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Chapter II





The plan for reconstruction of the disabled men of the Army, approved by the War Department on July 31, 1918, embraced authority to commission in the Sanitary Corps of the Medical Department the necessary personnel of educational officers to administer the work in the Office of the Surgeon General and in each of the hospitals designated for reconstruction.1

On July 31, 1918, the Surgeon General designated the following general hospitals to function in physical reconstruction:2 Walter Reed, Washington, D. C.; Letterman, San Francisco, Calif.; Fort Bayard, N. Mex.; No. 2, Fort McHenry, Md.; No. 3, Colonia (Rahway), N. J.; No. 6, Fort McPherson, Ga.; No. 7, Baltimore, Md.; No. 8, Otisville, N. Y.; No. 9, Lakewood, N. J.; No. 10, Boston, Mass.; No. 11, Cape May, N. J.; No. 12, Biltmore, N. C.; No. 20, Whipple Barracks, Ariz.; No. 21, Denver, Colo.; No. 24, Parkview, Pa.; No. 26, Fort Des Moines, Iowa; No. 28, Fort Sheridan, Ill.; No. 29, Fort Snelling, Minn.; No. 30, Plattsburg Barracks, N. Y.; No. 31, Carlisle, Pa.; No. 36, Detroit, Mich.; No. 38, Eastview, N. Y.; No. 41, Fox Hills, Staten Island, N. Y.; No. 42, Spartanburg, S. C.; No. 43, Hampton, Va.

The personnel of each of the hospitals designated comprised:

1. An educational personnel consisting of- .
(a) Chief educational officer, with assistants in technical and agricultural training and psychologists.
(b) Instructors in academic, commercial, trade, and agricultural occupations.
(c) Civilian women (reconstruction aides) qualified by previous experience as teachers and by intensive training to teach the sick and wounded in the arts and handicrafts and in academic and commercial studies in the wards.
2. A director and qualified personnel of enlisted men to apply to various types of physiotherapy, assisted by -
(a) Civilian women employees (reconstruction aides) qualified by education, experience, and intensive training to apply massage, thermo-, electro-, and local hydro-therapy.
3. A director of recreation in sports, games, gymnastics, and military drill, with a qualified personnel of assistants, in cooperation with the Commission on Training Camp Activities of the War Department, the American Red Cross, the Young Men's Christian Association, the Knights of Columbus, the Jewish Welfare Board, and the Salvation Army.

During the period preceding the armistice personnel for reconstruction service in Army hospitals was obtained by the selection and induction from civil life of specially qualified educators who, by reason of physical disabilities, were eligible only for limited service or were men over draft age. A careful canvass was made of the educators of the United States through correspondence with universities, colleges of education, and technical schools. From names so obtained an eligible list was made and a few men were commissioned prior to the beginning of the armistice.3 At the time the armistice was signed commissions were pending for a large number of such specially qualified men who


had not been inducted previously.3 In so far as the educational department was concerned, there was no need for a great number of educators prior to the time in question, since wounded men had not been returned in any great number to the United States from the American Expeditionary Forces. With the signing of the armistice, however, there came a stoppage of new commissioning and of promotions,4 and thus all pending commissions in the entire list of
available qualified candidates for the educational services automatically were wiped out. In the department of physiotherapy the personnel of administrative offices was obtained from the Medical Reserve Corps. In both the educational and physiotherapeutic departments an enlisted personnel was assigned.

Following the signing of the armistice the work of the reconstruction service properly began, since plans now were effected to return the wounded from France without undue delay. This rapid return of the wounded from overseas, however, made necessary an emergency expansion of the reconstruction service, when, as a matter of fact, the stoppage of new commissions referred to above actually made a relative shortage of personnel. Therefore it was necessary to secure from other Army organizations men who would be even fairly qualified for this service.3 Medical Department men were assigned from hospital detachments. Many of these men had had neither previous experience, training, nor aptitude for the work of instruction. Commissioned officers were sought and secured by transfer from the psychological division of the Medical Department, from the Infantry, the Engineer Corps, and the Signal Corps. Though this method of expanding the personnel inevitably resulted in many disappointments, it nevertheless brought to the educational service at a time of greatest stress and need some of its best qualified and most efficient instructors. Instructions were sent from the Office of the Surgeon General to all camps and organizations to initiate requests on commanding officers to make a search for all men who might be qualified to act as instructors and at the same time be willing to undertake such service.5 Other efforts along the same line were made. Commanding officers of base hospitals frequently were able to secure instructors by causing a canvass of camp personnel to be made. To obtain desired instructors in this way necessitated that the men be in the Army, that they be willing to remain, that they manifest a desire to enter the educational service, and that they have some aptitude and qualifications indicative of the fact that they might be successful teachers. Furthermore, it was essential that their respective commanding officers signify a willingness for this release.

In the spring of 1919, though the demand for beds in the reconstruction hospitals was slowly decreasing, the personnel of the Medical Department was being discharged at a faster rate than the decrease in demand for beds in reconstruction hospitals would seem to warrant, so that the individual burden was increasing. Therefore it became necessary to establish a policy which would provide not only for the demobilization of Medical Department personnel in the reconstruction service but also for the continued treatment of the patients, as the necessity for their care would continue long after general demobilization was completed.


As the Medical Department enlisted men were making insistent demands for discharge, the Surgeon General recommended, on April 22, 1919, that, for purposes of reconstruction, the enlisted personnel of the Medical Department be not replaced by civilian employees, as the work devolving upon them in the demobilization of troops and the care of sick and wounded demanded an organization both well trained and disciplined.6 He also believed that it would not be advisable to discharge some of them and then reemploy them as civilians, because of the dissatisfaction that would result among those not so favored; and, further, that the manning of hospitals by civilians would make the maintenance of discipline difficult and might decidedly impair the operation of the hospitals, as they could not be held to the obligation which must be fulfilled in the treatment of sick and wounded.

Later, the Surgeon General considered it necessary to change this policy, owing to the great demand for discharge, and he recommended to the War Department, in order to promote voluntary consent to remain in service for the duration of the emergency:7 That two or three sergeants, first class, of the educational and physiotherapy enlisted personnel of each hospital be promoted to the grade of second lieutenant, Sanitary Corps; that the educational enlisted personnel of each hospital be informed that that service would be acutely needed during the emergency; that the men who desired to make engagements as teachers in civilian institutions or to make arrangements for a continuation of their studies in schools and colleges might do so, with the understanding that these men would be released from service on or before the opening of the fall term of the next school year; that men who desired to take advantage of the opportunity for discharge should make an early written request to the Surgeon General for release on or before the date mentioned; that additional qualified civilian instructors be employed at $100 to $250 per month to make the necessary replacement of the enlisted men who would be released for special reasons before the emergency need ceased.

No action on his communication having been taken, the Surgeon General modified his recommendation on July 14, 1919.7 He now advised the discharge of all enlisted men who desired discharge, and their replacement with reconstruction aides as teachers, and civilian employees as instructors in shop work, in the belief that one individual who was voluntarily in the service was more efficient than three who were anxious to be discharged and were retained
against their wills.

On July 19, 1919, the War Department called upon the Surgeon General for an estimate of the number and cost of the civilian employees suggested; expressed the opinion that the salaries quoted were too high; disapproved the proposed promotion of noncommissioned officers to commissioned grade.7 The desired information was furnished from the Surgeon General's Office on August 9, with the comment that the character of the work was such that it could satisfactorily be performed only by individuals of higher intelligence and earning capacity.7 It had been estimated that 75 teachers of experience would be needed with salaries ranging from $125 to $175 per month, and 50 trades instructors at salaries from $175 to $200 per month.


Educational and vocational training had been extended in July to those of the entire enlisted personnel of the Army who desired to avail themselves of the opportunity, and this further interfered with the execution of reconstruction duties by the personnel of the hospitals.8

In lieu of the employment of civilians, it was determined to concentrate on the assignment of enlisted men to function in the care of sick and disabled, abandoning all efforts to organize and train divisional and other units. With the operation of this policy and the later increase in enlistments by the adoption of one-year periods of service, it became possible by December, 1919, to accomplish the separation of all temporary enlisted men who desired discharge.9

The question of a sufficient number of commissioned officers properly to care for the patients in reconstruction hospitals caused even more difficulty at the time in question. Congressional appropriations for the fiscal year ending June 30, 1920, limited the number of officers holding emergency commissions which could be retained in the service. This resulted in an order by the War Department in July, 1919, for the discharge of all such officers by September 30, 1919.10 Since this would seriously handicap the work of the Medical Department, the Surgeon General requested that the Medical Department be allowed to retain in the service 2,000 officers holding commissions for the emergency only.11 This request was made on the grounds that 619 officers were necessary to fill the existing vacancies in the regular Medical Corps and care for the normal sick of the authorized enlisted force of the Army, and 1,400 were required for the care of the 24,000 additional patients remaining from the war. Fortunately, the order for the discharge of temporary officers was rescinded by the Secretary of War in September, 1919, and the retention of a sufficient number in the Medical Department was authorized.12



The original organization of the division of special hospitals and physical reconstruction included a section of physiotherapy. 13 It was soon evident that this branch of therapy was too broad and too technical to be performed satisfactorily by enlisted personnel of the Medical Department alone, and investigation indicated that there were relatively few persons in this country with the requisite training to undertake the varied work which would be demanded in
our military hospitals. Accordingly it was proposed in September, 1917, to open a training school for medical aides in the general hospital to be established at the United States Soldiers' Home, Washington, D. C., the students to consist of two classes--enlisted men and civilians, the latter to be almost entirely women.13 Those who already were trained in the procedures required were to be given a course of instruction in the peculiar character of the work to be performed; the others were to receive a complete course of training to fit them for this work. Soon after this a woman was appointed as supervisor of aides.14 A consideration of the educational aspect of reconstruction indicated that some of the educational phases would be so closely related to the physiotherapeutic that it might be advisable to place the control of the medical aides under this section of the project, but such action was not taken.14


The medical officer who was appointed as chief of the section of physiotherapy, November 15, 1917, proceeded to organize the section to meet the prospective demands by a selection of personnel, as well as the standardization of apparatus and the drawing of plans for special-treatment buildings.14 The succeeding months were devoted to a study of the work to be accomplished. It was decided that the work in and for the hospital wards could best be performed by women in most instances, and a section of the civilian personnel employed by the Medical Department was accordingly planned, to be known as "The Women's Auxiliary Medical Aides."13 A circular had been published December 31, 1917, by the Surgeon General's Office stating that the object was to meet the need for a large number of persons properly trained to carry out the work of special massage and remedial exercises in the hospitals or other sanitary formations of the Army, especially in the orthopedic care of patients, and placing the aides under the direction of the division of military orthopedic surgery. This circular also provided for the pay and allowances of the aides; for a supervisor, defining her duties; for a chief aide where more than one aide was on duty; for a qualification standard and a uniform; and for a reserve to be called in time of emergency. The name for the class of employees referred to was soon after changed to "reconstruction aides," and this term included those engaged in education also.

The aides were obtained for the Medical Department by a canvas of institutions which trained teachers, and of other schools, and by general notices in the newspapers. Each candidate submitted a detailed statement of her experience and qualifications with her application for appointments.14 These were scrutinized carefully and inquiry was made of persons who were most likely to have known of her fitness for the work. Qualification in a physical examination insured the physical strength necessary for the work to be performed. The selections were made from a review of the accumulated information, often supplemented by an interview with the individual. In assigning the selected individuals to hospitals the aim was to appoint to each hospital a team of instructors, all familiar with elementary crafts, the general information and purposes of the reconstruction program, and each a specialist in an important line. The type of woman sought was one qualified and experienced as a teacher of adolescents or adults in high school, normal school, or college, and also possessed of knowledge of the crafts. The ability to associate with young men on a friendly footing without encouraging undue familiarity was a very necessary part of the qualification as a teacher.


All studies of reconstruction as practiced by our allies indicated the necessity of early ward occupation for convalescents, in order to prevent hospitalization, in its pre-war sense, by consuming as much of their time as possible. This light work was to reawaken their mental activities, arouse their ambitions, relax stiffened joints and contracted muscles, and prove to them that their usefulness was not at an end but depended upon their own exertions. So the
official specifications for this work, as approved by the Surgeon General, January 5, 1918, were:15
1. Purely medical function.
2. For the therapeutic benefit of activity-


(a) To be prescribed in the early stages of convalescence;
(b) To occupy;
(c) To prevent hospitalization;
(d) To prepare the mind for subsequent occupational (vocational) treatment;
(e) Not to be in any sense vocational; and
(f) The work to be simple, quickly done, and have commercial value.

Suitable work for men weakened by illness and injury consisted of activities which were along educational lines, such as beadwork, weaving of various kinds, academic studies, games, and drawing. Therefore, the aides engaged in that work were known as "occupational aides" and were under the immediate direction of the educational service,15 in contradistinction to the physiotherapy aides, who were under medical direction.

To supplement the limited number of persons who were qualified to conduct occupational work it was proposed in January, 1918, to introduce special courses in a number of established schools to train 1,000 women for this service by October 1, 1918.15 Such courses were established in March and April, 1918.

A call for women to serve as reconstruction aides in occupational therapy was issued by the Surgeon General's Office August 8, 1918.16 It was felt at the time that 1,000 such women would be needed for overseas service within a few months and others in hospitals in the United States to teach handicrafts and other subjects. The requirements for such service and the pay, allowances, etc., were given.

The classification of occupational therapy aides gives an idea of the scope of the proposed occupational work:16 Class A, expert in one or more lines-social worker, library service; teacher in industrial and fine arts, general science, English, commercial branches, free-hand drawing and design, mechanical drawing, telegraphy and signalling, French, manual training, agriculture (gardening and floriculture), music, plays, and games, mathematics. Class B, as teacher or craftsman in one or more lines-knitting (hand, machine, rake), weaving, clay and papier-mâché modeling, wood carving and toy making metal working, jewelry, and engraving. Class C, informed on all lines-military procedure in hospitals, War Department's program for physical reconstruction of disabled soldiers, regulations as to insurance, pensions, etc., under the War Risk Insurance Bureau, and opportunities offered by the Federal Board for Vocational Training.

Official consideration of the status, pay, and allowances of reconstruction aides led to the opinion that they should be placed on an approximate equality with nurses for pay and allowances.17 Official and unofficial discussion as to a desirable status emanated from the personnel for many months. Meanwhile, representatives from the Surgeon General 's Office unofficially but with the approval of the Surgeon General had been slowly developing a rudimentary reconstruction service at Walter Reed General Hospital, Washington, D. C. (initiated in February, 1918),18 and a like process was taking place at General Hospital No. 2, Fort McHenry, Baltimore, Md.; General Hospital No. 3, Colonia, N. J.; General Hospital No. 6, Fort McPherson, Ga.; and General Hospital No. 9, Lakewood, N. J. This early work was of extreme value as a proved basis on which to construct maturer plans. The first reconstruction


aides to be appointed were sent to Walter Reed Hospital in late February and early March of 1918. These were all occupational aides, although the earliest plans for training considered physiotherapy aides alone.


Certain schools in this country made provision for the establishment of preliminary training courses for those who wished to qualify as reconstruction aides, and were only awaiting the final determination of policy in the Surgeon General's Office before opening the courses. Early in the year 1918 the Surgeon General approved the outlines of courses submitted by these schools, and the following schools were conducting such courses in April: 19 In physiotherapy: a American School of Physical Education, Boston, Mass.; Boston School of Physical Education, Boston, Mass.; Prose Normal School of Gymnastics, Boston, Mass.; New Haven Normal School of Gymnastics, New Haven, Conn.; Normal School of Physical Education, Battle Creek, Mich.; Reed College, Portland, Oreg.; Teachers' College, Columbia University, New York City. In occupational therapy: b Teachers' College, Columbia University, New York City. The curriculum in the occupational therapy courses was as follows:

Weaving--hand and bead looms, simple rug and mat making; woodwork--whittling and carving, confined to the use of a few instruments, as knife, chisel, and gouge; basketry--reedwork, and possibly pine-needle work; block printing--applied to both paper and textiles; knitting, crocheting, needlework, and beadwork; incidentals--cord knitting, rake knitting, etc.; applied design--to include the principles of design and color work and the application to subjects taught in course; practice teaching--actual practice in teaching the required subjects in hospitals under conditions similar to those which would be met in military hospitals, hospital routine and methods of invalid teaching, lectures and conferences on the conduct of hospitals, and methods of teaching the convalescent and disabled, including visits to institutions.


In the latter part of July, 1918, the chief of the section of physiotherapy recommended to the Surgeon General that a school be established at once in Walter Reed General Hospital for the instruction of reconstruction aides in military physiotherapy because of the great, difficulty in getting adequately trained women for that service.20 The chief of the division of physical reconstruction stated in forwarding this recommendation that some civilian schools were giving a complete course for reconstruction aides while others were teaching only the fundamentals, and approved the recommendations for schools at Walter Reed General Hospital in both occupational therapy and physiotherapy.20 It was not until well after the period under consideration, however, that such a school was established.


In the early summer of 1918 the chief of the division of orthopedic surgery expressed the opinion that the influence and effectiveness of women in reconstruction work would be greater than that of returned soldiers, and requested

a A specialized and intensive course was later given by Harvard University to 85 selected aides.
b Courses in other schools had been approved-one in Boston, one in New York City, and a semiofficial one in Washington, D. C., but were not yet being conducted.


the assignment of two occupational aides and two physiotherapy aides to each 50 orthopedic beds.21 This proportion was tentatively approved as an experimental basis by the chief of the hospital division of the Surgeon General's Office on July 2, 1918. 21


There was a great deal of dissatisfaction among the reconstruction aides because they were not on the same status as the nurses for pay and allowances.17 The chief of the educational department recommended an equal status for all trained women in the department who were of a corresponding assignment, except that the chief nurse at a hospital should be responsible for the discipline of all. This recommendation was not adopted. 17


The necessity for social service work in military hospitals became increasingly evident. Many patients were so worried by family troubles, failure of payment of family allowances, morbid thoughts of their own, etc., as to interfere seriously with both their ability to recover and their willingness to remain in hospital for treatment. Experienced social workers were brought into the corps of reconstruction aides about the first of the year 1919 and assigned to such hospitals as requested them to act as head aides of the social service.22 Several adaptable reconstruction aides were to be assigned to each head aide as assistants; the duty of this service was to solve all possible individual problems of the patients through personal confidence attained and by securing cooperative action by welfare, insurance, vocational, and other departments through a knowledge of their requirements and of the benefits to which the soldier was entitled.


The educational personnel from October, 1918, to June, 1919, with the number of hospitals devoted to physical reconstruction during this period, is given in the following table: 23


The personnel in the department of physiotherapy from October 1, 1918, to May 31, 1919, is indicated in the following table: 23



(1) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1176.
(2) Circular letter, Surgeon General's Office, July 31, 1918.
(3) Crane, A. G., Ph. D.; Education for the Disabled in War and Industry. Teachers' College, Columbia University Contribution to Education, No. 110. New York City, 1921.
(4) Telegram from The Adjutant General to commanding generals of all territorial departments, replacements, central officers' training schools, camp headquarters, depot brigades, ports of embarkation, and to commanding officers of all other units of independent commands within the limits of the United States, the commanding general Philippine Department, and commanding general Panama Canal Department, November 15, 1918. Subject: Suspension of recommendations of emergency promotions and appointments. On file, Miscellaneous Section, Mail and Record Division, A. G. O., 210.2.
(5) Circular Letter No. 72, Surgeon General's Office, February 4, 1919.
(6) Memorandum from the Surgeon General to Lieutenant Colonel Highley, April 22, 1919. On file, Record Room, S. G. O., 230.14-1.
(7) Memorandum from Third Assistant Secretary of War, January 5, 1919, and attached documents. On file, Record Room, S. G. O., 230.14-1.
(8) Memorandum from Lieut. Col. H. M. Evans, M. C., to the Surgeon General, August 9, 1919, and attached documents. On file, Record Room, S. G. O., 353.91-1.
(9) Annual Report of the Surgeon General, United States Army, 1920, 284.
(10) Circular No. 350, War Department, July 12, 1919.
(11) Memorandum from Col. C. R. Reynolds, M. C., for the Chief of Staff, September 9, 1919. On file, Record Room, S. G. O., 210.801-1.
(12) Telegram from The Adjutant General's Office to the Surgeon General, September 3, 1919. On file, Record Room, S. G. O., 210.801-1.
(13) Letter from the Surgeon General to commanding officers of base hospitals, May 21, 1918. Subject: Transfer of patients for physical reconstruction. On file, Record Room, S. G. O., Miscellaneous Letters, A-893.
(14) Report on the physiotherapy service, United States Army, by Maj. F. B. Granger, M. C., director of physiotherapy service. On file, Historical Division, S. G. O.
(15) Report on the fundamental principles and the development of ward occupational therapy, made by the division of reconstruction, May 20, 1918. On file, Historical Division, S. G. O.
(16) Circular letter, Surgeon General's Office, August 8, 1918. Subject: Reconstruction aides in occupational therapy. Copy on file, Historical Division, S. G. O.
(17) Memorandum from Lieut. Col. H. M. Evans, M. C., to Col. Henry A. Shaw, M. C., October 18, 1919. On file, Historical Division, S. G. O.
(18) Annual report of the department of occupational therapy, Walter Reed General Hospital, December 30, 1918. On file, Historical Division, S. G. O.
(19) Memorandum from Maj. H. R. Hayes, Sanitary Corps, for Lieut. Col. E. G. Brackett, M. C., and Maj. H. E. Mock, M. C., April 26, 1918. On file, Historical Division, S. G. O.
(20) Memorandum from Col. Frank Billings, 'M. C., for Brig. Gen. Robert E. Noble, M. C., July 29, 1918, and attached documents. On file, Historical Division, S. G. O.
(21) Letter from the division of physical reconstruction to the Surgeon General, July 2, 1918. Subject: The assignment of reconstruction aides in occupational therapy and physiotherapy to general hospitals functioning in physical reconstruction. On file, Historical Division, S. G. O.
(22) Circular Letter No. 38, Office of the Surgeon General, January 18, 1919.
(23) Educational service reports (statistical). On file, Weekly Report File, Record Room, S. G. O.