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1911 Encyclopedia Britannica
Army Medical Service (United Kingdom)
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This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead.
"ARMY MEDICAL SERVICE (UNITED KINGDOM). - The British Army Medical Service never had such a task imposed on it as during the World War, from which it emerged with its organization tested by fire. Its duties cover the care of the sick and wounded of the military forces, the preservation of their health, the supply of medical and surgical material, the maintenance and administration of military hospitals and the command of patients in them, the medical examination of recruits and invaliding of men unfit for further service, the education and training of its own personnel, and the strategical and tactical employment of a variety of medical units concerned with the collection, evacuation and distribution of casualties in war.
Until 1873 the functions of an Army Medical Service had been carried out by a regimental system under which medical officers belonged, to and wore the uniform of the regiments to which they were gazetted, and under which many of the sick and wounded were cared for in regimental hospitals. Soldiers enlisted in the combatant ranks were trained in hospital duties and formed a Medical Staff Corps, but they were not under the command of the medical officers. In 1861 " Medical Staff Corps " was changed to " Army Hospital Corps," but the pay. and discipline of the men were directly under the department of the purveyor-inchief, and medical officers had no military position until 1869, when the director-general for the first time was attached to the military department of the War Office on the recommendation of a committee presided over by Lord Northbrook. In 1878 the personnel of the Army Hospital Corps was recruited by direct enlistment. In 1883 a committee under Lord Morley, after the Egyptian War, recommended that the Army Hospital Corps and the officers of the Army Medical Department should be merged into a " Royal Medical Corps," but this recommendation was not adopted at the time. A compromise was made by forming the officers into a body called the " Medical Staff " and the men into a corps called the " Medical Staff Corps," their original name. At the same time the officers of the Medical Staff took complete command over the personnel of the Medical Staff Corps, and their uniform was assimilated to that of the latter. Eventually, after considerable agitation on the part of the medical profession, Lord Lansdowne, then Secretary of State for War, announced, at a banquet given by the Lord Mayor of London on May 4 1898 to the medical profession, that the Medical Staff and the Medical Staff Corps in future would be consolidated into one corps, namely the Royal Army Medical Corps (R.A.M.C.), with military ranks and titles from private to colonel similar to those of other branches of the army. The ranks above colonel, however, retained the title of surgeon-general until 1918, when this title was abolished and replaced by that of major-general or lieutenant-general.
Peace Organization Administration. - The director-general of the Army Medical Service is the administrative head. He has the rank of lieutenant-general. His office is a branch of the adjutant-general's department at the War Office. He is not, however, a member of the Army Council, but may be required to attend council meetings when his advice is desired on any special subject. His staff consists of a deputy director-general, who is a majorgeneral, eight officers of the rank of colonel, lieutenant-colonel or major (some of whom hold temporary appointments only consequent on the World War) as assistant and deputy assistant directors-general, and colonels-on-the-staff or major-generals as directors of hygiene and pathology. The directors of hygiene and pathology have deputy directors, assistant directors and deputy-assistant directors of hygiene and pathology as assistants in their directorates. The administration of the Queen Alexandra's Imperial Military Nursing Service (Q.A.I.M.N.S.) also forms a branch of the director-general's office under the matron-in-chief assisted by two principal matrons and a nursing sister. In 1921 an inspector of dental services was added to the director-general's staff on the formation of an Army Dental Corps, with the rank of lieutenant-colonel.
The director-general's administration is assisted by an inspector of medical services, who is either a colonel or majorgeneral of the Army Medical Service. He visits all stations at home and overseas with a view to maintaining a uniform standard of training and efficiency. He reports to the adjutant-general.
In all commands at home and overseas the director-general is represented by deputy-directors and assistant-directors of medical services. In some of the smaller garrisons the senior executive medical officer acts in an administrative capacity without being graded as a deputy or assistant director. The staff of these administrative offices varies according to the size and importance of the command or the conditions under which troops are serving. Thus in the small garrisons in the tropics where medical research is of importance there is a deputy assistant director of hygiene and pathology, although the administration may be in the hands of a senior medical officer only. In India there is a special administration for the Army Medical and Indian Medical Service. Officers of the latter, when employed on military duties, are under the administration of a director of medical services, who is a major-general or lieutenant-general of the Army Medical Service, but the administrative appointments of the subordinate military commands in India may be held either by Army Medical or Indian Medical deputy directors and assistant directors. In 'war establishments there is a director of medical services in the headquarters of each army, a deputy director with each corps and an assistant director with each division. On their staffs are representatives of the directors of hygiene and pathology and other assistants.
Advisory Boards. - Connected with Army Medical administration there are several advisory boards or committees composed of military and civil members. An Army Medical Advisory Board advises on general professional questions. It is presided over by the director-general and its members are two consulting physicians, two consulting surgeons, the medical officer of the India Office and an officer of the Royal Army Medical Corps. An Army Hygiene Advisory Committee is presided over by the director of hygiene. Its members include an officer of the Royal Engineers (R.E.) and of the Royal Army Service Corps (R.A.S.C.), and military and civil sanitary experts. An Army Pathology Advisory Committee under the director of pathology is similarly composed of military and civil pathologists of eminence who deal with technical questions connected with research into the causes of disease. Queen Alexandra's Army Nursing Board, of which Queen Alexandra is president and the director-general chairman, is composed of the matrons-inchief of Q.A.I.M.N.S. and Territorial Force Nursing Service, of matrons of some of the large civil hospitals and of ladies nominated by the president. There is also a Technical Advisory Committee on Voluntary Aid under the director-general. It is composed of representatives of the War Office, British Red Cross Society, Scottish Branch of the Red Cross Society, the council of County Territorial Force Associations, and the St. John and St. Andrew's Ambulance Associations. These boards and committees meet at the War Office. Personnel. - The personnel of the Army Medical Service consists of officers, warrant officers, non-commissioned officers and men of the R.A.M.C. regular, special reserve, and territorial force, and of the Army Dental Corps, together with the affiliated nursing services of the regular army and territorial force, and the voluntary organizations recognized by the British Government under Article 10 of the Geneva Convention of 1906. The ranks of officers and men are the same as for other branches of the service. Officers and other ranks of the regular R.A.M.C. are under an obligation to serve in all parts of the world in peace or war: but only the officers serve in India, where the duties of subordinate ranks are carried out by a special Indian establishment consisting of an Indian Subordinate Medical Service, an Army Hospital Corps and an Army Bearer Corps. The members of the last two are natives of India. The members of the Indian Subordinate Medical Service are Indianborn British or natives of India educated in Indian medical schools. The higher grades rank as commissioned officers and the lower as warrant officers. The special reserve is organized on a militia basis and serves on embodiment under the same conditions as the regular Royal Army Medical Corps. The Territorial Force R.A.M.C. is organized for war purposes only. It has a general list of officers for service with regimental and medical units, a special list for territorial force general hospitals; and another for sanitary services. The rank and file of the regular R.A.M.C. are formed into companies, of which in 1921 there were 35, in addition to four depot companies. Eleven of the companies had their headquarters in overseas garrisons. Both at home and overseas the headquarters of R.A.M.C. companies are at one or other of the larger military hospitals. They provide detachments for smaller hospitals and general duty. The number in each company varies in accordance with local requirements. The normal peace establishment of the regular R.A.M.C. on the active list is approximately 1,100 officers and 3,800 other ranks, but this is greatly expanded in time of war by calling up reserves of every description. During the World War it had expanded to some 15,000 officers and 120,000 other ranks, in the case of officers chiefly by granting temporary commissions to members of the civil profession.
2 Military Hospitals
3 Medical Stores
4 The Regimental Medical Service
5 Field Ambulances
6 Motor Ambulance Convoys
7 Casualty Clearing Stations
8 Ambulance Flotillas
9 Convalescent Depots
10 Sanitary Organization in War
11 Mobile Laboratories
12 National Guard
13 Department and Corps Area Surgeons
14 Station Personnel
15 General Hospitals
16 Education, Training and Investigation
17 Administrative Organization in the Theatre of Operations
18 Communications Zone
19 Combat Zone
20 Army and Corps Medical Department Troops
21 Medical Department Troops Attached to a Division
22 Care of Sick and Wounded
23 Physical Examinations
The depot for training the regular R.A.M.C. is at Aldershot. Territorial Force R.A.M.C. are trained in a school of instruction in each of 12 territorial divisions by officers of the regular R.A.M.C., who act as adjutants of the schools. There is a R.A.M. College in London, where officers of the regular R.A.M.C., both on joining and before promotion to major, undergo a course of instruction in military hygiene, tropical diseases and other professional subjects. Training in field duties is carried out in the form of staff tours, camps of instruction and medical manoeuvres. Training in sanitation is carried out in an army school of hygiene at Aldershot and in schools of hygiene established in commands.
Military hospitals are established in all commands at home and abroad. They vary in size from large general hospitals, such as the Royal Victoria hospital at Netley with over t,000 beds, to small depot hospitals and detention wards in outlying posts. The number of beds normally maintained in peacetime in the United Kingdom is approximately seven thousand. In the World War this number expanded to more than 364,000; or, including beds in all theatres of war, to over 640,000.
An Army Medical Store is maintained at Woolwich for the supply of medical and surgical material and equipment to all garrisons at home and overseas, with the exception of India, which has its own stores. Supplies are obtained by contract from manufacturing firms. They are distributed through the central stores at Woolwich.
WAR Organization The organization of the Army Medical Service for war does not come into existence until mobilization is ordered. Medical units, the equipment for which is maintained in mobilization stores, are then brought into being by the assembly of personnel, material and transport at places of mobilization assigned to each unit. Three zones of medical work are recognized: The collecting zone, the evacuating zone, and the distributing zone. In these zones there are medical services for the collection, transport and treatment of sick and wounded, for the supply of medical and surgical stores, and for sanitary duties. Sick and wounded are collected in the first instance by a regimental medical service and passed from it to the field ambulances of the divisions. They are cleared from the divisions by motor ambulance convoys, which convey them to casualty clearing stations, whence they are passed down the lines of communication by rail, canal or road to the permanent hospital bases, and from there by seagoing hospital ships to the hospitals in the United Kingdom. The collecting zone may be regarded, therefore, as the area of work back to the casualty clearing stations; the evacuating zone as the lines of communication down to the sea bases or to the United Kingdom, and the distributing zone as the area of the hospital bases and the home territory.
The Regimental Medical Service
Each regiment of cavalry, battalion of infantry, brigade of artillery, ammunition column, squadron or bridging train of engineers and certain supply trains has an officer of the R.A.M.C. attached to it, together with a small detachment of R.A.M.C. other ranks for technical charge of water carts and water supplies. Sixteen men of the regiment are placed under him during battle as stretcher-hearers; and a non-commissioned officer and eight men, trained in sanitary duties, also work under him. Wounded are collected to a regimental aid post, which is established by the medical officer in a shelter or protected spot near regimental headquarters.
There are two forms of ambulances, the cavalry field ambulance for cavalry divisions and the field ambulance for divisions. They differed considerably in organization and transport before the World War, but since then the chief difference is in their transport. A cavalry division has a cavalry field ambulance for each brigade of which it is composed. Thus a cavalry division of four cavalry brigades would have four cavalry field ambulances. Divisions have three field ambulances each. Both a cavalry field ambulance and a field ambulance are composed of a bearer division and a tent division, and are organized in two sections, each section being formed of half the bearer and half the tent division. In the bearer division there are 18 stretcher detachments. They bring wounded back from the regimental aid posts to an advanced dressing station formed by one of the tent sub-divisions at a point to which wheeled transport can come up. Wounded are conveyed from the advanced dressing station to a main dressing station formed some distance back by the remainder of the field ambulance or by other field ambulances where there is less exposure to enemy fire than at the advanced dressing station. Formerly both classes of ambulance had each 10 horse-drawn ambulance wagons, six of which in cavalry field ambulances were light wagons, the remaining four being heavy wagons of the same type as the 10 wagons of the field ambulance. Motor ambulance cars replaced a proportion of the horse-drawn wagons after the British Expeditionary Force moved from the Aisne to the Flanders front in 1914. The ambulance transport of the cavalry field ambulance now consists of four motor ambulance cars and six light horse-drawn ambulance wagons; that of the field ambulance is seven motor ambulance cars and two heavy horsedrawn ambulance wagons. They are employed in battle in carrying wounded from the advanced to the main dressing station, but may go forward in advance of the former where it is possible to do so. Their carrying capacity is two lying or eight sitting in the light wagon or light ambulance car, and four lying or 12 sitting in the heavy wagon or motor ambulance car. Field ambulances are divisional troops and come under the command of the assistant director of medical services of the division.
Motor Ambulance Convoys
The first motor ambulance convoy used by the British in war was organized at the end of Sept. 1914 during the battle of the Aisne. It was formed of ambulance cars sent to France by the War Office early in Sept. and was rapidly followed by similar convoys, some of which were provided by voluntary organizations. Previously the system by which sick and wounded were brought from the field ambulances to railhead was to load them in the lorries of the supply columns returning empty to refill. But the system broke down early in the World War partly because this form of transport subjected the wounded to serious discomfort and jolting, and partly because the requirements of supply services and medical services were in conflict with one another. A motor ambulance convoy consists of 50 motor ambulance cars; it is under the command of an officer R.A.M.C. with R.A.M.C. personnel for medical duties, and a R.A.S.C. personnel, under an officer R.A.S.C., as drivers and mechanics. The number of these convoys allotted to an army is usually in the proportion of one for each army corps of which the army is composed, and one as an army reserve. They are normally army troops under the control of the director of medical services, who may, however, place them at the disposal of deputy-directors of army corps. Their function is to clear the field ambulance main dressing station of sick and wounded to casualty clearing stations at or near railheads, and to perform all other ambulance transport duties by road not carried out by the transport of field ambulances. In the event of railway transport breaking down or proving insufficient to relieve congestion of sick and wounded in the front areas, motor ambulance convoys may be employed for conveying sick and wounded to hospitals at the base.
Casualty Clearing Stations
These are medical units which form the link between the collecting and evacuating zones, or between the divisions of the field army and lines of communication. Their function is to receive the sick and wounded from the divisional field ambulances. Sick and wounded likely to be fit for duty after a short period of treatment are retained, as are also those too seriously ill for further transport. The remaining sick and wounded, after receiving temporary medical and surgical treatment, are evacuated as rapidly as circumstances and railway transport permit to the hospitals at the base. Casualty clearing stations are consequently organized with a convalescent or lightly wounded section, a hospital section, and an evacuating section. The number of casualty clearing stations allotted to an army is in the proportion of one for each division, but they are essentially strategical units and are army troops, the director of medical services being responsible for placing them where they may best receive and evacuate the number of wounded anticipated in battle. They are mobilized with personnel and equipment for the care of 200 casualties at a time, but are capable of expansion to any extent in the field from local resources or by bringing up additional equipment and stores from the base, whenever the nature of the operations admits of this being done. The organization of casualty clearing stations, therefore, depends very much on the nature of the military operations. The general principle upon which it is based is the mobilization of a light mobile unit in the first instance capable of following up an advancing army with sufficient equipment and shelter for surgical work at an advanced operating centre, and adding to it more extensive accommodation and equipment whenever circumstances permit. In its original composition a casualty clearing station had no transport of its own. During the World War three 3-ton lorries were allotted to it. It was customary to group them in twos or threes in the same locality. The lorries of a group of three casualty clearing stations would thus be sufficient to carry forward the advanced operating section of one of the three, and then return for the others. The weight of the original equipment, including marquees for 200 patients, was 21 tons, so that the nine lorries were capable of carrying this load. The heavier equipment and more extensive accommodation added during stationary warfare required 50 to 60 lorries for moving a casualty clearing station by road, or a complete train by rail. Casualty clearing stations are allotted two 3-ton motor lorries each. Ambulance Trains. - The evacuation of wounded by railway is effected by specially constructed or by improvised ambulance trains. The former are composed of ambulance coaches with through communication and accommodation varying from 300 lying down to 600 sitting up. They are commanded by an officer of the R.A.M.C. and are administered by the director of medical services on the lines of communication, whose staff regulate their journeys in association with the railway transport staff and in accordance with the demands of the field army. They are mobilized as a rule in the proportion of one for each division in the field, but their number depends on the length of the journeys from front to base and the time taken to return. Improvised ambulance trains are made up of passenger coaches or goods vans specially fitted for carrying sick and wounded. The ambulance trains were of this kind at the beginning of the World War, and were organized to carry 396 lying down on stretchers placed on special frames constructed to carry three stretchers each. Four frames were placed in each of 33 goods vans. Improvised trains subsequently were used in emergency only and were usually in the form of passenger coaches for transport of patients sitting up. When these improvised trains are used rest and refreshment stations are opened at intermediate halting places for supplying food and comforts and for removing patients unfit to continue the journey and transferring them to local hospitals. Rest stations for attending to patients pending their removal to hospital are also opened at stations where all classes of ambulance trains unload. They are formed by detachments from hospital units or by voluntary aid.
Although ambulance flotillas of river steamers or barges are war establishment units of continental armies, they are not definitely organized units of the British Army. They were formed, however, in 1914-8 for use on the canals in the north of France, and were composed of barges specially equipped as hospital wards and towed by steam tugs. Each barge had 30 beds, kitchen and stores, and accommodation for a staff of one medical officer, two nursing sisters and nine R.A.M.C. orderlies. Six barges formed a flotilla, and four flotillas were organized. They brought seriously wounded from casualty clearing stations to such hospitals on the lines of communication as were on or near a canal.
Hospital Ships. - Passenger or other ocean-going ships are chartered in time of war and fitted out as hospital ships for evacuating sick and wounded from the sea bases of a theatre of war to the United Kingdom. Their number and carrying capacity depend on the nature of the campaign, but the most suitable are those which are neither too large nor too small. A ship carrying 600 to Boo patients in cots was regarded as the best during the World War.
Hospitals are of two kinds, general and stationary. The former are fully equipped for all kinds of medical or surgical work. They are organized for 520 or 1,040 hospital beds, the smaller in the proportion of two and the larger in the proportion of one for every division in the field. They are situated at or near the sea bases but may be established in greater or smaller hospital centres elsewhere on the lines of communication. The stationary hospitals are smaller and less fully equipped than the general hospitals and are organized for 200 or 400 beds. They are intended to act as local hospitals for the sick of large camps or other posts on the lines of communication, or as hospitals for special purposes such as the reception and treatment of infectious diseases. They are mobilized in the same proportion as general hospitals. In the United Kingdom the Territorial Force R.A.M.C. mobilize 24 general hospitals in time of war, each of 520 beds.
These form large camps at the bases or elsewhere where convalescents on discharge from hospital are made physically fit to return to duty by convalescent treatment and graduated physical training. There is no fixed limit to their numbers or size. During the World War a convalescent depot could accommodate from 1,000 to 5,000 men.
Medical and Surgical Supplies in War. - Two kinds of units are organized for maintaining and distributing medical and surgical supplies, the base depots of medical stores and the advanced depots. They are in charge of quartermasters of the R.A.M.C. The base depots receive their supplies through the Army Medical Stores at Woolwich. They supply the hospitals and medical services at the base and on the lines of communication, and are placed as a rule at the sea bases. Originally the proportion was one for ever y two divisions, but there was no fixed proportion during the World War. As a rule there was one at each sea base or advanced base. Advanced depots of medical stores are army troops under the control of the director of medical services of the army, and are allotted in the proportion of one for each army corps. They are replenished from the base depots and supply the casualty clearing stations, the divisional medical units and other medical services of the field army.
Sanitary Organization in War
In addition to the sanitary detachment of each regimental unit, a sanitary section of one officer and 25 men is mobilized with each division and for each base. Sanitary squads of one non-commissioned officer and four men are also mobilized for each railhead or railway post on the lines of communication. The personnel of sanitary sections and squads act as sanitary inspectors, supervise the construction of sanitary requirements in camps and billets, and maintain sanitary establishments.
For special work in the field four classes of mobile laboratories are organized. Mobile hygiene laboratories for chemical analysis of water and food supplies and for other hygienic investigations are allotted in the proportion of one to each army. Mobile bacteriological laboratories for medical and surgical bacteriological investigation are allotted in the proportion of two to each army. A mobile X-ray laboratory and a mobile dental unit, in the proportion of one of each to an army, are attached to one of the casualty clearing stations. All these laboratories are constructed on motor chassis and can be placed in any area as required.
Nursing Services in War. - Members of the nursing services are employed in all the general and stationary hospitals, in ambulance trains and flotillas, hospital ships and casualty clearing stations.
Voluntary Organization in War. - Voluntary aid detachments of men and women are organized under County Territorial Force Associations by county directors of the British Red Cross Society or St. John Ambulance Association. They have a definite composition and are registered at the War Office. On mobilization they undertake the opening and staffing of auxiliary hospitals throughout the United Kingdom and the local transport of patients who are being distributed to hospitals in the United Kingdom. Members of women's Voluntary Aid Detachments (V.A.D.) may also be employed in nursing duties in military hospitals. In theatres of war the chief function of voluntary aid organizations is to maintain stores for supplementing hospital equipment and supplies by articles which may add to their comfort and appearance, and by distributing gifts. Medical units offered by voluntary services or private individuals are not recognized unless they are organized on the same lines as corresponding regular units and under the command of officers of the R.A.M.C. In addition to the voluntary aid detachments, the St. John Ambulance Brigade and the St. Andrew's Ambulance Association maintain a home hospital reserve, the personnel of which takes the place of the regular R.A.M.C. in the military hospitals in the United Kingdom when the latter are mobilized to form the medical units of the war establishments. At the beginning of the war in 1914 the St. John Ambulance Brigade had ready a home hospital reserve of 2,200 men and the St. Andrew's Ambulance Association 113, but these numbers increased so rapidly that by the end of 1915 over 15,000 of the St. John Ambulance Brigade were serving in the military hospitals in Great Britain. (W. G. MA.) United States Functions. - By Army Regulations the Medical Department in 1910 was charged with the following duties: Investigating the san itary conditions of the army and making recommendations with reference thereto; advising with regard to the location of per manent stations, the selection and purification of water supplies, and the disposal of wastes; caring for the sick and wounded; making physical examinations of officers and enlisted men; managing military hospitals; recruiting, instructing and controlling the enlisted force of the Medical Department and the Nurse Corps; and furnishing all medical and hospital supplies, except for public animals. In 1921 these functions persisted.
Composition Medical Department. - In 1911 the Medical Department comprised the Medical Corps, Medical Reserve Corps, Dental Corps, Hospital Corps (male), and Nurse Corps (female), to which could be added contract surgeons and other civilians. The National Defense Act of 1916 provided that the Department should consist of " one surgeon-general,. who shall be chief of said department, a Medical Corps, a Medical Reserve Corps,. .. a Dental Corps, a Veterinary Corps, an Enlisted Force, the Nurse Corps, and contract surgeons.. ." Subject to the appointment of great numbers of officers in temporary grades up to and including that of majorgeneral, as authorized by war legislation, this Act covered the organization of the medical service during the World War, with the exception that a new temporary body was formed which was known as the Sanitary Corps and consisted of officers and enlisted men, not graduates in medicine, who possessed knowledge or experience of value to the Medical Department. The Act approved June 4 1920 stipulated that the surgeon-general should have the rank of majorgeneral and should have two assistants with the rank of brigadiergeneral; it added a new branch, the Medical Administrative Corps; under this Act the enlisted strength of the Medical Department could not exceed 5% of the actual commissioned and enlisted strength of the army; the number of officers in the Medical Corps was fixed at 6.5 for every 1,000 of " authorized " (virtually actual) enlisted strength of the regular army.
As provided by Act of April 23 1908, the Medical Corps of the army consisted of one surgeon-general with rank of brigadier-general, 14 colonels, 24 lieutenant-colonels, 105 majors and 300 captains or first lieutenants, advancement being by seniority except in the case of lieutenants, who were promoted after three years' service. The scheme for promotion was modified by the Act approved June 4 1920, to provide that officers of the Dental and Medical Corps should be promoted to the grade of captain after three years' service, to the grade of major after 12 years' service, to the grade of lieutenantcolonel after 20 years' service, and to the grade of colonel after 26 years' service, all subject to the satisfactory passing of the required examinations. On Oct. I 1921 there were 43 colonels, 87 lieutenantcolonels, 483 majors, 474 captains, and 52 first lieutenants.
Beginning with 1901 the Medical Department employed civilian dentists under contract. The Act of March 3 1911 established a Dental Corps, consisting of lieutenants in the proportion of one to each I ,000 of actual enlisted strength of the army, but in no event to exceed 60. By an Act approved Oct. 6 1917 the Corps was made to consist of officers of the same grades and proportionate distribution of grades as were then, or as might thereafter, be provided by law for the Medical Corps. On Oct. 11921, there were in the Dental Corps eight colonels, 15 lieutenant-colonels, 62 majors, 132 captains and 25 first lieutenants. The Veterinary Corps was established by the National Defense Act and took over the veterinarians formerly assigned to mounted regiments and to the Quartermaster Department. On Oct. I 1921 there were in the Veterinary Corps four colonels, six lieutenant-colonels, 17 majors, 25 captains, 97 first lieutenants and six second lieutenants. The Medical Reserve Corps was established by Act of April 23 1908 for the purpose of securing a supply of medical officers available in emergency. The National Defense Act abolished the Medical Reserve Corps, as such, and established an Officers' Reserve Corps, with sections corresponding to the various arms, staff corps and departments of the regular army. Under this law a medical section of the Officers' Reserve Corps, containing approximately 1,256 physicians, existed at the outbreak of the World War. On Oct. 14 1921 there were 5,816 officers enrolled in the medical section of the Officers' Reserve Corps, 3,747 in the dental section, 390 in the veterinary section, 264 in the sanitary section, and 491 in the medical administrative section. A Hospital Corps, composed of hospital stewards and privates, was established by Act of March 1 1887, which directed that all necessary hospital services in garrison, camp or field, including ambulance service, should be performed by members of this corps, which was permanently attached to the Medical Department. The National Defense Act abolished the designation " Hospital Corps " and substituted therefor an Enlisted Force, consisting of non-commissioned officers, privates first class, and privates. The Army Nurse Corps (female) came into existence in 1901. No appreciable change in its organization was made until the Act of June 4 1920, when the members of the Nurse Corps were given relative rank, the superintendent having that of major, the assistant superintendents that of captain, chief nurses that of first lieutenant, and head nurses and nurses that of second lieutenant. In respect of matters within the line of their duties, nurses were given authority, in and about military hospitals, next after officers of the Medical Department. Nurses in 1921 continued to be employed under contract for a period of three years, and did not receive the pay of their relative rank. The Medical Administrative Corps was established by the Act approved June 4 1920. Appointees therein must have had enlisted service in the Medical Department. These officers act in the capacity of adjutants, mess officers, registrars, property officers, commanders of detachments, and the like, in medico-military units, thereby relieving medical officers of the necessity of performing these essential but non-professional duties.
The organized militia, known as the National Guard, possesses a medical department consisting of a medical corps, dental corps, veterinary corps and enlisted force, conforming in organization, discipline and equipment to like units of the Medical Department of the regular army. The personnel, known collectively as sanitary troops, is divided into three groups: (a) those assigned to combatant units; (b ) those organized into sanitary units such as medical regiments, hospital companies and ambulance companies; and (c ) those belonging to state staff corps and departments.
Peace-Time Organization Surgeon-General's Office. - Whether in peace or war, the surgeongeneral's office in Washington is one of the coordinate bureaus of the War Department which function under the Secretary of War through the intermediate channel of the chief-of-staff. The surgeon-general advises the War Department in matters relating to his bureau, coordinates all technical activities of the Medical Department through corps area or department surgeons, originates medical policies, compiles medical statistics, distributes personnel to the corps areas and geographical departments, and directly controls all matters relating to the purchase of supplies and the expenditure of appropriations for construction and repair of hospitals and employment of civilians. These functions did not change materially in character between 1910 and 1921 but the work expanded greatly; then the duties were divided between four divisions: - Personnel, Supply, Sanitation, and Museum and Library; the organization on Oct. I 1921 included the following eleven divisions, each being staffed with one or more officers specially selected because of their knowledge of the subjects handled: Administrative; Coordination, Organization and Equipment; Dental; Finance and Supply; Hospital; Library; Personnel; Sanitation; Statistical; Training; Veterinary.
Aviation Service. - Detailed administration of Medical Department matters relating to aviation is handled by a medical officer attached to the staff of the chief of the air service.
Department and Corps Area Surgeons
The continental United States is divided for administrative purposes into nine " corps areas," and the outlying possessions into three departments (Hawaiian, Philippine, and Panama Canal). A department or corps-area surgeon, as one of the staff of the commanding general of each department or corps area, presides over the medical activities therein.
At all military stations, other than general hospitals, medical officers and a suitable detachment of enlisted men of the Medical Department are assigned to care for the troops and to administer the station hospital, which usually provides beds for at least 3% of the forces. If the command is part of a tactical unit some or all of these medical officers and enlisted men are nominally attached to the combatant troops in preparation for active service.
Large institutions, known as " general hospitals," are maintained (a) to afford better facilities than can be provided at station hospitals for the observation and treatment of obscure, complicated and serious cases, (b ) to instruct and train junior officers, nurses and enlisted men, and (c ) to furnish a nucleus for expansion in time of war. In 1910 there were four such hospitals in the United States army, which number in 1921 had been increased to six.
Education, Training and Investigation
The Army Medical School, Washington, D. C., was established in 1893 with the object of training students in the duties which pertain to the Medical Department. The student body consists of officers of the Medical Corps, the Medical Reserve Corps and the National Guard, and of enlisted men in the Medical Department. From 1910 to 1919 the regular course covered about eight months, but it was shortened and instruction in the non-medical features of a complete medicomilitary curriculum transferred to the Medical Field Service School, established in 1920 at Carlisle, Pa.
WAR-Time Organization Object of the Medical Department in War. - The objects of Medical Department administration in war are: First, the preservation of the strength of the army in the field by (a) the institution of requisite sanitary measures for preventing avoidable sickness; ( b ) the retention of effectives at the front; and (c ) the prompt succour of wounded on the battlefield and their removal to the rear, thus preventing the unnecessary withdrawal of combatants from the firing line to accompany them. Second, the care and treatment of the sick and injured in the zone of the advance, on the line of communications, and in the home territory. Third, the promotion of general moral among the troops through the knowledge that efficient medical and surgical attention is immediately available.
Voluntary Aid and the Red Cross. - Organized voluntary aid may be utilized to supplement the resources and assist the personnel of the Medical Department only through the American National Red Cross. Before military patients are assigned to establishments maintained by the Red Cross Society these establishments will be placed under the immediate direction of a medical officer of the army.
Administrative Organization in the Theatre of Operations
The theatre of operations is divided into (a) the combat zone, including division areas, corps areas and army areas; ( b) the communications zone, including all territory from the rear of the combat zone to and including the base. In a large expeditionary force a chief surgeon coordinates all Medical Department activities of the force, including the combat and communications zones; he organizes his office on the basis described above for the surgeon-general's office.
The chief surgeon of this zone, as a member of the staff of the commanding officer thereof, exercises immediate control over the Medical Department units therein, such as station and general hospitals, supply depots, training schools, central laboratories, hospital trains, boats and ships, ambulance parks, etc. The function of the Medical Department in the zone of communication is medical procurement, storage and supply, care of the troops within its area, evacuation of sick and wounded, and definitive hospitalization. The following are the more important units: The general hospital (formerly termed base hospital) is for definitive treatment, having a normal capacity of 1,000 beds but capable of crisis expansion by tentage to 2,000. These institutions provide every facility for the care of the sick and wounded; certain ones specialize on particular classes of injuries or diseases. The authorized personnel consists of 40 officers, 120 nurses and 312 enlisted men of the Medical Department. The station hospital (formerly styled camp hospital) has a standard capacity of 300 beds and serves the immediate local needs of troops belonging to the communications zone. The personnel consists of 13 officers, 35 nurses and loo enlisted men of the Medical Department. A hospital train consists of 16 cars accommodating 360 patients, with a Medical Department personnel of four officers, 40 enlisted men, and female nurses as required.
The area covered by this zone includes the troops which are organized into divisions, corps and armies. The Medical Department personnel pertaining to an army, to a corps or to a division is administered by an army, corps or division surgeon respectively, under supervision of the surgeon of the next higher unit. The functions of the surgeon are coordination, supervision and control of the medical service at all times and during combat particularly the relief or reonforcement of the actively engaged Medical Department units by means of army, corps or divisional troops. The work concerns itself only with sanitation, care of troops, collection of casualties and temporary hospitalization.
Army and Corps Medical Department Troops
To an army, in addition to its administrative medical personnel, there are attached four medical regiments, 15 evacuation hospitals, 12 surgical hospitals, one convalescent hospital, one army laboratory, three army supply depots, three army veterinary evacuation hospitals, and one veterinary convalescent hospital; collectively these form part of the army troops. The 15 evacuation and 12 surgical hospitals are for the temporary care of non-evacuable cases and the convalescent hospital is for those practically well and needing little attention, but not yet ready to return to duty. A corps has an administrative medical organization similar to that of an army but smaller; it has one medical regiment as part of its corps troops. The evacuation hospital has the primary function of taking over patients from divisional (field) hospitals, established by the hospital companies of a medical regiment, so that these mobile units may move with their divisions; provision is made for very complete surgical treatment if necessary. The capacity is 750 beds and the personnel 38 officers, 50 female nurses and 281 enlisted men. The surgical hospital supplements the evacuation hospital for the purpose of handling near the front those cases requiring immediate operation. The bed capacity is 250 and the personnel consists of 19 officers, 20 female nurses and 90 enlisted men. The convalescent hospital has a bed capacity of 5,000 and a personnel of 21 officers and 153 enlisted men.
Medical Department Troops Attached to a Division
The infantry division, which is a basic tactical unit, has a Medical Department personnel of 148 officers and 1,375 enlisted men. Part of these are directly attached to combatant units; the remainder belong to the medical regiment. The regimental medical personnel cares for the sick and injured in camp and on the march; supervises local sanitation; goes into action with the troops; and establishes battalion or regimental aid stations where wounded are collected and given temporary care. The medical regiment, replacing the sanitary train of the pre-war period, consists of a sanitary battalion, an ambulance battalion with 40 motor and 20 animal-drawn ambulances, and a hospital battalion of three hospital companies, each operating a tent (field) hospital of 250 beds capacity. Its personnel consists of 68 officers (medical, dental and veterinary) and 860 enlisted men. The medical regiment of a division provides personnel for the division surgeon's office and for sanitation of the division area, collects wounded men by litter squads from battalion or regimental aid stations and transports them to the ambulances, maintains wheeled transportation service for movement of casualties, supplies temporary hospitalization, procures and issues medical supplies for the command, renders laboratory service and collects, treats and temporarily hospitalizes sick animals.
THE Department'S Work In The World War Sanitary Achievements. - The value of a medical service in war should be measured, first, by the degree to which it preserves the effective strength of the army by sanitary methods, and, second, by its success in evacuating and caring for the sick and wounded. In both respects the Medical Department of the American army attained notable results. The success in preventing infectious diseases and losses from them, as compared with the Civil and SpanishAmerican Wars, is shown by the fact that only 6,445 fatalities occurred as a result of typhoid fever, malaria, dysentery, smallpox, scarlet fever, diphtheria and other miscellaneous communicable diseases (excluding tuberculosis and pneumonia), whereas if the Spanish War rates had prevailed there would have been 101,439 deaths, and if the Civil War rate had prevailed there would have been 170,997 deaths from these causes.
Care of Sick and Wounded
In the succour of the sick and wounded great advances were made both in the theatre of operations and in the service of the interior. Personnel directly attached to combatant organizations was greatly increased. Mobile surgical hospitals were organized and operated close to the front; X-ray examinations were everywhere available; splints for use in transporting fracture cases were enormously improved. Motorization of ambulance service was carried to an extent hitherto undreamed of. Base hospitals were enlarged to accommodate I,000 patients or more, and were frequently grouped in centres, sometimes aggregating 20,000 beds, including the crisis expansion under canvas. In such centres the individual hospitals specialized, one treating gassed cases, another head cases and others chest wounds, fractures, abdominal injuries and medical patients respectively. Laboratory service both at the front and on the lines of communication was expanded beyond all precedent. Professional services were more carefully coordinated and supervised than ever before; the most expert personnel was divided into groups, such as operating teams, gas teams, shock teams, etc., for quick transport by automobile or train to points where need was greatest. Veterinary units were augmented in size and number, caring promptly for sick and wounded animals. In the zone of the interior hospital service was brought to the highest standard, the best professional talent of the country was mobilized, and notable progress was made in the treatment of the sick and injured, particularly in the direction of physical reconstruction of the wounded, with a view to returning the individual to the community as a self-sustaining citizen.
Nearly 4,000,000 officers and men were given a careful physical examination by the Medical Department before admission to the military service and approximately the same number were again examined before demobilization; careful records thereof protect the interests of both the individual and the Government. Valuable data as to the physical status of the nation were obtained from an analysis of these examinations.