the majority of cases a medical personnel consisting of a transport surgeon and an enlisted assistant. On vessels carrying a civilian ship's doctor, the transport surgeon was in charge on only that portion of the vessel that was occupied by troops. On vessels without a ship's doctor, the transport surgeon took care of the crew as well, and did the work ordinarily assigned to at ship's surgeon. It was on this latter group of vessels that conditions nearly approached the state of affairs on Army transports, for the transport surgeon was in charge of all medical work on board. These vessels had a regular run, always going from the same port to one or two ports in France, so that the personnel was permanent, and excellent results were obtained. The ship's officials usually gave the transport surgeon all the backing that he needed in carrying out regulations, in so far as it could be done, while in port and at sea. In addition to this, a spirit of cooperation was soon established.


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 ON VESSELS SAILING UNDER THE JURISDICTION OF THE MINISTRY OF SHIPPING OF THE VARIOUS COUNTRIES

Practically all of the vessels of this type were under the jurisdiction of the British. No definite arrangement could be made concerning the personnel, in that many had no definite home port in the United States, and the submarine activity made it necessary to change their destinations abroad quite frequently. These vessels were removed from the service from time to time, which necessitated the removal of United States Army personnel.

ON VESSELS IN THE STATUS OF WAR VESSELS OF THE RESPECTIVE COUNTRIES

There were relatively few of these during this period, but the three vessels, H. M. S. Olympic, Mauretania and Aquitania, each had a transport surgeon assigned to it. The crews of these vessels were of the same status as the crew of any warship, so that regulations had to be carried out with much more tact than aboard the ordinary transport. The ship's doctor on such vessels was the supreme medical authority by right of his position, and nothing could be done without his sanction.

ON CONVERTED COMMERCIAL VESSELS

Some of these converted commercial vessels had regular runs between New York and France or England; some between North American ports other than New York, but under the jurisdiction of Hoboken, and England; and others had no regular runs but were temporarily diverted from their home ports in Africa, Australia, and India to meet the demand for troop transports during this period. The medical service on this class of vessel will be described in detail, as by far the majority of transport surgeons were assigned to this class.

Difficulties were found in that regulations applicable to Army transports could not be made applicable to these commercial vessels. The relation of the United States Army medical officer to the master of the vessel and to the crew differed with the various types of captains and with the regulations and customs of the country under whose flag the vessel was sailing. There was an enormous increase at this time in the number of troops that were transported overseas, and, even though medical officers were relieved from duty on Army transports which were turned over to the Navy, the number of trained men

was not great enough to meet the demand, so that it was necessary to appoint medical officers who, in many cases, did not know the first principles of ship sanitation or of the problems incident to the transportation of troops.

This class of vessel was not uniform, as regards personnel or equipment. Taking the personnel into consideration first, they could be roughly divided into two classes, those without a ship's doctor and those with one.

It was found, early in May, 1918, that many of the British commercial vessels were without a surgeon. As stated above, port regulations required that, if more than 100 persons were carried, either as crew or passengers, a medical officer must be assigned. Arrangements were then made through the British Ministry of Shipping whereby any requests on the part of the shipping lines for officers would be met by the assignment of a medical officer of the


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United States Army. This arrangement furnished a good solution of the problem, but unfortunately, through a misunderstanding as to the exact status of this officer and the issue of conflicting orders, proper authority was lacking for the correct administration of his work. His status on board, prior to July 15, 1918, was as follows: So far as the troops were concerned, he was guided by United States Army transport regulations, being responsible for the troop hospital and the sanitation of that portion of the vessel occupied by troops and for all matters affecting their medical welfare. In addition to this, he had all the duties of a ship's doctor, viz, caring for the crew and passengers, rendering the port medical returns, and supervising the sanitation and inspection of the food throughout the entire vessel. He was responsible only to the master of the vessel. He occupied the quarters assigned to the ship's doctor and he was subsisted free of charge. Being a part of the ship's crew, he had a complete understanding of all the petty differences among them. One who has never been in charge of this work on commercial liners can not appreciate the necessity of paying attention to these various details, but this is most important

for the efficiency of the medical service.

After July 15 he had no active part in the administration of medical affairs pertaining to the troops. His status now was that of ship's doctor and not transport surgeon. The transport surgeon was thus without authority of any description so far as the troops were concerned, the senior medical officer with troops aboard becoming the responsible officer. As a result, transport surgeons were told that they had nothing to do with troops, and the opinion was current among officers and troops en route that the transport surgeon was merely a fixture of the vessel, not intended to have any jurisdiction over the troops. But

the transport surgeon was the only man with whom the debarkation officials had to deal when the ship arrived in England or France, and they held him responsible for the sanitary condition of the vessel and for the care of all the records and the sick, although he may have had no real authority throughout the journey in so far as the troops were concerned. The commanding officer of troops and the senior medical officer would quit the vessel immediately after the debarking troops, leaving the transport surgeon to straighten out irregularities for which he was not to blame. Each trip brought a new set of regulations, due to the rapidly changing personnel at all ports of embarkation, knowledge of which could not be ascertained until the vessel docked or anchored. This necessitated an entirely new set of reports each trip. This difficulty might have been eliminated by having a standard form for use in the American Expeditionary Forces in both France and England, and such a form was adopted toward the end of this period.

About August 1, it was decided to assign to foreign vessels carrying troops a transport surgeon whose status would be that of passenger, all his expenses being paid by our Government, but whose relation to the troops would be that of transport surgeon in so far as it was possible to maintain that relationship on commercial liners. This promised to be the ideal arrangement, for it provided for the permanent assignment of an officer to the ship who not only could study the problems which were peculiar to each vessel but also make himself well informed as to changes in regulations on each side of the water.


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The difficulties, in so far as the vessels themselves were concerned, were that the type of ship and the facilities for caring for the troops were not uniform-in some, bunks were used; in others, hammocks; some had up-to-date sanitary appliances, and others appliances that were always out of order one day from port; methods for preparing food and messing the troops depended largely on the customs of the country to which the vessel belonged. The greatest difficulty in this period was due to an untrained personnel, who entered upon a field of work without precedent in the matter of regulations and of general

orders governing the same.

During the period, November 11, 1918, to September 1, 1919, the transportation facilities were, in the main, the same as those used in the period, April 15 to November 11, 1918, except that the British vessels were gradually withdrawn from the service and replaced by French, Dutch, Italian, and Spanish vessels. The main difficulty of this period arose from the fact that, because of the return movement of troops, the ports of debarkation in Europe became ports of embarkation, thus necessitating a reorganization of their personnel; furthermore, the authorities there did not always avail themselves of the experience acquired by the transport surgeons. The latter frequently were overruled, and in many cases replaced, by order of a base surgeon or of the senior medical officer with troops, although the latter usually lacked adequate knowledge of the duties of a transport surgeon. There was confusion as a result, and many transports arrived in New York in a poor sanitary condition and with incomplete records.

A medical detachment, consisting of a transport surgeon, a sergeant, and four privates, was assigned to each of the foreign vessels carrying troops. They bore the same relation to troops as on the Army transports, but had the status of passengers and were provided with tickets to and from the ports of Great Britain and France. The surgeon was given commutation of quarters and the enlisted men were quartered and rationed in a near-by camp during such times as they were in foreign ports.

Two policies were in operation during this period: (1) The personnel was permanently assigned to a vessel as long as it continued to carry American troops. Vessels were withdrawn from the service at their home ports, and, according to the British Ministry of Shipping, it was only on the day prior to sailing from a British port that it could be decided whether or not a given vessel would carry American troops from France. This resulted in many of the transport personnel being returned as casuals when, had they been held for a little longer period, their services could have been utilized on vessels without a transport surgeon. There was less of this difficulty on ships other than British. (2) The personnel assigned to the transports was later removed upon arrival in European ports and sent to some such central port as Brest

for assignment to any vessel carrying troops on which their services were needed. They were then returned from the United States to this central port by the first available transportation. They assisted in debarkation and embarkation during the interim in port, thus becoming thoroughly acquainted with the rules and regulations of each port.


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On commercial vessels carrying troops, it proved to be the best policy to make the civilian ship's doctor a contract surgeon, a new contract being made each voyage. He was then always available in an advisory capacity, and the Government secured the use of instruments and appliances, so that it was not necessary to supply nonexpendable articles of this nature. The Army transport surgeon had his own way as long as the ship's surgeon was being paid by the Army, for rarely did the latter interfere, but there was little cooperation on his part when not so paid. In general, the personnel was satisfactory during this period.

HOSPITAL PROCUREMENT DIVISION

This division was organized in May, 1918, for the purpose of procuring suitable buildings in this vicinity for hospital purposes. On May 23, 1918, a representative body of real-estate men, all members of the Real Estate Board of New York, met and organized for the purpose of lending their aid, and as a result there was formed an advisory committee for this division. Altogether, more than 12,000,000 square feet of floor space were surveyed, of which some 7,000,000 were recommended or secured and the balance classified as not available or as unsuitable. The work of the division, as far as concerned the provision of suitable bed space at the port, was completed on April 23, 1919, when it was consolidated with the finance division (q. v., p. 303). Statistical records were turned over to the finance division and are included in its statistical report.

DIVISION OF DOMICILIARY HOSPITALS

Many offers of homes for the use of convalescent soldiers having been made to the Surgeon General of the Army and the surgeon of the port of embarkation, it was decided to make use of these offers as far as possible. To that end, a division of the port surgeon's office was established for the purpose of organizing and supervising a system whereby these places could be used. Six homes, with a capacity for 186 patients, were in use at the beginning of the fiscal year 1918; 14 other homes, with a capacity for 1,498 patients, had been offered but not yet accepted for use. The majority of these homes, or domiciliary hospitals, were closed in the fall of 1918, for various reasons, principally because there was no further use for them, but also because they were isolated and scattered over too wide a territory to be administered efficiently. Further need of a domiciliary hospital division not being apparent, it was discontinued.

SANITARY INSPECTION DIVISION

This division was organized for the purpose of making the various sanitary inspections at the port of embarkation which were required by existing regulations. During the first few months following the organization of the port, the work of this department was carried out by officers of the transport division. It was soon evident, however, owing to the rapid growth and development of the port and the increasing amount of work, that a separate division under the surgeon's office should be organized for the purpose of making the required inspections of transports, trains, and camps. This division was organized January 29, 1918, and had a maximum personnel of about 15 officers and 35 enlisted men.


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The duties of the division were as follows: Inspection of hospitals and camps; inspection of transportation facilities; supervision of delousing for the port; supervision of infectious disease cases and contacts arriving at the port, and control of venereal diseases and venereal prophylaxis.

INSPECTION OF HOSPITALS

Sanitary inspections of the hospitals under the authority of the port of embarkation were carried on daily, Sunday excepted. A list of the hospitals visited, with the date of inspection, was made of record. These inspections embraced all the activities of the hospitals-the administration, the work of the various services, the care of the patients, and the general sanitary conditions. A specified form was filled out once a month at each hospital and then filed at the office of the port sanitary inspector. Defects were noted and recommendations made in a special report which was forwarded to the port surgeon.

Special investigations were made of complaints in regard to the treatment of patients. An officer at each hospital was assigned as hospital sanitary inspector, who acted in conjunction with the inspectors from

the sanitary inspector's division. The inspection of hospitals under the control of the port of embarkation was started in January, 1918. By February, 1919, the work had increased to such a degree that three officers with the rank of major were added to the personnel of the division as hospital inspectors.

The inspector was usually accompanied by the commanding officer or the hospital sanitary inspector in making an inspection at a hospital, and the following points were especially noted: Construction, organization, and administration; nurses; detachment of enlisted men of the Medical Department; barracks and squad rooms; registrar's office; dispensary service; dental service; medical service; surgical service; eye, ear, nose, and throat department; main and ward laboratories; genitourinary service; psychopathic service; communicable diseases;' wards and care of patients; kitchen and mess management; exchange; laundry; medical supply department; quartermaster department and its ordnance section; fire protection; disposal of wastes; delousing; and general police of buildings and grounds.

The hospitals that were under the control of the port of embarkation and which were regularly inspected were as follows: United States Army Embarkation Hospital No. 1, Hoboken, N. J.; United States Army Embarkation Hospital No. 2, Secaucus, N. J.; United States Army Embarkation Hospital No. 3, Hoffman Island, N. Y.; United States Army Embarkation Hospital No. 4, 345 West Fiftieth Street, New York City; United States Army Debarkation Hospital No. 1, Ellis Island, N. Y.; United States Army Debarkation Hospital No. 2, Fox Hills, Long Island; United States Army Debarkation Hospital No. 3, Greenhut Building, New York City; United States Army Debarkation Hospital No. 4, Long Beach, Long Island; United States Army Debarkation Hospital No. 5, Grand Central Palace, New York City; United States Army General Hospital No. 1, Williamsbridge, New York City; Base Hospital, Camp Mills, Long Island; Base Hospital, Camp Merritt, N. J.; Jersey City Contagious Hospital.


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CAMP INSPECTIONS

Monthly inspections and reports were made of Camp Merritt and Camp Mills. These inspections were made by the chief of the sanitary inspection division and the reports were made of record. The following points were particularly noted in making these inspections: Organization, efficiency, and equipment of sanitary units; statistics of sickness, communicable and venereal diseases; vaccination, typhoid and paratyphoid prophylaxis; water supply, sewage disposal, and disposal of wastes; drainage; adequacy of baths; adequacy and condition of kitchens and messing facilities; food supplies, including milk

products and bakeries; examination of food handlers for carriers; exchanges; clothing; mosquitos and flies; delousing; and the general police of the camp site. The files of reports made to the commanding general show that these two camps, as a rule, were found in an exceptionally good condition.

INSPECTION OF TRANSPORTS

Prior to February 1, 1918, all sanitary inspections of transports were made by a representative of the port surgeon under the direction of the transport division. A board was appointed on this date, consisting of a representative from the Inspector General's Department, one from the shipping control committee, and an officer from the sanitary inspector's office representing the port surgeon. This board made a joint incoming inspection of all troop ships. The sanitary inspector on this board inspected all troop accommodations and ascertained if there were any deficiences. The sanitary report was embodied in the

board's report, and the latter was distributed to the proper authorities from the office of the inspector general. It was soon obvious that one board could not inspect all the vessels, owing to the great increase in the volume of business at the port. Arrangements were then made whereby the sanitary inspector could make his inspections independently of the board and increase the force of inspectors in proportion to the increase in the shipping. The sanitary inspector's reports were then forwarded to the inspector general's office and embodied in the reports of the board.

Numerous deficiences were reported during the latter part of April, 1918, on British and Italian transports under the control of the British Ministry of Shipping. The British authorities claimed that deficiences reported did not exist, as all ships under their control were equipped according to the requirements of British transport regulations. It was very apparent that a standard should be arrived at and agreed upon in order to overcome this difficulty. The sanitary inspector's office immediately prepared a specification and submitted it to the British and French authorities, and it was accepted by them. The British Ministry of Shipping worked in unity with this division thereafter and did their utmost to comply with recommendations made by the sanitary inspector.

After May 1, 1918, inspections of incoming vessels were made immediately upon arrival, and of outgoing vessels just prior to the embarkation of troops. These inspections involved all ships except those manned by the United States Navy. The shipping had greatly increased by this time, and this new manner


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of inspecting doubled the work of the inspectors. It was therefore recommended that a harbor boat be furnished to inspectors to enable them to meet the ships promptly, as many vessels would lie at anchor for several days awaiting a berth at the piers. A boat was furnished on May 15, 1918, which greatly facilitated the work.

Incoming inspections usually were made as soon as the ship arrived in port and usually with a representative of the steamship line and an inspector from the British Ministry of Shipping or French High Commission, depending on the nationality of the vessel. In making these inspections, the inspector usually obtained from the executive officer of the ship a complete list enumerating the first and second class accommodations with available toilets and bathing facilities, troop quarters, sleeping and messing capacity, galleys, cold-storage capacity, fresh-water capacity, both general and isolation hospital beds,

hospital equipment, medical and surgical supplies, wash basins, toilet seats, and shower baths available for troops. The inspection was then made, usually in the order specified, and all accommodations were checked, special attention being given to ventilation in sleeping quarters and hospitals, to location of hospitals, hospital equipment and surgical supplies, to latrines, their water supply and drainage, and to the galleys and galley equipment. Sanitary deficiencies or deficiencies in accommodations according to the accepted standard specifications were immediately reported to the representatives accompanying the inspector. The sanitary report of this inspection was made on a form giving a complete list of all accommodations, the general sanitary condition of the ship and, under "Remarks," any deficiencies or any remarks pertaining to sanitary conditions would be noted and appropriate recommendations made. Twelve copies of this report were made and distributed to the proper authorities. Each inspection was also recorded on a card. This card was made in duplicate and filed in alphabetical order, giving the name, nationality and location of the vessel, date of inspection, name of inspector, troop capacity

deficiencies, remarks, and recommendations.

Outgoing inspections were made on the day of embarkation a few hours before the troops came aboard. The inspector had a record of the last inspection and inquired from the executive officer of the ship if there had been any changes or alterations in the troop accommodations since the last inspection. Any changes were noted and checked while making the inspection. This inspection was made in the same manner as described for incoming inspections. Special attention was given to the crew, hospital equipment, medical supplies, and first-aid kits for the lifeboats. The report of this inspection was submitted on a form showing the deficiencies present and the date of previous inspection and existing deficiencies, if any, at that time. It also stated whether or not previous recommendations had been complied with, and if not, the same recommendations were again made.

Initial inspections of United States Navy ships were made with a representative of the port inspector, whenever this officer was notified by the naval authorities that a vessel was equipped to transport troops and was ready to be inspected. These inspections were made in the same manner as described for incoming inspections, and the same form of report was submitted. This inspection was the only one made on naval transports.


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After the armistice was signed an immediate joint inspection of all Army and commercial transports arriving at this port with military passengers was made. These inspections were made with a representative of the vessel, the commanding officer of troops, an officer from the port inspector's office, and the port sanitary inspector. As regards the sanitary inspection, the transport surgeon was interviewed and inquiries were made as to the number and classification of patients, the method of isolating contagious diseases and contacts, the provisions made for the care of insane patients, and the general care of all patients. Any complaints made by the transport surgeon were noted and immediately investigated. The sanitary inspector then visited the hospitals, and the patients were asked if they had any complaints to make. Particular attention was given, in the isolation ward, to the method of sterilizing dishes and other articles handled by contagious patients. After having obtained the above information, the sanitary inspector made the regular inspection with the commanding officer of troops, an officer of the ship, and a representative of the port inspector. All troop accommodations were carefully inspected and, if the

 troops had left the vessel dirty, a detail of them was immediately ordered by the port inspector to return to the ship and correct this condition. If the hospital was found dirty or untidy, the sanitary inspector required the Medical Department men on duty in the hospital to correct the conditions before leaving the ship. Reports of these inspections were made on a form similar to the form used prior to this date on incoming inspections. These reports mentioned the sanitary condition of all troop accommodations and the general sanitary condition of the vessel. Under "Remarks" were noted the medical personnel,

 number of patients, care of patients, method of caring for insane, and any sanitary deficiencies or deficiencies in accommodations, with appropriate recommendations.

HOSPITAL TRAIN INSPECTIONS

All railroad equipment used in the transportation of the sick and wounded from the port of embarkation to the various hospitals throughout the country was inspected by a sanitary inspector from the port surgeon's office. The passenger cars used during the summer and early fall of 1918 consisted mostly of Pullman and tourist cars. Special attention was centered upon the complete equipment of these for the comfort of the patients. The cars were thoroughly cleaned and amply supplied with linen and bedding. Sanitary conveniences were provided. Analyses of the water carried were frequently made and water

pollution was guarded against. All drinking-water tanks were scalded with live steam for five minutes on the day before use. Adequate medical supplies were carried on each train.

The addition of hospital trains and hospital unit cars gave greater comfort to the patients because of the trained personnel on each. This equipment was carefully inspected prior to receiving patients. Special attention was paid to the cleanliness of the kitchen and to the messing facilities. An adequate food supply was carried on each, and this was carefully inspected for its quality, quantity, and preparation.


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CONTROL OF LOUSE INFESTATION

Inspection of all men prior to embarkation for the presence of vermin or contagious diseases was begun in January, 1918. In February the camp surgeons were warned that a case of typhus fever had been certified by the public health officials in Boston and that efforts for the detection of vermin on all troops should be made stronger. In April, 1918, a report from the American Expeditionary Forces indicated that from 30 to 50 per cent of all troops then landing in Europe were louse infested. Recommendation was made that all ships be fumigated prior to embarkation and that universal delousing be practiced before the men were sent to the port. The infestation with lice prior to arrival in Europe was investigated by two experts. This investigation covered the course of the troops from the time they left the training camp until after their arrival in Europe and included troop camps, embarkation camps, hospitals, port of embarkation, transports, and the rest camp in Europe into which the men were evacuated from the troop ships. It showed that one-half of 1 per cent of the men arrived at the port infested with lice and that the men were being delivered in Europe practically louse free, that the rest camps in Europe were universally infested, and that a very large per cent of the troops in Europe were infested. In the summer of 1918, a visiting sanitary inspector made recommendation to the Surgeon General that all troops returning from abroad be deloused before being admitted into the United States. This report, with recommendation, was forwarded by the Surgeon General to the port surgeon for remark. The outcome of the correspondence was a recommendation made by the Surgeon General for the installation of delousing plants in all camps and particularly in those to which troops would likely be sent upon arrival from abroad. Recommendation was made at the same time to the commanding general, port of embarkation, based upon the original report, that preparation be made at the embarkation camps for the delousing of troops returning to this port. In giving study to the situation, it was seen that, when the war ceased, the stream of travel that had been going from this country to Europe would be reversed, and that troops and all classes of civilians would then be traveling in this direction. In view of the fact that almost the whole of Europe had been engaged in the war, it was thought that no class of civilians returning could be treated as free of lice, since all would be coming from the zone of infestation, whether they were camp followers, were engaged with the Army, or had remained in the rear area and assisted in the care of the soldiers who returned sick or wounded from the front. The problem seemed to resolve itself into one of general public health and seemed to belong to the Department of Public Health, since the Army could control only people who were identified with the Army and could not exercise restraint or enforce its orders upon the various welfare workers after their arrival.

On their return from the inspection trip of the debarkation camps of France, both of the officers above referred to, reported that a considerable percentage of louse infestation was found in the various camps inspected. Along the line of possible infestation of common carriers, such as troop ships and railroad equipment, the Surgeon General, United States Public Health Service, had an investigation made, by one of his entomologists, of railroad coaches immediately


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after the detrainment of troops, which were later proved to have been heavily infested with Pediculi vestimenti. This officer reported that in no instance were body lice or eggs found in the coaches inspected. This, together with numerous reports of inspections made of bedding on troop ships, absolutely discounted the theory that common carriers might have been a source of transmission of lice from man to man.

The disadvantages first experienced in the use of steam sterilization were expected, namely, shrinkage of the clothing and wrinkling to such an extent that it was difficult to make the uniforms again presentable. This method, however, was adopted by the Surgeon General's Office and proved to be exceedingly efficacious when carefully carried out. In this connection it is worthy of note that exhaustive experiments with the use of dry heat for delousing were carried out and the conclusion was reached that this method was imperfect and impractical.

Shortly after the armistice was signed, instructions were issued to the camp surgeons of Camp Mills and Camp Merritt to institute disinfection of railroad coaches used for transporting troops from the ships to the camps. This was accomplished by spraying the seats, floors, and walls of the cars with a 2 per cent cresol solution. This measure was instituted largely to forestall public adverse criticism, as it was considered that it was practically impossible to transmit the body louse through the intermediary of railroad coaches. This system was changed later to the use of vacuum cleaning of the cars immediately

after the detrainment of the troops.

On November 19, 1918, in view of the fact that construction on the delousing plants which had been ordered installed at Camps Mills and Merritt was still pending, an officer was ordered to proceed to Washington, D. C., for a conference with the Surgeon General on the delousing plan for the port of embarkation. It was recommended to the Surgeon General and the chief of embarkation that a central delousing plant be constructed near the piers at Hoboken and that all troops pass through this plant prior to entrainment for the debarkation camps. This recommendation was disapproved. Orders were

issued by the War Department to the construction quartermaster in the above mentioned camps to proceed immediately with the construction of the plants already authorized. As troops were expected to arrive from overseas at any time, it was deemed advisable to take immediate steps to install some type of temporary delousing machinery. The Surgeon General released to the surgeon, port of embarkation, Hoboken, 45 portable disinfectors which were in Hoboken awaiting shipment overseas. These machines were distributed between Camp Mills and Camp Merritt and were installed in temporary buildings for the purpose of delousing the first contingent of troops to return from France. The first temporary delousing plant was placed in operation in Camp Mills, Long Island, on December 4, 1918, and consisted of 25 portable steam disinfectors placed under a roof adjacent to an old, discarded bathhouse. The temporary plant at Camp Merritt, consisting of 15 portable steam disinfectors, was placed in operation on December 9, 1918, in approximately the same type of building. At this camp, however, a near-by barrack building was used to furnish dressing and undressing rooms, with a covered runway leading to the bathhouse. The


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first permanent plant was placed in operation at Camp Merritt, N. J., February 1, 1919. The permanent plant at Camp Mills was opened on February 15, 1919.

The number of troops that passed through the port of embarkation, Hoboken, from service overseas from the opening of the port to June 30, 1919, was 1,788,785. After the institution of universal delousing of all troops returning from overseas in 1918, there were reported only 13 cases of infestation with Pediculi vestimenti that were found on examination of these troops in the camps of the interior. In addition to these, a very small number of patients evacuated from the debarkation hospitals of this port were later reported to have been found louse infested. Investigation, however, failed to fix the responsibility

 on the debarkation hospitals.

It was deemed advisable to require a careful examination of the troops passing through Camp Mills, Long Island, in order to furnish figures on which to base relative statistics as to the degree of infestation to be found in the troops returning from overseas. In view of the fact that this examination was more or less inaccurate and time consuming, it was not considered advisable to have all troops examined when the orders required universal delousing. The examination of troops was therefore not carried out at Camp Merritt. Of a total of 238,219 troops who passed through the delousing plant at Camp Mills during the months December, 1918, to May, 1919, inclusive, the following were percentages of infestation: Pediculi vestimenti, 1.75; Pediculi pubis, 1.22.

From the experience gained at the port it was the opinion that, in installing delousing machinery in the future, considerable saving to the Government might be made if the machines were fitted with suitable racks to hold coat hangers, and that all clothing to be placed in the machine be hung on these hangers. The practice in the delousing plants of this port of placing the clothing in barrack bags and packing the carriage of the machine full of these bags was found to cause such a degree of wrinkling that it was practically impossible to again press the clothing so that they would be presentable. Steps were taken

on December 30, 1918, to have racks installed for coat hangers in a delousing machine in use in Hoboken.

CONTROL OF INFECTIOUS DISEASES

The control of infectious diseases at the port of embarkation was a very important factor in safeguarding the health of the troops while on board the transports. Daily inspections were required, and special emphasis was placed upon the early recognition and isolation of suspected contagious cases and the segregation of contacts. A liberal interpretation was made of the definition for a communicable disease contact so as not to interfere with the troop movement overseas. Any soldier who had been protected by a previous attack of a contagious disease was not held in detention by reason of being a contact in that particular disease. The number of cases of communicable diseases brought to the port with organizations necessitated the opening of a contagious disease hospital at Secaucus, N. J., to which were sent cases and suspects among the embarking troops. Rigid isolation measures were instituted and carried out. The patients wore masks in ambulances, and at all other times except when they were in beds in cubicles. The attendants were constantly masked and


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gowned. All fomites were carefully disinfected. Cross infection was prevented by using different ambulances and special attendants in the hospitals for the various diseases. The contacts and suspects were sent to the enibarkation camps and placed in quarantine, where they were closely watched for the appearance of contagious diseases.

In the base hospital at Camp Merritt and at Camp Mills, all patients admitted had throat cultures taken for diphtheria. A great many carriers were found. These were treated with 4 per cent argyrol or 1 per cent silver nitrate twice daily, and a gargle of Dobell's solution was used. The carriers promptly cleared up under this treatment.

Measles complicated with pneumonia constituted the chief menace to troops at the port in the winter and spring of 1918. Some of the transports manned by the Navy instituted the routine measure of spraying the nose and throat in commands from which cases of measles had been detained.

The influenza epidemic in the fall of 1918 greatly overtaxed all the hospital facilities at the port. This virulent type of influenza was recognized as early as May, 1918, on the British commercial transports hailing from Liverpool, but the danger was not realized until August, when the port surgeon recommended a reduction in troop carrying capacity on the transports and more rigid physical examinations. All influenza cases and contacts were eliminated, as far as possible, at the embarkation camps. Temperatures of all men were taken and all with a temperature above normal were detained. Special precautions were taken for the isolation of cases and contacts. These wore masks constantly and patients were placed in beds in cubicles. Special hospital trains were run from the port to various base hospitals to transfer the large number of cases that accumulated. The troops in the embarkation camps were not allowed passes. Special attention was given to crowding. The minimum amount of floor space for each man was 50 square feet and men slept head-to-foot. Mess contamination was guarded against by thoroughly boiling all mess equipment after each meal. The transports were disinfected prior to the embarkation of troops. The capacity was reduced 20 per cent, while the hospital bed capacity was increased from 2 to 10 per cent. Some of the troop ships were equipped with steam inhalation rooms. These did not meet with any great success because of the tendency to chilling after treatment. The reduction of troops carried on each transport did not decrease the percentage of influenza en route, for the least crowded transports were sufficiently crowded to afford the maximum exposure. The total number of influenza cases treated at the port reached the neighborhood of 17,000. Four thousand of these developed pneumonia.

The signing of the armistice was soon followed by an influx of troops from overseas. A new problem presented itself in the reception of large numbers of diphtheria cases and carriers among the returning sick and wounded and the troops. All patients admitted to the debarkation hospitals had throat cultures taken before being admitted to the wards, thus many carriers were found who otherwise would have escaped detection. A hospital ship, the Steamship General O'Reilly, was used in the care of these contagious cases. In addition, wards at Debarkation Hospital No. 1, Ellis Island, accommodated the overflow.


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The fumigation and disinfection of transports did not become a function of the sanitary inspector's office until April 17, 1918. It was the policy of that office to recommend fumigation for the destruction of rats, and for that purpose only, and then only in case a vessel was actually infested with rats or there was reason to believe that a vessel might have had plague-infected rats on board. The office was called upon to make numerous special inspections of vessels when fumigation had been recommended by the ship's officers. In only one instance did the office concur in their recommendations. Cyanide gas was the only fumigating agent used by this department, and it proved very satisfactory. Only three hours were required to fumigate a vessel of 8,000 or 10,000 tons by using fans for ridding the holds of the ship of gas.

During the height of the influenza epidemic, all troop quarters formerly occupied by influenza patients were required to be sprayed with a 2 per cent phenol solution. After November 11, 1918, all troops quarters were similarly sprayed for the destruction of lice. All foreign ships were disinfected by the owners, United States Naval ships by the naval authorities, and United States Army transports by the sanitary inspector's office. A summary of this work from February 1, 1918, to August 1, 1919, shows 1,483 vessels inspected, 87 vessels disinfected, and 7 vessels fumigated.

CONTROL OF VENEREAL DISEASES

The importance of preventing men with venereal disease from going overseas was recognized from the first. Provision for the treatment of such cases was made, and the offer of the New York State authorities of the use of Hoffman Island as a venereal hospital was accepted. The cases sent there were the ones which had not been detected at the embarkation camps.

All troops were examined daily after receiving sailing orders, and all cases of venereal diseases were detained at the camps where the examinations were made. By September, 1918, there was a daily average of 200 to 300 such detentions. The large number of venereal cases under treatment at the base hospitals under port jurisdiction made it imperative to have a specialized, highly trained venereal service to treat this type of disease and reduce the number of days spent in the hospitals. The hospitals were being crowded with influenza cases at about that time, but the venereal cases were segregated and held until cured.

A new problem presented itself after the signing of the armistice: Though every effort was made in the American Expeditionary Forces to prevent men with venereal disease from embarking for the United States until cured, relatively large numbers of such cases did reach the port of embarkation at Hoboken. These cases, if held at the port, would soon have so overcrowded the hospitals that no beds would have been left for other sick and wounded. The troops, therefore, were examined en route, all cases of venereal disease were recorded and treated on the transports, and those who could walk accompanied their organizations to the camps, where they were segregated and held until cured. The litter cases were placed in debarkation hospitals.


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HOSPITAL DIVISION

The hospital division was created on June 1, 1918, by verbal orders of the surgeon. (This should not be confused with the hospital procurement of buildings suitable for hospital and other medical purposes). In brief, the functions of the hospital division were the supervision of all hospital activities and coordination of the efforts of the directors of the various professional services. The chief of the hospital division did not maintain an office of record, the activities of his office being covered in the reports from the various hospitals.

DIRECTOR OF SURGICAL SERVICE

The order creating the office of director of surgery for the port was issued December 8, 1918. There were 13 hospitals under the jurisdiction of the port at that time, and the wounded were beginning to arrive very rapidly. It was at first the duty of the director, as the representative of the surgeon of the port, to visit the different hospitals and to consult with their commanding officers and advise their chiefs of surgical services as to the treatment of the wounded.

Surgical cases came in very rapidly for a considerable time and there were many very seriously wounded men among them. All hospitals under the port, with the exception of General Hospital No. 1, were either embarkation or debarkation hospitals and not intended to be treatment hospitals, except to give the necessary care during the few days the patients were to remain before being sent on to hospitals nearer their homes for definitive treatment. However, since many serious cases requiring special attention were received, particularly at Debarkation Hospital No. 3, it soon became evident that a treatment ward where a number of cases could be kept until they were sufficiently improved to travel was a serious need. A ward containing 63 beds was opened for this purpose. The wisdom of this move was soon apparent, and it resulted in the saving of a number of lives. The same condition was later found to exist when large numbers of patients were being sent to Debarkation Hospital No. 5, and a treatment ward was opened there with equal advantage.

Large numbers of fracture cases were returned during the early months of 1919, most of them wearing the Thomas splint, and information was sought as to whether patients wearing these splints traveled comfortably. Many transports were visited and the men were interviewed before being removed. As a result only one man was found who said he had not traveled comfortably, and but one ship's surgeon who did not think it the best apparatus for the purpose that had yet been found. This was very gratifying, as every effort had been made by the Medical Department to secure the best apparatus for this purpose and the Thomas splint had been selected after much investigation.

DIRECTOR OF MEDICAL SERVICE

The director of medical service for the hospitals under the supervision of the surgeon of the port of embarkation reported for duty on August 20, 1918. The duties of this office included general supervision of the medical service of the hospitals of the port; representing the surgeon of the port in consultation with commanding officers of the port hospitals pertaining to the conduct of the medical services of these hospitals; acting in an advisory capacity to the


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chief of the medical service of each hospital in regard to the diagnosis, management, treatment, and disposition of medical cases; cooperating with the personnel officer of the office of the port surgeon in regard to the staff of the medical service of each hospital; acting as medical consultant to all of the port hospitals. Later, the director of medical service was assigned the duty of determining

the disposition to be made of cases of critical illness arriving on transports from overseas. In this connection, arrangements were made with the United States Navy surgeon in charge of the Navy medical work at the port of embarkation whereby cases arriving on Navy transports in a critical condition were held on board ship and cared for by the United States Navy surgeon until their condition warranted transferring them to a port hospital. When it was found necessary to hold the critically ill on board commercial transports, medical officers, nurses, and enlisted men were provided for these cases by the

port surgeon's office. Especially in connection with the care of pneumonia, it was found that this plan materially reduced the mortality rate as compared with the plan of transferring such cases to hospitals upon the arrival of the transport.

DIRECTOR OF NEUROPSYCHIATRIC SERVICE

The director of the neuropsychiatric service reported for duty on July 14, 1917, and was designated by the surgeon of the port of embarkation as his personal representative to direct all the neuropsychiatric activities at the port. The duties of the office were to advise, assist, and cooperate in the organization of a special hospital for the care and evacuation of nervous and mental cases; to organize and establish special wards in various hospitals within the port for the brief and temporary care of such cases; to make official visits and act as consultant, and to assist and advise with the commanding officers of the

various hospitals in the examination, classification, and general care of nervous and mental patients; to examine and report special psychiatric cases that might arise within the port, including the mental examination of those who were charged with criminal offenses and in whom the question of mental responsibility arose; to advise the personnel officer in the office of the port surgeon in the assignment of medical officers having neuropsychiatric training to various hospitals as the necessity required.

Because of the special and technical character of the work, the relation of the director to the neuropsychiatric service in the port, and particularly to the special hospital, Ward 55 (Messiah Home), General Hospital No. 1, had, of necessity, to be very intimate.

Owing to the fact that nervous and mental patients were returned in large groups, the accommodations at the special hospital (Messiah Home) proved temporarily inadequate and, at various times, many of the milder cases had to be distributed to other hospitals until evacuated, which complicated the work of the division considerably. Notwithstanding this, in a service which is fraught with danger and where accidents, injuries, abuses, and complaints are frequent, such occurrences were happily rare. In fact, such difficulties were much less than are encountered in well-established, permanent civilian hospitals for the insane. This was largely due to the efficiency, ability, and conscientious watchfulness of the medical officers in the neuropsychiatric division.


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DIRECTOR OF ROENTGENOLOGY

The director of roentgenology for the port of embarkation was designated October 17, 1918. His duties included general supervision of X-ray service at the various hospitals of the port; consultation with commanding officers of the port hospitals relative to the conduct of the X-ray service; acting in an advisory capacity to the chief of roentgenology at each hospital.

LABORATORY DIVISION

The first laboratory to be opened within the area of the port of embarkation was that of the camp hospital at Camp Mills, Long Island. Personnel and facilities were very limited. Two medical officers were sent there from the Army Medical School, Washington, D. C., when two cases of epidemic meningitis developed in September, 1917, and much of their investigative work had to be done at the Rockefeller Institute for Medical Research. When Camp Mills was closed in December, 1917, the base hospital at Camp Merritt was about ready to open. The laboratory there was likewise at first inadequate, and it

was necessary to obtain assistance from the Rockefeller Institute, Cornell University, and the New York City Board of Health. This laboratory was enlarged and established an efficient service in February, 1918, sufficient to do all the work required by the camp.

Laboratories were established in the majority of the hospitals in the port area as they were opened. When Camp Mills was reopened in April, 1918, the laboratory service there was so inadequate that the Camp Merritt laboratory undertook to perform the necessary work. Not until June, 1918, was a laboratory division of the port surgeon's office established. A central laboratory for the port area was opened in the Greenhut Building, New York City, in August, 1918, and was designated United States Army laboratory, port of embarkation, Hoboken.

The functions of the laboratory division were to assist in the rapid embarkation of troops and debarkation of patients in such a manner as to minimize the danger from disease and to assist in the care of the sick. Laboratory aids to the diagnosis and treatment of communicable diseases constituted the bulk of the work. To best accomplish these functions, it was deemed essential to have all laboratories in the area well equipped and manned, to be able to shift equipment and personnel, and have a separate unit for the central laboratory. Rapidity and accuracy were necessary if the troops and patients were to be

kept moving. The division gave such assistance to the port surgeon as was possible on questions that pertained to the laboratory service and in the control of communicable diseases; coordinated all the laboratory work necessary in the various hospitals, camps, and posts in these headquarters; operated a central laboratory, essentially as a department laboratory where all Wassermann tests, all microscopic section work and chemical work and such other examinations as could not be well done at the local laboratories were done; furnished officers, technicians, personnel, and emergency supplies and provided laboratory animals and therapeutic sera; cooperated with the sanitary inspector of the port, making such investigations, examinations, and reports as were necessary.


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One of the early steps taken in organizing the laboratory service was to send a letter to all hospitals which prescribed that certain supplies should be kept on hand at all times, gave directions concerning certain examinations, and required a daily report concerning laboratory personnel and communicable diseases. This report was made by telephone, and the information it contained was transmitted to the sanitary inspector. Since the activities of the port sanitary inspector were often related to the laboratory work, provision was made for the necessary cooperation. A consolidated monthly report of the activities of all laboratories in the port area was made to the Surgeon General.

The Army laboratory actually began to function in a manner similar to a department laboratory about October 1, 1918. A service was initiated at this time by which all Wassermann tests, microscopical examinations of pathological specimens, chemical examinations of water, sewage, etc., for the port area, were made at the Army laboratory. It also supplied laboratory animals and culture media and sera upon occasions. Advance information was obtained from the liaison officer, after the signing of the armistice, as to the number and time of arrival of debarking troops and as to the number of accompanying sick which would be sent to the various hospitals in the port area. This information was then telephoned to the laboratories of the respective hospitals.

The laboratory was also used as an instruction center. Monthly conferences were begun early in 1919, primarily for chiefs of hospital laboratory services, and an instruction course on intestinal parasites was given to selected officers of the laboratory service, one from each hospital. The services of experts in nutritional subjects and sanitary engineering were available. This was replaced in May, 1919, by two broader courses-one consisting of the regular duties in the laboratory, and other of lectures and class work in clinical microscopy, bacteriology, parasitology, and immunology. Circular letters were sent out

from time to time giving data concerning certain diseases or conditions which might be expected at any time, variations encountered in performing certain tests, etc.

While the Army laboratory was intended primarily to furnish service for the port area only, a large proportion of its work originated in outside sources.

The laboratories in the port area differed much from those at the cantonments as regards buildings, personnel, and character of work necessary. They had to be prepared for anything, for troops came from everywhere, and further modifications were necessary with the debarkation and evacuation of patients from overseas. It was usually necessary to use for laboratories such space as might be available in the buildings taken over, the personnel had to be trained, and all of the work had to be quickly and accurately done, so that neither troops nor patients would be held up and patients could be properly treated. It was necessary to keep informed on the status of communicable diseases in the cantonments in the United States and in hospitals overseas, in order to have advance warning of the possible arrival of cases of epidemic diseases.

The first laboratories were small and poorly equipped. Much versatility and much hard work were necessary in order that the laboratories could fulfill the requirements, but usually, due to the freedom with which supplies and personnel could be shifted within a very short time, adequate facilities and


277

personnel were available. The space, arrangement, equipment, and personnel in the laboratories was a source of great comfort, satisfaction, and assistance to the port surgeon, the camp surgeons, and commanding officers of the hospitals. The laboratory space at the Army laboratory was over 6,000 square feet; the laboratories at the base hospitals at Camp Merritt, Camp Mills, and Camp Upton, and at Debarkation Hospital No. 2, were ultimately very large and commodious.

Most of the laboratories were equipped to care for themselves, except at Embarkation Hospital No. 4 and Debarkation Hospitals Nos. 4 and 5, which obtained prepared materials from the Army laboratory. Ward laboratories were but little used, and, where tried, proved an absolute failure. Every hospital had an autopsy room and, at all but Camp Merritt, there were good refrigerating plants for the storage of cadavers. There were room incubators in most of the laboratories, heated by electric carbon bulbs. Some of these incubators were built by the laboratory staff and others by the construction department.

Practically the same system of records was kept in every laboratory. There was always a receiving clerk who received specimens and made an entry on the daybook showing the name, rank, organization, and ward of the patient, the character of the specimen, and by whom it was to be examined. The form was then put on the "unfinished" file. After the examination was completed, the examiner noted the results in his protocol and put the form on the "finished" file. The result was then recorded in the book by the receiving clerk and the daybook marked to show that the report had been completed. The form was then signed by the officer in charge and the form put on the file "ready for delivery." Messengers then delivered the reports. Only at Debarkation Hospital No. 2 was the duplicate system used, the record book giving a more permanent and workable record.

A more elaborate system of records had to be developed at the Army laboratory. Enlisted men were trained to make blood counts, urine examinations, and throat cultures, and some developed into experts even though they had previously had no laboratory experience.

The personnel consisted of medical officers, Sanitary Corps officers, contract surgeons, women technicians, and enlisted men. The medical officers first assigned had had previous experience; later, medical officers and Sanitary Corps officers who had taken courses at training schools were assigned. The contract surgeons all were experienced in laboratory work. The technicians generally had had courses before assignment. Some of the enlisted men assigned had had special courses, but there were many who had not.

While an effort was made to unify all of the work in the laboratories, this attempt pertained particularly to getting accurate and early reports, and each chief of a laboratory service was left much freedom as to the details he employed to get the results. It was the general opinion that it was an asset to have officers with at least the rudiments of military training, that special courses were not necessary to make bright and intelligent officers, women technicians, and enlisted men of the greatest value to the laboratory service. In fact, a smattering of laboratory knowledge often unfitted them for a time for doing


278

good and efficient work. Sanitary Corps officers proved of much value. Women technicians could not replace enlisted men, nor were they as orderly and exact as one might have expected them to be. It must be stated, however, that some were very competent and that all were very willing and faithful and lost but little time from work. Enlisted men did not do well after special laboratory courses.

SPECIAL INVESTIGATIONS

The laboratories of the port of embarkation served in most diversified manners. It was the port's first purpose to get as many individuals overseas as was possible; its second, to cure as many of the sick as was possible; later, to receive and to evacuate to the interior as fast as possible. It was therefore necessary to separate from the main body those soldiers who were a source of danger. Had dependence been placed upon the "contact system," the port would have been so tied up with detained troops in the camps that embarkation of troops would have been interfered with, for nearly all embarkation troops

arriving on trains were "contacts." The actual carriers were picked out in every type of disease where it was possible; the efficiency of this will be seen later.

In the embarkation hospitals, it was essential to help in diagnosing disease, to help detect those not fit for active duty, and to keep contagion from spreading. In the debarkation period, the laboratory again had to help select out carriers of infectious disease found in the camps and hospitals, to help in the diagnosis and treatment of the sick and wounded, and to be of such assistance in the preparation for surgeon's discharge for disability as was possible. In addition, it tried to determine whether or not our troops had become carriers of the typhoid-dysentery group of bacilli and of amebę and other

intestinal parasites. All of this work had to be done promptly, completely, and with the greatest accuracy. Delay meant holding up the processes of embarkation and debarkation. Never were these processes interfered with in any way whatsoever.

EPIDEMIC MENINGITIS

The first cases of meningitis occurred at Camp Mills in September, 1917, and there were always cases among the embarkation troops from that time on, 83 in all. There were 61 cases in debarkation troops prior to July 1, 1919.

Whenever a case of meningitis occurred, all exposed persons were cultured and the carriers removed so that the others need not be held up in transit. The carriers were held until three successive negative cultures were obtained before being released. No cases of meningitis occurred in troops cultured after cases had occurred. Out of the 158 embarkation carriers detected, 3 developed clinical epidemic meningitis.

DIPHTHERIA

Diphtheria was definitely an Army disease in the embarkation and debarkation days. Troops from certain camps in the interior and from the American Expeditionary Forces were heavily infected. At the base hospital, Camp Merritt, from March, 1918, to September, 1918, 2.36 per cent of the patients

>

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admitted had diphtheria bacilli in the throat. Patients returning from overseas showed 1.26 per cent diphtheria bacillus infection up to May 15, 1919. The frequency of the occurrence of the disease in the port hospitals was a grave factor, for 5.76 per cent of the medical personnel in February, 1919, were carriers. It was necessary to culture the hospital personnel frequently to limit the spread of the infection. As a result of the frequency of clinical cases, deaths, and carriers, the plan was adopted to take cultures at the receiving offices of all patients admitted to the hospitals. With this precaution the disease remained under good control.

ANTHRAX

The first case of anthrax occurred at Camp Merritt, on April 10, 1918. The lesion was on the face. Another case occurred on May 4, 1918. This soldier had anthrax bacilli in the spinal fluid, which was bloody. He died. It was not decided whether or not it was a meningitis. There were 15 cases in men from the 91st Division in July. In addition, a number of soldiers from the 91st Division had what appeared clinically to be anthrax pustules, but no anthrax bacilli were found on examination, and it was deemed inadvisable to produce further trauma by persistence of the search for the organisms.

All of the pustules were on the face or neck where shaving was done, and nearly all gave a history of having cut themselves while shaving. Only one patient died. He walked into the hospital, had convulsions that night, and, when a lumbar puncture was done, a dark bloody fluid containing many anthrax bacilli, some in the spore stage, was found. Blood cultures were made in every case, using 2, 3, and 5 c. c. of blood per 100 c. c. of broth. In only one case were the organisms recovered from the blood. All of the patients had local cauterization, either by injection of phenol or by the actual cautery, and, in addition, a large intravenous injection of antianthrax serum. The actual cautery was preferred to phenol injections, the local condition clearing up more quickly under its use.

While shaving brushes, soap, and talcum powder were all regarded with suspicion, it seemed evident from the cases in the 91st Division that shaving brushes were responsible. Brushes had been issued at Camp Lewis about June 22 and the troops left there about June 24, and it was assumed that the issued brushes were used from the former date. The sanitary inspector of the division reported that one case of anthrax occurred prior to the departure of the division from Camp Lewis. That the face powder was not the source of the infection seemed evident from the fact that some 40 different varieties were

used by the men of one company of the 361st Infantry, and at least one man affected had not used any powder at any time.

Shaving brushes, soaps, and talcum powder used by the patients from the time of the occurrence of the first case of anthrax at the port and those obtained from the quartermaster were examined both in culture media and by animal inoculation, but no anthrax bacilli were found. Obtaining anthrax from these sources was difficult because of the occurrence of the hay bacillus.

Cases of anthrax pustules on the face developed at Camp Mills. No new cases occurred following the general order to sterilize all shaving brushes before


280

issuing, except one at Camp Mills, in May, 1919. This soldier had been issued a brush in December, 1917, at Camp Upton, had been overseas, but had not used his issue brush until again in the United States, and then he contracted anthrax infection.

As some shaving brushes of certain makes were found to be infected with anthrax bacilli, no brushes except those from designated manufacturers were later issued. For sterilization, 10 per cent formalin at 110° F. was used for 4 hours. Over 80,000 shaving brushes were sterilized.

There were 2 deaths due to the disease in over 50 infections.

PNEUMONIA AND EMPYEMA

The types of pneumonia and empyema that prevailed at the port hospitals represented those found at the various camps, as troops came from practically all of the camps. Particular attention was paid to the two chief varieties of the disease, namely, lobar and bronchopneumonia. While there were many contributing factors, the chief exciting causes appeared to have been pneumococci and hemolytic streptococci. Other organisms were present, such as nonhemolytic streptococcus, influenza bacillus, and a Gram-negative bacillus. The chief concern was with the Diplococcus pneumonię and the Streptococcus hemolyticus, for it was believed that the former produced most of the acute lobar pneumonias, such as were seen in civil life, and the latter produced a special variety of bronchopneumonia, sometimes called interstitial bronchopneumonia. A few cases were found at necropsy where a combination of the two types of the disease occurred with a mixed infection of pneumococcus and streptococcus. It was more than likely that one or the other of the diseases was primary, producing its type, followed later by a secondary infection and subsequently developing another variety. The clinical features of these combined pneumonias seemed to bear out this contention, and probably this was the only means whereby an early diagnosis as to which variety was primary could have been determined.

INFLUENZA

Though the epidemic of influenza began September 15, 1918, work on the etiology of the disease had been done before this. On October 8, 1918, the following report was made to the Surgeon General, United States Army:

OFFICE OF THE SURGEON, PORT OF EMBARKATION,

Hoboken, N. J., October 8, 1918.

Results of laboratory investigations on epidemic influenza in the various stations of the port of embarkation:

Since July, ships returning from European ports have had epidemics of influenza on the voyage. From the first these were investigated, but usually all the men had recovered by the time New York was reached. Cultures were made from the nasopharynx, tonsils, and sputum, and influenzalike bacilli were found in about 50 per cent of the cases. In addition, streptococci, hemolytic and nonhemolytic, and Micrococcus catarrahalis were found at times.

Investigations in the camps and hospitals in the port of embarkation were begun as soon as cases appeared. The methods and technique had first to be developed and the amount of material that required examination was so large that some time was required to evolve reliable and suitable methods to get all the information desired. With a fairly uniform technique in the various laboratories in these headquarters our results have still varied consider-


281

ably, largely due to the fact that our troops are only transient and come from all the cantonments and camps of training. Our investigations have been concentrated on (1) nose and throat cultures of influenza patients so that those patients with similar infection might be segregated; (2) study of the cultures from pneumonia sputa; (3) blood cultures; (4) investigations at autopsy; (5) white blood cell and differential counts.

(1) Nose and throat cultures.-During the winter and spring when many nasopharyngeal cultures were made for the detection of meningococcus carriers, influenza bacilli were so frequently found that surprise was often expressed that the disease influenza did not exist. In this epidemic, however, influenza bacilli have been less frequently found in the nasopharyngeal cultures. In all over 5,000 cultures were examined.

The results vary markedly, influenza bacilli being found in from 4 per cent to 90 per cent of the cases, hemolytic streptococci in from 1 per cent to 90 per cent of the cases, and pneumococci in from 3.3 per cent to 24 per cent of the cultures taken at the various hospitals and camps. This difference in results may, however, be more apparent than real. Opportunity was presented at one hospital to get good data on nasopharyngeal and tonsil cultures; influenza bacilli were found only 6 times in the nasopharynx as compared to 78 times when the tonsil cultures were taken. Hemolytic streptococci occur frequently and so do pneumococci, but not as frequently as influenza bacilli. The taking of throat cultures is advocated so cases can be segregated. In a series of influenza contact studies, hemolytic streptococci were found in 7.8 per cent of the cases as compared to 10 per cent in the influenza patients in the hospital.

(2) Examination of sputa in pneumonia.-A large number of sputa have been examined, about 1,000 to date. In these, influenza bacilli are found in a large percentage, especially when mice or rats are used. Pneumococci are very frequently found, the relative occurrence of the types at different hospitals being shown in the following tabulation:

Hospital

A

B

C

D

Type I

3

7

69

1

Type II

16

13

0

2

Atypical type II

0

8

0

0

Type III

5

29

0

2

Type IV

33

102

16

14


Hemolytic streptococci are being found in about 10 per cent of the pneumonia sputa.

(3) Blood cultures.-About 200 blood cultures have been made. The blood is generally sterile and so far influenza bacilli have not been found. Hemolytic streptococci have been found a few times and pneumococci about 10 times as frequently.

(4) Autopsies.-A considerable number of autopsies have been performed. Generally the trachea is congested and red and frequently contains seropurulent and blood-stained exudate. The lungs may show either complete consolidation or bronchopneumonia, but always intense engorgement and frequently solution of the red blood cells. Adhesions and empyema have seldom been found, probably because death has occurred too early for their development. The bacteriological findings at autopsy show that influenza bacilli occur in the tracheal exudate and the consolidated areas, but that hemolytic streptococci and pneumococci occur in the lungs in at least one-half of the pneumonic lungs.

(5) White blood counts.-White blood counts have shown generally but little increase in the total number of white cells, even when pneumonia existed. The differential counts frequently have shown an increase in the percentage of lymphocytes.

(6) There can be no doubt that the epidemic is due to the influenza bacillus but that the pneumococcus and hemolytic streptococcus are responsible for some of the severe complications. The particular type of the complicating organism is probably determined by the type already prevailing at the camp or cantonment.


282

On September 20, 1918, the following memorandum was made to the port surgeon by the director of the laboratory division:

The present status of cases is as follows: United States Army Embarkation Hospital No. 1 (St. Mary's), 100 cases; pneumonia, 7 (1 will probably die). Base hospital, Camp Mills, 24 cases; pneumonia 6; of these 1 probably streptococcus meningitis; 2 will probably die. Base hospital, Camp Upton, 400 cases, pneumonia, 21.

2. Bacteriology.-At Embarkation Hospital No. 1, no influenzalike bacilli in the sputum smears. Cultures on Avery medium in pneumonia cases in 6 (all examined) showed hemolytic streptococci and no influenza bacilli. Nose and throat cultures on blood agar plate were taken from 34 cases and will be reported on later.

At the base hospital at Camp Mills nose and throat cultures have been taken on all cases, and hemolytic streptococci but no influenza bacilli were found. Cultures on Avery medium in pneumonia cases showed hemolytic streptococci. A culture has been obtained from the spinal fluid of one patient and will be reported on later; it looks like a short-chained streptococcus at this time.

At Camp Upton no streptococci or pneumococci have been isolated, and the chief of the laboratory service so far has found only influenza bacilli. Whether this condition prevails will be determined.

3. Blood cultures so far have been negative. White blood cell counts so far in influenza and influenza pneumonia have seldom exceeded 11,000, with no increase in the percentage of polynuclear cells.

4. Major Winders, director of the medical division, port of embarkation, has observed that there is a marked difference between the cases at Embarkation Hospital No. 1 and those at the hospital at Camp Mills.

5. In going over the situation with Colonel Edwards at Camp Mills to-day, the following was developed for consideration at the port of embarkation:

a. The conditions in our camp and hospitals differ from those of the permanent cantonments in that we have troops coming in and going out at all times. If the epidemic is to start in the East and travel westward we will have new cases coming in for a long time.

b. Quarantine will probably not change the actual number of cases very much, but reasonable quarantine will probably prevent the cases from coming up faster than they can be taken care of. For this reason big gatherings as in moving-picture shows, meetings, and so forth, are discontinued.

c. The contacts will be put in the detention camp, but released to accompany organizations ordered for oversea duty. This will not tie up troops and will still give some protection against the rapid spread of the epidemic.

7. All chiefs of the laboratory service have been instructed on the intensive work that is to be done in connection with influenza and as soon as facts are established will report on them. We are cooperating with Doctor Park of the research laboratory, New York City, and with physicians at the Rockefeller Institute.

Influenza bacillus vaccine was sent out by the Army Medical School, and from September 25, 1918, to January 7, 1919, the permanent troops at Camp Mills were actively immunized, apparently with some good results when comparisons were made with the unvaccinated permanent troops of the same regiment at Camp Merritt. Mixed vaccine of influenza bacilli, streptococci, pneumococci, and staphylococci was used in treatment at General Hospital No. 1 and good results from it were claimed.

An intensive study as to the causal organism was begun in February, 1919, and attempts to get uniformity in methods were made. The influenza bacillus was found in 91.5 per cent of cases of acute uncomplicated influenza with leucocyte counts of 10,000 or less on the first, third, and sixth days of the diseases, and in 77.3 per cent of convalescent influenza patients. Influenza bacilli were found in 82.2 percent of pneumonias.


283

TYPHOID FEVER AND TYPHOID CARRIERS

Typhoid fever occurred from time to time. Five cases were found in troops embarking from January, 1918, to May, 1919. A considerable number of cases occurred in the American Expeditionary Forces, and six cases of clinical typhoid occurred in returning troops prior to July 1, 1919. Because of the occurrence of the disease in the American Expeditionary Forces, it was thought worth while to determine to what extent soldiers returning from overseas would prove a menace to the home population. Stools from 1,000 patients were examined. A dysentery bacillus of Hiss-Russell "Y" type and one of the Flexner-

Harris type were isolated, but no typhoid bacilli were found. Twenty-eight strains of a nonlactose fermenter not agglutinated by diagnostic sera and 11 "slow colon" bacilli were isolated. These cultures were verified at the Army Medical School, Washington, D. C., and the nonlactose fermenter was classed as belonging to the Graham-Smith groups, which were frequently found in the American Expeditionary Forces.

CATGUT EXAMINATIONS

The medical supply depot requested samples from all lots of catgut supplies to the Army through the depot and the United States appraiser's office, in order to make tests of tensile strength, elasticity, and sterility. Examinations for sterility were made in the Army laboratory. A satisfactory technique was developed for aerobic and anaerobic cultures. Four hundred and ninety-eight samples were tested in duplicate, and 99, or 2.31 per cent, were found infected. The tetanus bacillus was found once.

COMPLEMENT FIXATION TESTS

Complement fixation tests for the diagnosis of syphilis, gonorrhea, and tuberculosis were at first made at the Army Medical School, Washington, D. C. In July, August, and September, 1918, the tests were made at the base hospital in Camp Merritt, but with the establishment of the Army laboratory, port of embarkation, all of these tests were made there. Many tests were made for organizations and stations outside the port of embarkation. The human system was used entirely. The acetone insoluble antigen was used in the routine Wassermann test, but on request the cholesterinized antigen was also used. For the spinal fluid tests, 0.2 and 0.5 c. c. of the specimen were taken. The system was controlled by the interchange of specimens with various hospitals in New York City. The gonococcus antigen and old tuberculin were supplied by the Army Medical School.

WATER ON HOSPITAL AND TROOP TRAINS

With the return of overseas troops and sick and wounded, samples from the sources of supply of water and ice for troop trains and hospital trains leaving this port of embarkation were collected weekly, and examined bacteriologically once a week and chemically once a month. The sources of supply were always found to be good. Water from the drinking and storage tanks in troop trains was frequently tested. Colon bacilli were found in a few instances. The water supply of the hospital trains was carefully controlled and no car left the yards


284

without having the water examined. The tanks were flushed and steamed when the bacterial count was over 200 per cubic centimeter or there were many liquefiers of gelatin.

The water supply on the hospital cars improved as time went on. This was probably due to the fact that there had been much accumulation of sediment in the storage tanks and that many cleanings were necessary to remove all of the sediment. The whole problem was carefully studied, and it was evident that the water at the inland stations varied as to quality. It was not deemed advisable to chlorinate this water, as it had already been chlorinated and the addition of further chlorine would have made it unpalatable.

PATHOLOGICAL EXAMINATIONS

Autopsies were made when it was believed the findings would be of value in the diagnosis and treatment of soldiers in the hospitals. These were always carefully controlled. With the establishment of the central laboratory, all pathological examinations in the port of embarkation were done there by a competent pathologist. This officer was sent to hospitals when requested. Sections and gross specimens were provided, reports were made to the hospitals from which the specimens had come, and all good specimens and sections were sent to the Army Medical Museum, Washington, D. C.

CHEMICAL EXAMINATIONS

The principal chemical examinations for the port of embarkation were made in the central laboratory, where two chemists were on duty. These included testing the efficiency of sewage disposal plants and examinations of water from the camp and from troop and hospital trains. Food examinations, medico-legal examinations and diagnostic examinations were made. Of the last there were relatively few, as patients were retained in our hospitals for a short period only.

DISCONTINUANCE OF ARMY LABORATORY

The Army laboratory was transferred to General Hospital No. 1 when the Greenhut Building was returned to its owners in the summer of 1919. When this hospital was transferred from the jurisdiction of the port of embarkation to that of the Surgeon General, the Army laboratory continued to function only to complete the history of the work done on intestinal parasites.

SICK AND WOUNDED DIVISION

This division was established in October, 1917, for the sole purpose of checking, correcting, and forwarding to the Surgeon General the sick and wounded reports of the various organizations under the control of the port surgeon. This work was placed in charge of a noncommissioned officer under the supervision of the chief clerk.

The division was reorganized in December, 1917, in anticipation of the growth of the port of embarkation and of the large number of sick to be cared for from the troops passing through the port on their way overseas and the probable return of large numbers of sick and wounded from overseas. The division

 

285

then consisted of four sections-administrative, record, genitourinary diseases, and psychiatry. The last two were responsible for the supervision of the respective types of cases in hospitals within the port area, and were transferred to the newly organized hospital division in the summer of 1918.

Fluctuations in the number of the personnel on duty are shown in the following table:

Month

Commissioned officers

Noncommissioned officers

Privates

Civilian employees

1917

 

 

 

 

October

0

1

0

0

December

2

1

0

0

1918

 

 

 

 

August

3

1

4

0

September

3

2

8

0

November

5

4

20

0

1919

 

 

 

 

February

4

2

12

2

June

3

2

10

4

July

3

1

4

2


ACTIVITIES

The following brief outline illustrates the principal activities of the sick and wounded division during its final period:

ADMINISTRATIVE

(a) Daily port bed situation, a consolidation of bed and evacuation data to show available bed reserves.

(b) Checkerboard control of infectious and venereal patients in port hospitals as information and transfer guide.

(c) Dispositions of embarkation patients with infectious diseases, prisoners, insane, etc.

(d) Necessary action on miscellaneous official papers, leaves of absence, furloughs, special injuries, transfers, orders, etc.

(e) Collection, organization, and dissemination of advance information of incoming sick and wounded, based on advance reports by cable.

(f) Tentative assignments of patients to appropriate hospitals prior to arrival of transports.

(g) Receiving, verifying, recording for statistical purposes, and forwarding corrected classification lists for the action of the transport division.

(h) Advisory function in classification of patients for transfer from hospital.

(i) Transmitting tentative classification lists to Surgeon General's Office by telephone and confirming same by detailed wire.

(j) Relaying corrections and instructions from Surgeon General's Office to hospital by telephone.

(k) Turning over to evacuation division revised and verified nominal lists of patients for preparation of the necessary travel orders.


286

RECORD

(a) Compiling a card index of all embarkation patients in the port and all debarkation patients received from overseas, both at this port and Newport News, Boston, and Philadelphia, with complete information as to admission, diagnosis, and disposition.

(b) Checking, correcting, and forwarding all sick and wounded reports of all hospitals and commands under the port of embarkation, together with those of all organizations temporarily at Camp Merritt, Camp Mills, and Camp Upton, enroute overseas.

(c) Compiling and rendering daily reports of patients, classified diseases, and vacant beds in each hospital of the port.

(d) Rendering all reports of sick and wounded required by the Surgeon General's Office.

(e) Formulation of statistical records and reports of diseases and injuries in addition to sick and wounded report.

(f) Checking all recommendations for discharge on surgeon's certificate of disability.

CARD-INDEX SYSTEMS

A brief description of the sick and wounded card-index system is given below. Attention is drawn to the fact that more or less duplication was unavoidable in a system which numbered upward of 200,000 cards. This in no way lessened the value of the system, though it was apt to convey an exaggerated idea of the number of patients actually admitted to hospitals.

A card index was compiled of all embarkation patients who were sent to hospitals under the jursidiction of the port surgeon. Of the 1,630,534 men who actually went overseas from this port (May, 1917, to the signing of the armistice), there were card records of approximately 87,900 patients who were taken sick prior to embarkation or were selected out at preembarkation inspections, either at the camp or on board transports. These cards showed the hospital record of each soldier to the time he was released from Medical Department control.

A card index was made also of all patients who returned from overseas as sick or wounded and arrived at this port, Philadelphia, Charleston, Boston, or Newport News. There were approximately 180,000 card records of men who had been overseas and were returned as sick or wounded or who were admitted to one of the hospitals after arrival. The data on each card included, in addition to the man's name and organization, the date of arrival; the transport; the date of admission to the port hospital; designation of the port hospital; date of final disposition.

In addition to the above, any information that was received in reference to the soldier's service record was also noted on the card. This card-index system proved valuable in locating patients promptly. Service records and correspondence relative to patients (500 to 1,600 weekly) were checked and forwarded to the proper hospitals without delay.


287

TRANSPORT DIVISION

The title of this division is somewhat misleading, as its activities were concerned chiefly with preembarkation inspections of troops and debarkation of sick and wounded. The medical supervision of the transport service proper was handled by the port surgeon and, under him, the chief of the personnel division.


The transport division of the port surgeon's office was one of the largest in scope and in its ramifications in connection with the various divisions of the surgeon's office. Its work was not limited by any means to this port, but extended to camps and ports as distant as Montreal and Quebec in the North, Portland in the East, Camp Lee in the South, and Buffalo in the West, with many intermediate stations and camps. Unlike the other divisions in this office, it had no fixed office hours.

The various departments of the transport division as finally evolved were as follows: Chief of division, executive officer, assignments, inspectors in chief at Camp Merritt, Camp Mills, Camp Upton, and Camp Dix, branch office in Hoboken, inspection of casual officers, transfer officers in charge of debarkation of sick and wounded, statistical and boarding inspector's office at quarantine station, Staten Island.

Starting as a combined transport, inspection, and sanitary division, with a personnel of 2 or 3 officers, it eventually grew into a division requiring the services of over 300 medical officers. It is not to be inferred, however, that these officers were all permanent personnel, as about 50 per cent were officers on temporary duty. This percentage was of a constantly shifting nature, made up from men awaiting overseas base hospitals, evacuation hospitals, and sanitary trains, and from men temporarily relieved from duty as transport surgeons on one ship and awaiting assignment to another. With the necessity

of using such a loose organization, the work of this division, especially in the preembarkation physical inspections, entailed much unnecessary labor in constantly educating new men in this work and losing them almost as soon as they became really efficient.

DUTIES

The general duties of this division were as follows:

1. Transports were to be inspected upon arrival and the day before departure, and at such other times as would insure proper compliance with the provisions of United States Army transport regulations; reports of deficiencies were to be promptly rendered with recommendations for correction. Inspection upon arrival was to be made in company with other inspectors authorized.

2. Equipment of a transport hospital was to be verified upon arrival of the transport and timely requisition was to be made for its completion.

3. The transport surgeon was to be provided with requisite copies of general orders and regulations pertaining to them.

4. In connection with the embarkation of troops: (a) The preembarkation venereal inspection was to be conducted. (b) Disposal of venereal cases detained was to be made. (c) Escort (guard or other form) for these cases to the designated hospitals was to be provided. (d) Report was to be made


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of the detachment and its number as early as possible to the property division for transportation. (e) A medical officer was to be provided to be present at each embarkation of troops with instructions as to his duties in removing sick that should not proceed overseas.

5. In connection with debarkation of the sick: (a) A medical officer was to proceed to vessel as soon as its arrival was reported and be present, if practicable, at the lowering of the gangplank. (b) This officer was to obtain from the transport surgeon a transfer card and a service record for each patient, both indorsed to hospital, port of embarkation, together with a list of the sick, in duplicate, showing for each patient the full name, rank, organization, and regiment or corps, and a brief diagnosis. (c) He was to turn these records over to the sick and wounded division of the port surgeon's office; was to designate the hospital or hospitals to receive them; arrange the records in groups pertaining to each hospital and return them to the transport division. (d) He was then to arrange with the property division for necessary transportation and to deliver the patients to the designated hospitals.

6. Sanitary inspections of the surgeon's office were to be made at such intervals as to insure proper police and sanitation. Reports were to be submitted, together with sanitary reports of transports, to the sick and wounded division for action.

With the outbreak of the epidemic of influenza in September, 1918, the inspection of troops took much longer per man by reason of the necessity for eliminating from commands every man who might show the slightest signs of having contracted the disease. The temperature of every man was taken and, if any elevation above the normal was noted, he was at once isolated. He was transferred to a hospital if the elevation continued. The great increase in the amount of work required by these extra precautions may be readily visualized when it is recalled that during the month of September, 1918, 206,052 men

sailed from this port. Many of these were inspected several times before sailing, due to the fact that ships to which they had been assigned were not available at the expected time because repairs had not been completed, coaling was unfinished, or other similar conditions existed. Ships occasionally broke down when one or two days from port and returned, causing another increase in the work of this office. At Camp Mills, the same 21,000 men were inspected on three successive days (a total of 63,000 inspections), all of whom had their temperatures taken, thus making actually three times the number of inspections to the number of sailings. A similar condition existed at Camp Merritt, and more than 26,000 troops were inspected each day for six consecutive days before they embarked, a total of 156,000 inspections. These two instances were the extremes of a situation which pertained to a lesser degree on a great many occasions. In an effort to control the spread of the epidemic, a reinspection was held on the piers just prior to embarkation.


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PREEMBARKATION INSPECTION

The necessity for having permanent personnel from this division placed in certain camps which were under the jurisdiction of this port to take charge of the preembarkation medical inspection of troops became obvious in December, 1917. One medical officer was at that time assigned for the purpose at Camp Merritt, N. J. Later on, when Camp Mills, Long Island, was opened in the spring of 1918, another was assigned to similar duty there. Camp Upton, Long Island, was likewise cared for. In addition to these, medical officers were sent to Camp Devens, Mass., where one complete division and large numbers of auxiliary troops were inspected; to Camp Dix, N. J., with its two complete divisions and many auxiliary troops; to Camp Meade, Md., Camp American University, Washington, D. C.; Camp Lee, Va.; Camp Humphries, Va.; Camp Crane, Allentown, Pa.; Camp Colt, Pa.; Camp Vail, N. J.; Fort Myer, Va.; Fort Wright, Long Island; and Fort Wood, Liberty Island. Many other smaller stations were handled in a similar manner. The officers in charge of these medical inspections held station in the office of the surgeon, port of embarkation, Hoboken, N. J., and proceeded to these camps in accordance with instructions. The medical officers assisting in these inspections were at times taken from the permanent personnel of the surgeon's office and at other times partly or in whole from the medical officers on duty, either permanent or temporary, at the camp where the inspections were to be held. At Camp Merritt, Camp Mills, and Camp Upton, where inspections were conducted almost daily, the arrangements for inspection, with the necessary orders and assignments, were almost invariably completed on the day preceding the inspection. This prevented loss of time. At other camps, however, the entire corps of inspectors had to be taken from the surgeon's office, as the camps in question did not come under the jurisdiction of this port.

The following method of procedure was adopted and carefully followed in all these inspections, and each inspector was thoroughly instructed in his duties. The men to be inspected were stripped to the waist and their breeches dropped to the knees. The inspection included an examination of the hair for lice and nits; the eyes for inflammation; the nose and throat for exudates, membranes, and patches; the chest, back, and abdomen for rashes and eruptions; and the genitals for venereal lesions and discharges.

Each man was checked on the sailing list of his organization and the names of absentees were taken, with their rank, serial number, and organization. These absentees were inspected later at the gangplank before they were permitted to board the transport. A list of those to be detained was given to each company commander, with instructions as to the disposition to be made of each case. A duplicate list was given to the camp surgeon, and a third list was filed with the report of the inspection in order that a check could be obtained at the time of embarking. Inspections at railroad stations and places other than the

camps were frequently necessary, owing to the rush of troops overseas. After each inspection, a complete report of the day's duty was written, typed, and delivered at the division office in Hoboken.


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Following is a summary of the examinations conducted during the existence of the transport division:

Month

Total examined

Total detained

Month

Total examined

Total detained

1917

 

1918-Continued

October

31,805

311

October

158,552

2,224

November

24,837

203

November

47,719

283

December

50,460

816

 

1,757,807

9,735

1918

 

OVERSEAS REPLACEMENTS

 

January

41,301

204

February

48,418

123

1919

 

March

78,793

174

May

3,822

---

April

98,304

244

June

4,102

---

May

202,395

287

July

1,893

77

June

236,914

1,589

 

9,817

---

July

272,022

579

August

260,235

803

September

206,052

1,895

Grand total

1,767,624

9,812


INSPECTION OF TRANSPORTS

During the embarkation days inspection of all United States Army transports was made by a board, consisting of one officer from the Inspector General's Department, one officer from the Quartermaster Corps, and one medical officer, which met on board each incoming transport as soon as it docked or as soon thereafter as practicable, and made the necessary inspections and recommendations. The transport division also transmitted to the senior medical officer of the troops on board a transport all necessary orders, special emphasis being placed on General Order No. 20, headquarters port of embarkation, 1917, which put upon the commanding officer of troops the necessity for seeing that all men had received smallpox vaccination and typhoid prophylaxis before debarking on the other side.

OTHER DUTIES AT THE PIERS

On board each transport, about to embark troops, were medical officers, representatives of the surgeon, in numbers varying as occasion demanded, from 1 to 30. It was the duty of these medical officers to see that no cases previously ordered to be detained were permitted to go on board; that all absentees from the preembarkation inspection were inspected; that any cases of illness developing after leaving the embarkation camp, with communicable disease contacts, were removed to properly designated hospitals; that any cases developing during the stay of the transport at the pier were removed; and that all service records and transfer cards were correctly indorsed and accompanied the patients. These officers remained on duty until the transport left her dock. A full report was then made of the duty performed.

DEBARKATION INSPECTIONS

The method of procedure in debarkation inspections was as follows: A corps of medical officers, known as boarding inspectors, was stationed at quarantine. One of these officers boarded each incoming transport, ascertained the number of sick and wounded on board, the number of ambulatory and litter cases, the types of the cases, and the number of dead. This infor-


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mation was at once telephoned to division headquarters at Hoboken. The boarding officer proceeded with the transport to her docking place, seeing that all records of the sick and wounded were properly indorsed, and then took charge of these records. He received correct lists of the sick and wounded and saw that the preparations for debarking these cases were complete.

Upon arrival of the transport at her dock, a medical officer, known as the transfer officer, who was in entire charge of the debarkation of the sick and wounded, boarded the transport and received the lists and records of all patients. These patients were then transferred by him, in accordance with a previously arranged disposition received from the sick and wounded division, to the proper hospitals. The means employed for this transfer were Army and Red Cross ambulances, receiving ships and transfer boats of the port surgeon's office, and trains. This work became enormous, as the task fell upon the transfer division of anticipating all transport arrivals, notifying all the other interested departments of the port surgeon's office of expected dockings, handling the actual debarkation of the sick and wounded, and seeing that the patients were cared for en route to the hospitals as well as moved as expeditiously as possible. On more than one occasion, 1,000 sick and wounded were removed from a transport to ambulances or to transfer boats in less than one hour's time, and yet with no evidence of haste. This work exceeded that of any other of the transport division's activities from December 1, 1918, to August, 1919. In addition to the officers mentioned above, one medical officer was assigned to accompany the sick and wounded to each one of the hospitals to which patients were transferred. Reports were made by each officer of the exact duties performed, and check lists, with receipts attached, were placed on file at the port surgeon's office. Great care was needed at all times in transferring communicable cases in order not to expose others to the infection, and no two types of contagious disease were permitted to occupy the same ambulance or the same compartment on a transfer boat.

The following is a monthly record of sick and wounded debarkations:

Month (1918)

Number

Month (1919)

Number

February

169

January

13,270

July

539

February

14,032

August

706

March

17,981

September

1,883

April

17,421

October

2,666

May

13,659

November

3,474

June

8,212

December

18,443

July

4,287

Total

27,880

Total

88,862

Grand total

116,742


CORRESPONDENCE

Owing to the enormous amount of paper work connected with the numerous reports of the division, it became necessary, in June, 1918, to establish a subdivision to properly coordinate, correct, and file this correspondence. The duties of this subdivision were the compilation, classification, and filing of the statistics gathered from the combined reports of all the activities of the transport division.


292

OTHER ACTIVITIES

In addition to the above, this division maintained a 24-hour service for the dissemination of information concerning the arrival and departure of transports and the disposition of sick and wounded to all other divisions of the port surgeon's office and to other departments of the port. It also inspected for communicable diseases nearly 30,000 casual officers returning from overseas. An office for this purpose was established in Hoboken. Another function performed by this division was the transportation of all nurses and female civilian employees returning from overseas to the Polyclinic Hospital, New York City, for physical inspection and, after inspection, to the Hotel Albert, over 9,000 having been thus transported.

TRANSPORT SUPPLY DIVISION

This division was organized in February, 1918, to provide for a systematic supply for transports. Transports had been furnished with medical supplies through the transportation and property division prior to that time, little attention having been required to provide the supplies demanded by the small number of ships engaged in the transportation of troops. It became necessary to have an efficient organization for this purpose when the number of ships was increased. No system of supply being in effect when the division was organized and assumed control of the medical supply of transports, some time and study were allotted to standardizing the amount and variety of supplies and equipment required on transports according to the number of troops carried. This plan, as accepted and later modified by the action of a

board, was placed in operation in February, 1918, and proved satisfactory.b

In April, 1918, the Surgeon General authorized the employment of civilian ship's surgeons of commercial vessels carrying troops to perform certain services which would be paid for from Medical Department appropriations. The duties connected with the procurement of such services, the preparation of vouchers, etc., were assigned to the transport supply division, it being in direct contact with the persons concerned.

The personnel of the division ultimately increased from a force of 1 commissioned officer and 1 enlisted man to 2 officers and 14 enlisted men.

The duties assigned to the division were as follows, on June 30, 1918: Equipment of hospitals on board transports; placing adequate medical and surgical supplies, vaccines, and Medical Department blank forms aboard the same; arranging for the shipment of vaccines and sera overseas for the use of the American Expeditionary Forces; contracting with ship's surgeons of commercial vessels carrying troops for their services and certifying vouchers for the payment of the same; and arranging for the medical supply of troop ships which sailed from Montreal, Halifax, Portland, Boston, Baltimore, and Philadelphia.

This division was consolidated with the finance division on November 20, 1918.

bBoard met Sept. 2, 1918. See account of the transport supply section of the finance division (p. 305) for record of the board proceedings.-Ed.


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TRANSPORTATION DIVISION

From August 8, 1917, when an ambulance from Governors Island was assigned to the surgeon, port of embarkation, until December 25, 1918, when the evacuation division was organized for the transfer of the returning sick and wounded to hospitals of the interior, and assumed the functions of the transportation division, changes in methods, policy, and personnel were a frequent occurrence, and had, of necessity, to keep pace with the general growth and development of port activities.

Beginning with the ambulance section, transportation, which then consisted entirely of ambulances, was directly under the Medical Department; later, when hospital trains and harbor boats were obtained, all the Medical Department transportation was placed in charge of an officer of the Quartermaster Corps who was assigned to duty in the office of the port surgeon, August 15, 1918. With the advent of the Motor Transport Corps (September 5, 1918), the control of ambulances passed to that branch of the service, although the actual operation of equipment remained under the Quartermaster Corps officer.

On October 2, 1918, when the port utilities office was established, it assumed control of the transportation, among other activities then being performed by the Quartermaster Corps, and held the control until May 15, 1919, when all transportation, whether water, rail, or ambulance, was placed in charge of the port transportation officer. On March 8, 1919, the port surgeon assumed control of Medical Department harbor boats, through a medical officer placed in direct charge to represent him, and on May 2, 1919, he took over the ambulances and placed them under an officer of the Sanitary Corps assigned to duty in his office. At first glance, it would seem that such frequent administrative changes would have resulted in endless confusion, and, no doubt, such a state would have obtained had not the port surgeon, either directly (as he actually did during the early days), or through a medical officer assigned to represent him for the purpose, maintained the most intimate supervision.

Soon after the receipt of an ambulance from Governors Island the New York World donated an ambulance to the Medical Department. This was followed by the donation of an ambulance from the sheriff's panel of the grand jury, New York City. Shortly afterwards, a number of Medical Department ambulances were assigned to the port from General Hospital No. 1, New York City. A noncommissioned officer was placed in charge of ambulances and ambulance transportation August 28, 1917. On November 13, 1917, ambulances were placed under the officer in charge of the property division.

The first step was taken for the provision of rail transportation for the Medical Department on December 23, 1917. Hospital train No. 1, consisting of 10 cars and a personnel of 2 officers and 25 enlisted men, reported for duty at Hoboken on the above mentioned date. A school of instruction for officers and enlisted men was inaugurated January 22, 1918, in order to have trained personnel available for the purpose of manning additional hospital trains in the United States. When the organization of this school had sufficiently progressed, the officer conducting it was relieved from duty with the train and sent to Chicago, Ill., where he supervised the construction of hospital trains Nos. 2, 3, and


294

4. Hospital train No. 4 was sent to Hoboken on June 29, 1918, and hospital train No. 2 reported on October 11.

The transportation division in the office of the surgeon was officially established on January 16, 1918, with the following duties: Operation and maintenance of motor ambulances; enforcement of instructions from the War Department regarding the same; transportation of sick and supplies; procurement and insurance of transportation (street car and ferry tickets) used in the port surgeon's office, and accounting for same.

OFFICE OF TRANSPORTATION OF SICK AND WOUNDED

This office was created on August 9, 1918, after the assignment to the Medical Department of certain harbor boats for the transportation of sick and wounded. It was placed in charge of an officer of the Quartermaster Corps. All transportation, land and water, whether Government owned, Red Cross, or commercial, assigned for the use of the Medical Department at the port was placed under the control of this office, in so far as movements of that transportation were concerned. This officer was also charged with the responsibility of procuring such additional transportation as might be necessary for the use

of the Medical Department. Liaison was maintained by him between the port surgeon's office and the United States Railroad Administration for the procurement of rolling stock, issuance of rail transportation and requests for sleeping-car accommodations, and the routing of sick-and-wounded movements. In addition, this office handled the disbursing of money for commutation of rations on the hospital trains and unit cars. The maximum personnel on duty in the office was 8 officers and 13 civilians. Orders from headquarters, port of embarkation, on October 11, 1918, directed that, on request of the port surgeon,

transportation should be furnished by the port utilities officer and the Motor Transport Corps for conveying enlisted sick men to their respective organizations when fit for duty. This function was carried out through the officer in charge of transportation of sick and wounded.

ESCORT DETACHMENT

Perhaps the first important step looking to an organization for the evacuation of sick and wounded from overseas was the creation of the escort detachment, on October 15, 1918. This organization, established with headquarters at the Greenhut Hospital, was later moved to the adjoining Cluett Building. The commanding officer of the detachment was responsible for the transfer of all patients from the debarkation hospital to the railhead at which entrainment took place. From this point, the commanding officer of the unit car or hospital train took charge of the transfer, unless the movement was without

hospital train or unit car but made on equipment attached to a regular train, in which case the senior escort officer was responsible from the debarkation hospital to destination. An officer of this organization was detailed to make daily trips to every debarkation hospital in the port for the purpose of investigating the condition of patients scheduled for transfer. The size of the escort and the quantity of medical supplies necessary for each trip were determined from the report of the liaison officer. The commanding officer of the escort


295

detachment maintained a course of instruction for officers and enlisted men in the routine duties which they were expected to perform while on the road, and, when called upon by the officer in charge of the transport service, he furnished personnel to assist in the debarkation of sick and wounded received from overseas. The maximum personnel of the escort detachment was 93 officers and 491 enlisted men.

DIRECTOR OF HOSPITAL TRAINS

Prior to November 23, 1918, the hospital trains functioned independently, but their activities had been most limited. On November 23, 1918, however, the office of the director of hospital trains was established.

ORDERS SECTION

It was the invariable practice to list the name of every patient transferred from this port in the order directing the movement. These orders were written at headquarters, port of embarkation, upon request from the office of the port surgeon, but the work increased to such an extent that it became advisable on August 9, 1918, to detach five field clerks from headquarters for duty in the office of the port surgeon, where their work was supervised by the evacuation officer.

EVACUATION DIVISION

One of the most important and difficult problems arising during the war was the change to be effected at the port of embarkation from a function as a port of delivery of soldiers for shipment overseas to that of a receiving port for their return to their homes. The problem of evacuating the sick and wounded from the debarkation hospitals in which they were entered upon return from overseas to hospitals in the interior was successfully solved by thoroughly organizing and building up a system sufficiently elastic to meet the most exacting and unexpected requirements, for it may be readily understood that any system,

to be successful, must be prepared to evacuate patients as rapidly as they are received from overseas.

The return of sick and wounded from overseas was so small numerically, prior to the signing of the armistice, that little effort had been made to systematize or coordinate the activities of the various organizations described above, all of which were engaged in the transfer of patients. It was deemed expedient to create a separate division under the surgeon, port of embarkation, for this purpose, when increased demands were made upon the transportation machinery. Accordingly, on December 25, 1918, the surgeon created the evacuation division as a separate department by consolidating the above-mentioned units. The officer in charge of this division was made responsible for the supervision and coordination of the efforts of all individuals and organizations concerned in the transportation of sick and wounded between the various hospitals at the port, and from these hospitals to those of the interior. This organization carried on its work to a successful conclusion without material change in the system as outlined.

The evacuation division consisted of seven separate organizations: Three hospital trains, the unit car group, the escort detachment, the office of trans-


296

portation of sick and wounded, and a detachment of field clerks, comprising a maximum personnel of 155 officers, 865 enlisted men, 71 civilian employees, and 6 field clerks.

The bed capacity at the port of embarkation during the most active period of the return of sick and wounded soldiers was 18,000, and this was not too large, for on several occasions the margin of safety was reduced to 2,500 beds. The arrival of several of the larger transports carrying patients at these times might easily have filled all hospitals to full capacity.

In accordance with cabled estimates from the American Expeditionary Forces, the evacuation division was organized to handle a maximum of 10,000 patients a month; however, this estimate was exceeded

in the months of December, 1918, and January, February, March, April, and May, 1919, and in the month of March it was nearly doubled.

Fundamentally, the purpose of the evacuation division was to keep the sick and wounded moving through the port to interior hospitals at the same rate at which they were received from overseas. In order to perform this function, it was necessary to provide rolling stock-that is, hospital trains and hospital unit cars-suitable for the transportation of both ambulant and litter patients, and to train medical personnel in the correct conditions governing the safety, care, and subsistence of these patients while en route.

HOSPITAL TRAINS AND UNIT CARS

On January 21, 1919, 10 hospital unit cars were sent to this port. Each car was built to accommodate approximately 28 litter patients, and the beds were of such a type as might be used for any kind of medical or surgical case. They could be converted into several positions by a single adjustment, depending upon the type of accommodation desired. A kitchen with a capacity for feeding approximately 250 persons was installed at one end of each car. The plan proposed was to use each of these cars as a nucleus upon which to assemble a hospital train, thus Pullman or tourist cars could be attached to the unit

car up to the feeding capacity of the kitchen. The unit car carried the administrative personnel and the more seriously sick and wounded. When it became apparent that even this amount of equipment would not be sufficient, an arrangement was made with the Pullman Co. whereby 10 more cars-tourist, kitchen, hotel, and private car types-were leased to the Government for the purpose of transporting our sick and wounded. This brought the total equipment up to 3 hospital trains and 20 unit cars, and with this number it was found possible to evacuate 20,000 patients a month to interior hospitals and to feed most of them to destination.

Each hospital train carried a personnel of 3 officers and 25 enlisted men and functioned as an independent organization. Its personnel were quartered and rationed on the train at all times. When, as rarely happened, it became necessary to increase the personnel, an additional escort was drawn from the escort detachment. The unit cars were placed in a separate organization, known as Hospital Unit Car Group No. 1, on January 26, 1919. Each car carried a personnel of 1 officer, 1 noncommissioned officer, 2 cooks, and 2 privates or privates first class. When a hospital unit car was extended into a hospital


297

train by the addition of tourist or Pullman cars, the necessary increase in the complement of commissioned and enlisted personnel required for a trip was drawn from the escort detachment. The escort personnel returned to the mother organization at the conclusion of a trip. All hospital trains and unit cars of this port were located at the Pennsylvania Railroad yards, Waldo Avenue, Jersey City, N. J., and were under the direct control of the director of hospital trains. This officer had general supervision of the equipment and personnel, and he was held responsible that these units were kept in a state of

efficiency and readiness for service at all times. He also supervised the work of the entrainment officers, six in number, and had charge of the entrainment of patients at the various railheads in the city of New York and vicinity.

FEEDING

The problem of feeding patients on hospital trains and unit cars was by far the most difficult one that this division had to solve. There were several reasons for this. In the first place, enlisted cooks were extremely hard to get and those that were obtained were lacking in training. The ranges and other kitchen paraphernalia on kitchen cars and hospital trains offered many difficulties to the uninitiated which would not be met in stationary hospitals. It is obvious that individuals traveling on trains, owing to the lack of exercise, monotony of travel, and the tendency to car sickness, required an unusually

attractive and appetizing diet. Before the Red Cross canteen service had perfected its organization, many well-meaning but misguided citizens were a bit overzealous, and proffered all sorts of delicacies, fruits, candy, etc., to the patients en route, and these at unseasonable hours. The soldiers thus indiscriminately fed naturally did not relish the wholesome food served by the Medical Department at regular hours.

Movements of patients by railroad were of three types, from the feeding point of view: By hospital train, by unit-car combinations, and by nonfeeding combinations. A hospital train provided a complete feeding equipment for the entire trip. In a unit-car movement, the unit car was attached to a train of sleeping cars. These latter movements consisted of patients destined for several hospitals which were so located that the various detachments of patients could travel a considerable distance as a unit before it was necessary to divide the train for its several destinations. Feeding in the third type, if of more

than a few hour's duration, was provided for by sending cooked rations with the men, by purchasing meals en route, or by a combination of the two. The cooked ration method was not satisfactory, particularly when cooked rations were supplied for more than one meal. The patients preferred hot and more appetizing food and a large proportion of the food provided was wasted. The expense of

preparation was greater than the ration allowance, thereby forcing an unwarranted necessity for economy upon the remaining patients in the hospital of origin. The purchase of meals en route was equally unsatisfactory, owing to the irregularity of stops where such purchases could be made.

Feeding difficulties were largely overcome through the efforts of the mess officer, who made special investigations of this problem for a period covering


298

approximately six weeks and whose recommendations were found most helpful. The first step was to standardize the menus so that even a mediocre cook could learn to prepare well a few simple diets. Somewhat later, on request of the Surgeon General, the commutation rate for patients traveling on hospital trains was increased to $1 per diem for each patient. Twelve colored cooks were

obtained from the Pullman Co. early in 1919 and employed on the trains, as an experiment. The experiment worked so well that, subsequently, all enlisted cooks were replaced by colored Pullman chefs, most of whom were men who had had many years experience in cooking on railroad trains. After adjustment of the difficulties enumerated, the hospital train cuisine was generally conceded to be highly satisfactory.

DISH WASHING

The problem of dish washing on hospital trains originally seemed almost insurmountable. This can be understood when one considers the lack of space and facilities necessary for proper sterilization of kitchen and mess equipment. This difficulty was overcome, however, by the use of paper cups and dishes. These were used for but one meal and were then discarded, thus obviating the necessity for washing anything but silverware.

EVACUATION OF OFFICERS

A number of complaints were received from officer patients traveling with the enlisted sick on hospital trains during the early part of the work. It was difficult to provide separate accommodations for officers and, obviously, a special officers' mess was not practicable. This situation was met by sending all officers who were physically able to travel without medical attendance on regular trains with ordinary commercial transportation. These constituted about 90 per cent of the entire number, and the scheme expedited the evacuation of officers.

RAILROAD SERVICE

Due to the splendid system of railroads under the control of the United States Railroad Administration, transporting sick and wounded from the port of embarkation was done, on the whole, in a highly satisfactory manner. This feature of the work offered many problems, due, however, to the fact that the railroads at first were very slow to appreciate the difference between an ordinary troop movement and a movement of sick and wounded soldiers. The port surgeon insisted from the very beginning that trains carrying patients be given the very best service available and right of way over all other classes of transportation and every delinquency on the part of the railroads affecting the evacuation of sick and wounded was investigated by an officer familiar with railroad transportation. His reports were brought to the attention of the local representative of the United States Railroad Administration.

COORDINATION OF TRANSFER

Another phase of the work requiring very careful study was the coordination of transfers from the various hospitals in and about New York to the railhead or point of entrainment. Transportation facilities in New York were excellent, but the 13 hospitals were scattered over an area approximately 35


299

miles in diameter. Five of these hospitals were located on islands; 3 were on the island of Manhattan itself; 2 were in the Bronx; and 4 were on the west side of the Hudson. It will be seen that every movement had to be initiated by a rather complicated system of local rail, ambulance, and water transportation. It was only by a study of the requirements for each particular movement and the preparation of a detailed itinerary for the information of all concerned that this complicated situation could be met.

MEDICAL ATTENDANCE EN ROUTE

The problem of medical attendance en route was at first very simple because the large majority of cases were healed or convalescent surgical patients who required little attention in the way of medical treatment or diet. Later, however, the medical cases predominated, so that more attention had to be given to treatment and to diet. It was found necessary to send female nurses on hospital trains for the first time on June 6, 1919, and after that date this practice was employed wherever there was any indication for such care. The requirements in the way of medical attendance and diet were carefully studied for each individual before entrainment, and the interest of the patient was at all times a matter of first importance, all other issues having been subordinated to this. As one example of what could be and was accomplished wherever the need arose, the following case is cited:

On August 20, 1919, private John Doe, a patient in General Hospital No. 1, New York, was transferred to the Letterman General Hospital, San Francisco, Calif.; this patient was suffering from a broken back, and was in a very hazardous condition. In fact, the risk of transporting him was so great that it was not deemed advisable by the surgeon, but upon written request from the man's relatives and a statement signed by them in which they assumed all responsibility for the transfer, arrangements were made to bring it about in such a manner as to provide the greatest comfort with the least risk to the

patient. Accordingly, a bed (which was so constructed that it could be removed from the car and used as a litter) was removed from a section on unit car No. 16 and taken to the hospital in New York, where the patient was received and transported to destination at Letterman General Hospital, San Francisco, Calif., without change from this bed. In addition to the regular personnel of this car, consisting of 1 medical officer and 5 enlisted men, 2 female nurses were ordered to accompany this patient, so that a 24-hour attendance was provided throughout. The patient reached his destination safely, apparently in

as good condition as when he left New York.

HOSPITAL TRAIN NO. 1

Hospital train No. 1 was assigned to the port of embarkation in December, 1917, but up to June 30, 1918, little use was made of the train. Several transfers only were effected during this period. During July, August, and September, 1918, the train was undergoing repairs at the Waldo Avenue yards, Jersey City, N. J., and at the Pullman car shops at Pullman, Ill. On October 11, 1918, the train returned to this port and was then active in the transportation of the sick and wounded. The first movement of patients was accomplished on October


300

19, 1918. First-class colored cooks, former Pullman employees, were used on this train and, after the ration allowance of hospital trains and unit cars was raised to $1 a day for each patient, excellent meals were served, consisting of several varieties of meat, fowl, fish, and vegetables. Ice cream was served to patients once daily, and they apparently were satisfied with both cuisine and treatment. The personnel of the train consisted of 3 officers and 25 enlisted men. Didactic lectures and practical instructions were given to the personnel as opportunity offered, between trips, and they were kept in good physical

condition by foot and litter drills.

Following is a statistical table showing the activities of this train:

Statistical report, hospital train No. 1

Month

Trips made

Mileage

Patients carried

Meals served

1918

 

 

 

 

March

1

480

101

202

April

1

60

45

45

October

1

2,700

104

566

November

2

5,400

312

2,053

December

4

9,300

579

3,089

1919

 

 

 

 

January

3

2,500

421

1,077

February

4

8,200

648

3,101

March

6

8,900

824

3,357

April

2

6,700

573

2,284

May

4

15,000

698

5,003

June

5

9,900

802

3,130

July

6

11,700

825

3,769

Total

39

80,840

5,932

27,676


HOSPITAL TRAIN NO. 2

Hospital train No. 2 was assigned to duty at the port of embarkation on October 11, 1918, and made its first trip with patients on October 16, 1918, carrying 91 patients to General Hospital No. 26, Fort Des Moines, Iowa. The statistical report immediately following gives the statement by months of the activities of this train.

Statistical report, hospital train No. 2

Month

Trips made

Mileage

Patients carried

Meals served

1918

 

 

 

 

June

3

1,250

124

523

October

3

6,280

213

1,163

November

1

320

134

268

December

5

8,720

598

2,500

1919

 

 

 

 

January

3

6,260

442

2,387

February

4

5,300

643

2,844

March

5

11,780

752

3,806

April

4

8,300

699

2,810

May

5

8,680

961

4,200

June

4

6,760

257

2,286

July

2

800

172

350

Total

39

64,450

4,995

23,137


301

HOSPITAL TRAIN NO. 4

This train generally was used for the transportation of patients from the port hospitals to various interior hospitals. The majority of the patients transported were ambulatory, approximately 9 per cent being litter cases. Appended is a statistical report of the activities of this train.

Statistical report, hospital train No. 4

 

Month

Trips made

Mileage

Meals served

Patients carried

1918

 

 

 

 

August

3

2,100

152

58

September

2

104

0

265

October

5

4,770

984

494

November

3

804

242

361

December

4

8,020

2,430

627

1919

 

 

 

 

January

3

6,420

2,068

547

February

3

5,500

1,537

435

March

5

12,840

3,415

938

April

2

5,020

1,545

331

May

4

7,020

2,350

736

June

5

7,020

3,138

797

July

2

2,030

1,137

441

Total

41

61,648

18,998

6,030



HOSPITAL UNIT CAR GROUP NO. 1

This organization was created on January 26, 1919. Ten new unit cars designed by the Medical Department, United States Army, for the transportation and the feeding of sick and wounded were then lying in the Waldo Avenue yards, Jersey City, N. J., without equipment of any kind and with no personnel assigned. Car No. 12 was fully equipped, an officer was placed in charge, and it departed on its first trip for Camp Grant, Ill., in 12 hours, with 187 patients. All 10 cars were fully equipped and personnel assigned within four days and they were ready for active service. During the next two weeks, it was decided to

assign the leased cars which were already in operation at the port to the unit car group, and nine more cars with personnel were added to the organization. Three more kitchen tourist cars of the "1300" series were added early in March when the work became so heavy it was seen that the 19 cars in service could not handle the enormous numbers of sick and wounded returning from overseas. One car was removed from service because of age, but the remaining 21 cars were in active service until June 30, 1919.

Patients with wounds of every kind were transported, and the condition of the patient was such as to require special diet in a large number of cases. Many were absolutely helpless and had to be bathed and fed and every personal want attended to. Many were gassed cases or were suffering from advanced tuberculosis. Extreme care was necessary with every change of altitude and temperature when transporting these cases. Others were mental cases, some being so violent as to require restraint. Yet, in spite of all of the seemingly hopeless conditions of many of the patients, this enormous amount of work was accomplished without the loss of a single case en route, either by accident or from natural causes.

The statistical table immediately following gives an idea of the number of patients carried, distance traveled and meals served en route.


302

Statistical report, hospital unit car group No. 1

Months

Trips made

Mileage

Patients carried

Meals served

1919

 

 

 

 

February

33

75,800

4,825

11,259

March

73

151,850

10,548

16,020

April

127

331,590

7,933

77,464

May

62

178,960

7,540

60,422

June

34

89,850

4,693

22,800

July

17

41,200

2,708

11,748

Total

346

869,250

38,247

199,713


DIRECTOR OF AMBULANCES

In this office the ambulance transportation was handled as follows: (1) Local transfers; (2) debarkation (transport to debarkation hospital); (3) evacuation (debarkation hospital to railhead).

A garage was maintained at 512 West Fifty-sixth Street, New York City, which accommodated about 85 ambulances. The evacuations from hospitals in New York were taken care of by ambulances from this garage, as well as the debarkation of sick and wounded returned from overseas destined to hospitals in New York. A garage accommodating about 20 ambulances was maintained at 208 River Street, Hoboken, N. J., for the evacuation of patients from hospitals on the New Jersey side, and the transporting of sick and wounded returned from overseas from the transports to the hospitals of New Jersey. This latter garage was the only one operating under the Medical Department at the end of June, 1919.

The American Red Cross and the Motor Corps of America cooperated with the Medical Department in the transporting of nurses and sick and wounded when the Government service was congested by the simultaneous arrival of any considerable number of transports.

The maximum number of personnel on duty was 3 officers and 130 enlisted men. The following table shows the activities of this service.

Statistical report, director of ambulances

Month

Ambulances

Unserviceable

In operation

Patients transferred

Nurses transferred

Trips made

Calls received

1918

 

 

 

 

 

 

 

March

(a)

(a)

(a)

1,297

0

336

276

April

(a)

(a)

(a)

1,386

0

428

342

May

(a)

(a)

(a)

691

0

356

219

June

(a)

(a)

(a)

1,061

0

414

321

July

39

14

25

1,157

0

316

264

August

39

4

35

1,767

0

341

312

September

39

4

35

2,444

0

686

581

October

43

6

37

3,285

1

964

821

November

45

5

40

1,311

77

564

416

December

91

11

80

8,657

34

2,621

1,289

1919

 

 

 

 

 

 

 

January

85

12

73

11,350

169

1,627

736

February

71

11

60

12,475

249

1,710

739

March

112

19

93

24,825

421

2,874

1,012

April

112

29

83

24,069

89

2,755

769

May

114

21

93

21,849

423

2,374

874

June

137

30

107

10,534

1,532

1,987

667

July

29

0

29

5,752

1,421

1,404

671

Total

---

---

---

133,910

4,416

21,757

10,309


aNo record


303

FINANCE DIVISION

This division was organized in August, 1917, and placed under the charge of a noncommissioned officer. Its principal duty was the purchase of supplies and the preparation of the proper vouchers in payment therefor. In September, 1917, this division was incorporated with the property division. In the latter part of November, 1917, the Finance Division was again instituted as a separate division under the control of the executive officer, and in December, 1917, the finance division was entirely reorganized, with duties as follows: Checking, modification, or approval of requisitions for medical, dental, or veterinary

supplies for all organizations under the control of these headquarters; checking of all money papers for the Medical Department-i. e., vouchers for supplies purchased, services rendered, pay rolls for nurses and civilian employees; and all matters and papers pertaining to the hire, discharge, resignation, etc., of civilian employees of the Medical Department at this port. In January, 1918, the medical supply depot, Camp Merritt, was reorganized and also placed under this division.

All matters relating to the medical supplies and equipment of hospitals organized at the port of embarkation were under the immediate jurisdiction of the chief of this division; also medical supplies for organizations proceeding overseas.

From January, 1918, until the signing of the armistice, November 11, 1918, all troops embarked from this port were completely supplied with such medical equipment as they required, this equipment often being a complete combat equipment, camp infirmary, of full authorized equipment. Other shortages in authorized equipment were made up prior to their embarking. To make this feasible, it was necessary that these supplies should be promptly furnished the medical supply depots at Camp Merritt and Camp Mills by the supply division of the Surgeon General's Office. It frequently happened that when there was an insufficient amount of equipment to meet requirements on hand at these depots, the chief of this division could telephone or telegraph to the supply division, Surgeon General's Office, and these supplies would immediately be rushed from one of the large medical supply depots and would reach the destination within three days, therefore very little difficulty was experienced in supplying troops en route overseas.

On November 20, 1918, the division known as the transport supply division of the port surgeon's office was transferred to the finance division, all personnel and duties of that division being assumed by the chief of the finance division. On January 1, 1919, pursuant to War Department instructions, all matters pertaining to requisitions, supplies and medical supply depots were removed from the jurisdiction of the Medical Department. On April 23, 1919, the division known as the hospital division, office of the surgeon, was transferred to the finance division.

The organization of the finance division at the end of the fiscal year, 1918, was as follows:

FINANCE SECTION

Personnel on duty: Commissioned, 1; enlisted, 1; civilian employee, 1.

The duties of this section were as follows: (a) Checking all money papers for hospitals and medical organizations at this port. (b) Charge of all matters


304

relating to civilian employees of the Medical Department at the port. (c) The checking of hospital fund statements. (d) Charge of all matters relating to supplies or equipment pertaining to the Medical Department.

From the date on which this division was organized (August, 1917) until July 1, 1918, vouchers amounting to approximately $1,913,139 were checked and verified by this section.

TRANSPORT SUPPLY SECTION

Personnel on duty: Commissioned, none; enlisted, four.

The duties of this section were as follows: (a) To enter into contract with the ships' surgeons of commercial vessels carrying troops, for their services, and to certify vouchers for the payment of same. (b) Upon the arrival of any vessel at this port, which had carried troops from Europe or that was to carry troops from the United States to Europe, to verify the medical supplies and hospital equipment aboard, and to determine what supplies would be required for the next voyage of the vessel, and to submit requisitions to the supply division for the supplies required. (c) To direct the removal of medical supplies on

vessels arriving at this port which were not to be used for transporting troops.

The transport supply section was organized as a division in January, 1918, to supply and place aboard transports of all classes sufficient medical supplies for the needs of the American troops carried overseas. The division became a part of the finance division on November 20, 1918. Much difficulty was encountered in determining what medical supplies would be necessary to provide adequate medicines and equipment on these vessels. A medical unit was finally determined upon by the officer in charge of the division. A unit was placed on each vessel leaving this port; in case adequate hospital supplies or

equipment were not already installed on the vessel, the supply of such articles as were necessary was also placed aboard the vessel.

Supplies were furnished the four general classes of vessels used in the transportation of troops, as follows: Army transports: All medical and hospital supplies and equipment were provided by this division. Navy transports: The Navy provided medical and hospital supplies on these vessels. Vaccines, sera, and U. S. Army Medical Department blank forms were provided by this division. Commercial transports: It was necessary that a survey be made on each vessel to determine what equipment, instruments, etc., would be needed to provide adequate hospital and surgical facilities aboard the vessel, inasmuch as such equipment as was aboard the vessel would be available for the use of the Army. A requisition was then submitted covering the deficiencies noted. All medicines, dressings, and other expendable items were supplied and put aboard these vessels at this port prior to their departure. Animal transports: It was necessary that each vessel be surveyed to determine the amount of supplies and equipment necessary to provide for the troops assigned to the vessel and to supply such deficiencies as were noted. It was also necessary to provide veterinary medicines, instruments, and equipment for the care of the animals

en route.

A board of officers was appointed early in September, 1918, in an endeavor to standardize this demand for transport supplies. The recommendations of this board, as given below, were adopted and utilized in the supply of all transports.


305

PROCEEDINGS OF A BOARD OF OFFICERS CONVENED AT PORT OF EMBARKATION, HOBOKEN, N. J., TO INVESTIGATE AND REPORT UPON THE ALLOWANCE OF MEDICAL AND HOSPITAL SUPPLIES WHICH SHOULD BE PROVIDED ABOARD TRANS-ATLANTIC TRANSPORTS

Orders, No. 170

OFFICE OF THE SURGEON, PORT OF EMBARKATION,

Hoboken, N. J., September 2, 1918.

1. A board of officers, consisting of: * * * is hereby appointed for the purpose of submitting recommendations as to the medical supplies to be furnished troopships of the several classes-(1) Army, (2) Navy, (3) allied, assigned to American convoy, and to (4) animal transports, sailing between ports under the jurisdiction of these headquarters and European ports.

SEPTEMBER 2, 1918.

Pursuant to foregoing order, the board met on September 2, 1918, and thereafter daily until their work was completed, all members being present at each meeting. After due consideration as to the requirements of the various classes of transports carrying troops to Europe and at the same time the probabilities of each of the several classes carrying sick and wounded from Europe to this port, it is recommended:

1. That a unit to be known as a "surgical unit" be put aboard all vessels carrying troops to Europe when an Army medical officer is assigned to duty as transport surgeon, regardless of the class of vessel or number of troops carried. It is further recommended that, on vessels having adequate hospitals and operating-room equipment, which would be available for use by the transport surgeon, the officer in charge of the transport supply division of the office of the surgeon, port of embarkation, Hoboken, N. J., be authorized to reduce this equipment as may be required in order to prevent duplications. List of articles selected for the unit to be known as a "surgical unit" attached * * *

2. That a unit to be known as a "medical unit" be put on transports of every class leaving this port en route to Europe. List of articles selected for the unit attached  *  * * This unit is based on the allowance of 1,000 men for the trip, and it is further recommended that one of these units be placed aboard for each 1,000 or fraction of 1,000 troops carried.

3. That a unit to be known as "dental emergency outfit, B " be put aboard each transport carrying troops, this unit to be as per list attached * * *.

4. That a unit to be known as a "sera and vaccine unit" be put on transports of every class leaving this port en route to Europe. List of sera and vaccine and amounts selected for this unit attached * * *. This unit based on allowance for 1,000 men for the trip and it is further recommended that one of these units be placed aboard for every 1,000 troops carried, and that, in cases where fractional parts of 1,000 troops are carried, it be reduced in proportion.

5. That blank forms be placed aboard ships according to the class of vessel. Lists of forms selected for the various classes of vessels attached * * *. This unit is based on the allowance of 5,000 men for the trip, and it is further recommended that one of these units be placed aboard for every 5,000 or fraction of 5,000 troops carried.

6. It is recommended that all medical supplies and equipment placed on transports be provided by the property officer, office of the surgeon, port of embarkation, and that, in order to reduce the paper work in connection with reports and returns, he be authorized to drop from his return all articles of expendable property called for in these units, but that he invoice to the transport surgeon all nonexpendable articles, invoices, and receipts to be accomplished in accordance with existing regulations.

7. That the transport surgeon be furnished with a copy of each of these units, and that he be instructed that, upon his return to the port on each trip, he put in a requisition to the transport supply officer, office of the surgeon, port of embarkation, Hoboken, N. J., requesting such articles as he may need to bring his supply up to the authorized allowance.


306

MEDICAL UNIT

Acidum boricum, powder, ½ pound in bottle

bottle

1

Adrenalin chloride, 1-milligram tablets, 25 in tube 

tube

1

Ęther, ¼ pound in tin

tins

8

Alcohol, l-quart bottle

bottles

2

Apomorphinę hydrochloridum, 6-milligram hypodermic tablets, 20 in tube

tube

1

Argyrol, 1 ounce in bottle

bottle

1

Aspirin, 324-milligram tablets in bottle, 500 in bottle

bottles

2

Argenti nitras fusus, 1 ounce in bottle

bottle

1

Atropinę sulphas, 0.65-milligram hypodermic tablets, 20 in tube

tubes

2

Bismuthi subnitras, 324-milligram tablets, 500 in bottle

bottle

1

Chloralum hydratum, 324-milligram tablets, 500 in bottle

do

1

Chloroform, ¼ pound in tin

tins

2

Cocainę hydrochloridum, 10-milligram hypodermic tablets, 20 in tube

tubes

2

Codeina, 32-milligram tablets, 500 in bottle

bottle

1

Collodium, 1 ounce in bottle

bottles

2

Digitalinum, 1-milligram hypodermic tablets, 20 in tube

tube

1

Glycerinum, 1 pound in bottle

bottle

1

Hexamethylenamina, 324-milligram tablets, 500 in bottle

do

1

Hydrargyri chloridum corrosivum, tablets, 500 in bottle

do

1

Hydrargyri chloridum mite, 32-milligram tablets, 500 in bottle

do

1

Hyoscinę hydrobromidum, 0.65-milligram hypodermic tablets, 20 in tube

tube

1

Iodum-potassi iodidum, in tube, 10 tubes in box

box

1

Liquor formaldehydi (37½ per cent), 1 quart in bottle

bottle

1

Magnesii sulphas, 4 pounds in tin

tins

4

Misturę glycyrrhizę compositę, tablets, 1,000 in bottle

bottle

1

Morphinę sulphas, 8-milligram hypodermic tablets, 20 in tube

tubes

4

Nitroglycerin, 0.65-milligram hypodermic tablets, 20 in tube

tube

1

Normal saline solution tablets, 100 in bottle

bottle

1

Oleum carophylli, 1 ounce in bottle

do

1

Phenylis salicylis, 324-milligram tablets, 500 in bottle

do

1

Pilulę catharticę compositę tablets, 500 in bottle

bottles

4

Pilulę camphorę et opii, 25 in box

box

1

Potassii bromidum, 324-milligram tablets, 500 in bottle

bottle

1

Potassii iodidum, 324-milligram tablets, 500 in bottle

do

1

Protargol or equivalent, 1 ounce in bottle

bottles

2

Pulvis ipecacuanhę et opii, 324-milligram tablets, 500 in bottle

bottle

1

Quininę sulphas, 200-milligram tablets, 1,000 in bottle

do

1

Sodii bicarbonas, 324-milligram tablets, 1,000 in bottle

do

1

Sodii salicylas, 324-milligram tablets, 500 in bottle

do

1

Spiritus ammonię aromaticus, ½ pound in bottle

do

1

Strychninę sulphas, l-milligram hypodermic tablets, 20 in tube

tubes

4

Trochisci ammonii chloridi, 100 in bottle

bottles

2

Unguentum hydrargyri, ½ pound in bottle

do

2

Unguentum hydrargyri chloridi mitis, 30 per cent, ½ pound in bottle

do

2

Stationery

Envelopes. official, letter

number

25

Paper, letter:

   

Typewriter

quire

1

Manifolding

do

1

Paper, carbon, letter

sheets

4

Miscellaneous

Medicine droppers

dozen

½

Pins, safety

do

1

Sutures, catgut, plain, sterile, 3 sizes in package

packages

6

Syringes, penis, glass, in wooden box

number

12

Thermometers, clinical

do

2

Needles, curved, surgical

do

4

Brushes, hand, fiber

do

1

Plaster, adhesive, zinc oxide, 2½ inch by 6 yards, on spool

spools

4

Cotton, absorbent, 1 pound in roll

rolls

3

Gauze, plain, 25 yards in roll

do

2

Bandages, gauze, roller, 6 dozen in box

boxes

2

Tongue depressors, wooden

number

100

Tags, diagnosis, in book

book

1

Applicators for throat, wood

number

50

DENTAL EMERGENCY OUTFIT "B"

Medicines

Adrenalin chlorid, 1-milligram tablets, 20 in tube

tube

1

Cocainę hydrochloridum, ¼ ounce, in wide-mouth bottle

bottle

1

Cresol, 1 pound in bottle

do

1

Eugenol, 1 ounce in bottle

do

1

Phenol, camphorated, ½ pound in bottle

do

1

Tinctura aconiti, 1 ounce in bottle

do

1

Tinctura iodi, 4 ounce in glass-stoppered bottle

do

1

Novocain, 50-milligram hypodermic tablets (or equivalent)

number

10

Blank forms

Register of dental patients card, Form 79

number

150

Report of dental work, Form 57

do

12

Instruments and appliances

Cases, office, preparation, extra ½-ouncc glass-stoppered bottles for

number

6

Chisels, 3, 48, of each

do

1

Cleaners, root-canal, Donaldson's or S. S. W., No. 5, all fine, in package

packages

4

Elevators:

 

 

Knott's type, right and left, metal handles, of each

number

1

No. 3, metal handle

do

1

Engine instruments for hand piece No. 7:

 

 

Burs, round, 4, 6, 8, 9, of each

do

1

Drills, 100, 103, of each

do

1

Excavators, Black's cutting instruments, No. 57, 58, 63, 64, 81, 83, of each

do

1

Explorers, L. H., 11, 12, 18, of each

do

1

Forceps, tooth-extracting, 15, 18R, 18L, 65, 150, 151, of each

do

1

Holders:

   

For cotton, Metho's type

do

1

For nerve broach, No. 2

do

1

Hones, oil, Arkansas stone, in wooden box

do

1

Lancets, abscess, metal handles, octagon, No. 2

do

1

Mirrors, mouth:

   

Aluminum handles, No. 4

do

2

Extra glasses for, size No. 4, plain

do

2

Pliers, dressing, No. 17

do

2

Pluggers, amalgam, Woodson's, 1, 2, 3, of each

do

1

Scalers, L. H., No. 3

do

1

Scissors, gum, curved on flat, No. 22

do

1

Slabs, mixing, glass, No. 6

do

1

Spatulas, No. 24

do

1

Syringes:

   

  Hypodermic-

   

  All metal-

   

  Dental, 172A

number

1

Extra needles for, straight and curved, of each

do

12

  Extra needles for conductive anesthesia (Fisher's type)

do

12

  Extra hubs for, of each

do

1

Water, 21A

do

1

  Extra bulbs for

do

1

Miscellaneous

Brushes, hand, fiber

number

1

Cotton, absorbent, 1 ounce in package

package

1

Floss, silk, waxed, 24 yards in spool

spool

1

Napkins, dental, aseptic, 50 in box

box

1

Sandarac, gum, varnish, 2 ounces in bottle

bottle

1

Soap, Ivory

cakes

12

Towels, hand

   

Additional articles

Bit (bur) holder, revolving head

number

1

Case, dental, emergency, "B"

do

1

Cement, temporary, calxine or equivalent

box

1

Tray, w. e., sterilizing, 9 by 6 by 3, with cover

number

1

SURGICAL UNIT

Acidum boricum, 324-milligram tablets, 500 in bottle

bottle

1

Acidum nitricum, ½ pound in bottle

do

1

Adrenalin chlorid, 1-milligram tablets, 20 in tube

tubes

5

Ęther, ¼ pound in tin

tins

10

Ęthylis chloridum, 3 ounces in metal tube

tubes

2

Alcohol, 1 quart in bottle

bottles

3

Amylis nitris, 5 drop spirets, 12 in box

box

1

Aquę hydrogenii dioxidi, 1 pound in bottle

bottles

2

Argenti nitras fusus, 1 ounce in bottle

bottle

1

Argyrol, 1 ounce in bottle

do

1

Balsamum Peruvianum, ¼ pound in bottle

do

1

Chloroformum, ¼ pound in tin

tins

5

Cocainę hydrochloridum, 10-milligram hypodermic tablets, 20 in tube

tubes

5

Collodium, 1 ounce in bottle

bottles

3

Emplastrum belladonnę, 2 yards by 6 inches, in tin

tin

1

Foot powder (par. 902), ¼ pound in tin

tins

3

Glycerinum, 1 pound in bottle

bottles

2

Hydrargyri chloridum corrosivum, tablets, 250 in bottle

do

2

Hydrargyri chloridum mite, 2 ounces in bottle

bottle

1

Iodum potassii iodidum, in tube

tubes

20

Liquor cresolis compositus, 1 quart in bottle

bottle

1

Liquor formaldehydi (37½ per cent), 1 quart in bottle

do

1

Normal saline solution tablets, 100 in bottle

bottles

2

Petrolatum, 3 pounds in tin

tin

1

Petrolarum liquidum, 1 pound in bottle

bottle

1

Phenol, ½ pound in bottle

do

1

Sapo mollis (green soap), 1 pound in jar

jars

2

Sodii carbonas monohydratus, for surgical use, 1 pound in bottle

bottle

1

Spiritus ammonię aromaticus, ½ pound in bottle

do

1

Spiritus frumenti, 1 quart in bottle

bottle

1

Sulphur lotum, ½ pound in bottle

do

1

Talcum, 2 pounds in tin

tin

1

Unguentum hydrargyri chloridi mitis, 2 pounds in jar

jar

1

Zinci oxidum, ¼ pound in bottle

bottle

1

Stationery

Bands, elastic

dozen

2

Books, blank:

 

 

Crown (cap), 250 pages

number

1

Svo, 150 pages

do

100

Envelopes, official, letter

do

100

Ink, black (powder or tablets), sufficient in box for 1 quart of fluid

box

1

Pads, prescription

number

1

Paper:

 

 

Blotting, for desk

sheets

2

Writing, letter

quires

2

Penholders

number

2

Pens, steel

do

12

Miscellaneous

Applicators, for throat, wood

gross

1

Atomizers, hand

number

1

Bags, rubber, hot water

do

2

Bandages:

 

 

Gauze, roller, assorted, 6 dozen in box

boxes

2

Plaster of Paris

number

12

Suspensory

dozen

1

Basins, white enamel, for operating room

number

2

Bath robes (gowns, convalescent)

do

25

Bedpans, white enamel

do

1

Boilers, instrument

do

1

Brushes, hand, fiber

do

3

Cases, general operating (par. 916, M. M. D.)

do

1

Cotton:

 

 

Absorbent, in roll

pounds

10

Bat

do

1

Crinolin (stenta-book), 6 yards in piece

piece

1

Crutches, rubber tips for, size No. 18 (¾ inch)

number

4

Cups:

 

 

Feeding

do

1

Spit, paper

do

100

  Metal frames for

do

6

Cushions, surgical, Kelly's

do

1

Gauze, plain

yards

250

Gloves, plain, rubber

pairs

4

Gowns, operating

number

6

Graduates, glass, 250 cubic centimeters

do

1

Inhalers, ether

do

1

Litters, with slings

do

2

Medicine droppers

dozen

1

Medicine glasses

number

1

Pajamas:

 

 

Coats

number

25

Trousers

do

25

Pillow cases, cotton

do

12

Pins, safety

dozen

3

Pitchers, white enamel

number

1

Plaster, adhesive, zinc oxide, 5 yards by 2½ inches

spools

13

Plaster of Paris, 4 pounds in tin

tin

1

Pus basins

number

1

Sheets, cotton

do

12

Shirts, cotton

do

6

Slippers

pairs

25

Soap, Ivory

cakes

6

Sterilizer, for dressings

number

1

Stethoscope, double

do

1

Stove, coal oil

do

1

Extra wicks for

do

1

Sutures, catgut, chromicized, 1 suture in tube

tubes

24

Syringes, glass. Luer type, 10 cubic centimeters

number

1

Tables, operating, field, folding

do

1

Tongue depressors, wood

gross

2

Towels, hand

number

36

Trays, instrument, white enamel

do

1

Tubes:

 

 

Drainage, rubber, in yard lengths, 3 sizes

yards

3

Stomach

number

1

Urinals, glass, graduated

do

1

Paper, litmus:

   

Blue, 100 strips in vial

vial

1

Red, 100 strips in vial

do

1

Test tubes

dozen

1

Urinometers

number

1

Additional (field)

Chest, medical and surgical (par. 932, M. M. D.) less case, operating, small; case, forceps, hemostatic

number

1

Head mirror in case (par. 933, M. M. D.)

do

1

Speculum. ear, 3 in set

set

1

SERA AND VACCINE UNIT

 

 

 

Smallpox vaccine

units

1,000

Lipo typhoid vaccine

cubic centimeters

100

Antimeningitis serum

do

480

Diphtheria antitoxin

units

100,000

Tetanus antitoxin

do

15,000


311

BLANK FORMS

Commercial troop transports

No.

 

 

47a. M.D.

number

4

50, M.D.

do

2

51, M.D.

do

4

51a, M.D.

do

4

51b, M.D.

do

4

52, M.D.

do

200

55a, M.D.

do

50

55c, M.D.

do

50

55d, M.D.

do

50

55e, M.D.

do

50

55g, M.D.

do

50

55h, M.D.

do

50

55j, M.D.

do

50

55m, M.D.

do

10

56, M.D.

do

10

57, M.D.

do

50

71, M.D.

do

4

75, M.D.

do

50

76, M.D.

do

50

77, M.D.

do

50

78, M.D.

do

10

79, M.D.

do

50

81, M.D.

do

100

48, Q.M.

do

50

Naval troop transports

No.

   

47a, M.D.

number

4

51, M.D.

do

4

51a, M.D.

do

4

51b, M.D.

do

4

52, M.D.

do

200

56, M.D.

do

10

71, M.D.

do

2

75, M.D.

do

50

76, M.D.

do

50

77, M.D.

do

50

78, M.D.

do

10

81, M.D.

do

100

48, Q.M.

do

24

Army cargo transports

No.

   

17, M.D.

Number

4

17a, M.D.

do

50

17b, M.D.

do

50

17c, M.D.

do

4

28, M.D.

do

12

35, M.D.

do

6

50, M.D.

do

6

48, Q.M.

do

24

Army troop transports

No.

   

17, M.D.

number

10

17a, M.D.

do

100

17b, M.D.

do

100

17c, M.D.

do

10

28, M.D.

do

10

35, M.D.

do

6

47a, M.D.

do

4

50, M.D.

do

6

51, M.D.

do

4

51a, M.D.

do

4

52, M.D.

do

200

55a, M.D.

do

10

55b, M.D.

do

10

55c, M.D.

do

10

55d, M.D.

do

10

55e, M.D.

do

10

55g, M.D.

do

10

55h, M.D.

do

10

55j, M.D.

do

10

55m, M.D.

do

10

56, M.D.

do

10

71, M.D.

do

4

75, M.D.

do

100

76, M.D.

do

50

77, M.D.

do

50

78, M.D.

do

10

81, M.D.

do

100

48, Q.M.

do

24


 

The debarkation of troops at this port was not materially different from embarkation. While it was determined that the medical supply of vessels carrying troops from Europe would be accomplished at the port in Europe from which the vessels sailed, experience proved that it was more satisfactory to provide these supplies at Hoboken for the returning voyage, and this method was followed throughout the debarkation period.

REAL ESTATE SECTION

This section assumed the duties of what was formerly the hospital procurement division, the duties of which were to survey suitable buildings in the vicinity of this port for hospital purposes. The later duties of this section were


312

all matters pertaining to leases, renewal of leases terminating or expiring, for the Medical Department at this port, and all matters relating to the construction or repairs of hospitals or property under the jurisdiction of the Medical Department at the port.

The later organization of the finance division and the duties of the various sections as above specified were considered to have been an excellent arrangement. The personnel required for its operation consisted of 2 commissioned officers, 7 enlisted men, and 2 civilian stenographers.

PROPERTY DIVISION

This division was organized with the opening of the port of embarkation. The personnel consisted of 1 officer and 3 enlisted men in November, 1917, of 1 officer and 19 enlisted men in June, 1918, and 1 officer and 20 civilian employees in July, 1919.

The functions of the division at the time of its origin were to supply the office of the attending surgeon with medical and surgical supplies, the port surgeon's office with stationery and office supplies, the dental surgeons of the port with dental supplies, and the transports then in operation with sera and vaccines. It later verified and receipted for Quartermaster, Medical, and Ordnance Department property and prepared and forwarded the prescribed returns; maintained in proper mechanical condition the wheel transportation of the Medical Department; and prepared and shipped medical supplies to the

various other embarkation points under the jurisdiction of this port.

On November 5, 1917, pursuant to Order No. 24, surgeon's office, a board of medical officers was appointed to compile a list of supplies and equipment for use on transports, at which time each transport was supplied with a medical and surgical chest as part of its equipment. During the year 1918, 115 chests, medical and surgical, were issued. Large quantities of medical supplies for use in the port and on transports were obtained with difficulty during 1918, owing to the large number of medical units being equipped for overseas service and the amount of supplies being shipped to our Army in France. This office was also charged with and maintained motor ambulances for the transportation of sick and wounded to the various embarkation hospitals of the port. Ambulances and their equipment were turned over to the Motor Transport Corps on November 29, 1918.

A second board of medical officers was ordered on September 2, 1918, per orders, No. 170, surgeon's office, to investigate and report upon the allowance of medical and hospital supplies which should be placed on board all transports. This board submitted a report as to the allowance of sera and vaccines to be placed on board for each 1,000 troops. They also submitted a list of medical supplies which were to be consolidated and packed as a medical unit, each unit to care for 1,000 troops en route from overseas. Two hundred and ten of these units were packed in boxes according to the list submitted.

The use of hospital boats in removing sick and wounded patients from transports was inaugurated in the fall of 1918. These boats were supplied with medical and surgical chests, litters, blankets, pillows, and various other supplies.


313

Ten hospital unit cars arrived at this port in December, 1918, and were here equipped with the necessary mess equipment, linen, blankets, pillows, medical and surgical chests, office equipment, etc., to take care of the patients carried. These cars then continued to draw supplies and equipment as occasion arose. Fifteen additional hospital unit cars were supplied with hospital, medical, and mess equipment in February, 1919, making a total of 25 hospital unit cars and 3 hospital trains which were drawing supplies from this office in addition to the many other separate units.

This office took a complete physical inventory of all property on hand pursuant to Circular No. 131, War Department, December 10, 1918, and a new system of property accounting as outlined in the above mentioned circular was instituted. Much difficulty was experienced at this time in obtaining supplies, due to the change in property accounting. Requisitions submitted to the zone supply office for supplies were often not filled for many months, thereby causing depletion of stock and necessitating many unnecessary efforts in trying to replenish it.

Transports carrying returning troops were supplied with medical units, sterilizers, operating tables, and all necessary supplies for use in the care and treatment of sick and wounded returning to the United States. From January to June, 1919, 140 medical units were placed on board. Beginning in January, 1919, chartered transports were taken out of the service to carry on the commercial work which they had been doing before the war, thus necessitating the removal of all supplies from them. Medical and surgical chests and about 5,400 blankets were removed, from January until July, 1919, not including various

other supplies which had to be handled.

Though the chief work of this office during the years 1917 and 1918 was to obtain and issue supplies, in 1919 it was also charged with the receiving of all property from transports taken out of the Government service. Supplies in excess of the required amount for the return trip would be placed on board in England and France. Upon arrival at Hoboken, N. J., this property had to be taken from the boats and stored in warehouses. Since transport surgeons very seldom made more than one or two trips on the same transport, some of his property would be found missing, in practically every case, and it was necessary not only to instruct the transport surgeon in regard to the preparation of his survey but in most instances, also, to prepare it for him, inasmuch as he had no clerk who could do this work. The division was also called upon to straighten out transport surgeons' property accountability and, upon their release from the service, to audit all their accounts.

The work was increased further in May, 1919, by the return of dental surgeons from the American Expeditionary Force. Each dentist was ordered to bring with him a portable dental outfit. These outfits were carried to Brest or St. Nazaire, France, and there loaded in transports for the United States. This property was often not placed on the same transport with the officer, and his property was short upon his arrival at this port. It was then necessary to prepare property accounts for this property and surveys for the lost property, thereby increasing the clerical work to a very great extent.


314

The division supplied clothing and equipage for 1,000 men, and medical and hospital supplies, dental supplies, general supplies, and blank forms to the following organizations: Surgeon's office, including all subdivisions; medical detachments at 200 Washington Street and Scheutzen Park, North Bergen N. J.; medical detachments on hospital unit cars, hospital trains, hospital harbor boats; attending surgeons at Bush Terminal and at 209 River Street, Hoboken, N. J.; the dental surgeons at Bush Terminal; at 209 River Street, Hoboken, N. J.; at 54 Dey Street, New York City; at the Whitehall Building, New York

City; at the Army base; at the Holley Hotel and the Hotel Albert; at the Rest House in Red Bank N. J.; and several rest rooms in the various big offices where female employees were at work.

Storage space was inadequate to handle all these supplies, and storerooms were usually filled to capacity. Every effort was made to dispose of all excess property by turning the same in to general supply depots as it accumulated.

CORRESPONDENCE DIVISION

A department, in operation from the establishment of the office of the surgeon of the port, under several different designations, was concerned with the preparation for signature, filing, and forwarding of official correspondence. This department was ordinarily the office of the chief clerk, but in December, 1917, it was placed directly under the executive officer. Known at first as the correspondence division, and later as the mail and files division, it retained the same status as regards functions, but owing to an increase in the volume of work and for purposes of better administration it was divided into two separate sections and known as the mail and files division. The two sections were consolidated with the finance division in December, 1917, not because of any similarity of duties but for convenience of administration. It was later necessary, on account of the increase of business, to separate the correspondence division from the finance division. The entire method of operation was revised, correspondence was reclassified, and the methods of distributing orders, circulars, etc., were changed. The organization and duties remained practically the same throughout the period of activity of the port, except for a large increase in the

amount of correspondence handled. The duties were as follows: Receiving, recording, forwarding, and filing of official correspondence; distribution of orders, circulars, memoranda, etc., to all persons concerned; and the preparation for signature of letters, indorsements, reports, and office orders.

There were approximately 5,000,000 pieces of correspondence in the files at the end of the fiscal year 1919. The War Department system of filing was used and maintained in a high state of efficiency. Numerous cross references were made, and the suspended file was closely checked and kept up to date.

ATTENDING SURGEON'S DIVISION

A place for the medical and surgical treatment of military persons on duty in the port of embarkation became necessary shortly after its establishment, and a dispensary was opened at 209 River Street, Hoboken, N. J., with an attending surgeon in charge. The personnel of the office at that time consisted of one medical officer and three enlisted men. As the activities of the port


315

increased, so the demands upon this office increased. The office became a division of the office of the port surgeon for convenience of administration, and branch offices were established in Bush Terminal, Brooklyn; on West Fifty-seventh Street in New York City; in Kearny, N. J.; and in Jersey City.

The duties of the attending surgeon of the port of embarkation, Hoboken, N. J., differed somewhat from those of the usual attending surgeon, whose duties are to render medical attention to those entitled to such in the territory. In addition to rendering medical attention to Army personnel at this port, and to their families, this office made preembarkation examinations of all casuals and gave typhoid and smallpox vaccinations to all persons going overseas not with organizations, which included officers, Army field clerks, welfare workers, and civilian employees.

This office also made physical examinations for promotion. A dispensary was operated in connection with the office, where night and day service was maintained and first aid was administered to all persons on duty at the piers, both military and civilian.

During the demobilization period a board of medical officers was created for the physical examination of officers and enlisted men prior to their separation from the service. Ten thousand five hundred and ninety physical examinations were made by this board up to July 31, 1919.

The activities of the office steadily increased, reaching their maximum during July, 1919, when the personnel was composed of 32 officers and 45 enlisted men, the office occupying two floors of the main building at 209 River Street, Hoboken, N. J.

DIVISION OF DENTAL SERVICE

The first dental service for the care and treatment of officers and enlisted men attached to the port of embarkation was established in August, 1917, one dental officer being assigned to duty with the guard at the piers. This guard consisted of approximately 600 men. The dental surgeon's equipment consisted of a portable field outfit, and his office was a small room which served as both operating and waiting room. This office was maintained until May, 1918, when larger quarters were secured in the office of the attending surgeon wherein a base dental equipment was installed.

Five dental officers reported on October 16, 1917, for duty at Camp Merritt, N. J., where approximately 5,000 troops were quartered without the services of a dental surgeon. Three were assigned to the base hospital and two to the camp surgeon's office. One dental officer reported for duty on December 10, 1917, and was assigned to Army hospital, Hoffman Island, N. Y. The increasing arrival of troops at the camps for embarkation and the assigning of additional personnel to the port of embarkation caused the port surgeon to request the assignment of dental officers to meet the increased requirements of

the dental service. Three dental officers reported for duty in May, 1918, and were assigned to Camp Mills, Long Island. Additional dental officers were assigned for duty during June, 1918, and 66 officers were equipped with portable field equipment upon their arrival at this port for duty overseas. This constituted the dental service at the port of embarkation prior to the summer of 1918.


316

The dental service for the port of embarkation was placed upon an organized base July 1, 1918, when the port surgeon designated an officer then on duty in his office as director of dental service. This officer directed the organization and supervision of all dental work at hospitals and camps under the jurisdiction of the port surgeon and cooperated with the personnel officer, office of the port surgeon, in recommending the assignment of dental officers where their need became apparent.

A survey of hospitals and the two embarkation camps revealed that no facilities for the functioning of the dental service were provided at the embarkation camps except a small outbuilding at Camp Mills, Long Island, and two small rooms at Camp Merritt, N. J. The space in both places was totally inadequate. Recommendations were made for a dental unit building and the necessary base dental equipment for each camp. Hospitals acquired and those in course of construction were equipped with base dental equipment and bedside X-ray units.

A dental society was organized in August, 1918, with the object of promoting closer relations between the officers in their professional work, free discussions of the dental work as a whole, individual  suggestions for the betterment of the service, and of holding clinics at which papers were to be read and discussed. These meetings occurred monthly and had a great influence upon the morale of all officers concerned.

The increasing arrivals of troops for embarkation in August and September, 1918, and the opening of debarkation hospitals for the reception of the sick and wounded from overseas, so increased the demands for dental service that additional officers were requested to properly supply this service. This demand was later relieved when the War Department authorized the increase of dental

personnel at hospitals from 1 dental officer per 1,000 beds to 3 dental officers per 1,000 beds, and 47 dental officers accompanied by their dental assistants arrived.

Authority for the construction of a building for the exclusive use of the dental service was granted for Camp Merritt, N. J., on October 22, 1918. Work was immediately begun, and requisitions were made for a complete base dental equipment laboratory outfit and X-ray unit to properly furnish this building.

Heretofore, due to lack of adequate dental equipment, almost all dental work done was of an emergency character. The increasing arrivals of sick and wounded presented so many cases of Vincent's angina, trench mouth, fracture of the maxillaries, facial wounds, restorations with artificial dentures, and many affections of the soft tissues that it was necessary to classify and assign the dental officers best adapted for the work, as many cases required the attention of those skilled in oral dental surgery.

Meanwhile, the two embarkation camps under the jurisdiction of the port surgeon were urgently in need of better dental facilities. At Camp Merritt, N. J., a dental infirmary had been authorized and the building was under construction. At Camp Mills, Long Island, following considerable delay, authority was granted for the erection of a similar building. Thus the dental service was prepared for the approaching return of sick and wounded troops needing the attention of the dental surgeon.


317

With the signing of the armistice and the return of wounded and sick from overseas, many cases required special skill on the part of the dental surgeons. Since no existent Medical Department form included space to record the oral conditions of patients in hospital, the chief of dental service at the base hospital, Camp Merritt, N. J., utilized Form 55-g with the result that the dental service was greatly benefited. With the approval of the port surgeon, Form 55, as modified for dental progress, was given a trial at all hospitals under his jurisdiction, resulting in thousands of oral focal infections being detected and eliminated. The addition of the emergency dental equipment "B " to hospital dental equipment made it possible to give treatment to patients confined in bed. The completion of the dental infirmaries at Camp Merritt and Camp Mills had now placed the dental service on an efficient basis, in so far as quarters were concerned. Delays experienced in securing the proper base dental equipment necessitated the installation of the portable field equipments until such times as requisitions were filled. With the exception of the two camps, all stations and hospitals were equipped for adequate dental service in time to meet

the rush of the homeward-bound troops, beginning in December, 1918, and continuing until May, 1919.

LIAISON OFFICER

It was very difficult, prior to March, 1918, to procure information concerning the movement of troops and transports at a time sufficiently far in advance to enable the various divisions of the port surgeon's office properly to perform their duties. Advance information as to the departure of troops from the embarkation camps and arrival at the different railroad centers and at the docks was almost unobtainable. Such information was strictly confidential and was delivered by messenger, the messenger starting at about the same time as the troop movement and often not arriving until after the movement was completed. The boarding of transports by troops, therefore, often was delayed while the medical personnel were being collected and inspections made. To correct this condition a liaison officer was appointed, whose duty it was to obtain such information in advance from port headquarters. Thus, information of prospective movements often was obtained 48 hours before the movement order was published. The value of this work was particularly appreciated during the influenza epidemic in the fall of 1918, when the assignment of organizations to transports was changed as often as three times in one day.

He also obtained information to assist the personnel division in the assignment of transport surgeons and surgeons of troops on transports. Usually, the senior medical officer on board was appointed surgeon of troops. As he might be sailing either as a casual or with an organization, his identification necessitated an almost endless search through the passenger lists. Passenger lists frequently failed to show the branch of the service to which an officer belonged, and it was then necessary to telephone to the various camps for the required data.


318

MISCELLANEOUS ORGANIZATIONS

RECEIVING SHIPS

Prior to November, 1918, the debarkation of sick and wounded was carried on by various officers assigned from the office of the surgeon, transport division, 316 River Street, Hoboken, N. J., to the incoming transports. The number of sick and wounded was usually very small, probably an average of five cases, some of which would make the transfer directly from the transport to various hospitals which had been designated by the port surgeon. The small number of men to be transferred were taken care of by one officer, without medical enlisted men, as it was always possible to obtain assistance from the transport in carrying out litters, baggage, etc. Such patients were loaded directly into ambulances on the piers.

With an increased number of sick and wounded, it was found impracticable to have patients carried long distances by ambulance. This was overcome by putting into commission small steamers that could go alongside vessels and make fast. Gangplanks were rigged from the deck of the incoming transport to the transfer steamer, thereby making transfers much easier. Patients were taken to a point near the hospital where ambulances were waiting. Hoboken debarkations were sent directly by ambulances to hospitals. Bush Terminal and New York debarkations were usually carried by small steamers to the Hoboken side.

In November, 1918, it was deemed practical to establish a receiving ship whose sole purpose would be debarkation. For this purpose the steamship Shinnecock was commissioned, with a medical officer in command, also carrying a large number of enlisted men as litter bearers. The receiving ship was then operated as an independent unit under the direction of the surgeon, port of embarkation. Quarters and mess were furnished the enlisted men on board. Crews and men were available for any transfer, either day or night, on a few minutes' notice. Debarkations were made from transports, the piers, in midstream, and in the lower bay. Transfers were necessarily more or less routine, with slight changes needed at times to overcome difficulties presented by tides, winds, fog, etc., but in general there was never experienced any great difficulty in any debarkation.

It was necessary to increase the number of officers, enlisted men, and boats during months of heavy debarkations. The greatest number of officers (seven) were on duty in April, 1919; also, at this time, the largest number of small steamers (six). Beginning with May, 1919, owing to the decrease in the number of sick and wounded, it was recommended that the Montauk, a smaller steamer replace the Shinnecock. The organization of the Shinnecock was placed upon the Montauk, which then became the receiving ship. There was a gradual decrease in the number of sick and wounded after May. Many of these were in such condition that they needed no special attention and had been formed into casual companies on board ship. These were taken directly to near-by camps.

The following tabulation shows the harbor boats assigned to the Medical Department, and the dates upon which they were obtained and released. It will be seen that at one time the surgeon had nine of these boats at his disposal.


319

Name of vessel

Date assigned

Date released

Princess

Aug. 22, 1918

 

Gonnold

Aug. 22, 1919

 

Montauk

May 14, 1919

Aug. 16, 1919

Columbia

Aug. 22, 1918

 

Gardner

Jan. 10, 1918

July 1, 1918

Lexington

Aug. 22, 1918

Oct. 1, 1918

Islesboro

...do...

July 18, 1919

Bronx

...do...

July 1, 1919

Shinnecock

Nov. 1, 1918

May 14, 1919

Joseph E. Johnston

Aug. 22, 1918

Do.

Casining

Oct. 1, 1918

July 10, 1919


HOSPITAL SHIP

In the latter part of 1918, anticipating the arrival of large numbers of sick and wounded from overseas, steps were taken to provide sufficient water transportation at this port to handle them. Among the vessels surveyed for this purpose was the steamship Crosby, which had been plying the Great Lakes for several years. The length of this vessel was 202 feet, beam 40 feet, with a gross tonnage of 1,920. This ship seemed to be suited for the above-mentioned purpose, particularly that of making coastwise transfers from this port to Boston, Baltimore, Philadelphia, and other seaports of the Atlantic coast. The vessel was considered entirely seaworthy, and accordingly was procured for the Medical Department and fitted as the hospital ship General Robert M. O'Reilly.

There was no occasion to use this boat as a hospital ship in making coastwise transfers under the debarkation system as organized at this port. The boat, accordingly was tied up at Pier 45, North River, and designated as a hospital for the treatment of contagious diseases. As a hospital ship, she had a capacity of 274, in 9 wards. A total of 606 patients were treated in the hospital before it was discontinued on April 15.

The maximum personnel on duty consisted of 11 commissioned officers, 84 enlisted men, 20 Army nurses, and a crew of 43.

NURSES' MOBILIZATION STATION

The nurses' mobilization station was opened on June 15, 1917, with headquarters at United States Quarantine Hospital, Ellis Island, N. Y., with a personnel of 4 Army nurses and 3 enlisted men of the Medical Department. The first detachment transferred overseas left the station June 30, 1917, and consisted of 54 nurses belonging to 5 separate units. A substation was opened on December 17, 1917, at 120 Madison Avenue, New York City, with a personnel of 5 nurses and 2 civilian employees. This station was used to take the overflow from Ellis Island and, later, the overflow from the Hotels Holley and

Albert, New York City.

The main station was operated at Ellis Island until April 1, 1918; subsistence and quarters were furnished in kind. Headquarters was then transferred to the Holley Hotel, and a medical officer assumed charge. Another change was made to the Hotel Albert, on September 1, 1918. This station was made an independent organization on April 1, 1919. On the transfer from Ellis Island, subsistence and quarters for nurses and civilian employees of the Medical Department were furnished by the Holley Hotel Co. under contract,

 

320

and later it was frequently necessary to have nurses quartered in from 15 to 20 different hotels when large numbers were present at one time.

The work of the mobilization station was aimed toward completely preparing individuals for overseas duty and comprised the preparation of expense accounts, pay accounts, identification certificates, allotment and insurance applications, and the completion of inoculations and equipage. The work progressed in a methodical fashion and without confusion, as units were mainly dealt with prior to the signing of the armistice and these remained at the port for considerable periods. The routine was disturbed early in October, 1918, by the transfer of many nurses to hospitals at embarkation camps in this vicinity

for temporary duty during the influenza epidemic. The nurses later were returned to this station and the work of forwarding was again taken up during the latter part of the month.

Nurses continued to be sent overseas for about one month after the signing of the armistice, the last one leaving this station on December 8, 1918. The designation of the station was then changed from mobilization station to demobilization station. During January, 1919, the first nurses were received from overseas for transfer to their homes for discharge or relief from active service or to other stations for duty. Nurses and civilian employees of the Medical Department continued to return in increasing numbers, and all accounts of those who requested discharge or relief from active service were completed

in the Office of the Surgeon General. This work had assumed such proportions by the latter part of March, 1919, that instructions were issued by the Surgeon General that all such accounts should be completed at this station, and this was put into effect on April 14, 1919.

Prior to April 1, 1919, the station had functioned as a part of the office of the surgeon, port of embarkation, and the necessary medical officers to make the physical examinations of such as were leaving the service were sent over from the office of the attending surgeon, port of embarkation, as needed. Four officers were assigned for duty at the station, shortly after this date, and an agent of the disbursing officer, port of embarkation, New York City, opened an office at the station for the purpose of expediting payments.

The personnel of the station consisted of the following, as of July 31, 1919:  Five medical officers, 1 Sanitary Corps officer, 12 enlisted men, 18 nurses, and 17 civilian employees. Eight thousand two hundred and ninety-one nurses and civilian employees passed through the station en route overseas, and 8,343 were debarked prior to September, 1919.

EMBARKATION CAMPS

In the plans for the utilization of the port of New York for embarkation purposes, it was necessary to include locations of rest camps in which to receive troops prior to their embarking on transports. The medical service at an embarkation camp differed from that at a demobilization camp in that there was little field training to consider, its place in the schedule being taken by preembarkation physical examinations, completion of equipment, etc. The camp personnel was very largely casual and was changed frequently.


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CAMP MERRITT, N. J.

CAMP SITE

A board of officers appointed by the War Department inspected several locations in the vicinity of New York in June, 1917, principally sites in New Jersey and Long Island within easy access to the water front. Several sites were inspected in New Jersey, the two which offered the greatest advantages being one on the Phelps estate between Englewood and Teaneck, the other being near Cresskill. The board's recommendation in favor of the latter site, submitted on July 12, was approved. This selection was made "for the reason that the geological substructure and location afforded the speedier and less expensive construction for sewer and water systems, and because the land could be obtained with less expense to the Government." This site was designated as Camp Merritt, and actual construction was begun August 20, 1917.

Camp Merritt was located in Bergen County, N. J. Its borders overlapped the towns of Cresskill, Dumont, Bergenfield, and Tenafly, and it was about 3 miles from the suburban town of Englewood and about 15 miles from New York City. The terrain was rolling, the main portion of the camp being located on a north and south ridge, 2 miles distant from the palisades of the Hudson. The land consisted mostly of small cultivated estates with considerable wooded areas. Both on the ridge and at the foot of its slopes were found some rather marshy areas. The soil for the most part was a sandy clay. The underlying stratum of red shale was a continuation of the Hudson palisades formation. The soil was more sandy in the lower ground leading toward the Hackensack River bed, and even quicksands were encountered at certain points during sewer construction. The natural drainage was excellent, due to the rolling character of the terrain, and the ground dried quite rapidly after rains. Considerable dust developed on ground exposed to much traffic during dry weather. The planting of grass over extensive areas in the camp served to eliminate much of this difficulty.

The climate was generally similar to that of New York City and vicinity, sharing in the humidity produced by the waters of the river and bay and being subject to frequent mist and fog during the night and early morning. Winds were not common in these parts. Rainfall was of the average for this locality. Flies were quite prevalent in the surrounding towns. Mosquitoes bred freely in the numbers of small marshes and wet areas in the wooded lands of the vicinity. Anopheles breeding occurred to a small extent in three or four scattered localities within a mile of the camp; however, cases of malarial fever were infrequent among the civilian population. The two main approaches to the camp site were macadam roads. One of them was of asphalted surface. The other roads in the vicinity were country roads productive of considerable dust. Much improvement was made in the roads after occupation of the camp. The two main intersecting highways were rebuilt of concrete within the camp limits; other roads were resurfaced

with crushed stone, gravel, or cinders, and several of these were further treated with asphalt.

Two small brooks arose within the camp and were of little importance. Near the borders of the camp were Dumont brook on the west and Tenafly


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drainage brook on the east. Two and one-half miles west was the Hackensack River, a narrow creek at this point, showing daily tidal influence. The two brooks mentioned and others called for the attention of the sanitary engineer in measures for the control of mosquito breeding.

CAMP BUILDINGS

Camp Merritt was more closely built up than the average cantonment. The camp was subdivided into 21 blocks or areas. Eighteen of these were used as quarters for soldiers, one as a warehouse and stable area, and another exclusively for base hospital purposes. Block XII, located in the most central portion of the camp, contained most of the administrative buildings, the Young Men's Christian Association, Knights of Columbus buildings, Merritt Hall, and officers' club. Each block was divided into two divisions containing 16 two-story barrack buildings (quarters for four companies), each 30 by 60 feet

in size, and 4 mess halls with kitchens, 20 by 98 feet, each consisting of two separate units. Speaking generally, the camp was in the form of a quadrangle, the barrack buildings occupying the west, north, and east sides, the hospital group the south side, with administration buildings, theater, Young Men's Christian Association building, auditorium, Red Cross headquarters, officers' club, and enlisted men's club (Merritt Hall) occupying the center. The warehouses, bakery, refrigerating plant, and garbage transfer station were located to the north of the quadrangle. The barracks were two-story buildings separated

from each other by a distance of 40 feet. Company streets were 80 feet in width. One hundred-foot fire breaks had been left in the center of each block. Four barrack buildings with officers' quarters, one mess hall, and lavatory, formed a company group. The barracks were designed to accommodate 33 men to each floor, giving approximately 600 cubic feet of air space, or 52 square feet of floor space, per man. There was one orderly room in each group of barracks. There was an orderly room in each of the more recently constructed barracks. The lower floors of the barracks were ventilated by galvanized-iron ducts taking off from the ceilings and exhausting above the roof, draft being induced by room heaters. All camp buildings were equipped with sliding windows. One-story buildings and upper floors of the two-story barracks were equipped with ridge ventilators, opened and closed by board flaps extending along the entire length of the lavatory building.

Lavatory buildings were placed adjacent to the troop barracks. The buildings were divided into two equal sections each intended for use by one company. The equipment comprised 11 shower baths and hot and cold running water, a galvanized trough with several faucets for washing hands, 4 urinal troughs, and 12 standard porcelain toilet bowls. One hot-water heater was provided in each section of the lavatory building.

LAUNDRY FACILITIES

No laundry was operated at this camp. All laundry work for organizations, individual enlisted men, and the base hospital was sent to a laundry operated by the Quartermaster Department in Hoboken. This was formerly a commercial plant and was taken over under a contract of operation by the Government.


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HEAT AND LIGHT

Heating of barracks, mess halls, lavatories, and administration buildings was provided by stoves or large heaters; officers' quarters were heated by steam, supplied by a boiler installed in each building. Hot water and steam heat for the base hospital were supplied by two large central heating plants. Electric lighting was furnished to all buildings and streets of the camp by a commercial company.

WATER SUPPLY

Water was supplied to the camp by the Hackensack Water Co. The source of the supply was the head waters of the Hackensack River and its adjacent watershed. The company operated a modern plant on the Hackensack River about 3 miles from Camp Merritt. The works included a large storage basin, settling basins, filter beds, purification tanks, and pumping plant. The water was treated by the alum sedimentation process and purified by chlorine bleach. Samples of water were examined weekly by the Army laboratory, Hoboken. The quality of water supplied was at all times of high grade. The supply was delivered through iron mains and wood-stove pipes which were capable of furnishing 75 gallons per capita daily.

ICE

Ice was supplied on contract. Manufactured ice was supplied during almost the entire time and was of satisfactory quality. Natural ice was purchased during a short period early in 1919. This came from mountain lakes and the quality was very good.

DISPOSAL OF WASTES

Sewage.-Pit latrines with Havard box seats were used throughout during the period that the a amp was under construction and before the sewer was available for use. The pits were well fly-proofed and burned out in the usual manner with straw and oil, or their interiors sprayed with a mixture of lampblack and oil. These temporary toilets were surrounded by substantially constructed screens. The decision to locate Camp Merritt at this site contemplated the construction of a sewer running 212 miles westward to discharge into the Hackensack River at the town of New Milford. Work on the sewer system was commenced in August, 1917. The system included a purification plant located at New Milford. The effluent from the septic tanks flowed through an iron pipe line about 500 feet to the river. The discharge was effected below the surface of the river by means of a curved section of pipe having three top outlets, 10 inches in diameter, with trap covers. A more even distribution into midstream was thus effected.

The original sewage treatment plant comprised a screen chamber, septic tank compartments with a capacity of 362,600 gallons, liquid chlorine treatment apparatus, and sludge drying beds. Each unit had a detention period of 42 hours when the sewage flow was at a rate of 1,000,000 gallons per day. As the average rate of flow for the year ending July, 1919, was 1 million gallons per day, the average detention time for digestion of sewage was 2.8 hours. The sludge drying beds were designed upon a basis of one-half square foot per capita.


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The 8 original beds had a total area of 12,960 square feet. Excess fluid was carried away by a small drain to the river; the remaining liquid filtered through this gravel bed. Liquid chlorine was employed in the treatment of the effluent as it flowed from the last tank. The amount of chlorine was originally regulated automatically but was later set by hand, the quantity being determined by hourly reading.

The plant was put in operation November 24, 1917, but good septic action was not obtained owing to the immediate onset of cold weather. The fat of sewage was high, causing excessive formation of crust in the tanks. This became especially bad in April, 1918, and was mainly due to the inadequate grease traps originally installed. The conditions grew rapidly worse following the large increase in the shipment of troops which had commenced about that time. It was evident that the tanks were much overtaxed when the average camp population exceeded 15,000. The conditions were the result of poor digestion,

with the formation of fatty acids hindering septic action end with the presence of excessive grease. The heavy accumulation of crust-8 feet in the first two chambers-necessitated its removal by scoops and pails and required several months of labor. Disposal of this material offered the problem of avoiding the formation of a sanitary nuisance by constituting a place for fly breeding. It was removed in cans, some to pits for burial and some hauled to a farm a mile distant and plowed under. An experiment was made of breaking up the crust with a water stream and pumping the mass into two large pits. This method

was abandoned owing to fly breeding in the mass before it was dry enough to cover with earth. Sludge accumulated rapidly as a result of the poor digestive action in the tanks and had to be removed at frequent intervals. It also had to be spread too thickly on the sludge beds and removed therefrom before it was thoroughly dried. The quality of the sludge obtained was indicative of the poor operation of the tanks, being very fecal in character and the grease content much above the normal average.

Steps were taken late in the fiscal year 1918 to remedy these defects by doubling the capacity of the sewage disposal plant through the construction of an additional set of tanks. These were completed and put in operation January 10, 1919. The original plan of construction was changed by the installation of a single large screen chamber connecting with both sets of tanks. An arrangement of sluices and gates permitted the operation of one or more units as required. A retention or mixing chamber of 33,000-gallon capacity was added on the distal side of the system, wherein the chlorine dosing then took

place. The detention period for chlorination averaged 47 minutes. The area of sludge drying beds was increased 50 per cent by the construction of four new beds. All of the old, small grease traps were replaced by traps of much larger capacity and improved design. The first sludge of the 1919 season was drawn from compartments of the old tank on May 16. This was greatly improved in character, being dark in color, fine grained, and with practically no odor. This was the result even after a period of great activity in camp. The accumulation of crust and sludge was decreased during the season of 1919.


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Bacteriological examination of the sewage was made weekly. The examinations during 1918 indicated a general reduction of about one-third of the count in the effluent from the septic tanks over that of the raw sewage. This reduction was still further reduced after the construction of additional tanks and improved operations.

Complaint was made during the summer of 1918 by the boroughs situated along the Hackensack River, into which the effluent sewage was discharged, that this practice was a nuisance and menace to the health of the neighborhood. Careful observations of this condition were frequently made, including chemical and bacteriological tests of the sewage effluent and of the river water in the vicinity of the outfall. These inspections demonstrated that the cause of the complaint was not all chargeable to this camp, but largely to primitive systems of disposal used by boroughs bordering upon the river. The completion of

new septic tanks and improvement in the operation of the disposal plant, effected by the substitution of larger grease traps throughout the camp, further lessened any possible grounds for complaint.

Garbage.-The removal of all garbage and kitchen waste was under the supervision of the salvage department. In accordance with Special Regulations, No. 77, War Department, garbage and wastes were separated as follows: (a) Bones; (b) meats, fats; (c) other garbage. It was collected by motor and wagon transportation and delivered to a garbage transfer station situated at the north end of camp, whence it was removed by a rendering company under contract with the Government, until July 1, 1919. Removal was made after that date by parties who fed the garbage to pigs. Collections were first made

by prisoners and later by civilian employees of the quartermaster. Garbage cans were washed in large wooden vats in boiling water containing strong washing soda and then rinsed before they were reissued to the kitchens. The covers were wired to the cans after washing in order to insure fitting.

The wooden platform of the original garbage transfer station was replaced by a concrete floor, and the road around the platform was also concreted so that the entire stand and roadway could be thoroughly washed down by a hose, drainage being effected by means of a sewer with which the plant was connected. The platform and surroundings were washed down twice daily with hot water. Garbage was at all times kept protected from flies. Plenty of fly-paper coils were hung about and large pyramid-shaped (21 by 18 inches) flytraps were used.

Other wastes.-Tin cans were first disposed of by being loaded, unwashed, into freight cars, but were later washed at the various kitchens, punctured at both ends, and the label removed before being brought to the collecting station. Grease was collected separately and sold as such to a contractor. There were 149 grease traps in camp, 1 for every 2 kitchens. They were cleaned out about every 10 days. Two modified Williamson incinerators were adequate for the destruction of all the paper mixed with garbage, rubbish, hospital dressings, and other waste which came to the transfer station. Stable refuse was collected daily, removed and disposed of at a point sufficiently distant from the camp to prevent its becoming a nuisance.


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PROVISIONS FOR FEEDING

Kitchens and mess halls.-Buildings for use as kitchens and mess halls were located adjacent to each company group of four barracks, and were designed to cook for and mess 250 men. Each building was divided into a kitchen, mess hall, and two storerooms. The portion used as a mess hall had two long rows of mess tables. The tops of the tables were so changed as to provide loose boards to facilitate cleaning. The kitchen was separated from the dining hall by a large serving shelf extending entirely across the building. Two Army ranges, which used hard coal, were provided. These also served to heat water for the ample water tank. Two refrigerators were furnished. These were originally installed in the kitchen too close to the ranges, but were later removed to the storeroom. The troops were rationed by issues in kind from the opening of the camp until March, 1918. This ration, which was very liberal, contributed much unnecessary waste of food supplies, particularly among the transient troops, as troops arriving in this camp received a certain number of days' rations and frequently were ordered to embark before the supplies were consumed. Furthermore, the method favored a feeling of prodigality among the cooks and there was no inducement to be economical with a view of obtaining ration savings. The most noticeable waste occurred in the items of bread and meat. There was no effort to utilize beef bones for the making of soups, chiefly because of lack of time and the uncertainty as to time of departure.

The camp was visited by a nutritional survey party late in January, 1918, which conducted some investigations among the various messes and made some useful recommendations in regard to the rationing, preparation of foods, and conduct of the messes. The ration savings privilege was put in operation soon after this and a commissioned officer was required to be present and supervise each meal. The benefits accruing from these changes were soon apparent. Wastage ceased almost entirely, the preparation of food improved, and much better satisfaction was obtained in the messes. The transient troops, during

 the early period, always furnished their own cooks and helpers and much of their cooking equipment.

Bakers' and cooks' school.-A system which had been under discussion for a short time was put in practice in August, 1918. A school for bakers and cooks was established at this camp. A considerable personnel was ordered here and was further increased by detaching others to this duty. Mess sergeants and cooks were assigned to permanent duty in the kitchens throughout the camp. An officer of the school was detailed to supervise the kitchens of each district. Supplies of staple articles were stored in the kitchens and storerooms of each district. Upon notice that troops were expected to occupy a certain area, the kitchens therein were started in full operation and meals were prepared for the number of troops expected. Upon the arrival of the organizations, their own cooks proceeded to duty in the kitchens and had the assistance of supervisors of the permanent school organization. This plan was highly successful. It provided efficiency and effected economy in the handling of the ration, promoted satisfaction among the men, and increased the morale of troops by relieving men, weary from travel, of much of the arduous task of preparing food, and avoided waiting indefinitely for a meal. It placed this camp somewhat in the position of furnishing satisfactory hotel accommodations.


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The matter of cleansing mess kits in a thoroughly satisfactory manner always presented some difficulties. There was always more or less of a disposition on the part of the organizations to furnish a mere semblance of washing facilities in the form of a boiler or two of warm, soapy water. These had to be placed outside near the door of the mess hall as, on account of lack of space in the kitchen, it was impracticable for a company of men to pass through the building in order to wash their mess equipment. The water in these boilers soon became cold and dirty. Much stress was laid upon the necessity for cleaning and sterilizing mess equipment in water actually boiling, especially during the occurrence of epidemic diseases. Instructions of the War Department in this regard were observed as closely as conditions would permit. Most of the permanent organizations in camp used crockery or pooled their mess gear and were able to boil their dishes or to rinse them in boiling water. For transient troops, larger vessels of wash water were provided and the hot water was changed frequently during the washing of the company's dishes. A field range was set up in the kitchen to furnish boiling water in one or two instances. This method was not practical, however, because of the increased fire risk involved and the need of wood for fuel.

Bread.-The bread for this camp was made in the camp bakery, which was located in a low frame building in the northwest part of camp. The building was divided into a dough-mixing room, oven room with 3 sets of ovens (1 Marshall and 2 Hubbard), proof room, storerooms for supplies, a large storeroom for bread in racks, and a toilet and dressing room. The plant was operated by Bakery Company No. 332 until their departure for overseas duty. The bakers of the School for Bakers and Cooks took charge in July, 1918. The equipment included an electric dough mixer and, more recently, a mechanical flour sifter. The bakery had a capacity of 22,000 pounds per day. Delivery of bread in camp was made by means of covered trucks having a removable flat floor. Bread was of excellent quality, with rare exceptions. Various flour substitutes were used until the end of 1918, and some of these occasionally produced abnormally heavy bread. Ropey bread was encountered only once, in August, 1918. The trouble was discovered promptly, radical measures were resorted to, and the fault was corrected.

Meats.-The meat supply of the camp was furnished by several of the well-known packing firms under monthly contracts, and was delivered in refrigerating cars. It was at first handled directly from the cars to the organizations, the cars sometimes being held on the sidings several days at a time before disposal of the contents, especially when the population was low. The doors of the cars had to be opened too frequently and this was the cause of much sweating and spoiling of meat during the summer months. A large refrigerating plant was constructed in order to overcome this difficulty. It was operated in a very

satisfactory manner. All shipments of meat were inspected by the camp veterinarian. Meat was delivered to the various kitchens by means of covered trucks provided with a removable slat bottom. The meat, in general, was of good quality. Care was taken to prevent access of flies in the cutting room and on the platform outside. Inspection of all meat handlers was frequently made.


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Milk.-Canned milk was used by company messes. Fresh milk was used only in the officers' messes and was supplied by large dealers. Weekly examinations were made of all milk and ice cream. Dairies were inspected at various times. The milk was always of good average quality as to fats and bacterial content. All food handlers in camp were examined every six months. The number of examinations of food handlers for typhoid, paratyphoid, and intestinal parasites was 1,756. No typhoid or paratyphoid was found. The following parasites were found: Necator Americanus, 52; Strongyloides stercoralis, 1;

Ascaris lumbricoides, 14; Trichuris trichiura, 9; total, 76. The men in whom the parasites were found were immediately removed to the base hospital for treatment. One case of dog tapeworm was found in a member of the bakery company, and here the dog was located and the parasite found.

MEDICAL PERSONNEL

A medical officer was assigned in September, 1917, as sanitary officer on duty with the constructing quartermaster, and seven medical officers arrived later in the month with a regiment of Infantry. A camp surgeon was designated about November 1, 1917, and the sanitary officer was transferred to duty as commanding officer of the base hospital, which was then under construction.

The 14 medical Department officers on duty with the camp proper by April 1, 1918, were grouped into five divisions-administrative, sanitary, attending surgeon, dental, and overseas' casual service.

Necessary changes in duties and personnel were made, from time to time, during the history of this camp. Only slight modifications of the duties were required after the signing of the armistice, such as the following: In connection with medical attendance, a variable number of officers, often as many as 25 or 30, were on duty accompanying troops to their demobilization camps; also from December 1, 1918, to March 15, 1919, the Medical Department was in charge of and operated the delousing plant; a medical examining board was formed at various times for the examination of officers as to fitness for duty or promotion, of enlisted men for duty or for discharge at close of their service for the emergency, and for the physical examination of recruits subsequent to March 1, 1919.

MEDICAL INFIRMARIES

Dispensaries were maintained from the beginning in various parts of the camp for holding sick call and for emergency treatments. The first infirmaries were located in a plain barrack building, with improvised furniture and equipment and with no water supply. Three new infirmary buildings, built on a standard design, were completed in the early part of 1918. One was centrally located. It contained the central dispensary and the office of the camp surgeon. Another was assigned for use of the guard regiment (then the 49th Infantry), and the third for the overseas casual service. Each building served the troops quartered in its vicinity. No beds for the sick were maintained in these infirmaries, all sick men being conveyed at once to the base hospital. The organized units, accompanied by medical officers with some of their field equipment, frequently held their own sick call at a barrack in their own camp area. The permanent guard regiment had a complete combat equipment which was kept intact while in garrison.


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MEDICAL SUPPLY DEPOT

A medical supply depot was established at this camp in January, 1918, as a branch depot under the direction of the surgeon, port of embarkation. The depot occupied three warehouses on the main highway running through the camp, near the base hospital. Supplies were promptly furnished for all organizations, both permanent and transient. After January 1, 1919, the camp medical supply depot was included in the consolidation of supply departments under direction of the purchase, storage, and traffic division of the General Staff Corps.

OVERSEAS CASUALS SERVICE

A casual company was organized by camp headquarters in November, 1917, to dispose of the casuals then accumulating in camp. This organization grew rapidly to such proportions as to require a large administrative personnel. The overseas casual service was later formed to take charge of these duties. It included medical personnel, for which seven medical officers were assigned, and occupied an infirmary building.

Numbers of enlisted men were received here late in the summer of 1918 as casuals, who had been returned to duty from absence without leave, sick in hospital, or otherwise detached from their units. These men were organized into casual companies for service in the American Expeditionary Forces. A board consisting of five medical examiners was formed in order to determine their fitness for duty overseas. There were 12,013 examined, of whom 1,857 were found disqualified for overseas duty. Medical attendance was rendered to large numbers of men by means of the several infirmaries. Those belonging

to organizations were recorded on the sick and wounded reports of those units. Other transients and the personnel of the permanent garrison were carried on the records of this office or on those of the overseas casuals detachment. The medical records of the overseas casuals detachment, known after November 11, 1918, as the casual battalion, were consolidated with records of the camp surgeon's office on February 1, 1919.

CONTROL OF COMMUNICABLE DISEASE

The great importance of the control of communicable diseases among the troops was recognized from the first and precautions were taken with that end in view. Hence one of the most important functions of this department was the medical inspection of troops. The earliest orders emanating from the War Department dealing with the subject (in September, 1917) required inspection of embarking troops for the elimination of active cases of venereal diseases. It was at once apparent that the attention of medical officers should be directed to measures for the early detection of infectious diseases. Rules for their

guidance were accordingly formulated and were published in the following general order:

General Orders, No. 9.

HEADQUARTERS CAMP MERRITT, N. J.,

November 19, 1917.

Upon recommendation of the camp surgeon, the following regulations for guidance of medical officers will obtain until further orders.

1. Report of arrival.-The senior medical officer will report to the camp surgeon as soon as practicable after arrival in camp, submitting at that time a list of the medical personnel with the organization.


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2. Infectious diseases.-Report will be made immediately of the infectious diseases to which the organization has been exposed at their previous station or en route.

3. Field report of sick (Form 83) and of personnel (Form 82) will be rendered to the camp surgeon daily at 9 a. m.

4. Sanitation.-The senior medical officer with each organization is charged with the supervision of the sanitary conditions in and around the quarters of his organization, and with close observation of the health of the members of that command.

5. Sick call.-Sick call will be held at the hour designated in camp orders, and will be conducted by a medical officer.

6. Contagious diseases.-The surgeon will keep himself informed by personal inspections as to the existence and nature of any diseases, being especially alert to detect in their earliest stages cases of measles, scarlet fever, mumps, pneumonia, diphtheria, cerebrospinal meningitis, or other epidemic or contagious diseases, and body lice or vermin. The clothing of contagious cases will be promptly disinfected, underclothing by means of formalin, if practicable, or by exposure to sunlight and free ventilation for four hours. On the occurrence of measles, scarlet fever, or mumps in a command, the surgeon thereof will make daily inspection of every "contact" with a view to the early detection of new cases. (General Order No. 45, War Department, 1916.)

7. Epidemic diseases.-Every case of epidemic disease will be at once reported in writing to the camp surgeon.

8. Ventilation.-Ample ventilation of barracks must be maintained at all times to limit the spread of respiratory infections. Inspections at night should be made frequently by medical officers to see that sufficient windows are kept open in dormitories.

9. Prophylactic station.-A venereal prophylactic station will be maintained by each organization having a medical personnel. It will be open for use day and night, with a competent attendant of the Medical Department on duty at all times, who will supervise the treatment and prepare necessary register. Organizations without a medical detachment will have a dispensary designated for their use.

10. Prophylaxis.-In compliance with War Department orders, prophylaxis against typhoid and paratyphoid fevers must be completed before embarking. Materials and facilities are available. (General Order No. 20, port of embarkation, October 16, 1917.)

11. Disposal of the sick.-Until the completion of the hospital at this camp, the sick will be transferred, after approval of camp surgeon, to the hospital, port of embarkation, Hoboken, N. J., in accordance with Circular No. 2, Headquarters, Camp Merritt, November 11, 1917.

12. Transfer cards.-A transfer card (see par. 215, M. M. D.) will accompany each patient sent to the hospital.

13. Other regulations.-Attention is directed to General Order No. 11, General Order No. 21, port of embarkation, Hoboken; General Order No. 45, War Department, 1916, and Special Sanitary Regulations No. 28, War Department, 1917.

By order of Colonel Bennett:

F. J. PEARSON,

  Second Lieutenant, 49th Infantry, Camp Adjutant.

It became necessary later to issue more detailed instructions, describing exactly the method to be observed in conducting the physical inspections. After January 1, 1918, orders of the port of embarkation prescribed a careful inspection of all troops daily over a period prior to embarkation for the detection of all cases of communicable diseases and the detention of the contacts of such cases. Thereupon an organization of medical inspectors was gradually built up and a system perfected by which every command or detachment of troops was inspected daily, either by their own medical officer or by a representative of the camp surgeon, and a special final inspection was made (on the day prior to embarkation) under the direction of an inspector detailed from port headquarters. All cases of infectious and contagious diseases immediately were isolated. These had to be transferred to hospitals in Hoboken and Englewood


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during the early period of the camp, pending completion of the base hospital. Transportation was at first effected by ambulances; later, from the middle of December, 1917, to early in January, 1918, by means of a hospital car of the Erie Railroad to Jersey City, where the patients were transferred to hospitals of Hoboken or Jersey City.

Contacts.-Contacts, at first, were quarantined in their own barracks. This resulted in groups of contacts scattered in various portions of the camp. In order to keep the contacts together and more easily hold them in strict quarantine, a detention camp was organized in January, 1918, under the supervision of a line officer. This camp was located in one corner of the reservation and consisted of a group of troop barracks, several mess halls, and lavatories. The contacts of different diseases were grouped and messed separately. The camp surgeon's office assigned a medical officer to duty in the camp who inspected every man twice daily for the presence of secondary contagious cases. Sick men promptly were removed to hospitals and the quarantine of the contacts in the same room was extended from the last date of exposure. The quarantine period for measles and German measles was 14 days and for scarlet fever 8 days. Carriers of meningitis and diphtheria were held and treated in the detention camp at various times. The contacts of these latter diseases were always subjected to laboratory culture and held until negative results were obtained. A guard was maintained about the detention camp and its several subdivisions. This duty was performed by the permanent garrison whenever practicable. At other times, the guard was drawn from among the contacts themselves and was under the direction of the officers and noncommissioned officers assigned to the detention camp. Increasing numbers of venereal cases were held in the detention camp while undergoing treatment after the middle of 1918.

In the selection of contacts of contagious cases it was attempted to follow a reasonable method to secure those who were the most frequent associates of the actual case; hence, during the first eight months it was the rule to detain all men occupying the same floor of the barrack with the sick man. Observation of the secondary cases which developed further justified this practice, as most secondary cases occurred among men who lived and slept in the same room (30 to 35 men were quartered on one floor of a barrack). This, of course, at times, resulted in the quarantine of a large number of contacts. The number of

contacts detained was sometimes reduced by careful investigation of the epidemiological history of each case, only a few contacts being held if the organization had a good health record, usually the 8 or 10 men sleeping nearest the patient, nonimmunes, and his intimate associates. This procedure obviated extensive depletion of organizations so urgently needed overseas. An organization was quarantined as a whole when it was involved in an epidemic, and, with a spreading infection, was withheld from embarkation until quite free from the appearance of new cases after the lapse of the period of quarantine. This

was the case with certain organizations quarantined for scarlet fever and measles late in 1917, and for influenza in 1918. The number of contacts held in the detention camp itself, from July 1, 1918, to July 1, 1919, was as follows: Influenza, 504; scarlet fever, 689; measles, 3,282; meningitis, 67; diphtheria, 115. This does not include the contacts held within their own area, especially in the instances when whole organizations were detained.


332

Influenza.-A few cases of epidemic influenza made their appearance in this camp about the middle of September, 1918. Instructions were given to all medical officers to be on the lookout for cases suggestive of this disease and to remove them at once to the hospitals. Daily temperatures were taken and intimate contacts were segregated for five days. Attendants and patients in dispensaries, visiting infirmaries, or removed in ambulances wore masks of gauze or a handkerchief. Special orders were published by camp headquarters placing the camp in quarantine and directing the attention of all concerned to the necessity for constant ventilation, avoidance of overcrowding in barracks, early treatment of any ailment, and the use of individual toilet articles and mess equipment. Auditoriums and the theater were closed and the troops were segregated within their own barrack areas. Careful, detailed inspection of troops was instituted for the removal of early cases and their contacts. But few troops arrived from other camps after influenza became pandemic. Organizations in this camp were not prevented from embarking so long as their sick rate was low and not increasing. Between September 15 and November 15, 1918, there was a total of 5,025 cases of influenza; of these, 396 died, a mortality of 7.7 per cent.

Typhoid fever.-Only 6 cases of typhoid fever were admitted to the base hospital, none of which was attributable to this camp. The first 2 cases occurred in 1918; the remaining 4 cases were men just returned from overseas in the summer of 1919.

Venereal disease.-As was stated previously, preembarkation inspections were made for the detection of active cases of venereal disease. The numbers found and detained rapidly increased during the first months of the embarkation period. This was almost wholly attributable to the influx of the draft troops.

Venereal patients were sent from this camp to a special hospital for the treatment of venereals, located on Hoffman Island in the old quarantine station of the port of New York. It was not long before the capacity of that hospital was overtaxed and cases had to be retained in the camp hospital. Many cases held in this camp in the early summer of 1918 were restricted and treated in a section of the detention camp. A urologist, with an assistant, was assigned to duty for the treatment of these cases. These diseases were found in a higher rate among the negro troops than among the white, and gonorrhea was almost always of the chronic type. In September, 1918, the port had accumulated so many venereal cases that measures were urged to evacuate them to other camps in order to relieve the congestion of hospital and barrack facilities in the embarkation service. Over 1,000 cases were transferred to a development battalion at another camp late in September. The majority of these men, after the subsidence of the acute signs, were able-bodied and capable of manual labor, drill, and other duties. The special conditions prevailing in the port made it difficult to utilize the labor of these convalescents except in a few

 instances.

Five venereal prophylaxis stations were located in various parts of the camp early in 1918, with attendants on duty at all times. The reports pertaining to men of this camp were forwarded to the port surgeon's office. The number of prophylactic treatments taken was 2,623. This is an insignificant number,


333

notwithstanding the fact that practically all transient troops had received instructions in venereal prevention and hygiene at their mobilization camps and by moving pictures and lectures while at this camp. The permanent garrison received special instruction at various times through talks given by medical officers. All organizations were notified of the location of early treatment stations and they were plainly marked. Semimonthly physical inspections were made of the permanent garrison, and included all civilian employees handling food supplies. There were reported only 47 new cases of venereal disease among

the permanent garrison.

INSECT CONTROL

Fly prevention.-Measures for fly prevention were adopted early in the seasons of 1918 and 1919. In addition to the thorough policing of stables and the daily removal of all refuse, 4,000 flytraps were distributed throughout the camp; together with large quantities of fly paper and "swatters," for use in kitchens and mess halls.

Mosquito control.-When the site of Camp Merritt was officially sanctioned, the Bergen County Mosquito Extermination Commission immediately prepared a survey of the camp and surrounding territory, showing all swamps, ponds, streams, and other possible mosquito breeding places. This survey showed an unusually large number of such places. The records of the county commission also showed that anopheles had frequently been found breeding in this part of the country. This map was presented to the camp sanitary inspector, and at his request the work of draining the worst of the swamp lands shown was started in September of 1917. This drainage was done by civilians in the employ of the constructing quartermaster and under the supervision of the Bergen County Mosquito Extermination Commission. The work to the west of the camp followed three main drainage lines, the Dumont brook, the Bergen Fields brook, and the hospital brook. The main streams were cleaned and regraded, culverts rebuilt, and laterals cut. A large swamp to the east of the camp in the borough of Demarest was drained. A force of 30 civilian laborers was employed for 26 working days, 38,519 feet of old ditching were cleaned,

6,738 feet of new ditching cut, and 412 cubic yards of filling done. The cost was about $3,500.

The work was resumed early in the spring of 1918. The maintenance of the ditching done in 1917 and the necessary oiling were taken care of by the detachment of the Sanitary Corps, consisting of 50 enlisted men under 2 experienced white sergeants. These men also enlarged the drainage system established by cleaning 22,560 feet of old ditching and cutting 3,825 feet of new ditching in the Haworth area to the north of camp. On the outside of the camp, the work of expanding the systems installed in 1917 was conducted by the United States Public Health Service and the Bergen County Mosquito Extermination Commission, working in close cooperation. They cleaned out the Tenakill drainage brook on the east of camp, a wide, sluggish stream, and completely drained the many swamps lying on either side of it. The swamps around Dumont railroad station on the west were drained and the Bergman brook, Bergman's Pond and Gilpin's Pond were thoroughly cleaned. The extra-cantonment work embraced a zone averaging about a mile from the outside


334

perimeter of camp, and included approximately 11½ square miles of territory. The estimated population of the area controlled was 10,500. The work was done with a gang of 12 laborers under a competent foreman. Work was started April 15 and completed on September 30. In addition to the 45,787 feet of Tenakill drainage brook trimmed and cleaned, these men cleaned and cut 73,326 feet of old ditching, cut 12,670 feet of new ditching, cleaned 5,146 feet of pond edges, and filled in 40 cubic yards of lowland. The average cost of cleaning ditches and streams, including the Tenakill, which in some places was badly congested, was 3½ cents per linear foot. The total cost of this work was $5,920.27, of which the mosquito commission paid $2,888.39 and the United States Public Health Service the balance.

The ground in the vicinity of camp was wet in the early spring of 1918, and it was necessary to oil quite generally to suppress the first brood. The effect of the drainage was noticeable after that, and oiling in most areas was necessary only in occasional deep depressions or in small, scattered pools. Thirty barrels of oil, or 1,500 gallons, was enough to check the breeding during the 1918 season. Night collections of mosquitoes were made every week from June 1 to September 30. Stations were made at various spots in camp, at each picket line, and at selected places in the near-by towns. These collections

showed that mosquitoes had been reduced to a marked degree. The average catch at the stations in camp and at the picket lines was about 1 mosquito every 10 minutes. The stations outside of camp, many of which were at the edges of swamps, showed a catch of about 1 every 3 minutes. During the summer there was never a complaint of mosquitoes in the men's sleeping quarters. Less than 2 per cent of the mosquitoes caught were Anopheles and the base hospital did not record a single case of malaria attributable to Camp Merritt.

Delousing plants.-Cases of lice infestation were treated in an improvised delousing station until December, 1918, using a lavatory building for the purpose. All clothing of infested men was steam sterilized by a portable disinfector at the base hospital. The men were shaved and received a cleansing bath. General delousing assumed greater importance after the armistice was signed. To prevent the introduction into this country of typhus fever, plans for a large delousing plant for use in camps at the port had been pending for a number of months. Actual construction of a large plant at this camp was begun in October, 1918. Pending completion of this building, an extemporized delousing plant was arranged for in November and was ready for operation on December 9, 1918. This plant consisted of four barracks, one mess hall, and a lavatory building. The disinfestation of clothing and blankets was effected by the use of 10 portable steam sterilizers which were obtained for the purpose. The capacity was 200 men per hour. A new "sanitary process plant" was put in service on February 4, 1919, with a capacity of 190 men per hour. This building was constructed in accordance with standard plans prepared by the War Department, and comprised a receiving and disrobing room, bathroom equipped with 50 showers, a barber's room, drying and dressing room, a sterilizing room equipped with a large autoclave sterilizer, and accessory rooms for office and storage of valuables.


335

The operation of both of these plants was conducted by the Medical Department until the middle of March, 1919, when it was turned over to the camp utilities. The personnel required for duty at both of these plants was as follows: One captain, Medical Corps, in charge, with 12 commissioned assistants and 84 enlisted men. These worked in three shifts of 2 medical officers and 28 enlisted men. One engineer and one fireman were furnished for each shift to run the boilers and sterilizer in the new plant. In the extemporized plant, a detachment of 25 men, Sanitary Corps (colored) operated the portable sterilizers. After the utilities branch took charge of this work, the post surgeon's office continued to furnish medical officers for duty as inspectors of the men undergoing the sanitary process. There were treated from December 9, 1918, to July 31, 1919, 275,551 men.

The following table shows the infestation detected during an active period of this work:

Month

Number inspected

Pediculi capitis

Pediculi corporis

Pediculi pubis

Scabies

1919

         

March

52,857

2

11

1,610

9

April

47,623

---

7

1,433

3

May

48,268

---

3

537

8

June

44,357

2

8

96

20

July

82,646

50

73

3,445

88

Total

275,551

54

92

7,151

128


Routine examination of the clothing of the men for the presence of lice was not made a part of the process at this camp. The physical examinations conducted as the men passed into the shower-bath room were mainly for the purpose of detecting head and pubic lice and skin and venereal diseases, and for a general observation of the physical condition of the soldier. The latter was especially observed during the winter months and when examining convalescent casuals, in order to prevent men physically unfit from being exposed to the possibility of contracting respiratory ailments while undergoing the process.

The medical authorities proceeded on the policy that infestation with body lice was well eradicated in the universal sterilization of all clothing. The inspection therefore detected almost exclusively infestation with Pediculi pubis.

A number of modifications in the details of the process had to be made from time to time. The method originally in use of packing the clothing into barrack bags for sterilization resulted in very unsightly wrinkling of uniforms, sufficient to necessitate the issue of new equipment in many instances. A method suggested by the salvage officer was adopted in order to diminish this fault, using baskets having dimensions of 24 by 18 by 8 inches. The articles of clothing were packed into these, the uniform being carefully folded to avoid creasing. The result was a marked improvement in the appearance of the

uniforms.

The formula for the liquid-soap mixture, furnished for the baths as an insecticidal soap, required a number of modifications. The original mixture, made with soft soap and kerosene or gasoline, was entirely too thick to flow through the faucets with which the soap dispensing cans were equipped. The


336

product was unsatisfactory even after several changes in the proportions of the ingredients. It was believed that the small proportion of gasoline content usable in the mixture was of very questionable value as a disinfectant and it was omitted after a thorough trial. Liquid soap, or at times Ivory soap, was thereafter furnished.

A large clothing room was maintained in connection with the plant, where clothing exchanges were liberally made after inspection of the soldier, in order that he would have clean and serviceable equipment. Careful inspections were made of bedding in barracks and quarters and of troop trains used by infested troops at various times during the summer of 1918 and later, for evidence of lice infestation, but with constantly negative results. The interior of the cars of all troop trains arriving at the camp with overseas troops was subjected to a disinfecting spray consisting of 2½ per cent compound solution of cresol.

This disinfection was performed by enlisted men of the Medical Department.

TROOP TRAINS

Medical attendance was furnished on all troop trains departing from this camp for demobilization camps. It was the duty of the medical officers on these trains to treat minor ailments and to dispose of all cases of acute illness occurring en route by transfer to the nearest hospital. Daily inspection of troops and of the sanitary condition of train equipment was required. There were made, during the first eight months of 1919, 785 troop movements accompanied by officers attached to this office. This figure does not include casual officers similarly employed and demonstrates the necessity for having retained

a considerable personnel.

MEDICAL BOARDS

The duties of the camp surgeon's office included the assignment on many occasions of medical officers to serve on boards to conduct physical examinations for various purposes. There was not at any time a board of specialists such as were constituted at mobilization camps for the drafted forces.

EXTRA-CANTONMENT ZONE

The United States Public Health Service sent an officer in February, 1918, to take under his immediate charge the sanitation of the extra-cantonment zone. This zone supervision was maintained by frequent inspection of restaurants, cafes, barber shops, and systems for waste disposal. All sources of food supply of the camp were investigated by a sanitary inspector from the camp surgeon's office. This necessitated the making of trips to all near-by towns as far as New York and vicinity. Special attention was paid to the barber shops and various restaurants. Regulations governing sanitary requirements for such establishments were drawn up after consultation between the camp surgeon and the public health officer, and permits were issued to approved places. Soldiers were not permitted to visit places not showing both camp and Public Health Service permit. Weekly inspections were made by a civilian inspector of the Public Health Service. Inspections were frequently made by one of our own sanitary officers, and he was accompanied by the public health officer at least once a month. Places found insanitary were temporarily closed in a num-


337

ber of instances by combined action of the military and Public Health Service authorities. A high standard was required of all eating places and, in general, was well maintained. Reports of contagious diseases in the vicinity of the camp were furnished.

Material help was given, as noted, in mosquito-extermination work, an assistant public health officer supervising this work with the aid of civilian help. The funds to carry on such work were furnished by the Treasury Department. Extensive work was done in the marshes located in the vicinity of the near-by towns. There were frequent consultations with our own officer in charge of the camp mosquito work.

Valuable aid was given to prevent fly breeding. All stables, privies, and other fly-breeding places were sought out and defects remedied by such means as the construction of new and replacement or repair of old privies. The total number of such improvements was as follows: Concrete vault privies, 277; new fly-proof buildings, 439; all others repaired, 423; total improvements, 1,139.

DENTAL SERVICE

The first dental surgeon reported for duty on October 23, 1917. The original dental service was established at the regimental infirmary of the 49th Infantry. The dental officers were without equipment until about the 15th of November, except for that which was available at the infirmary. The dental office was moved into the casual infirmary building upon the arrival of equipment, where the work was carried on until the completion of the building occupied by the camp surgeon. This building contained a dental office with space for two chairs. The camp was then divided into two sections on account of the increasing dental service required. Five officers reported for duty before the end of the year 1917, and as only two portable outfits were available they worked in alternate shifts. It became evident that it would be necessary, as the personnel increased, to have a chief of the service. On October 22, 1918, the foundation was laid for a camp dental infirmary, of the unit type that was being constructed throughout the mobilization camps, to house the dental service. Requisitions were put in at the same time through proper channels to equip the the building to accommodate 20 operating dental surgeons. Anticipating the

completion and the equipping of the camp dental infirmary, request was made for an increase in the dental personnel. Ten officers reported for duty on November 8, 1918.

The new building was opened in January, 1919, with 18 dental officers on duty. It was complete and well organized, with its various operating rooms, laboratory, and X-ray service, and with different officers having their special work, such as oral surgery, prophylaxis, orthodontia, and general operating.

VETERINARY SERVICE

The Veterinary Corps was represented at this camp by 1 first lieutenant, Veterinary Corps, 1 sergeant, first class, and 1 private, first class. This personnel was at first under the direction of the camp surgeon's office, but early in 1918, it was placed in a separate status and the senior veterinary officer was designated as camp veterinarian. This officer had under his jurisdiction the care of animals, the stabling conditions, and the inspection of meat products received by the subsistence department. There were 10 stables and 3 large and 1 small corral situated in a group in the northwest part of the camp.


338

Stables were of frame construction, located on sloping ground well ditched and drained. No flooring was provided, but one concrete floor was installed in a portion of the stable used as a hospital. There were about 250 animals in this camp. Great care was taken to prevent fly breeding. The manure was removed before 10 a. m.; all droppings were gathered frequently, especially around the picket lines, and placed in tightly covered galvanized-iron cans. The general sanitary conditions of stables were satisfactory. Very little fly breeding was found.

CAMP MILLS, LONG ISLAND

Camp Mills was originally a tent camp, intended for the mobilization and embarkation of the 42d Division, but was also occupied by the 41st Division after the departure of the former. It was situated near Mineola, Long Island, about 10 miles from the eastern boundary of New York City. The flat terrain was composed of a sandy loam containing a small proportion of gravel. The drainage problem was particularly difficult because some areas had no natural spill, but sumps accomplished the desired results until a system of ditches could be completed.

Because this was a tent camp, it was impossible to use it during the winter of 1917-18. During 1918 construction was started to provide barrack space for 50,000 troops; however, during the last week of November, the barrack plans were changed to accommodate 25,000, since it was estimated that, as a debarkation camp there would be about 25,000 troops to be quartered.

While Camp Mills was not taken over by the port of embarkation as an embarkation camp until April 4, 1918, supervisory control of its camp hospital previously had been assumed by the surgeon of the port, in order to make available to this tent hospital the facilities afforded by civilian hospitals in the port area.

WATER SUPPLY

The water supply was obtained from the public supply of Garden City village until June 5, 1919,with a subsidiary supply from the village of Hempstead, after which date the whole supply was from drilled wells on the edge of the camp. Its quality was satisfactory, the bacterial count was always very low, but, like most Long Island ground water, it had a high organic content.

DISPOSAL OF WASTES

Garbage.-During the tent camp period, April 4 to September 30, 1918, solid garbage was burned in individual rock-pit type incinerators modified to suit the material available and the conditions to be met. These were all constructed and kept in repair by sanitary squads detailed from permanent labor companies and each under the charge of a noncommissioned officer of the medical detachment. After September 30, 1918, garbage was collected and transported to a pig farm operated under the direction of the camp quartermaster. Liquid kitchen wastes, during the tent period and following this

when the tent portion of the camp was occupied. were disposed of through grease traps leading into deep absorption pits. The grease traps were built by the camp quartermaster and the pits were constructed by labor details working under the direction of the camp surgeon. This method of disposal was satisfactory. They were maintained and kept in order by the sanitary details previously mentioned.


339

Exereta.-Latrine pits, with boxes of the Havard type and inclosed by a screened shelter, were used until the occupancy of the barracks. The pits were sprayed daily with oil-lampblack mixture, and on account of the large amount of waste thrown in by transient troops were burned out weekly. This work was done by sanitary details, as it was found that only matters of general police could be left to troops passing through. Urinal troughs coated with tar were eventually replaced by galvanized-iron troughs. Disposal by sewerage system, except in occupied tent areas, was in effect after September 30, 1918.

BATHING FACILITIES

These were unsatisfactory at first. The showers, being in open pavilions, were not provided with heat or hot water. Early in May, 1918, however, the camp quartermaster built a bathhouse and used waste steam from a near-by plant to heat water for 60 showers. Another bathhouse was improvised out of an old detention ward building a little later. This was provided with showers of hot and cold water. These, together with the company showers which were utilizable when the weather became warm, provided satisfactory bathing facilities until the barracks, with their lavatories, were completed. Bath water

was disposed of in absorption pits. Much trouble was experienced from these overflowing when the camp was fully occupied. This was met by digging large drainage ditches in the low-lying areas and conducting the water to a system of shallow, large area pits near the edge of the camp.

MOSQUITO PREVENTION

As mosquitos were prevalent in this vicinity, prevention was vigorously carried on from the beginning of the camp. Outside areas were controlled by the Nassau County Extermination Commission, acting with the local Hempstead authorities and with the camp surgeon. Drainage pits and other breeding places within the camp were regularly inspected and oiled under the direction of the camp sanitary inspector.

EXTRA-CANTONMENT SANITATION

The immediately adjacent restaurants and barber shops were controlled directly by regulations drawn up by the camp surgeon, and these regulations were carried into effect by frequent inspections. At the request of the camp surgeon, the adjacent village of Hempstead, largely visited by men from this camp, adopted the same rules and regulations, which also were enforced by a sanitary inspector detailed from the camp surgeon's office.

PREVENTION OF INFECTIOUS DISEASE

The orders that contacts with cases of infectious diseases were not to be taken to embarkation camps failed to prevent many cases from developing en route or during their short stay here. The measures employed here were to  physically examine all troops on arrival, and to institute daily physical inspections of troops in order to remove the sick at the earliest possible moment. Men actually suffering from a contagious disease were sent to a hospital, while contacts were sent to the detention camp.

The detention camp, at first, was only an area in the tent camp which was set aside for the purpose. A standard detention camp was completed in November, 1918, with a capacity of 500, in separate buildings holding 8 men each.


340

All nonimmune contacts were sent to this camp except those in which cultural methods could prove that they were not carriers, and except those of smallpox, chicken-pox, and mumps. Smallpox contacts were revaccinated and returned to their organizations. Meningitis and diphtheria contacts were isolated until the actual carriers could be detected by culturing. The following tables show the numbers of cases and of carriers of the different diseases encountered. They also show  the fluctuations in occurrence and the varieties for which accommodations must be provided.

Cases of infectious diseases, by months

Month

Anthrax

Diphtheria

Measles

Mumps

Meningitis

Meningitis
carriers

Diphtheria
carriers

Pneumonia

Scarlet fever

Typhoid fever

Smallpox

Malaria

Influenza

Trachoma

German measles

Chicken-pox

Tonsillitis

Empyema

1918

                                   

April

0

93

17

40

0

0

0

17

3

0

2

1

12

1

6

0

10

0

May

0

27

52

78

6

9

0

10

11

0

1

7

12

2

15

0

24

0

June

2

5

61

37

15

6

0

5

5

1

3

13

3

2

0

0

30

0

July

1

8

96

80

10

5

0

5

8

0

0

9

0

6

0

6

8

0

August

1

6

112

83

2

28

5

2

2

0

0

7

0

1

0

0

16

0

September

0

0

182

49

3

3

1

26

0

0

0

6

545

1

0

1

21

0

October

0

1

48

31

4

0

0

915

0

0

0

1

5,070

1

0

0

3

0

November

0

2

54

84

1

0

0

0

1

0

0

1

505

1

0

0

15

0

December

1

0

8

72

2

8

0

0

0

0

1

0

309

0

0

0

30

0

1919

                                   

January

0

1

1

176

0

15

0

34

2

0

0

0

249

58

0

0

58

2

February

0

0

0

143

0

0

0

40

1

0

0

0

174

0

0

1

105

10

March

0

0

3

69

1

1

0

29

8

0

1

0

116

0

0

1

137

3

April

1

0

8

23

4

3

0

29

3

0

3

0

90

0

0

0

70

6

May

1

0

9

9

0

0

0

19

3

0

0

0

55

0

0

0

29

2

June

0

0

0

5

0

6

0

2

0

0

1

0

0

0

0

01

29

1

July

0

0

0

3

1

0

0

15

0

0

0

0

0

0

0

0

10

0

Total

7

143

651

982

49

79

6

1,148

47

1

12

45

7,140

73

21

10

596

24

Contacts and carriers sent to the detention camp

Months

Measles

Diphtheria

Scarlet fever

Meningitis

Smallpox

Total contacts and carriers

Contacts

Cases developing

Contacts

Cases developing

Contacts

Cases developing

Contacts

Cases developing

Contacts

Cases developing

Number

Per cent

Number

Per cent

Number

Per cent

Number

Per cent

Number

Per cent

1918

                               

April

275

9

3.02

133

3

2.02

11

0

0

0

0

0

0

0

0

419

May

637

3

.47

86

0

0

56

0

0

0

0

0

0

0

0

779

June

686

11

1.60

0

0

0

54

0

0

0

0

0

0

0

0

740

July

775

4

.51

0

0

0

37

0

0

5

0

0

0

0

0

817

August

1,265

13

1.02

0

0

0

12

1

.83

0

0

0

0

0

0

1,277

September

265

6

2.26

0

0

0

0

0

0

0

0

0

0

0

0

265

October

45

2

4.44

0

0

0

0

0

0

0

0

0

0

0

0

45

November

129

4

3.10

0

0

0

0

0

0

0

0

0

0

0

0

129

December

20

1

5

0

0

0

0

0

0

0

0

0

0

0

0

20

1919

 

January

3

0

0

0

0

0

2

0

0

7

0

0

0

0

0

12

February

0

0

0

0

0

0

2

0

0

0

0

0

0

0

0

2

March

2

0

0

0

0

0

9

0

0

0

0

0

0

0

0

11

April

2

0

0

0

0

0

2

0

0

0

0

0

0

0

0

4

May

18

0

0

a30

0

0

9

0

0

0

0

0

0

0

0

57

June

0

0

0

0

0

0

0

0

0

0

0

0

b66

0

0

66

July

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Total

4,122

53

c1.28

249

3

c1.20

194

1

.81

12

0

0

66

0

0

4,643


aDiptheria contacts.
bSmallpox contacts ordered in quarantine by the surgeon.

cAverage.


341

VENEREAL DISEASE PREVENTION

Cases of venereal disease were not to be brought to this camp, but many cases escaped former inspection and were detected here. Efforts were directed chiefly to the prevention of infection while here, by the use of prophylactic stations, and, in cooperation with a representative of the law-enforcement division of the Commission for Training Camp Activities, by reducing prostitution in the vicinity of the camp. A social hygiene division was established as an educational measure, and an effort was made to reach all troops passing through by means of company lectures and by films in the various social welfare tents of the camp. During the debarkation period lectures were given by officers especially detailed for this purpose. Attendance was made compulsory and special efforts were made to reach every man by educational propaganda before his return to civil life.

LOUSE INFESTATION

This was early given attention to prevent the embarkation of infested men. Careful search for infested men was made at the time of the initial physical inspection of arriving troops. Any necessary delousing was done by the organization concerned prior to June 1, 1918. An improvised plant at the detention camp handled all such work during the ensuing six weeks, when it was taken over by a small plant of local design. As no sterilizer was then available, clothing was taken to Field Hospital No. 2 for sterilization. This sufficed during the embarkation period. Universal delousing of returning troops was instituted during the debarkation period. A larger plant was improvised in November, 1918, by using one of the bathhouses as a nucleus, adding additional buildings and supplying additional heating and hot-water facilities. Twenty portable field sterilizers were installed for the sterilization of clothing. This plant, constructed largely from plans and specifications furnished by the Surgeon General's Office, was ready for operation December 4, 1918, upon the arrival of the first contingent of overseas troops. The sanitary process plants were operated entirely by the commissioned officers and enlisted personnel of the camp surgeon's office from December 4, 1918, to April 28, 1919. Both plants were operated by the camp utilities division after April 28, the camp surgeon's office furnishing officers and men for inspection service and for scheduling troops. All troops were inspected, upon arrival, at the plants, after which they passed into the bathroom where they were painted with a kerosene-soap emulsion and passed to the showers. Men

found to be infested had the hairy parts shaved, and while this was being done their clothes were sterilized and returned to them in the dressing room. Each man was furnished with a bath robe while waiting. The ultimate total capacity of the plants was about 8,500 men daily if three operating shifts were run. The plants were operated with two shifts after April, 1919, a total of 18 hours daily, and, except in a few instances, were able to handle troops within 24 hours of their arrival.

MEDICAL SUPPLIES

Unit surgeons arriving during the embarkation period were required to submit lists of medical supplies and equipment on hand. Where found deficient, these were completed by the medical supply officer on duty at this camp. The shipment of combat equipment with medical detachments was discontinued after September 30, 1918, this being supplied overseas.


342

CARE OF THE SICK

Medical attendance of permanent troops and of those without their own medical officers was given by the office of the attending surgeon. Medical attendance of transient troops was given by their own medical officers. 

All but minor cases of sickness or injury and all infectious cases were transferred to the base hospital of the camp for treatment. A receiving station of the base hospital was operated in the camp proper during April, 1918, and patients were transferred through it to the hospital; this was found to be unnecessary, as the base hospital was within 1½ miles of camp and patients could be transported there quickly. Ambulance service in the beginning was supplied by the Women's Motor Corps. This organization did excellent service and their services were indispensable until sufficient ambulances could be

secured by the base hospital. Regulation Medical Department ambulances in sufficient numbers were available after June, 1918. One ambulance was always on duty at the camp infirmary for emergency use, direct request being made on the base hospital for routine calls.

DENTAL SERVICE

There were three dental officers on duty previous to July 1, 1918, and the dental infirmary was supplied with three portable outfits. The dental work done was mostly emergency, as there was an average of 30,000 troops in camp at this time. The number of dental officers on duty was increased to five during the months of July, August, September, and October, 1918, and the work done was still largely of an emergent nature. Sixteen dental officers were assigned to this camp on November 1, 1918. There were only 5 portable outfits available, but 10 more were soon procured. Only 9 outfits could be put

 up owing to the lack of room, so each officer worked one-half of each day. This arrangement continued until the medical infirmary building was completed, when the second floor of this building was turned over to the camp dental surgeon and 15 portable outfits were installed. This enabled 15 operators to work daily, thereby greatly increasing the dental work accomplished.

The camp changed from an embarkation to a debarkation camp during January, 1919, and an effort was then made to do a larger proportion of permanent work, as the men returning needed a great amount of dental work.

The dental infirmary building was completed in February, and the outfits were installed. The building was arranged for 20 base outfits, but owing to difficulties in getting base outfits at this time, portable outfits were installed until the proper equipment could be obtained. Most of the base equipment was installed in March, 1918, including a complete laboratory equipment, X-ray outfit, and base chairs. The service was then able to still further increase its output of permanent work.

Bridge and plate work was not generally done, owing to the brief stay of transient troops at this camp, but every effort was made to have returning troops looked over and such work as could be completed was done. It was considered especially important to give the soldiers final instructions as to the care of the teeth before returning them to civil life.

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