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It should be noted that on September 4, 1917, a hostile aeroplane attacked the hospital group, Base Hospitals Nos. 12 and 15, which were grouped with several British general hospitals. As a result, one first lieutenant, Medical Officers' Reserve Corps, two privates, first class, of the Medical Department, and one private, first class, Medical Emergency Reserve Corps, were killed. Three lieutenants, six privates, first class, or privates, were wounded. Thus the first members of the American Expeditionary Force to lay down their lives or suffer wounds in the great war at the hands of the enemy were not from among the combatant forces, but from those who were engaged in deeds of mercy.

The first chief surgeon of the American Expeditionary Force was Col. (now Brig. Gen.) A. E. Bradley, Medical Corps. When he later returned to the United States on account of his health, Col. (now Surgeon General) M. W. Ireland was appointed in his place.

The chief surgeon's office was organized in six divisions-1, hospitalization; 2, sanitation and statistics; 3, personnel; 4, supplies: 5, records and correspondence; 6, gas service. The chief surgeon's office was later consolidated with the Medical Department of the Service of Supplies. It was then divided into the following divisions:

1. Division of Hospitalization, Evacuation and Hospital Administration. 2. Division of Sanitation, Sanitary Inspection, and Medical Statistics.

3. Division of Personnel.

4. Division of Medical Supplies.

5. Division of Finance and Accounting.

2. HOSPITALIZATION.

A large number of hospital beds are now available, and plans are already made to provide a sufficiant number, or at least as large a number as practicable. A number of buildings are being constructed and a number are also being obtained from the French Medical Service. Hospital trains have also been provided. Two of these were purchased in France and a number from the English Government.

3. EPIDEMIOLOGY.

The hardest problem that the medical officers of the American Expeditionary Force and the Navy have to grapple with in safeguarding the health of the men is the control of epidemic diseases. Contagious diseases are found in practically all organizations arriving at base ports. This is well nigh unavoidable, due to the necessary overcrowding on shipboard, and the inactivity and lowered vitality of the men. Practically every threatened epidemic of communicable disease has been traced back to the base ports.

Weather conditions and overcrowding in billets and barracks increase the spread of these diseases. There are certain factors. however, which have been repeatedly stressed by the office of epidemiology which are capable of materially helping the situation. Among these the following should be noted: (1) The absolute necessity of personal cleanliness, (2) the danger of overcrowding, not only in the matter of bed space, but crowding about the stoves in the barracks.

As a commentary on the sometimes doubted efficiency of the Army noculation and vaccination, it is worthy to note that after the death of an officer from smallpox and the occurence of several cases of yphoid it was found that in the smallpox case and in nearly every case of typhoid the individuals had for some unknown reason failed o be vaccinated or inoculated, or that such artificial immunization ad been reported unsuccessful.

4. LABORATORY SYSTEM.

This important division has been thoroughly organized with a entral laboratory in a suitable place housed in suitable buildings, which were secured from the French Medical Service. One of the nain functions of this central laboratory is as follows:

The standardization of technical methods, the supply of standard materials, diagostic and therapeutic sera, vaccines, cultural media. special mobile outfits, and ersonnel for the investigation and control of transmissible diseases and the training I personnel for special laboratory problems arising during the course of the war. This laboratory has since proved of the utmost importance in safeuarding the health of the Army. Several large basé laboratories ave also been established.

5. SANITARY INSPECTION.

Sanitary inspections are made periodically. There are two general anitary inspectors on duty in the office of the Chief Surgeon. These fficers make inspections of base hospitals, depots, camps, and other laces as necessary. There are two especially great problems affectg the health of the Army. These are prevention of (1) skin diseases ad (2) venereal diseases.

6. PREVENTION OF SKIN DISEASES AND BODY LICE.

One of the greatest problems which has arisen in maintaining the ealth in all armies at all times has been that of body vermin. This oblem has been made especially acute in the present event because the trench life bringing with it congested quarters in dugouts and >cessarily unsanitary conditions. The experience of the British handling this problem is brought together briefly in the following

mmary:

The main factors in keeping troops free from vermin are personal cleanliness, complished by bathing and frequent washing of the clothes. But little help in s is given by the use of chemical agents, and their use is rather discouraged by the itish authorities as producing a false sense of security.

This problem can probably best be handled by thorough and freent bathing, frequent laundering of the clothes, with additional am or hot-air disinfection as necessary. The disinfection and rilizing can best be handled by the Medical Department and the indry by the quartermasters.

7. VENEREAL DISEASES.

The American attack on venereal diseases has been upon the followlines:

The education of soldiers and civilians as to the physical dangers of venereal

jases.

2. Discouragement tending to prohibition of the use of all forms of intoxicants, the idea being that the sexual impulses are always excited by such stimulation and selfcontrol diminished.

3. Repression of all forms of illicit sexual intercourse, both clandestine and public, under the theory first advanced by American medical men that the exercise of the sexual functions is not essential to health and manly vigor.

4. A thoroughgoing provision for, and use of, the prophylactic treatment.

5. The employment of stern measures and adequate punishment for those contracting venereal disease.

6. The calling into play of physical, social, moral, even religious factors, that might aid in keeping men free from illicit sexual intercourse and thus free from disabling venereal disease. The encouragement of the Y. M. C. A. and allied agencies in their propaganda, making for physical, material, social, and moral betterment, forms a notable example of this.

The chief surgeon is convinced that the campaign against venereal diseases which has been carried on is progressing satisfactorily and that the rate is beginning to show the satisfactory result of the campaign.

8. AMBULANCE UNITS.

For some time prior to the entrance of the United States into the war, ambulance companies had been organized in France of volunteers chiefly from colleges in the States. This movement received considerable extension in the early part of 1917 as it became evident that the United States would enter the war. It was suggested by the French mission that the United States should organize these volunteers on a military basis. The organization of the United States Ambulance Service was authorized to consist of 160 sections. Of these 120 were to be organized in the United States and 40 in France.

When the organization was undertaken there were 45 volunteer sections in operation. When arrangements had been made for the enlistment in the voluntary sections, it was found that a large number of these men did not desire to enlist, either prefering to go into a combatant branch of the service or to go home. It was therefore possible to organize only 25 sections from the American Ambulance Service. From the personnel of the 15 Red Cross sections there were only enough enlistments to make 3 sections. These sections were reinforced by a number of sections which had been organized in Allentown, Pa.

The entire United States Ambulance Service with the French Army now consists of 77 sections, 49 of which were trained and organized in Allentown, Pa., and 28 of which are the original volunteer American sections as stated above. These sections are now doing duty with the French Armies at the front, with the exception of 3 serving in the entrenched camp in Paris, one headquarters section, and half a dozen in reserve at the base camp of the service.

The service is a part of the American Expeditionary Force, and in its organization, discipline, and supply is subject to the commander in chief, American Expeditionary Force. Its men are fed, clothed. and equipped and its motor vehicles, gasoline, oil, and spare parts are furnished by the American Government. When, however, its organized units pass into the zone of the front and report for duty to the French Direction des Services Automobiles, the disposition of these units passes absolutely under the French military authority and is in every way subject, as far as movements, station, and performance of

duty are concerned, to that authority. The chief of the service can not issue orders affecting the movements of units in the zone of the ront, and all orders affecting individuals and material pass through the French military authorities. Outside of the zone of the front, however, the chief of the service has exercised entire control over the personnel and material and over the units of the service, as well as he individual members, and over the base camp.

9. SUPPLIES.

When it became evident that war would be declared, the Medical Department authorities immediately set about organizing the country or production. Through its medical representative on the Council of National Defense an invitation was sent to all the great manufacurers in the country who produced articles used by the Medical Department to appear in Washington for consultation. Represenatives of the Surgeons General of the Army and Navy and also repesentatives of the Public Health and Marine Hospital Service were present at this conference and outlines of procedure were adopted. Committees on the supplying of textiles, medicines, surgical instrunents, dental supplies, etc., were organized. These proceeded to comnunicate with all the manufacturers with the object of meeting the ' eeds of the Government, as shown by lists prepared in the Surgeon General's Office, based on an army of 1,000,000 men.

The country had been practically denuded of many of the needed rticles by purchases rendered necessary by the mobilization on the Rio Grande. A large proportion of the instruments, drugs, medical nd laboratory supplies, etc., had been manufactured in Germany or lsewhere abroad, and this supply was, of course, entirely shut off. he Japanese had begun to manufacture in a modest way, but it was vident that the great bulk of medical supplies must be secured from ur manufacturers. The committee on instruments allotted to arious firms the articles they were best equipped to supply, and in ke manner provision was made for the making of dies for instruents. The great textile mills took over and divided among themlves, in proportion to capacity, the making of gauze and articles kindred manufacture, and the glass factories did likewise for labotory supplies. The greatest shortage appeared to be in the prorement of sufficient dental equipment, but the large manufacturers ok up this matter also and, in addition, each dental surgeon from vil life was authorized to bring with him into the military service rtain articles of absolutely necessary equipment, which were afterrds inspected and appraised by a board of officers and taken over the Government after a just valuation.

MEDICAL SUPPLIES IN THE AMERICAN EXPEDITIONARY FORCE.

The medical supply problem in the American Expeditionary Force s especially complicated by the shortage of available bottoms. is was partially compensated for by purchase in France, England, d other allied and neutral countries. However, the facilities of ance and England being strained to the utmost has resulted both in ays in completing contracts and inability to obtain certain items.

By the middle of August about 7,000 cubic tons of supplies had been secured at * * * and 8,000 more were due on requisition. There were, however, no veterinary supplies on hand, and the only dental supplies were the personal chests carried by the dental officers. An attempt was made to secure some from the French, a dentist and a veterinarian going to Paris for consultation with the purchasing officer.

On September 4 * was still the only port used in unloading medical supplies. In the seven weeks succeeding the arrival of the first shipment 9,000 tons had been unloaded and forwarded. The storing facilities were wholly inadequate; consequently all goods had to be rushed from the ships to freight cars. Though credit is given to the officers at * * * in moving the supplies through to the intermediate zone, there was great confusion, and storage facilities near the port were strongly urged.

As our forces began materially to increase, more and more requisitions were necessarily incompletely filled, as the shipments from the United States did not keep pace with the demand. This condition improved a little later, and by the midle of November the chief lack was in field medical supplies.

A number of supplies has been purchased in France and England through the respective Governments. It is interesting to note that the Medical Department placed the largest individual drug order ever given in England. It consisted of more than 22,000,000 tablets and more than 13 tons of other drugs. These arrangements for purchase in France and England helped greatly in the solution of the supply problem.

It has been difficult at times to secure adequate storage facilities for the supplies.

11. ACCOUNTING DIVISION, MEDICAL SUPPLY DEPARTMENT. This division has had a rather interesting and unique history. It was organized and brought to France as a separate detachment.

On September 26, 1917, an act of Congress was passed authorizing the Comptroller of the Treasury and the Auditor for the War Department to perform the duties of their offices and audit the accounts of the Military Establishment at any place other than the seat of government.

A colonel of the Regular Army was informed by communication from Washington in the early part of October that he would be selected for the purpose of collecting and taking to France a force of men qualified to audit the accounts of the Medical Department in France, and was ordered to proceed to Washington for consultation. Upon arriving there he was informed of the nature of the work and directed to obtain a sufficient force to correspond to an army of 2,000,000 men. The organization of the office of the Surgeon General in Washington was taken as a model and the auditor and various other department organizations who were engaged in similar work were consulted. In order to get men qualified for the character of the work they would probably be called upon to do, all the large banks in New York, Baltimore, Washington, Philadelphia, and as far west as Chicago, and a large number of the great insurance companies, railroads, and department stores were communicated with and requested

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