THE U.S. I-- A Srhc^ Bethesda. Md- ■„■.. a! C / THE HUSE PUBLISHING CO., NORFOLK, NEB. unaaA- J • An Orthopedic Surgeon's Story of the Great War H. Winnett Orr, M. D., Formerly Lieutenant Colonel, Medical Corps, United States Army. THE LIETAFY U.S. Naval f^li- ISraool National fViv. «v lic&ll Center Bethesda, Md. Fellow of the American College of Surgeons, Member (Secretary 1915-1917) American Orthopedic Association, Member (Chairman Orthopedic Section 1920-1921) American Medical Association, Member (President 1920) Nebraska State Medical Associa- tion. ■*&£ Lincoln, Nebraska, U. S. A. December 1921. Dedication This little booklet is respectfully and affectionately dedicated to Major John Ridlon of Chicago, under whose guidance first and prin- cipally, I have endeavored to acquire some proficiency in Orthopedic Surgery. General Sir Robert Jones of Liverpool, Director of Military Ortho- pedics in Great Britain and Ireland and the greatest teacher of Ortho- pedic Surgiry in the world He has done more than any other to awaken everywhere the "Orthopedic Conscience." Colonel Joel E. Goldthwait of Boston, Chief Consultant in Orthopedic Surgery in the American Expeditionary Force. H. Winnett Orr. U The following were on Duty as Medical Officers Assigned to the Orthopedic Division A, E F dur- ing 1917 and 1918.* Adams, Major Z. B., Boston, Mass. Base Hospital No. 6; Special Training Battali- on, St. Aignan, British Army, C. C. S. No. 48, 26th Division, 41st Division; Orthopedic Con- sultant at Bordeaux Hospital Center. Abbott, Major LeRoy C, Ann Arbor, Mich. First Orthopedic Unit, May 1917, Bangour War Hospital, Edinburgh; Base Hospital No. 8 Base Hospital No. 9, Chateauroux, American Red Cross Hospital No. 2, Paris. Alexander, Capt. D. T. Chief Orthopedic Service, Base Hcsp., 100, Savenay. Allison, Colonel Nathaniel, St. Louis. Orthopedic Surgeon Base Hospital No. 21; As- sistant Director of Orthopedic Surgery, A. E. F., Consultant in Orthopedic Surgery First Army, Croix de Guerre. Baldwin, Lieut.-Colonel Walter I., San Francisco, Cal. First Orthopedic Unit, May 1917, Bangour Military Hospital, Edinburgh; Chief of Ortho- pedic Service, Letterman General Hospital, San Francisco, until June 23, 1919. Silver Citation G. H. Q., A. E. F. Bidwell, Lieut. A. H. Orthopedic Service, Base Hospital No. 88, Savenay. Billington, Major R. W., Nashville, Tenn. First Orthopedic Unit, May 1917, Senior Sur- geon Orthopedic Centre, Newcastle-on-Tyne; Chief Orthopedic Service, Camp Meade Base Hospital and Reconstruction Centre. Brackett, Col. Elliott G., Boston, Mass. Director of the Division of Orthopedic Sur- gery, Surgeon General's Office, U. S. A. Of- ficial visit to the Orthopedic Division, A. E. F., in August and September 1918. Brewster, Lt. Albert H., Boston, Mass. Peter Bent Brigham Hospital. Cary, Lieut. S. B. Roanoke, Va. Welsh Metropolitan War Hospital, Cardiff, Wales, Base Hospital No. 8, Savenay. Chollett, Capt. B. G., Toledo, Ohio. B. E. F, No. 9, at Rouen, Shepherd's Bush Hospital, London. B. H. 9, Chateauroux. B. H. No. 114, Bordeaux. Camp Sherman, Chilli- cothe, Ohio. Cilley, Lieut.-Colonel Arthur H., New York City. Bella Houston Military Hosp., Glasgow; Base Hospital No. 36, A. E. F.; B. H. No. 119, Sav- enay, A. E. F.; U. S. Genl Hosp No 9, Lake- wood, New Jersey. Cole, Major Wallace, St. Paul, Minn. First Orthopedic Unit, May 1917. Alder Hey Military Hospital, Liverpool. Cone, Major Sydney M., Baltimore, Md. First Orthopedic Unit, May 1917. Alder Hey Military Hospital, Liverpool. Conn, Capt. Harold R., Akron, Ohio. B. H. 8., Savenay. Crum, Major C. C, Milwaukee, Wis. Special Training Bn., St. Aignan; B. H. 48; Mars sur-Alter; B. H. 69, Savenay. Danforth, Major M. S., Providence, R. I. First Orthopedic Unit, May 1917, Bangour Mil. Hosp., Edinburgh; B. H. 69, Savenay; Orthopedic Service Walter Reed Hospital. Dauterive, Capt. H. J. New Iberia, La. •This is published as a preliminary list. It is requested that addi- tions and corrections be sent to the Author so that a complete and en- tirely correct list may be published at a later time. Orthopedic Center, Bangour Hospital, Edin- burgh; B. H. 9, Chateauroux; B. H. No. 8, and B. H. No. 69, Savenay. Davis, Capt. A. G. Erie, Pa. Welsh Metropolitan War Hospital, Cardiff, Wales. Base Hospital No. 8, Savenay. Dickson, Major Frank D., Kansas City, Mo. British Orthopedic Center, Oxford, England; Orthopedic Surgeon 26th Division; Orthopedic Surgeon First Army Corps; Consultant in Orth. Surg., to the Third Army. Dignan, Capt. H. H., San Francisco, Calif. Welsh Metropolitan War Hosp.., Whitchurch nr. Cardiff, Wales. Dillehunt, Major Richard B., Portland, Ore. Chief Orthopedic Service Base Hospital 46. Consultant in Orthopedic Surgery, Hospital Center at Perigueux. Walter Reed Hospital. Discharged July 2, 1919. Dorsey, Lt. George H. Fort Sam Houston, Texas. Welsh Metropoli- tan War Hospital, Cardiff, Wales. Dunlop, Major John, Los Angeles, Calif. Member of the Committee on Preparedness American Orthopedic Association and Ameri- can Medical Association. British Orthopedic Centers at Oxford, Shepherds Bush and Edin- burgh War Hospital at Bangour. Later at Liverpool and Aberdeen. Discharged April 9, at Camp Dix. Durham, Major L. T., New York City. First Orthopedic Unit, May 1917. Alder Hey Military Hospital, Liverpool. Consultant in Orthopedic Surgery, Camp Hospital, Fort Dodge, Iowa. Easton, Lieut. S. H. Peoria, 111. Amputation Service, Base Hospital No. 8, Savenay. Eikenba^-y, Lieut.-Colonel Charles P., Spokane, Wash. First Orthopedic Unit, May 1917, Orthopedic Center, Glasgow, Orthopedic Surgeon Second Division also Eighty-ninth Division. Ortho- pedic Consultant for the Hospital Centers at Beaune, Dijon, and Allerey. Orthopedic Sur- geon Letterman General Hospital. Discharged May 1919. Erving, Major W. G., Washington, D. C. First Orthopedic Unit, May 1917. Orthopedic Center, Oxford, England. Walter Reed Gen- eral Hospital, Washington, D. C. Farr, Lieutenant Richard, New York City. New York Orthopedic Hospital, N. Y. C. Fayerweather, Major Roades, Baltimore, M. First Orthopedic Unit, May 1917. British Or- thopedic Center, Leeds. Divisional Surgeon's Hqrs., Second Division; Base Hospital No. 8; U. S. A. Gen. Hosp. No. 3; U. S. A. Gen. Hosp. No. 11; U. S. A. General Hospital No. 6. Discharged Oct. 1, 1919. Figley, Capt. Karl D., Toledo, Ohio. City of London Military Hospital. Special Training Battalion near Neufchateau, France. Orthopedic Surgical Team. At Compiegne Auto. Chir. No. 7; A. R. C. Hosp. No. 1; Mo- bile Hosp. 39; A. R. C. No. 114; Evac. Hosp. No. 12. B. H. 8., Savenay. Walter Reed Hos- pital Fiske, Capt. E. W. Pittsburgh, Pa. Chief Orthopedic Service, Base Hospital No. 27, Angers. Fitch, Major R. R., Rochester, N. Y. On duty with the French for the four years of the war. For the last part in charge of American Red Cross Hospital No. 109. Con- sultant in Orthopedic Surgery for the Area in and around Paris. Fradd, Lieut. N. W. Boston, Mass. Physical Reconstruction Amputation Depart- ment Base Hospital No. 8, Savenay. Francisco, Lieut.-Colonel C. B., Kansas' City, Mo First Orthopedic Unit, May 1917, Orthopedic Center, Abderdeen. Consultant in Orthopedic Surgery First Division. 32nd Division. 35th Division, and 76th Division. Consultant in Orthopedic Surgery, Hospital Area at Mes- ves and later at Savenay. George, Lt.-Col. Frank William, Worchester, Mass. Fort Benjamin Harrison, Ind. 7th Coast Ar- tillery, Assistant Surgeon. Camp Hospital No. 13, A. E. F. Adjutant and Chief of Surgical Service. Commanding Officer Camp Hospital No. 13. Base Hospital No. 9. Base Hospital No. 69. Chief of Orthopedic Service. Dis- charged March 25, 1919. Goldblatt, Lieutenant Harry, Cleveland, Ohio. Goldthwait, Colonel Joel E., Boston, Mass. Chair- man Preparedness Committee, American Or- thopedic Association and Orthopedic Section, American Medical Association 1916. Com- manding Officer First and Second Goldthwait Orthopedic Unites May and November 1917. Chief Consultant in Orthopedic Surgery A. E. F. Goodwyn, Lt. Thos. P., Hurt Bldg., Atlanta, Ga. Asst. to Major F. G. Hodgson at Blois. Graves, Lt. Col. James T. Rochester, N. Y. First Orthopedic Unit, May 1917. Bellahouston Mil- itary Hospital, Glasgow. Consultant in Or- thopedic Surgery, Blois Hospital Area, A. E. F. Consultant Bordeaux Area. Hall, Major Custis Lee. Washington, D. C. First Orthopedic Unit, May 1917. Welsh Metropoli- tan War Hospital, Whitchurch near Cardiff, Wales. Bangour Military Hospital, Edin- burgh. Camp Hospital No. 2, St. Nazaire, A. E. F. Hartmann, Major John V. Findlay, Ohio. Base Hospital No. 9; Consultant in Orthopedic Sur- gery, Hospital Centre, Kerhuon. Harvey, Capt. T. W., Prattsville, Ark. Base Hos- pital 66. Base Hospital 206. Base Hospital 94. Hawley, Lieut.-Colonel George W. Bridgeport, Conn. Chief Orthopedic Service and Commanding Officer, Base Hospital No. 9, Chateauroux. Hospital Consultant Orthopedic Surgery, Base Hospital No. 9, Limoges. Hodgson, Major F. G., Atlanta, Ga. Chief Orthope- dic Service Base Hospital 43. Consultant for the Area of Blois. Chief of Orthopedic Ser- vice, Camp Pike Hospital. Jelks, Capt. Edward, Jacksonville, Fla. Second Northern General Hospital, Leeds, England. Base Hospital 36, A. E. F. Evacuation Hos- pital No. 2. Orthopedic Service, Savenay, Base Hospitals 8, 69 and 88. Orthopedic Ser- vice Base Hospital, Camp Grant, U. S. A. Dis- charged July 1919. John, Major Rutherford L., Philadelphia, Pa. Fort Slocuns, N. Y., April 16, 1917. Base Hosp. 34, Sept. 4, 1917. Commanding Officer, Camp Hospital 25 A. E. F. Base Hosp. 34, Nantes. Consultant Hospital Area, Nantes. Discharg- ed June 21, 1920. John, Capt. R. L. Philadelphia, Pa. Chief Orthopedic Service, Base Hospital No. 34, Nantes. Johnson, Capt. W. H. Orth. Service, Base Hospital No. 119, Savenay. Jones, Major E. O., Seattle, Wash. Base Hospital 50. Kidner, Major F. C, Detroit, Gross Pointe, Mich. First Orthopedic Unit, May 1917, on duty with the British. Consultant in Orthopedic Surgery for the A. E. F. in p]ngland. Kramer, Lieut. James G., Akron, Ohio. On duty with the British. Orthopedic Surgeon 26th Division. Consultant in Orthopedic Surgery 7th Corps. LaFerte, Major Alfred D. Detroit, Mich. Base Hos- pital 17. Langworthy, Capt. Mitchell, Spokane, Wash. First Orthopedic Unit, May 1917, served with the British. Orthopedic Surgeon Second Division. Chief of the Orthopedic Service, Base Hosp. 23, Vittell. Lawler, Capt. D. H. Baltimore, Md. Orthopedic Service, Base Hospital No. 8, Savenay. Orth. Consultant Hospital Center, Kerhoun, Brest. Luce, Captain, R. V., Akron, Ohio. Blackpool, Eng- land. Alder Hey Military Orthopedic Hosp., Liverpool. Welsh Metropolitan War Hospital, Cardiff Wales. Base Hospital 8, Savenay. MacAusland, Lt. A. R., Boston, Mass. First Or- thopedic Unit, May 1917, served in England, Alder Hey, Liverpool. Head of Surgical Team No. 2. Magruder, Capt. Thos. V., Birmingham, Ala. Served in England, Special Training Battalion, St. Aignan. Base Hospital No. 8, Savenay. Marble, Capt. H. C, Boston, Mass. Base Hospital No. 6, Chief Orthopedic Service, June 1917 to March 1919. U. S. Army General Hospital, No. 3, Colonia, N. J., June 1919. McChesney, Major George J., San Francisco, Cal. B. E. F., Hospital No. 9, Rouen, France. Shep- herd's Bush Military Hospital, London. Mil- itary Orthopedic Hospital, Birmingham, Eng- land. Consultant, Base Hospital No. 88, Sav- enay. McHugh, Lieut. P. F., Wilkes-Barre, Pa. Brigade Orthopedic Surgeon, Third Division, Battalion Surgeon 6th, U. S. Engineers. Division Or- thopedic Surgeon, 37th Division. Battalion Surgeon 147th Infantry. B. H. 113, Savenay. McKenna, Capt. Charles H., Chicago. Welsh Met- ropolitan War Hospital, Whitchurch near Car- diff, Wales. Chief Orthopedic Service, B. H. 101, A. E. F. (St. Nazaire.) McKenna, First Lieut. Donald H., Brooklyn, N. Y. Base Hospital No. 9. Base Hospital No. 63. Consultant Orth. Surg., Nantes Hosp. Center. Orthopedic Surgeon Grand Central Palace, Debarkatia Hospital No. 1. Orthopedic Sur- geon General Hospital No. 1. Dischare-ed Sept. 15, '19. Metcalf, Lieut. Colonel Carleton R., Concord, N. H First Orthopedic Unit, May 1917. Ulster Vol- unteer Force Hospital, Belfast, Ireland. Base Hospital No. 36, A. E. F. Vittel, France. At the Front with a Surgical Operating Team. Evacuation Hospital No. 6. Evacuation Hos- pital No. 3. Orthopedic Consultant at Mars, France. Chief of the Surgical and Orthopedic Service, Base Hospital No. 88, Savenay. Meyers, Lt., Nashville, Tenn. Base Hosp. No. 32. Miller, Captain Orville R., Louisville, Ky. Bella- houston Hospital, Glasgow, Scotland. Chief of Orthopedic Service, B. H. 66. Evacuation Hospital No. 8. B. H. 94. B. H. 88, Savenay. Moore, Major Howard, Boston, (Newton) Mass Chief of Orthopedic Service, Base Hospital No' 44. Chief of Orthopedic Service Convalescent Camp, Mesves Hospital Center. Morgan, Capt. D. W. Orthopedic Service, Base Hospital No. 8, Savenay. Morral, Major Ralph R., Youngstown, Ohio. Chief of an Operating Team, St. Miheil and Argonne: Bella-Houston Hospital, Glasgow. Base Hosp. 31, A. E. F. French-Auto chir No. 7-3rd. A. R. C. Hospital No. 1. F. H.-163 Operating Team. Chief of Orthopedic Service, Base Hosp. 202 Orleans. B. H. 85, Angers, Chief of Orthop. Service. B. H. 69 and 88, Savenay. Mumford, Capt. E. B., Indianapolis, Ind. Base Hosp. 32, A. E. F. Belgian Hosp. at La Panne (Dr. DePage). First French Army at Grand- villier. Myll, Capt. Nelson A., Garden City, N. Y. On duty with the British. Orthopedic Surgeon 30th Division. Hospital Centre at Savenay. Neill, Lieut. William Charlestown, W. Va. Orthope- dic Surgical Team, Evacuation Hospital, No. 1. Surgeon in Charge Casual Operating Team, No. 11. Ober, Major Frank R., Boston (Brookline), Mass. Base Hospital No. 5, Serving with the British. Orr, Lt.-Col., H. Winnett, Lincoln, Nebraska. First Orthopedic Unit, May 1917, Orthopedic Center Welsh Metropolitan War Hospital, Whitchurch near Cardiff, Wales. B. H. 9, Chateauroux. Consultant in Orthopedic Surgery, Savenay Hospital Center, Nantes Hospital, Center B. H. 27, Angers, B. H. 101, St. Nazaire, and other Hospitals in Base Section No. 1, A. E. F. Con- sultant in Orthopedic Surgery, U. S. A. Gen. Hosp. 26, Fort Des Moines and Camp Hospital at Camp Dodge. Discharged June 1, 1919. Osgood, Lieut.-Colonel Robert B., Boston, Mass. Base Hospital No. 5. Transferred in the sum- mer of 1917 to the American Expeditionary Forces. On duty in England, Liaison Officer, American Orthopedic Group and R. A. M. C. First Assistant Director of Orthopedic Sur- gery, A. E. F. Consulting Orthopedic Sur- geon, Surgeon General's Office, U. S. A. Plummer, Major, W. W., Buffalo, N. Y. On duty in England. Special Training Battalion Ameri- can Expeditionary Force. Consultant in Or- thopedic Surgery hospital, Areas in the Ad- vance Section. Potter, Lieut. Allen. Brookline, Mass. Sanitary Corps. Statistician Orthopedic Ser- vice, Base Hospital No. 8, Savenay. Randolph, Capt. H. C., Aberdeen, Wash. Base Hos- pital 50. Rooney, Capt. J. F. Hartford, Conn. Orthopedic Service, Bordeaux. Hospital Cen- ter Base Hospital No. 8, Savenay. Rose, Capt. E. J. Colonia, New Jersey. Amputation Service Base Hospital No. 8, Savenay. Amputation Service U. S. G. H., Coron. Schrock, Major Robert D., Omaha, Neb. Base Hos- pital No. 9. Chief of the Orthopedic Service, Base Hospital 114. Detached Service, Ambul- ance des Allies. Shortell, Lieutenant Joseph, Boston, Mass. Smith, Major Allan DeForest, New York City. On duty with the British. Orthopedic Surgeon First Division. 83rd Division. Rase Hospital No. 27. Consultant in Orthopedic Surgery, Third Army. Smith, Major R. V. Tulsa, Okla. Base Hospital No. 9, Chateauroux. Amputa- tion Service B. H. No. 8, Savenay. U. S. Gen. Hosp. No. 26 Fort Des Moines, Iowa. Spencer, Capt. L. E., New Orleans, La. First Or- thopedic Unit, May 1917. Orthopedic Center, Leeds, England. Stephens, Capt. R., New York City. Base Hospital No. 9. Orthopedic Service, American Red Cross Hospital No. 1. Orthopedic Service, Carlis, Pa. Thaxter, Captain Langdon T., Portland, Maine. Sec- ond Orthopedic Unit. Third Southern General Hospital, Oxford, England. British War Of- fice, Assistant to Maj. Gen. Sir Robert Jones. Hospital Center, Savenay, Base Hospital Nos. 8, 69 and 88. Discharged at Camp Dix. Thomson, Lieut. James E. M., Lincoln, Neb. Base Hospital 49, A. E. F.. Allerey, in Charge Or- thopedic Service. Orthopedic Surgeon, Second Army Sanitary Train. Tracy, Capt. W. J., Hornell, N. Y. Orthopedic Ser- vice, First Scottish General, Aberdeen, Scot- land. Orthopedic Surgeon 26th Division. Div- ision Orthopedic Surgeon 82nd Division, B. H. 69 and 88, Savenay. Van Gorder, Lieut. G. Base Hospital No. 8, Savenay. Venable, Major C. S., San Antonio, Texas. Base Hospital 41, A. E. F., in Charge of Orthopedic Service. Walsh, Capt. J. J. Escanaba, Michigan. Fracture Service, Base Hospital No. 8, Savenay. Willard, Major DeForrest P., Philadelphia, Pa. First Orthopedic Unit, May 1917. Shepherds Bush Military Hospital, London. Consultant in Or- thopedic Surgery, Vichy Hospital Center, A. E. F. Wentworth, Capt. Edward T., Rochester, N. Y. Base Hosp. 19. Camp Pike, Orthopedic Surgeon 87th Division. Orthopedic Surgeon Base Hospitals at Vittel-Vosges, Vichy-Allier and Perigueux- Dordogne. Asst. Consultant in Orthopedic Surgery Vichy Hospital Center. Consultant Vichy Hospital Center Jan. 2, 1919. Amputa- tion Section, Walter Reed General Hosp. Dis- charged July 19, 1919. Wilson, Major Philip D., Boston, Mass. On duty with the French 1916-1917. In Charge Ampu- tation Service, Division of Orthopedic Surgery, A. E. F., Base Hospital No. 9; Hospital Centre, Savenay. Walter Reed Hospital, Washington D. C. Wolcott, Capt. W. E. Omaha, Neb. Orthopedic Center, Alderhey, Military Hospi- tal, Liverpool. Base Hospital No. 8, Savenay. Wyant, Captain, James Edward. Hospital for Rup- tured and Crippled, New York City. Index PAGE Abbott, Capt. LeRoy C................ 17 3^ ofi -n Adams, Capt. Z. B. ...................... ' ' db' 2, Alexander, Lt. D. L. ..... ..............................rq Allison, Col Nathaniel........... .........................................?n Americans, Arrival of in France """27 Amputation Cases, British Care of ""is Amputations, Care of at Cardiff "" .............25 Amputation Service at Savenay '" y; Amputation Stumps...... .......................'53 Angers, Base Hospital 27 at.......... ..................... .....38 Ankle, Gun Shot Wounds of ""'53 Arm, Conservation of Case Report ..................36 Armistice 3*5 Armistice, Announcement of ....................... .....39 Astor, Lady, Canadian Hospital.. ..................... "'"l6 Baer, Col. W. S........ .........................43 Baldwin, Capt. Walter I............... .......................18 Base Hospital No. 8...................... 33 Base Hospital No. 8, Statistics from...............................5$ Base Hospital No. 9........................... 32 Base Hospital No. 10.................... ........... 15 Base Hospital No. 11.................... 33 Base Hospital No. 21.................................. ...... 15 Base Hospital No. 27................................................. 33 Base Hospital No. 27, Report of .................... 55 Base Hospital No. 34........................ "33 Base Hospital No. 38.............................. ...........""33 Base Hospital No. 69..................... 35 Base Hospital No. 88........................... ................""36 Base Hospital No. 101.................................... ..............33 Base Section No. 1, A. E. F...................... ......33 Bayumi, Mr. M., of Cairo................. ........20 Belfast, Visit to............................ .......26 Bidwell, Lt. A. H......................................................\\.....;.....59 Billington, Captain R. W............................................. 18 Bizarro, Mr. A..........................................................................20 Blake, Miss Margaret.............. 50 Brackett, Col. E. G...................................................i3, 23,'"33 Braddock, Lieut. W. H...........................................................20 Bunions ......................................................................................53 Card Index Method for Patients.....................................'36 Cardiff, Orders to....................................................................18 Chateauroux ............................................................................32 Christmas, Celebration of in Great Britain....................27 Chutro, Pietro, in Paris........................................................41 Cilley, Major A. H.................................................................45 Clivedon ....................................................................................16 Cole, Capt. Wallace............................................................18 Cone, Capt. S. W.....................................................................18 Consultant in Orthopedic Surgery, Savenay, Re- port of................................................................................57 Consultant in Orthopedic Surgery, Savenay, Final Report of............................................................................59 Cooper, Col. Webb E.......................................................35, 58 Crippled Children, Plans for in Cardiff........................26 Cummings, Private John......................................................21 Curative Work Shops at Cardiff........................................23 Curzon Hotel, London............................................................15 Danforth, Major Murray S...........................................35, 59 Dedication ..................................................................................9 Diagnosis, Table of................................................................47 Dignan, Lieut. H. H...............................................................21 Donner, Miss Mia....................................................................35 Dorsey, Lieut. G. H...............................................................21 Dublin, Visit to........................................................................26 Durham, Lieut. L. T...............................................................18 Edinburgh, Visit to................................................................24 Edwards, Private J. C..........................................................21 Eikenbary, Capt. Charles F...............................................18 Elbow, Gun Shot Wounds of..............................................51 Erving, Major W. G...............................................................18 Estill, Lieut. Col. R. J...........................................................35 Examining Room, Methods..................................................21 Extremities, Upper and Lower, Soft Part Wounds with damage to iMuscles and Tendons of............53 Fayerweather, Capt. Roades..............................................18 Femur, Fractures of.....................................£.......................27 Femur, Fractures of in France................'.......................35 Femur, Fractures of, Transfer to the United States..45 Femur, Gun Shot Wounds of..............................................52 Figley, Lieut. K. D...............................................................59 Fiske, Capt. E. W..................................................................33 Fitch, Major Ralph R...........................................................13 Flat Foot....................................................................................53 Foot, Gun Shot Wounds of..................................................53 Foot Strain................................................................................53 Forearm, Gun Shot Wounds of..........................................51 Fradd, Lieut. N. W.................................................................59 Francisco, Capt. C. B.......................................................18, 42 Goldthwait, Col. Joel E...............................9, 13, 33, 41, 58 Goldthwait Unit, First. Group Picture..........................14 Goldthwait Unit, Departure from London..........18, 19 Goodall, Col. E.........................................................................19 Grant, Mr. Geary......................................................................20 Graves, Capt. J. T...................................................................18 PAGE Haddon, Corporal C. R..... 21 Hall, Lieut. C. L.....................................................................ig Hallux Rigidus......................................................... 53 Hand, Gun Shot Wounds of..................................................51 Hartman, Major J. T.............................................................32 Hawley, Lieut. Col. Geo. \V...............................................32 Head Injury................................................................................50 Hip, Gun Shot Wounds of.................................................52 Hughes, Lieut. L. W.............................................................21 Humerus, Gun Shot Fractures of......................................51 Introduction.............................................................................8 Johnson, Capt. W. H.............................................................59 Jones, Lady................................................................................15 Jones, Lieut. Bassett.............................................................22 Jones, Sir Robert........................................................9, i.5, 20 Kean, Col. Jefferson R.................... 8 Kidner, Capt. F. C...................................................................ig Knee Joint Derangements of..............................................52 Knee Joint, Gun Shot Wounds of....................................52 Langworthy, Lieut. Mitchell................................................18 Leg, Gun Shot Wounds........................................................53 Leg, Gun Shot Wounds of with Nerve Injury..............52 Limbless, Care of....................................................................26 Little, Mr. Muirhead..............................................................18 Liverpool, Arrival at..............................................................15 Luce, Lieut. R. V.....................................................................59 Macausland, Lieut...................................................................18 McKenna, Capt. W. H...........................................................59 Median Nerve, Gun Shot Wounds of................................51 Metcalf, Capt. C. R.........................................................14, 18 Morgan, Lieut. D. W.............................................................59 Musculo Spiral Nerve, Gun Shot Wounds of................51 Nantes, Base Hospitals 34, 38 and 11 at........................38 Orders to Cardiff....................................................................18 Orders to Consultants in Orthopedic Surgery in France ..................................................................34, 43, 45 Orders to France....................................................................32 Orders, Travel in Base Section No. 1..............................58 Orders, Travel to Great Britain..........................................14 Orthopedic Hospital Service, Organization of..............36 Orthopedic Patients, Final Inspection of......................54 Orthopedic Patients, Instructions as to the Final Care of..................................................................39, 47, 50 Orthopedic Patients, Treatment of in War Hospi- Orthopedic Service in France Defined............30, 31, 44 Orthopedic Service at Savenay..........................................46 Orthopedic Surgery, Conference on, Liverpool............31 Orthopedic Staff Meetings in Great Britain................47 Osgood, Col. Robert B...........................................................13 Osier, Sir. William & Lady................................................24 Oxford, Visit to........................................................................24 Page, Ambassador, at London............................................16 Patients, Admission of at Savenay..................................47 Patients, Arrival of in the United States........36, 39, 42 Patients, Classification of..................................................48 Patients, Condition of Upon Arrival at Savenay........37 Patients, Evacuation of to the United States............49 Patients, Evacuation of, Instructions............................55 Patients, Tags of Instructions Regarding Splints..46, 47 Patmore, Miss Amy F.....................................................35, 58 Plaster of Paris, Use of.....................................................'..35 Plaster of Paris, Use of in France....................................36 Plaster of Paris, Use of at Savenay.................................^46 Plummer, Capt. W. W...........................................................34 Potter, Lieut. Allen..........................................................50, 59 Prince of Wales Hospital, Cardiff............................. ' 21 Printing Shop at Cardiff.................................................~24 Prothesis, Provisional.........................................................."54 Ration Scheme in Great Britain........................................28 Reconstruction Aides..............................................................58 Red Cross Units................................ ........14 Reid, Lieut. W. D......................................................\\\\\".'.'."\'.21 Ridlon, Mayor John............................................................9J 13 Roehampton Military Hospital..............................".'.".'. 17,' 18 Rooney, Capt. J. F......................................................." ' 59 Rose, Lt. E. J...............................................................!!!!...".. 59 Sanderson, Miss Marguerite....................................'.'..'.'.'.'.'.'.'.'.'.35 Savenay, Arrival at............................................................ ZZ Savenay, Condition of Patients Upon Arrival............. 37 Savenay, Orthopedic Service At..............35, 37, 43, 48 50 Savenay, Report of the Orthopedic Service at..' ' 43 Shepherds Bush Orthopedic Hospital............................16 Shoulder, Gun Shot Wounds of........................................51 Shrock, Lieut R. D........................................................... .....Z2 Singer, Dr. and Mrs. Charles............................................. 24 Smith, Major S. Alwyn...............................................~. .....19 Spencer, Lieut. L. E............................................................. 18 Spine, Gun Shot Wounds of......................................\\........51 Splinting, Condition of Patients as to.............'.'".'.'.'.'.'.'......37 Splints, Making and Application of at Savenay"" 46 Star and Garter Hospital............................................... 17 Stephens, Lieut. Richmond....................................~.~^""...~ 32 Stiles, Sir Harold........................................................."".".. 24 St. Nazaire.................................................. 33 Story, Dr. C. D..........................................................."""""'.'.20 PAGE St. Paul Steamer......................................................................14 tals ......................................................................................50 Stump Treatment....................................................................5 4 Surgeon General's Comment Upon Condition of the Wounded ............................................................................3S Tendon Surgery in Nerve Injury....................................26 Thigh, Gun Shot Wounds of With Nerve Injury........52 Third Western General Hospital..... ............ ...................20 Thomas, Col. Sir. John Lynn......................... ..............21, 26 Thomas, Hugh Owen ..........................................................2*5 Traction ....................................................................................53 Treatment. Program of.............................. . 54 Wade. Mr. J. O. D................................. ................................20 Walsh, Lieut. J. J........................... .................................59 PAGE Welsh Hospital Staff............................................................22 Willard, Capt. DeForest P...................................................18 Wilson, Capt. Phillip D................................................26, 59 Wolcott, Lieut. W. E...........................................................59 Workshop, Curative, at Cardiff....................................23, 24 Workshops, Hospital, Methods of....................................17 Wound Treatment.................................................................53 Wounded, Evacuation of to America..............................33 Wrist, Gun Shot Wounds of..............................................51 Ulnar Nerves, Gun Shot Wounds of..................................51 United States, Return to......................................................42 Van Gorder, Lieut. G. H.......................................................59 Vannes ......................................................................................38 Welsh Metropolitan War Hospital............................19, 20 Introduction The following pages are offered to the medical profession with a certain particular purpose. The war gave us a marvelous opportunity to learn something about accident—injury—reconstruction—orthopedic sur- gery. The war hospitals were an enormous laboratory for surgery. Many experiments were tried. The careful students learned much. Those who saw a great deal and worked hard arrived at certain conclu- sions. The writer saw many hospitals in England, France and America. He saw hundreds of surgeons at work and he examined and treated thousands of wounded soldiers. A few of his observations and conclu- sions are here offered, to those who will read, for what they are worth. H. Winnett Orr. An Orthopedic Surgeon's Story of the Great War CHAPTER I. Improvement in the civilian practice of surgery can be brought about by a more gen- eral recognition of the lessons of the war. The death rate, from disease and wounds was much lower during this war than in any preceding one. Not only that, but the return of wounded to duty was one of the astonish- ments of the entire military experience. We do not have accurate figures as to the return of industrial wounded to duty. I venture to assert, however, that for wounds of similar character the degree of crippling and the length of disability for our industrial wound- ed is more than twice what it came to be in the military hospitals of the American Ex- peditionary Force in France. How this hospital efficiency came about is what the writer of this story desires to re- cord. It is rather expected—perhaps even hoped—that the statements made here will arouse some discussion. Nevertheless, it is intended to set things down as they ap- peared to me at the time and since. The writer of these pages has now been engaged in the practice of medicine and sur- gery—as a graduate—for 22 years. There were seven years of University training— and a sort of medical apprenticeship before that. After five years of general practice (fairly extensive) the study of Orthopedic Surgery was begun in Chicago under the direction of Dr. John Ridlon (to whom I am indebted for much help in many ways). From that time (1904) until the beginning of the war, I had devoted all of my time to ortho- pedic practice and to the development of what Sir Robert Jones calls an "Orthopedic Conscience." Orthopedic surgery had come to mean the prevention as well as the relief and cure of disability and deformity. Also it came to mean opportunities for relief and cure where the patient himself had given up hope. In 1914 came the war. During its first year the orthopedic work in France, of Dr. Robert B. Osgood of Boston and Dr. Nathaniel Alli- son of St. Louis stirred my imagination. One knew that there must be much deformity to prevent and correct. With my family of five, however, and a far from certain financial position, it seemed quite out of the question for me to think of embarking upon a foreign military excursion. In the summer of 1916 both the American Orthopedic Association (of which I was then secretary) and the Orthopedic Section of the American Medical Association appointed committees on preparedness. We were ex- pecting American participation in the war. Dr. Ralph R. Fitch, former Secretary of the American Orthopedic Association, and Mrs. Fitch had gone to France in 1914 and were operating their own hospital. Dr. Joel E. Goldthwait of Boston, was made chairman of both preparedness committees, and with the foresight and energy for which he has since become universally known, he began to pre- pare for orthopedic participation in the war. In the winter of 1916 the Central States Orthopedic Club met in Cleveland and Cin- cinnati; Dr. E. G. Brackett of Boston came out and spoke to us on the orthopedic work of Sir Robert Jones in Great Britain. Sir Robert had been made Director of Military Orthopedics for Great Britain and Ireland. He was undertaking the establishment in each of the British Military Hospital areas, of Orthopedic centers. There were neither trained surgeons nor surgeons to train to staff these proposed centers. Dr. Ridlon elo- quently seconded Dr. Brackett's appeal for some of the Americans to volunteer. Even more than on the former occasion I was stirred to go. But the obstacles seemed in- superable. When America entered the war, however, in the following April (1917) the call came in direct form and I decided at once that it was time to respond. The British Commission that came over immediately upon our entrance into the war, brought a request from Sir Robert Jones for twenty orthopedic surgeons to be sent to Great Britain. Dr. Goldthwait immediately accepted a commission as Major and set about the organization of the first Gold- thwait unit. This unit was organized at once from volunteers by telegraph. The unit met 13 in New York, on May 17, 1917, and sailed on the St. Paul, the next day. This unit like the earlier hospital units, was got together and sent out under the aus- pices of the Red Cross. Col. Jefferson R. Kean was acting as director at this time. Plans for the departure of the unit were not complete until about May 15. I left Lin- coln at 4:30 that afternoon (Thursday.) I left with many misgivings. I had been in practice in Lincoln for 18 years and was ful) I got my Commission (as Captain) and drove about town and out to Walter Reed Hospital, collecting my outfit. Washington as I saw it at that time was in tremendous confusion. I was told at first' that it would be quite impossible for me to get the neces- sary commission, orders, etc., to get to New York that night. The St. Paul was to sail next day. However, at three o'clock, Capt. Metcalf and I were at the station and with my outfit mostly in paper parcels we got off 23 3 4 5 fi 10 ) 11 20 24 12 21 13 25 14 22 26 The Goldthwait Unit at the home of Sir Robert and Lady Jones, Liverpool May 28 1017 4 T^wlJ'Tr^r;-1521"™"- 2~°aPt- GraveS' San Francisco. 3-Capt. Allison,' St. Luis. 4-Lt WUlard PhUadelphia. 5-Capt. Kidner, Detroit. 6-Capt. Abbott. San Francisco 7-Capt L.kenbary. Spokane. 8-Capt. Cone. Balt.more. 9-Lt. Cole, St. Paul. 10-Capt Baldwin San Fran- 14SC°Lt s™ %3US,n ?' B°St0^ i2-CaPt Da,lf0rth' Pr°"<^e- 13-Capt. Frarcesco Kan*. cTy GVd^rB^n.^aS0-^8- ""^ ^^.™*£ ^Lt- *""/ «**•**«»• 17~™-' Rob't. Jones. 21-Lady Jones. 22- 19~ Ma]°r f,™ TWashlnl°"- 20-General Sir Durham. New York ,itv. 25-Cap, Metcatf. Concord. N. H. 26^'O^r" Uncoln ChlCa8°- '^ leaving my own family as well as my parents behind. The opportunity for important ser- vice, however, seemed very great. The Brit- ish were asking for help and one could fore- see that the American need might be consid- erable before the war was over. I speak of this because of certain situations to which I wish to refer later. I arrived in Washington at nine o'clock on Saturday morning. Major Goldthwait and eighteen members of the unit had gone to New York the evening before. With a letter of instruction from Major Goldthwait and the help of Capt. C. R. Metcalf of Concord, N. H., (to whom I shall always be very grate- 14 to New York. Our orders were as follows: WAR DEPARTMENT. THE ADJUTANT GENERAL'S OFFICE WASHINGTON. ™ m, ,,. ■ Ma^ 18th>1917- From: The Adjutant General of the Army. To: The Commandant Army Medical School, Wash- ington, D. C. Subject: Travel Orders. The Secretary directs as necessary in the military service that the following named officers of the Medica Officers Reserve Corps, now at the Army Medical School proceed to New York City, and take the first available transportation for England, and upon arrival, proceed to London, and report in per- son to Colonel Alfred E. Bradley, Medical Corps, Adastra House, Victoria Embankment, for further orders. Captain Carleton R. Metcalfe. Captain Hiram W. Orr. First Lieut. George P. Howe. First Lieut. Louis J. Genella. W. M. Wright, Adjutant General. A true copy. Major Medical Corps, U. S. Army. At ten o'clock that night we were strug- gling with khaki shirts, belts, leggings, etc., for the first time. Next morning at ten we were on the boat. (The St. Paul.) Our experience on the journey from New York to Liverpool did not differ in many re- spects from that of many thousands who fol- lowed us during the next year and a half. We left New York harbor toward evening. Base Hospital units No. 10 from Philadephia and No. 21- from St. Louis were the most import- ant part of the passenger . list. The Gold- thwait Orthopedic unit numbered twenty-one. Definite training for our work abroad be- gan the first day out. We even had a little of the physical discipline of which so many officers had more in the camps later on. We lined up for the exercises and drill twice a day. On each occasion a few were missing on account of sea-sickness or from the effects of anti-typhoid vaccine. Once or twice a day there were discourses by Major Goldthwait, with an opportunity for questions and dis- cussions by the other members of the unit. Church service was interrupted by our three and six inch guns at target practice. At first the passengers crowded the upper deck to watch the guns shooting at barrels which had been dropped astern. After about the second or third day, however, the decks were cleared of passengers during target practice; later we learned that this was because of the accident which happened on another boat leaving New York harbor the same afternoon we did in which two nurses were killed. There was an obvious increase in nervous tension as we approached the European side and the boat began to zig-zag instead of go- ing straight ahead. Lookouts for submar- ines were increased in number and kept con- stantly on duty. The gun crews remained by the guns at all times. Very early on the sec- ond morning before reaching Liverpool the word went around that a torpedo boat de- stroyer might be expected to convoy us in. From the time this rumor spread until the little destroyer, with the stars and stripes appeared, the decks were crowded with pass- engers. The sight of the destroyer gave us the most inspiring moment of the trip; it was greeted with a rousing cheer. We had had two days of rough weather and were just be- coming anxious about the danger from sub- marines. As we approached Liverpool the Irish sea was as smooth as a mirror. We were across without having been, at least in so far as we knew, in any serious danger. We came into the port at Liverpool late in the afternoon. We were not allowed to go ashore until about 7 o'clock the next morning. A British officer came aboard and gave us full instructions as to hotels, transportation to London, etc. Not only that, but he acted as our personal escort until we were safely established in the Hotel Curzon, London. The trip to London was made next day. In the meantime we had the day in Liverpool with quarters at the North Western Hotel. Sir Robert Jones and Dr. Osgood, who was on leave from France, met us at the hotel. We were entertained at tea during the after- noon at their home by Sir Robert and Lady Jones.* At this time the situation in Great Britain was more definitely described to us. Quite large orthopedic centers were already going on at London, Liverpool and Edin- burgh. Others were being started at Leeds, Bristol, Cardiff, Manchester, Glasgow, Dub- lin and Belfast. Plans were being made for the Americans to be assigned almost imme- diately. A few days opportunity, however, was to be offered for us to observe, in Lon- don, the work at one of the largest and most important Orthopedic clinics at Shepherd's Bush Military Hospital. *Lady Jones died during the year following the war CHAPTER II. In Liverpool, Sir Robert Jones gave us our first accurate ideas of the British scheme for the care of the war wounded. Upon arriving in London, Major Gold- thwait immediately set about to give us a real course of instruction in the treatment of war wounds and fractures, and methods in war hospitals. First of all, we were formally and official- ly welcomed. Ambassador Page and Mrs. Page entertained the nurses and officers of the various American organizations that had just arrived. At this reception Lady Astor invited us to visit the Canadian Red Cross Hospital at her own place at Taplow. We went out next day. At this beautiful estate of several thou- sand acres, about 30 miles from London there was a Red Cross Hospital of 1100 beds for Canadians. At Lady Astor's house overlook- ing the Thames, we had tea. Before tea there was a baseball game. King George later attended an exactly similar function at this hospital. We returned to London on the evening train and were the guests of Major Gold- thwait at a performance of "Romance," by Miss Doris Keane. With war impressions ac- cumulating, this wonderful play seemed out of place. The gaity of "Chu Chin Chow," a few evenings later seemed even more so. However, Captain Metcalfe and I went to see "London Pride," and found that even the theaters were only partly succeeding in get- ting away from the awful tragedy of the war. On the next day (June 1, 1917) we really 1 began our war hospital training. We went * in a body to Shepherd's Bush Military Orth- j opedic Hospital at Hammersmith. Here there j were about 1200 beds for orthopedic cases. Much of the best reconstructive surgery in . Great Britain was being done at this hospi- 3 tal. Such well known surgeons as Elmsiie, r Dunn, Aitken and Bristow were on duty. Dr. _ Menell was in charge of the physiotherapeu- i tic work. It was through the kindness of 2 these men that we were permitted during the t ten days following, to see the administrative, surgical and training methods by which the 5 *Later on a number of Americans were cared for at this hospital. During 1921 Lady Astor has built a beautiful memorial to the 40 Ameri- cans who died at "Clivedon." Officers, nurses and patients at a V. A. D. (Volunteer Aid Department) Hospital in Great Britain. This hospital operated during almost the entire period of the war as an auxiliary to one of the large section hospitals. There were beds for fifty patients. Commandant, secretary and nurses were vol- unteer, unpaid workers. Only the graduate nursing sister received compensation. 16 British wounded were being rehabilitated af- ter their physical injuries in France. At this time, it was already more than two and one-half years since the beginning of the war. We were all astonished to find how many of the patients were past the period of youth. Also, we had our eyes opened to the very serious character of the war wounds. It was almost beyond belief to see how very extensive was the physical damage done. The infections were appalling. Large open wounds involving bones and joints were bathed in pus. In those who had survived, there were some fearful evidences of the de- structive power of gas gangrene. The larger number of the amputes were at home or at Roehampton, (which will be described later) but we saw a few amputations done and a few patients recently amputated who gave us some impression as to what the loss of limb as well as the loss of life for America, was going to be. It was curious then, for us to find that the number and kind of casualties were being predicted for both attacking and defensive engagements and that all the way from the Front to the Base Hospital, more or less de- finite provisions were made before each at- tack for the transportation and care of the various kinds of cases. To illustrate how effective this service was, I may relate that I talked one Saturday night to a boy who was being taken off a hospi- tal train in Cardiff. He told me that he had gone to France for the first time on Thurs- day. His company went to action about noon on Friday. He was hit in the leg late Friday afternoon, and he was back on a hospital train in Great Britain on Saturday morning. I, myself, saw him in bed in a Base Hospital the same evening. Moreover, he had on a good splint, a good dressing and had had antitetanic serum during the first few hours that he was hurt. How the British did this for their hundreds of thousands was what the Americans had come to learn. Major Goldthwait, and the members of our unit were particularly interested at Shep- herd's Bush, in the following problems: 1. Methods of immobilization for com- pound infected bone and joint injuries. 2. The cleaning up of infected wounds in- volving bones and joints. 3. The correction of late deformities af- ter war wounds of bones, joints and soft parts. 4. The repair of peripheral nerve in- juries. 5. Postoperative splinting by the meth- ods of Hugh Owen Thomas and Sir Robert Jones. 6. Rehabilitation of war cripples by voca- tional training. The British had already formulated an elaborate program covering this whole mat- ter. However, much of it was still only on paper. In fact, for reasons that will be ex- plained later, a large part of the program never did work out, (either in Great Britain or in the U. S.) However, all of the problems suggested above had been solved to a considerable ex- tent at the time we arrived at Shepherd's Bush. With money largely collected by King Manuel, (formerly of Portugal) excellent curative work shops had been built and five or six hundred men were working daily. The shops served three purposes: 1. They gave occupations to a number of men whose recovery was hastened by the mere performance of certain arm and leg movements. 2. Other men were learning new trades adapted to their changed physical con- ditions. 3. The shops produced a large amount of splints, carpenter work, mattresses, brooms, brushes, etc. From this time on our time was mostly spent on duty. However, we saw London Tower, and on. the morning of June 3, attend- ed an imposing flag ceremony at St. Paul's The Stars and Stripes were given a place of honor with the British flag at the head of the procession. Sunday we spent, with thousands of other people on the Thames. The Thames on Sun- day is a lively scene. We went as far as Hampton Court where Henry VIII spent so much of his time trying to solve one of the greatest of all problems. Next day we went out in the same direc- tion to Richmond to visit the Star and Gar- ter Hospital on the site of the old hotel. Across the valley, as one climbed the steep hill, was Windsor Castle. The Star and Garter was established and rapidly enlarged for the care of men hope- lessly crippled because of spinal cord injur- ies.* These men were tended with special "Fine new buildings have been built and this work is still being carried on. 17 care. Even they were encouraged to employ themselves as best they could. One poor chap was doing quite well making and selling flies to fishermen. Roehampton, which we visited a few days later, presented quite another picture. There was an atmosphere of hope. With two thou- sand men minus arms and legs, almost every one was busy. Mr. Muirhead Little in charge, had done and is still doing excellent work. One may pause to remind the reader that it was Mr. Little's father who named Little's disease and who brought subcutaneous teno- tomy from Stromeyer to England. The British were facing an immense prob- lem in the care of their men with amputa- tions. Most of them were at home waiting for care. However, at Roehampton, stumps were being improved surgically, deformities were being corrected, temporary and artifi- cial limbs were being put on, and best of all, the vocational schools were really work- ing. From the motor repair 41 aining schools alone, about fifty limbless men a week were being graduated for work as expert motor mechanics or drivers. So we were gathering our impressions and getting our first war training. We found that the British had achieved wonders in their preparation for and care of the wound- ed. Just when we were getting restless to lend a hand in the great work, assignments for the members of the Goldthwait unit be- gan to come through. One of the first contingents was sent to Liverpool. This consisted of Captain Cone, Captain Cole, Captain Billington, Captain Danforth, Lt. Durham and Lt. McAus- land. A day or two later Captain Francesco and Lt. Langworthy went to Aberdeen. Capt. Graves and Capt. Eikenbary went to Glas- gow. Major Erving went alone to Oxford. This was an interesting and important post. Capt. Fayerweather and Lt. Spencer went to Leeds. Capt. Metcalf was sent to Belfast where he did fine work. Captain Kidner* and Willard remained in London. Capt. Baldwin and Lt. Abbott were sent to Edin- burgh, while Lt. Hall and I were ordered on June 12 to Cardiff. On June 11, I received two important let- ters. My first from home, and the second, my orders to proceed for duty at Cardiff. This read as follows: Aaiy further communication on this subject should be addressed to— The Secretary, War Office, Adastr%l House, Victoria Embankment, E.C., and the following number quoted. 24/America/2. (A.M.D.I . ) War Office, Adastral House, Victoria Embankment, E.C. 4. 11th June 1917. Sire, «,<* v. v1*8™ "fectfd t0 request that you will proceed to Whitchurch for duty at the Military Orthopoedic Hospital on 12th instant. herewith, A railway warrant for your journey is enclosed I am. Sir, Your obedient Servant, for Director-General Army Medical Service. ' "aptain H.*; Orr, Lieutenant C.L. Hall. United States Medical Service, Hotel Curzon. Major Kidner \\a< v. (lie Americans in England. ■tc rhawer on the later work ot IS CHAPTER III. The members of the Goldthwait unit left the Hotel Curzon, where we had been staying in London, during June 11 and 12, 1917. Those assigned to Liverpool, Edinburgh, Glasgow and Aberdeen were the first to leave. Lieutenant C. L. Hall of Washington and I, assigned to Cardiff, left London on the afternoon of June 12th; afterwards we learn- ed that we just missed one of the worst air raids that London had during the war. We arrived at Cardiff at 7 o'clock in the evening. In keeping with the hospitality already shown us, we were escorted to the hotel by a fellow traveler and were cordially received by several Cardiff citizens, who promptly re- cognized the first of the American uniforms to arrive in that territory. A young British officer, home on leave, and his father insisted upon our spending the evening at their home. This was typical of the cordial treatment we had during our whole stay in Great Britain. Minor incidents of a different character were nothing to the courtesies accorded us by nearly all of the English, Irish, Scotch and Welsh with whom we came in contact. We were quite apprehensive as to the man- ner in which we might be received, not only by the British officers, but by the soldier patients. It took some time to establish the fact that we were on duty with the British with a sincere desire to be of service. When this had once been accomplished, however, we had very little difficulty in getting along either with the officers or with the men. An interesting discussion arose over the question of uniforms. The insignia of rank are of course entirely different in the British and American armies. Very few of the Brit- ish could tell whether we were corporals, sergeants, or captains, consequently we miss- ed many a salute in the first few weeks be- cause of the absence of sleeve marks, Sam Browne belts and sticks. After General Pershing had set a precedent for wearing the Sam Browne belt and after we learned how to carry gloves and canes, we were more readily recognized as proper officers by mem- bers of the British military establishment. On the morning after «our arrival in Car- diff, we reported at the Welsh Metropolitan War Hospital to Lieutenant Colonel E. Good- all, the Commanding Officer, and to Major S. Alwyn Smith, the officer in charge of the Orthopedic service. The hospital was a beautifully built and equipped institution con- structed a few years before the war, for the care of mental patients. It was built in the View of the Hospital from the outer edge of the "fan", showing wards. The tower was near the central offices. 19 shape of an open fan with the administra- tive offices at the center of the handle. The service buildings, were spread out over the fan proper with the corridors, passages, etc. Ten two-story wards extended out from the edge of the fan. There was plenty of space for about 1200 patients. The wards on the left of the fan with operating rooms, plaster rooms, X-ray, etc., were set aside for the or- thopedic service. The right hand side of the fan was occupied then and later at different times, by the surgical, medical and mental services. Here at the hospital, we were received cor- dially. It was not understood, however, just what our position, status or duties were to be. For some days, therefore, we waited about with nothing to do and no place to go. After some little correspondence, however, with Sir Robert Jones, the liaison officers in London and the British quartermaster de- partment; we secured for ourselves certain duties in the hospital, quarters outside the hospital, two meals a day in the officers mess and allowances from the British for susten- ance. Salaries were paid by the United States. Very shortly Colonel Goodall provided an office or examining room for the Americans, which operated under the direction of Major Smith in the conduct of the orthopedic de- partment. The medical officers on duty at this time were as follows: There was a young Egyptian surgeon, Mr. M. Bayumi of Cairo. He was an F. R. C. S., and a fine worker. There was also a brilliant young surgeon from Lisbon, Dr. A. Bizarro. These two were assigned as assistants to two Car- diff surgeons, Mr. J. 0. D. Wade and Mr. Geary Grant. These gentlemen were engag- ed as civilian contract surgeons. Each had charge of two wards of about fiftv beds each. In addition Dr. C. D. Story and Dr. W. H. Braddock, two Americans, were on duty with the British. Dr. Story was Red Cross and Dr. Braddock, R. A. M. C. The latter with his wife had just arrived in England after an exciting year in Serbia. Thev had both endured severe privations in the Serbian re- treat. In a word, there were enough surgeons on duty for the three hundred patients then in the orthopedic division of the Hospital. I soon saw that if Lt. Hall and I were to have an opportunity we must first locate special work and then demonstrate our ability to do it. A single trip through the hospital revealed the fact that, as always in any large hospital, civilian or military, there were, from the or- thopedic standpoint, a number of neglected cases. One found cases of chronic osteomye- litis with shell wounds that had not yet been X-rayed. There were ununited and malunit- ed fractures poorly splinted or not splinted at all. There were gunshot wounds of wrist and ankle in which healing was taking place, with hands in palmar flexion and feet in plantar flexion. These were all things to cor- rect. Orthopedic principles were not being generally applied. Major Smith was a pupil and former assistant to Sir Robert Jones, but he had been on duty only a short time and 1 felt that we could be of help to him in thes matters. None of the other surgeons re- ferred to, had had special orthopedic train- ing. In the Cardiff area the care of the wound- ed generally was under the jurisdiction of the Third Western General Hospital. This hospi- tal, or center, had about 7,000 beds. From this entire area we were supposed to receive patients requiring orthopedic treatment. Actually they sent us only a fraction of such cases. Later, however, our orthopedic ser- vice, including six auxiliary hospitals, grew to about 700 beds. This included 50 beds for pensioners—for whom we did quite a lot of good work. Soon after taking up the work, Major Smith agreed to a policy of having all new patients admitted through an examining room, and those already in the hospital, up for reconsideration at least once a month. Very soon after the second Goldthwait unit arrived in Great Britian, members of this unit were distributed to the British Ortho- pedic centers to assist in the work and to be- come familiar with methods of administra- tion, as well as methods of dealing with pa- tients; which had been demonstrated to be useful by the experience of the British. Shortly after this time the organization of our orthopedic service at Whitchurch, was as follows: Lt. Col. E. Goodall, R. A. M. C, Registrar. Welsh Metropolitan War Hospital. Capt. J. R. Beatty, R. A. M. C, Registrar. Consulting Surgeon, Col. J. Lynn Thomas, C. B., C. M. G., Deputy Inspector Military Orthopedics—Western Command. Officer-in-Charge Orthopedic Division, Major S. Alwyn Smith, D. S. 0., R. A. M. C. Assistant, Capt. H. Winnett Orr, M. R. C, U. S. A. General Surgeon, Mr. J. 0. D. Wade. Examining Room, Monday 2-4:30; Thurs- day 10-12:30. Ward M-l—Capt. Orr. 70 beds. Ward M-la—Dr. Bayumi. 64 beds. Ward M-2—Lt. W. H. Braddock, R. A. M. C. 68 beds. Ward M-2a—Lt. H. H. Dignan, M. C, U. S. A. 65 beds. Ward M-3—Capt. C. H. McKenna, M. R. C, U. S. A. 54 beds. . Ward M-3a—Lt. Davis. 50 beds. Ward M-4—Capt. Orr, Lt. L. W. Hughes. 45 beds. Private J. Cummings, Corporal Haddon and Private Edwards, clerks in the Examining Room. Ward M-5a—(Officers' Ward). 45 beds. Major Smith, Lt. W. D. Reid, M. R. C, U. S A., Lt. G. H. Dorsey, M. C, U. S. A. Workshops—Lt. H. H. Dignan, M. C, U. S. A. Prince of Wales Hospital—50 beds, Mon- days 10-12 (Limbless patients). Col. J. Lynn Thomas, Major Smith, Mr. J. O. D. Wade. Clyne House—Major Smith. 40 beds. Of- ficers Hospital. Mr. Wade. Penarth V. A. D.—60 beds. Fridays 2-3 :- 30. Capt. Orr, Lt. Braddock. Samuel House—40 beds. Fridays 2-3:30. Lt. Davis, Capt. Orr. Llandaff Lodge—50 beds. Fridays 3:30-5. Capt. Orr, Lt. Davis. St. Pierre—48 beds. Tuesdays 2-3. Capt. Orr, Lt. Braddock. Lt. Hall had been transferred to Edin- burgh a short time before. An interesting feature of our Examining Room, was the card index. It was a new feature of the work at this institution. A sample card is submitted to illustrate how it worked. Name—Litchfield, A. Rank, Pte. Regt., No. 14336. Unit, 1st Coldstream Guards. Age, 24. Ward, M. 1. Admitted, 28-3-17. Diagnosis (in detail G. S. W. L. leg. Back. Fract. R. Leg. (No. IX. 4). X-ray No. 2534. 2930. Time in previous Hospitals. Six months. Discharged from W. M. W. H................................... To...................................................................................... REVERSE. History: Wounded Sept. 15th, 1916 in France. Bullet went through a point above patella and came out inner side of knee joint. Knee joint stiff, foot in position of varus. Short 21/4 inches. Skiagram shows fracture of lower end of femur. 19-4-17. Op- eration. Inner sinus enlarged. Sequestrum removed. Full drainage established. Previous treatment. Drainage, dressings, etc. Treatment here. 19-4-17. Inner sinus enlarged. Seq^e^trum removed. Bone scraped. Full drainage established. 18-7-17. Not yet healed. Sinus 3-inch. Hot fomentations. 3-9-17. Examination Board: No attempt at extension. Through and through drainage. Sequestrotomy. Arthrodesis of second toe and tenotomy by Major Smith, 22-9-17. Operation of femur, also Sequestro- tomy. 19-11-17. Wounds healing satisfactorily. Latest X-ray shows signs of bony union in good position. Shortening Wz inches. Thomas splint with extension. 1-12-17. Erysipelas. To Ely Isola- tion Hospital. 24-12-17. Readmitted from Ely Hos- pital. 5-1-18. To get up. To have caliper splint and S. W. C. (Soldiers Wounded Convalescent) Boots. In the examining room decisions were also arrived at as to operation; what kind and by whom to be done. Prescriptions were writ- ten for the gymnasium, electrical massage department or splint shop. Also transfers were arranged here, from the main hospital 21 to the auxiliary or back to the main hospital or special treatment were required. All trans- fers had to be arranged through the officer in charge of the Orthopedic Department and the registrar. One of the features of the work during the fall and winter of 1917-18 was the staff meeting, held three times a week. A speci- men weekly program was as follows: WELSH METROPOLITAN WAR HOSPITAL ORTHOPAEDIC DEPARTMENT STAFF MEETINGS. Monday, Nov. 19th, 1917, 12:30 P. M. "The Prevention and Correction of Deformi- ties of the Hip and Thigh." Capt. Orr. Wednesday. Nov. 21st. 6-7 P. M. "Dem- onstration and Discussion of the Uses of Electricity in Diagnosis and Treatment." Lieut. Bassett Jones. Friday, Nov. 23rd, 12:30 P. M. "Amputa- tions and the Application of Artificial Limbs." Major Smith. Certain other features of the work in Car- diff as it developed and the activities of the other members of the Goldthwait unit will be described in the next chapter. CHAPTER IV. In July, 1917, the American officers who came to Great Britain as members of the first Goldthwait unit were all located and working in the British Military Orthopaedic centers. About this time Major Goldthwait received orders to return to the United States. He spent two months in the Surgeon General's office in Washington. This time was devoted, with Col. E. G. Brackett, Direc- tor of Orthopedic Surgery in the United States, to developing plans for the American orthopedic activities in France and to re- cruiting the second Goldthwait unit for ser- vice overseas. This unit, consisting of forty- five officers and twelve nurses, left the Unit- ed States in October. It was my privilege to visit members of this second unit, in the Curzon Hotel in London, early in November. During the time between June and Novem- ber there had been many changes in our ideas as to what our part was to be in the war and as to the future of the Orthopedic Service. Original plans had been that we should remain on duty with the British only a few months; and that American orthopedic participation in the war would require our services in France or perhaps even our re- turn to the United States by November. However, it had become clear that there was no particular need for most of us in France and that our greatest field of usefulness for the present, lay with the British. Conse- quently, most of the members of both the first and second Goldthwait units remained or were now assigned for duty, with the British. On November 7th, Major Goldthwait was given the rank of Lieutenant Colonel and ap- pointed Director of the Orthopedic Service for the American Expeditionary Forces in France. Major Osgood was appointed as his first assistant. More definite plans for the conduct of the Orthopedic Services in France were begun at this time. It was, however, some months before Col. Goldthwait's origi- nal ideas had much effect upon the organiza- tion and operation of the hospital services in France. At any rate my visit to London enabled me to talk over with Col. Goldthwait, Major Osgood and a number of other old friends, the work so far, and to get at least some hazy ideas regarding the future. By way of consoling myself for the Xoti' from the Commanding Officer on the occasion of the formal open ing of the work shops. The photograph (by Dr. Orr) inserted shows ail of the shops and the gymnasium at the left. 23 disappointment of not getting to France, I secured permission to visit the orthopedic centers at Edinburgh and Glasgow. I had al- ready spent a few days with Major Erving at Oxford. The orthopedic service there was smaller but very interesting. Patients were distributed through the dormitories and liv- ing quarters of several of the Oxford Col- leges. Major Erving, himself, was quartered in New College, where I had the privilege of being entertained at dinner with the mem- bers of the faculty at the "high table". had charge of approximately 500 beds in the Orthopedic Service. A number of other Am- ericans including some of those who had just arrived in Great Britain were associated with Captains Danforth and Baldwin as juniors. This same plan brought to Cardiff the other Americans who have already been mentioned, for training in the Orthopedic Service. The next afternoon I had the pleasure of having dinner in Glasgow with Captains Graves and Eikenbary and the other Ameri- cans who were on duty at Bellahouston Hos- Curative Print Shop at the Welsh Metropolitan War Hospital. Fall of 1917. (Capt. Orr in charge). Later on, I visited at Oxford again, this time as the guest of Dr. and Mrs. Charles Singer. Dr. Singer was professor of the His- tory of Medicine and an associate of Sir Wil- liam Osier. I am happy to say in passing, that no one in Great Britain was more cor- dial to the Americans than Sir William and Lady Osier. Sir William made trips to near- ly all of the places where Americans were stationed and performed many acts of kind- ness and generosity to contribute to their comfort and welfare. At Edinburgh, I found Captain Baldwin and Captain Danforth doing very important and very useful work. Sir Harold Stiles re- ceived me at his home and took me out in his car to the Surgical Clinic at Bangour Hospital the morning that I arrived. He was particularly enthusiastic about the work of both the above Americans, each of whom pital. The Orthopedic Service here was nei- ther so well organized nor so well developed as at Edinburgh, but the two American offi- cers referred to, both of whom were sound orthopedic surgeons, were exercising a de- finite influence upon the orthopedic work in Glasgow. I was sorry for many reasons not to get up to Aberdeen where Capt. Francesco, a very good orthopedic surgeon from Kansas City, and Lieut. Langworthy of Chicago were at work. Both of these officers also did good work with divisions in France later on. At Edinbugh, Sir Harold Stiles was doing some of the best technical surgery to be seen in Great Britain. This was true particularly of his work on the injuries of the peripheral nerves. It is gratifying to find so satisfac- tory an account of this work in Sir Robert Jones' recent book, "The Orthopedic Surgery 24 of Injuries". As pointed out at that time and since, the war hospitals have brought us to a much more definite realization of the importance of reuniting divided principal nerves. Still more important has it been shown to be, to liberate from scar tissues, the injured or divided nerves that have be- come involved in the wound at the time of accidental injury. On the return trip from Liverpool to Edin- burgh, I spent a few hours in London just after a terrific air raid. As we came into the velop usefulness in crippled hands, wrists and fingers. Soldiers with lame knees were en- couraged to run the foot power printing press. Those who had lost right hands were taught typesetting and distributing to in- crease skillful use of the more or less clumsy left hands and fingers. We had here, however, a difficulty which was always a serious matter in the voca- tional retraining of soldiers; that is, many of the men were too old to adapt themselves readily to education or reeducation of any ,o ?*>, THE PRINCE OF WALES' HOSPITAL, CARDIFF. FOR LIMBLESS SAILORS AND SOLDIERS, ADMIT BEARER To the Hospital (side entrance in West Grove) on Wednesday, 2oth February, 10.18, to witness the formal opening of the' Hospital by 1b.IR.ltx Sbc prince of Males, 1R.6. The Ceremony will take place out of doors, and the holder of this ticket should arrive at the Hospital not later than 3, .so p.m. Tickets are not transferable, and if not required, should be returned by post forthwith. Guests who are unable to inspect the Hospital: at the conclusion' of the Opening Ceremony on Wednesday, are invited to visit the Hospital on either of the two following, days (Thursday or Friday) between.the hours of 10 and 12. w, or 2.0 and ;.<>: Invitation card to the formal opening of the Prince of Wales Hospital. It was upon this occasion that the American officers were presented to His Boyal Highness The Prince of Wales. station at 7:00 o'clock in the morning, we found the concrete corridors, stairways and platforms crowded with people who had spent the night there. The crowd was ap- parently not very much alarmed but very un- comfortable and thoroughly resentful. In the streets it was found that a good deal of ma- terial damage had been done. During the fall of 1918, at Cardiff we de- veloped the Orthopedic Service considerably. The auxilliary hospitals were well organized and were taking care of several hundred of our patients during the time when they re- quired less active treatment. The curative work shops were formally opened and became a useful adjunct in the prosecution of our work. In the print shop, in which I was especially interested, a con- siderable number of men were taught to de- kind. In particular many of them had diffi- culty in deciding upon work in which they would be interested or in applying themselves to the serious mastering of a new trade. At Cardiff the printing shop really succeeded in developing a few such men. Our best shop in this regard was perhaps the boot shop. Here a considerable number under the guidance of an accomplished and skillful instructor be- came proficient in boot and shoe repairing. Quite a number of the men also did good work in the brush shop, and weaving shop, the brace shop and the carpenter shop. In addition, our Sergeant Jones contributed to the progress of many of those with amputa- tions and stump deformities in the gymnas- ium. The care of our amputated at the Welsh Metropolitan War Hospital almost deserves a separate chapter. Certainly my experience in this work had a considerable influence up- on my attitude towards the large number of our own amputations that I saw with Capt. Phillip P. Wilson in our service at Savenay in France. The British had got so far behind in the care of their amputated men that they were compelled to send them home from the hos- pitals as soon as the primary wounds had healed. The intention was to bring the men back to the limb fitting centers to be cared for as rapidly as possible and to have arti- ficial limbs put on. Neither the hospitals nor the artificial limb factories, however, were able to keep pace with this demand. In 1918 there were said to be about 10,000 men wail- ing at home to be sent for for limb fitting. Our experience with these men showed how important it is to make the treatment con- tinuous from the time of the original opera- tion. Of 500 patients who returned to Whit- church and went through our service, more than 300 required either reconstruction or surgical treatment, or both, before their limbs could be put on. Many of the men had discharging sinuses from osteomyelitis or from foreign bodies in the stump, thac had not been removed. Others had contracture deformity, flexion of the thigh, flexion of knee, adduction of the arm, etc., so severe that an artificial extremity could not be put on in a position to be worn. All of these things had to be corrected. In two instances I had the privilege of correcting by the Sout- ter operation, a thigh stump flexion deform- ity which had been pronounced by the limb factories too severe for an artificial leg to be worn. Both of these men were success- fully wearing artificial limbs when I last saw them. For the success of this service in Wales, the greatest possible credit is due to Colonel Sir John Lynn Thomas, who conceived, se- cured the funds for. and successfully devel- oped the Prince of Wales Hospital for limb- less men in Cardiff. This hospital is still performing an excellent function for these men and will doubtless continue to do so for many years. In December, 1920, this hospi- tal also opened a ward for crippled children, a feature which I had the privilege of dis- cussing with Sir John Lynn Thomas on sev- eral occasions during my stay in Cardiff. In December, 1917, a conference of all sur- geons on duty in the British Military Ortho- pedic Centers, was called by Sir Robert Jones, to meet in Liverpool. For that confer- ence, I prepared a paper on "The Importance of Tendon Surgery in the After Care of In- jured Soldiers with Irreparable Peripheral Nerve Injuries." The largest part of the discussion, how- ever, was given over to peripheral nerve sur- gery alone. Sir Robert Jones presided at the conference and gave us the benefit of his comments on the papers presented and the influence of his always interesting and help- ful personality. It was my privilege on this occasion to visit Sir Robert Jones' rooms at No. 11, Nelson Street, where he and Hugh Owen Thomas before him have cared for their thousands of patients. This in itself, was a most helpful and inspiring experience. The three days following this conference were spent in Ireland, visiting the Orthopedic Centers at Black Rock, Dublin and at Belfast. 2fi CHAPTER V. One of the most interesting and pleasant surprises of my stay in Great Britain was the celebration, even under war conditions, of the Christmas holidays. I found that at all times the Britisher has an extraordinary capacity for laying aside business and other cares when a proper rest time arrives. This applies to afternoon tea, week ends, bank holidays and all other similar occasions. At Christmas time in 1917, war conditions had still not become so bad but that we were able to really enjoy the elaborate provisions that were made for the season. A great deal of food had apparently been stored away for Christmas. We had been strictly economical up to that time but in the Welsh Metropoli- tan War Hospital and among the British friends who had been so kind to us at other times there was sufficient food for sev- eral very excellent Christmas dinners. We had these at various times from Christmas up to New Year's Day. Major Alwyn Smith, Mr. Bayumi, Mr. H. Spence Thomas and the Lord High Sheriff Mr. Radcliffe, all acted as hosts to the Americans who were on duty in Cardiff at that time. The nurses, officers and men in the hospital all entered very thoroughly into the spirit of Christmas. Singing troupes were organized and several concerts were given in the Hall at the hospi- tal, the wards were all gaily decorated. At the Officers ward (MSA) two dances were given to which the American officers were invited. To me at least the entire holiday season was a succession of pleasant surprises and a conclusive demonstration as to the strength of the British spirit, even after three years of war. The end of 1917, however, was marked by a good deal more than the celebration of Christmas. The British War Office and the Ministry of Pensions had just become arous- ed on certain questions which were of great importance. The shadow of the coming spring offen- sive on the western front was already spreading over the country. The British hospitals of all kinds, permanent and emer- gency were filled even in the comparatively quiet times about the holidays. Many sick and wounded were arriving in the British Isles daily. This situation led to an investi- gation which revealed the fact that patients were being detained in hospitals longer than necessary. This was the result both of fail- ure to provide . prompt treatment upon ar- rival at hospital and efficient treatment afterwards. The important question of methods of shortening the period of dis- ability arose. It was soon found that a considerable number of cases could be re- turned to usefulness much more promptly by transfer from general to orthopedic hos- pitals. This was true particularly of those patients who had been months in the hospital with drop foot, contraction of the hip or knee or some other disabling deformity that could be corrected surgically or by mechani- cal apparatus. There was a considerable in- THE TIMES, WEDNESDAY, JUNE 5, 1918. GREAT FRENCH DEFENCE. ENEMY GAINS AT HEAVY COST, FINE FIGHTIKa BY AMERICANS., The' following , Frcnqh communiques were •ssucd-yesterday :*— • ■ « • ' AFTERNOON. .'■■■■ ALLIES' FAITH IN VICTORY. ------... ■»........----» AMERICAN HELP WILL DECIDE THE SUPREME WAR ....,, -COUNCIL* the following official statement toqs 'issued last night;*— ......-.. - ■• ■'' crease in the activity of the orthopedic centers after this time. It was also found that many men were delayed in hospitals because of failure to systematically re-examine patients; conse- quently they were not promptly discharged when ready. It is not commonly appreciat- ed how much unnecessary disability there is because of failure to inspect frequently pa- tients of this class. Very often the removal the patient's record side of many hospitals had been very seriously neglected. Fortu- nately for us, our card index system which had been in operation for nearly six months supplied us promptly with most of the infor- mation which was called for. However, the increased "paper work," as it was called, was a serious burden to the medical otaff and it was only by the loyalty and industry of some of the patients themselves who acted as ISSUED m FOOD '%/>//-/?*%*** apmfcrrftrA to Um CaaateuUag Offl«*r *>r duty. «»« tram! dir»«t«4 i* r*»*MMuy la ii* Soli- tary MrvlM. Offlotal: ROBERT C: DAVIS, Adjutant Qonaral. By Command of"0»t»«ral Perar.ing: J AMES «,., M«AHDKES, CM»f of Staff 32 considerable number of wards in which, eith- er because of lack of knowledge, lack of in- terest or lack of industry on the part of the ward surgeons, there were uncorrected, un- splinted, and otherwise more or less neglect- ed patients. This neglect showed itself in a few principal ways. There was shortening and deformity of some fractures, especially of the compound fractures. There were also many patients with shoulders, elbows, wrists, knees, and ankles that were healing after compound injuries in bad position. One of the most striking illustrations of this was to be found in the upper arm and elbow injuries. These patients were mostly returning from the front in what were called hinged ring Thomas arm splints. This splint made traction on the arm with the\ whole arm straight and the hand pronated. It was a good splint for transportation because the arm would lie beside the patient on a litter or in a cot. It was a bad treatment splint, however, because the straight stiff arm is a useless arm. In many of these cases, how- ever, at Base Hospital No. 9 and elsewhere, this straight splint was left on while large shoulder, upper arm, or elbow wounds were being carefully dakinized and healed. Our method of dealing with this large problem at Savenay will be spoken of in another chapter. One found in the Army hospitals a con- siderable number of surgeons who were never able to adjust themselves to the problem of splinting a compound fracture. This was one of the things we had borne down upon us in our experience with the British. I was ex- tremely anxious to apply here, at my first opportunity, the methods of Sir Robert Jones, which we had learned in the British hospitals. To my genuine sorrow, however, I found neither in Base Hospital No. 9 nor else- where a receptive attitude in this matter. Those who had had a few months of exper- ience with the Americans had acquired meth- ods with which they were satisfied. Those who had had little or no experience whatever, in such cases were apparently even less will- ing to learn. My own position in Base Hospital No. 9, therefore, resolved itself into the care of the patients in one 40 bed ward and a few days later of the officer patients in the officers' ward. At about this time, Col. Brackett, Chief of the Orthopedic Service in the United States, who had come over from Washington, visited our hospital. With his usual generosity he afforded me an opportunity to discuss this situation with him. He had many interesting and valuable comments and suggestions to make. A day or two later Col. Joel E. Goldth- wait, Chief Consultant in Orthopedic Surg- ery, A. E. F., also arrived. As an immediate result of a similar conference with him, I was assigned as consultant in Orthopedic Surgery to Base Section No. 1, A. E. F., with headquarters at Base Hospital No. 8, Save- nay. Other Americans who had been on duty with the British were assigned as consultants the same time. On my way to the new station, I stopped for a few hours in Angers with Captain E. W. Fiske. Captain Fiske was conducting a large and important orthopedic service at this hospital (Base Hospital No. 27). He was furnishing good care to a considerable num- ber of patients. In Angers I saw for the first time the very extensive use of Balkan frames, weight and pulley traction and elab- orate apparatus which had become quite gen- erally used in the American hospitals, espec- ially in Paris. This work was along the line of methods worked out by Col. Joseph A. Blake, and differed to a considerable extent from the simpler and what appeared to me to be the more practical methods of the British. Upon arrival at Savenay a most interest- ing situation was found. I was assigned as Chief of the Orthopedic Service and Consult- ant in Orthopedic Surgery to Base Hospital No. 8, Savenay, Base Hospitals No. 34, 38, and 11 at Nantes, and Base Hospital No. 101 at St. Nazaire. My duties as specified par- ticularly, were to inspect all patients in Sav- enay or upon arrival as to their condition for transfer to the United States. A large hos- pital center had already been planned for Savenay and the area had been designated as the hospital center through which all Am- erican sick and wounded were to be sent t© America. Already one or two train loads of patients had been sent, and it had been re- ported that their condition for transportation had not been satisfactory. It became, then, my duty to decide whether the wounded, upon arrival in Savenay, were suitable for immediate transfer to the United States or whether they should be detained for splints, the correction of deformities, fur- ther surgical treatment or even amputation. It was stipulated in orders that no amputa- tions were to be done in any area except af- ter consultation with and approval by the Consultant in orthopedic surgery. My position was one which, of course, brought me at once into conflict with the surgical service. Until the moment of my ar- rival, patients had been designated for trans- fer to the United States by the ward sur- geons, who were accountable to the Chief of Surgical Service. In making up the first con- voy to leave Savenay, after my arrival, this plan was followed. I was given no oppor- tunity to see the patients until they were on the train. Upon inspection of this train load of patients, about 400 in number, I found about 40 whom I considered unfit to go. They presented such conditions as com- pound fractures, ununited and without moval from the train and return to their splints, wrists, ankles and knees which were healing or ankvlosed in bad position. Some cases of nerve injuries had drop wrists and drop feet with no splints to support them. All of these patients were marked for re- wards The Chief of Surgical Service pro- tested my decision with regard to these cases but Colonel Webb. E. Cooper, Commanding Officer, after considering carefully my writ- ten and signed report in regard to these pa- tients, made a ruling sustaining me in the matter. It affords me much pleasure to say that this attitude of Colonel Cooper was one he maintained consistently throughout our entire service at Savenay. During the time that he was commanding officer in Base Hos- pital No. 8 and subsequently of the Savenay Hospital Center, both officially and unoffi- cially he was always deeply concerned for the welfare of soldier and officer patients. AMERICAN EXPEDITIONARY FORCES France, 27th August, 1918. CIRCCLAR LETTER NO. 7-A. Prom: The Chief Surgeon. To: C. O.s all Base Hospitals. Hospital Centers and Surgeons of Sections. Subject: Consultants in Orthopaedic Surgery. 1. The following named officers have been appointed as Consultants in Orthopaedic Surgerv for the hospitals in the districts given after their names. Hospitals requiring tne services of consultants in orthopaedic surgery can apply to the nearest Consultant at me ;.ddress given: Name Major Geo. W. Hawley, MRC Capt. Z. B. Adams, MRC Capt. C. F. Eikenbary, MRC Capt. C. B. Francisco, MRC Capt. J. C. Graves, MRC Capt. H. W. Orr, MRC Capt. W. W. Plummer, MRC Address Base Hospital No. 9 Base Hospital No. 114 Beaune 3rd Depot Division St. Aignan-Nevers Base Hospital No. 8 Base Hospital No. 116 Capt. DeForest F. Willard, MRC Vichy Center District Base Hospital No. 9 Limoges Beau Desert Center Bordeaux Vauclaire Beaune Center Allerey Center Dijon Autun 3rd Depot Division St. Amand-Montrond Mars Center Mesves Center Pougues-les-Eaux 1st Depot Division Tours Blois Orleans Savenay Center Nantes Center St. Nazaire Bazoilles Center Vittel-Contrexeville Neufchateau Chaumont Langres Rimaucourt _ Vichy Center ;Chatol Guyon Royat Roanne M. W. Ireland, Brig. Gen., M. C, N. A., Chief Surgeon. 34 CHAPTER VII. The subsequent experience of the Ortho- pedic service at Savenay was one which I shall always be very glad to remember. In the first place Colonel Goldthwait sent to Savenay a number of the very best medical officers available for this special work. Captain LeRoy C. Abbott came a few days after my arrival. He developed into a fine surgeon and did most of the surgical work in the Orthopedic Department at Base Hos- pital No. 8. He became chief of the Ortho- pedic service in Base 8, and was promoted to the rank of Major. With the transfer of the amputation ser- vice from Chateauroux, Captain Wilson (lat- er Major) also came to Savenay. More than 3,000 amputation cases came through our de- partment there and Captain Wilson developed a fine service. To these two officers and later to Major Murray S. Danforth, who came in December to Base Hospital No. 69, we were largely indebted for the really excellent work that was done in the Orthopedic Service at the Savenay Hospital Center. In addition to the excellent personnel of the Orthopedic Staff, we developed many good friends in other departments who con- tributed in many ways to the care of our large service. Col. Webb E. Cooper, com- manding officer of Base Hospital No. 8, and Lt. Col. R. J. Estill, who succeeded him were both in hearty sympathy with the surgical and splint methods worked out for the trans- port and treatment of these cases. Miss Amy F. Patmore, who was chief nurse of Base Hospital No. 8, and later chief nurse of the Savenay Hospital Center, was always sin- cerely devoted to the welfare of the soldier patients. The nurses on the operating room staff of Base Hospital No. 8 were always of the greatest help in carrying out our plans for the care of these patients. Finally and of great importance were the Reconstruction Aides, who came to Savenay in September, 1918. They worked not only in the field for which they came, physiother- apy and occupational therapy, but assisted in many ways in the progress of our work. Miss Marguerite Sanderson, Chief Aide for the A. E. F., and Miss Leah Thomas, Chief Aide for Base Hospital No. 8, lent themselves and their helpers to the conduct of the Ortho- pedic headquarters, splint department, oper- ating room and even to the making of plaster of Paris bandages, when the situation re- quired the help and cooperation of everyone. All of these features contributed in no small manner to the tremendous amount of work that was accomplished during the fall of 1918, and during the rush at the Savenay Hospital Center following the Armistice. One can sketch only very superficially what happend during these seven months at Savenay. From July 1918 to March 1919, more than sixty thousand patients passed through the Savenay Hospital Center. Of these about sixteen or eighteen thousand were classified by us as orthopedic. This in- cluded a large share of all the battle casual- ties. We had not only flat feet, sacro-iliac and back strains, and the various bone and joint disabilities of a minor sort; but also all of the fractures, all of the joint injuries, all amputations, practically all of the peripheral nerve injuries and soft part injuries in which, because of scar contraction or failure to splint, there were beginning or fully de- veloped contracture deformities. Savenay had been designated as the area to receive all sick and wounded from all the other base hospitals throughout France. At Savenay the patients were to be classified for return to duty, transfer to the United States, or to be held for treatment. It became my duty therefore, as Consultant in Orthopedic Surgery, to pass upon all of the kinds of pa- tients referred to above, with reference to these points. Patients were arriving during August at the rate of about five thousand per month. One of the first indications, therefore, was for a scheme by which patients belonging to the Orthopedic department could be located and dealt with immediately upon arriving at the Savenay hospital center. Two plans were adopted for this purpose. One was to locate the patients needing our attention as they came through the receiving room, and the other was to assign patients to certain wards according to diagnosis. A little later we had in Base Hospital No. 35 8, separate wards for femur fractures (192 beds), arm fractures (256 beds), leg frac- tures (128 beds), knee joint injuries (34 beds), amputations (320 beds), etc. The other hospitals in the center followed this plan to some extent. This was true especially of Base Hospitals 69 and 88, where the work developed splendidly under Major Danforth and was continued later by Major Metcalf to whom I referred in Chapter I. In order to assist us in this matter, we also adopted the plan of having a daily card index made in the registrar's office. These cards were prepared between midnight and operation, kind of splint, or for a decision as to other disposition of the case. I have had several gratifying experi- ences since my return to civilian prac- tice as the result of this kind of work. A young man came into my office not very long ago with three useful fingers attached to what was left of his right hand. He was using the hand and fingers very well and asked me what I thought of it. I told him I could see no indications for fur- ther treatment except for the removal of a small scar which was painful upon certain movements. He then reminded me that the WAME no./ ff~~. ^ o ? W / nv/ ■i. i „. „. ...£~. #**. i... , . i *■■■'- - f I n * j. 14 - .CONDITION; 1. 2. 3. f 4 < > •KARD ■_^L B- c< ("L f < -t (1.,., "i;/ • i _2_ • - - <~3~~ ^ -.y; : _4j morning by soldier clerks, who were assigned to this special duty. On my desk at eight o'- clock in the morning, I found sometimes fifty and sometimes several hundred cards for pa- tients admitted with orthopedic conditions during the preceding twenty-four hours. These cards were at once distributed to medi- cal officers who went out to the wards and located the men wherever they were. The cards came back at noon marked, "return to duty", "transfer to the United States", "splint required", "operation required", or with such other information or recommendations as the medical officers thought proper. Recommen- dations regarding treatment were usually compiled with the same day. In a certain number of instances each day it was necessary for me to see these patients in consultation to decide upon the kind of 36 question came up at Savenay as to whether or not his hand should be amputated because of a compound infected wound, I made the decision at that time against amputation, al- though it had been recommended. He was very grateful and appreciative on account of the hand having been saved. Sometimes decisions in these cases were difficult to make. On one occasion we had two brothers brought to me for examination, one more seriously injured than the other. They were both anxious to return to the United States. It was far from easy there- fore, to mark one of these brothers for trans- fer home and the other for return to duty in France. During September and October, we ex- amined and passed upon more than five thou- sand patients in the Orthopedic service. Cap- PATIENTS RECEIVED AT BASE HOSPITAL NO. 8, SAVENAY SEPTEM- BER 1st TO 28th, 1918. Total number from each Hospital. Condition as regards splinting on arrival explained in numbers.* Condition as regards splinting on arrival explained in per centum. "a" indicates an improvement in later convoys. "b" indicates poorer condition in later convoys. Showing: Remarks xt No. No. No. No. % % % % Re- Name___________Total 12 3 4 12 3 I marks 5- g- JJo. 1..................266 67 29 69 101 25 11 ~^~ ~Tq ^ 5" 5' S°- 1..................9?6 1? 13 20 35 22 15 23 40 "a" g- g- NT°- J..................359 135 38 97 91 36 11 27 26 "b" g- g- No- 7................... j> 1 0 2 2 20 00 40 40 g- g- NT°- 8.................. 3 2 0 1 0 66 00 34 00 g- g- NT°- ?-................103 51 9 18 23 50 9 18 23 "a" g- g" g°- Jl................ 19 4 2 4 9 20 10 20 50 "a" g g' J!0' }%................ 1 ° x ° 0 00 100 00 00 g- g- NT°- J3,................ 12 4 0 3 5 34 00 25 41 "a" £" S" S0, It................ 8 2 1 l 4 25 12.5 12.5 50 "a" g g' ^r°' ^................ 14 2 1 2 9 14 7 14 65 g' 5' NT0, 17................ 7 5 ° 0 2 73 00 00 27 g- g- No. 18................ 8 114 2 12.5 12.5 50 25 g g" H°- i«................ 28 9 1 8 10 32 4 28 36 "b" B. H. No. 20................ 24 5 4 4 11 21 16 17 46 "a" B. H. No. 22................ 23 13 3 4 3 57 14 15 14 "a" B. H. No. 23................ 18 7 3 4 4 39 17 22 22 "b" B. H. No. 25................ 15 9 0 0 6 60 00 00 40 "b" B. H. No. 26................ 42 9 3 21 9 21 7 50 22 "b" B. H. No. 27................137 42 19 43 33 31 14 31 34 "b" B. H. No. 28................ 25 7 0 9 9 28 00 36 36 "b" B. H. No. 29................ 21 1 0 0 0 100 00 00 00 B. H. No. 30................ 58 22 4 17 15 38 7 29 26 B. H. No. 31................ 21 3 15 2 1 14 71 10 5 "a" B. H. No. 32................ 3 2 0 1 0 66 00 34 00 B. H. No. 34.........r......100 21 23 35 21 21 23 35 21 "a" B. H. No. 35................ 2 0 2 0 0 00 100 00 00 B. H. No. 36................ 6 4 0 1 1 66 00 17 17 B. H. No. 38................ 27 7 5 8 7 26 8 30 26 "a" B. H. No. 39................ 1 1 0 0 0 100 00 00 00 B. H. No. 40................ 6 2 0 1 3 33 00 17 50 B. H. No. 44................ 9 3 0 0 6 34 00 00 66 B. H. No. 46................ 2 1 0 0 1 50 00 00 50 B. H. No. 48................ 46 5 8 27 6 11 18 56 15 "a" B. H. No. 49................ 2 0 0 0 2 00 00 00 100 B. H. No. 50................ 8 3 2 1 2 37 25 13 25 "a" B. H. No. 66................ 2 1 0 0 1 50 00 00 50 B. H. No. 67................131 56 11 20 44 43 9 15 33 B. H. No. 68................ 14 4 2 5 3 29 14 36 21 B. H. No. 101.............. 54 14 5 14 21 26 9 26 39 "a" B. H. No. 114.............. 71 27 12 12 20 38 17 17 28 "a" B. H. No. 115.............. 17 7 0 2 8 41 00 13 46 B. H. No. 116............... 3 1110 33.3 33.3 33.3 00 B. H. No. 202.............. 4 0 0 1 3 00 00 25 75 RC. H. No. 1.............. 1 0 0 0 1 00 00 00 100 RC. H. No. 2.............. 14 3 0 3 8 22 00 22 56 RC. H. No. 5.............. 5 1 0 2 2 20 00 40 40 Mil. Hosp. No. 1........ 1 0 0 0 1 00 00 00 100 St. Aignan................. 23 14 0 3 6 61 00 13 26 Blois ............................ 6 3 0 0 3 50 00 00 50 Camp Hosp's 26 14 6 1 5 54 23 4 19 Total ..........................1904 614 227 482 581 32 12 25 31 Received at Base Hospital No. 8 September 1 to 28, 1918. *The above is a summary of patients seen in the Orthopedic Service at Savenay during September 1918. In the vertical columns (condition upon arrival at Savenay) No. 1 indi- cates "No. Splint required", No. 2 "Splint on and Satisfactory." No. 3 "Correction of posi- tion or Change of Splint or both Required." No. 4 "Condition requires correction of posi- tion or application of Splint or both." 37 tain Abbott, who had become our chief re- liance in the operating room and Captain Wil- son, in charge of amputations, were operat- and October. Even so, "the worst was still ing almost every day. Some days Captain Abbott had as many as fifteen or twenty op- erations. Three principal splint shops had been developed in which a hundred to two hundred plaster casts and splints were being applied daily. The question of the use of plaster of Paris was an interesting one. At first the use of plaster was forbidden. Within a few days af- ter arriving at Savenay, however, our supply of splints gave out. After that we manufac- tured most of our own splints. We even de- veloped a very creditable shoe shop which did a great deal of fine work. Crinoline arid plaster of Paris, were available and several of the officers assigned to this department by Colonel Goldthwait, were experts in the use of plaster. With my own fondness for plaster as a fixative dressing, it came there- fore into extensive use. Even a great many of our spine and fracture cases were put into plaster of Paris for transfer to the United States. Plaster of Paris came to be the pre- ferred dressing for both simple and com- pound fractures below the knee, and many hundreds of these casts were put on. We never heard of any very serious effects as result of this method. In fact the only com- plaint we had was that occasional cooties were found inside the casts. With regard to the condition of patients upon arriving in the United States, the fol- lowing letter received by us after the armis- tice, indicated that on the whole the patients arrived in a satisfactory condition. The end of the war which came suddenly and dramatically on November 11, found us extremely busy. Before the Argonne offen- sive began, the forward hospitals had been cleaned out and we were crowded. Strenuous efforts were being made to clear beds for the victims of the severe fighting that was expected and that we had during September to come". With the signing of the Armistice, there was almost a panic among the hospi- tals to get home. Train loads of patients came pouring into Savenay from hospitals all over France and our patient population grew from 8,000 to 11,000 in a few days in spite of the fact that some thousands were sent awav. Even so, the signing of the Armistice was an occasion of great rejoicing. No one who had seen the thousands of shattered and crip- pled men could fail to be glad that the firing . „„n RBO:H.ML In reply refer to S.G.O........................................ W\R DEPARTMENT OFFICE OF THE Sl'RGEON GENERAL WASHINGTON November 30. 19 IS. Krom: The Surse.m General. V. S. Army. To- Major H. Winnett Orr, Base Hospital No. 8 A.E.F., France. (Thru Chief Surgeon) Subject: Returning wounded. 1 I have had the opportunity to visit nearly all the hospitals in this countrv to which the wounded are returning, and it is extremelygrati'fving to find that the care and overhauling which theTases receive/at Base Hospital No. 8 H™™*'"^* returning to this country in most excellent condition. There are very few preventable deformities and the splinting is well done. •> Thev are bearing their transport excellently. This, we realize is" largely due to the remarkable supervision which you and Abbott and your staff are giving the cases. The few cases of preventable deformities which we have found have, as far as we have been able to ascertain, not come under your supervision. By direction of the Surgeon General: R. B. OSGOOD. Lt. Colonel. Medical Corps, USA In replying please refer 24 Dec 1918 to file No. i' S 321623 2396 1st Ind. O.C.S.. Am.K.K.. France. December 24, 1918.* To Major H. Win- nett Orr, M.»'. (Thru CO., Hospital Center, Savenay, AEF). 1. Forwarded. Bv Direction: FWW-.1KS F. W. WEED, Lt. Col., Med. Corps. Rec'd Hosp Center Dec 27, 1918. All communications should be addressed to the Surgeon General U. S. Army, Washington, D. C. "TRIE COPY" (copy) at the front had stopped. At any rate, we felt that when we were repairing the dam- aged limbs we could make some progress with the job as a whole. There would not be more and more train loads of wounded to take the places of those who got well. One wondered how the British and the French could have carried on for over four years with thousands of wounded coming in every month and never an end of the war in sight. After the first big rush matters began to ease up again. Evacuation of the wounded to the United States began to be easier and more regular. Medical officers were released from the front and began to help us in the rear. Some were pretty anxious to get home but we had the assistance of many. It was soon apparent that the war was far from over for us. During all of Novem- ber and December our hospital was com- pletely filled and it was not until January that we began to receive the last of the pa- tients from some of the other Base Hospitals and Hospital Centers. In the meantime my own consultation territory had been widened so that not only Savenay, Nantes, and St 38 Nazaire had to be visited but Angers, Van- nes and Camp Hospitals at Coetquidon, Mon- toir and La Baule (19 in all) were in our area. This gave us a real glimpse of lower Brit- tany and a wider scope for usefulness. Several other things stand out in my mem- ory of the service at Savenay. During Octo- ber I spent a week in bed with bronchitis. We had just begun to arrive at definite con- clusions regarding the scope of our work and the best methods to be employed. With the assistance of Miss Margaret Blake, who was a most helpful Reconstruction Aide, and with the collaboration of Captain Abbott and Cap- tain Wilson, I wrote a fairly complete out- line of the teachings of Sir Robert Jones and Colonel Goldthwait together with our own conclusions regarding the work. This was ac- cepted at once by Colonel Cooper and sent out by him as Circular No. 138, Savenay Hos- pital Center*, to all chiefs of services and to all ward surgeons. Later at the suggestion •This circular of 36 pages will be printed in full when this story Is published in book form (See page 50). of Col. Goldthwait this was sent to other Base Hospitals also. The following letter sent out in November is along similar lines and suggests both meth- ods and results of our work. Nov. 20, 1918. From: Consultant in Orthopaedic Surgery, Sav- enay. To: Chief of the Surgical Service Base Hosp. Subject: Orthopaedic Patients. Sir: Since Sept. first a statistical study has been made of patients arriving in Savenay for evacuation to the United States. The conclusions reached and to which it is desired to call your attention in this communication are based upon the observation of somewhat more than 4,000 cases. It has been found that about 350 patients of each 1,000 arrive in condition for immediate transfer to the United States, requiring no treatment or splint- ing of any kind. About 200 of each 1,000 arrive wearing proper splints. Some may require simple surgical dressings. A few patients of this class re- quire drainage operations but most are ready for transfer to the United States within a few days. 300 patients of each 1,000 require extensive modi- fication or complete change of splints with or with- out other treatment. The majority belong to two classes: (a) Gun shot wounds of the upper arm [Editidn speciak \zMorhihm, F.aKt'rr \m tt'.?tt i)S-*I.>!-5 «t.Wt. | two TBIBQ8E L1BHE /autre Danger IV .i, . t«4 ■■ l': I^'Artntetlee e^ les Fftactidaaaires \(Ofjickl)VAgenceftavasnousffl£gTaphie:\ Les Socialists* son? 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