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Last Online: Today, Last Online: 08 Nov, Last Online: 39 min ago. In three of these armies he followed the line of evacuation from the battalion aid post [station] to the evacuation hospital.
Typical fixed installations of the Communication Zone were visited on the Continent and in Great Britain. Particular pains were taken to cover the entire range of facilities from tented units to units housed in buildings of every degree of adequacy. The medical organization of the several echelons was covered in detail by qualified members of the staff.
Clinical subjects of special interest to General Morgan, such as cold injury, hepatitis, malaria and "field" nephritis, were.
Through the cooperation of the Senior Consultants in Psychiatry and Dermatology, special facilities in these fields were demonstrated to General Morgan. Through Colonel Diveley and Colonel Stinchfield, similar opportunities were afforded for the study of the program in physical rehabilitation fig. The complete cooperation of the administrative and clinical divisions of all echelons of the Medical Department made this tour possible. The Medical Consultation Service profited immeasurably from the firsthand counsel of General Morgan on his European tour of duty. The first of these conferences was held on 25 March at Cheltenham.
Fourteen of the sixteen chiefs of medicine in fixed hospitals in the theater at that time were in attendance. James B. There were detailed discussions on the following subjects Gas defense; records; laboratory service; functions of the chiefs of medical services; distribution and utilization of medical personnel; current clinical problems in the theater; clinical procedures in communicable diseases; syphilis; shock; supply problems, including drugs, special diets, and equipment; disposition of patients; convalescent hospital facilities; evacuation and transportation of patients; educational programs; professional relations; and military responsibilities.
Mimeographed transcripts of the proceedings were circularized to the hospitals of the theater and to the headquarters staff. The chiefs of medical services of 22 fixed installations and the following representatives of General Hawley's office were present: Colonel Spruit, Deputy Chief Surgeon; Col. Edward M. Curley, VC fig. David E. Liston, MC, Chief, Personnel. Walter L. John K. The subjects considered were milk supply; fever therapy; intensive arsenical therapy of syphilis; anesthesia; laboratory services; current clinical problems of the theater, including respiratory infections, infectious mononucleosis, primary atypical pneumonia, poliomyelitis, mumps, encephalitis, and allergy; administrative problems, particularly involving the cooperation among hospitals; special training of nurses and enlisted men; and disposition problems.
Colonel Curley presented an analysis of the problem of bovine tuberculosis in Great Britain which was timely and revealing. The presence of representatives from the several divisions of General Hawley's office led to an open forum, with most profitable discussions of such subjects as plans for special hospitals, availability of special equipment, supply and procurement of nonstandard drugs, nomination for special schools, proposed medical bulletins, and records.
By , the theater had grown to such an extent that it was necessary to divide the third conference of the chiefs of medical services into two sections. The first, held on 26 January , included the chiefs of the medical services. Curley, VC left , and Col. The second, held on 2 February , was attended by the chiefs of the medical services from the hospitals of the Southern Base Section.
At the two meetings, 70 chiefs of the medical services of the respective hospitals or their representatives were in attendance. The following representatives of General Hawley's office took active part in the proceedings of these sessions: Col. Rex L. Kenneth D. William G.
In opening these sessions, Colonel Middleton outlined the organization of the medical service on a functional basis. The subjects considered were delegation of duties, training, clinical duties, consultation; clinical problems,. In the open forum, Vincent's stomatitis, disposition, detachment of patients, and evacuation received due consideration. The Records Division, Office of the Chief Surgeon, Headquarters, ETOUSA, made a special appeal for the accuracy of diagnostic nomenclature and stressed the importance of maintaining forms and of careful paperwork in support of statistical analyses, as well as in the soldiers' interest to establish the service connection of disabilities.
X-ray supplies and equipment received full attention. Air transportation and evacuation between Northern Ireland and the United Kingdom and between the United Kingdom and the Zone of Interior were discussed.
The deliberations of the earlier meetings led to the promulgation of a memorandum concerning policies of procedure for chiefs of medical services, which proved both opportune and effective. The conferences of the chiefs of the medical services had clearly established their extreme usefulness. By the same token, it had also become evident that further similar conferences would prove unwieldy; hence, subsequent meetings of this nature were set up on a base section level. With the further development of the theater and the attendant restrictions on transportation, these conferences were eventually limited to the hospital center level.
All senior consultants, base section consultants, and any consultants were invited to these meetings, and an opportunity for the free discussion of plans and problems was afforded to members of General Hawley's office in attendance. General Hawley and Colonel Kimbrough cultivated this relationship by every attention to social and professional amenities.
Every courtesy was shown to Colonel Middleton and his senior consultants. Sir Alexander H. Lorne C. Army in the European theater. Rees, Consultant Psychiatrist; Brigadier G. James, Consultant Psychiatrist; Brigadier F. Osmond, Consultant Venereologist; Brigadier R. In the deliberations of this group of British clinicians, free and uninhibited discussion of mutual problems was encouraged. The regular meetings of the Army Medical Directorate Consultants Committee were held the day after the meetings of the Medical Subcommittee, under the leadership of Lt. Sir Alexander Hood. Although these sessions were important, the proceedings represented a duplication of the activities of the medical and surgical sub- committees.
Hence, regular attendance, while invited, was deemed redundant. Under the chairmanship of Prof. John A. Ryle, the Interservices Medical Consultants Committee was organized. Army, and the U. Navy met in Kelvin House, London, at regular intervals to discuss mutual problems. Air Commodore Alan Rook served as its secretary.
Rowlands, R. Within military circles, there can be no question as to the supreme importance of preventive medicine in reaching such objectives. In the European theater, in General Hawley's office, there was a complete meeting of the minds between the Professional Services Division and the Preventive Medicine Division. Few days passed without an interchange of information between Colonels Gordon and Middleton. As a rule, the propinquity of offices made such contacts very simple.
For a short period, the detachment of the Preventive Medicine Division to London while the Professional Services Division remained in Cheltenham was immediately felt as a distinct dislocation between two divisions with a common objective. The interlocking interests of these divisions should always be borne in mind in future planning in the interest of the health of a command. Their missions are inseparable, and they can operate effectively only when interdependent.
The medical care of the patient is secondary only to the prevention of disease and disability.
The former responsibility fell clearly within the pur-. Thirelstaine Hall, Cheltenham, England, 2 April In the interest of the best possible medical care, the primary function of the medical consultants must perforce be clinical. At an early stage in the evolution of the theater, Colonel Middleton made clinical rounds of each hospital in the United Kingdom at least once a month. During this early period, calls for personal professional consultations multiplied these clinical exposures many times.
Whenever possible, Colonel Middleton used such contacts as a teaching outlet. Aside from the obvious professional aspect, these recurring consultations with young clinicians ultimately paid dividends in the assessment of their capabilities for growth and, in turn, aided Colonel Middleton in making recommendations for personnel assignment when new and understaffed units flooded the theater.
With the mounting trooplift and accelerated hospitalization program ultimately a total of , beds, of which , were in fixed hospitals , the routine of monthly clinical rounds, which had been so profitable, was necessarily modified by decentralization. In place of a single consultant for the theater, a base section or a hospital center consultant made periodic and requested professional visits in the area of his responsibility, with distinct advantage to the service to the individual soldier.
The weekly statistical reports of deaths presented an unusual challenge. These weekly lists were checked for preventable diseases by Colonel Middleton.
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By direct correspondence with the chief of the medical service in the hospital reporting such deaths, a copy of the complete clinical record was obtained. General Medical Laboratory A submitted a duplicate set of the histologic sections of the pathologic materials from such subjects to Colonel Middleton, so that all points of discrepancy might be reconciled.
The situation having been reconstructed from the available evidence, arm analysis with appropriate observations was forwarded to the responsible medical chief. As a rule, this constructive procedure was well received. Although its value is impossible of estimation, undoubtedly, the result was intangible dividends in the improved care of the sick in this theater.
In turn, the Personnel Division depended implicitly upon the consultants of the Professional Services Division for such counsel. In the interest of the best medical service under existing conditions, there must be an optimal utilization of the available personnel. Obviously, extreme inequalities existed in many of the hospitals assigned to the Communications Zone.
In the early phases of development, disproportionate professional strength was evident, particularly in the affiliated units. With the increasing demand upon the decreasing pool of medical officers in the Zone of Interior, this situation was eventually reversed. As already intimated, the existing professional assets of the theater had been carefully cataloged by Colonel Middleton on the basis of personal and professional observations in the wards of the existing units.
Upon the arrival of new hospitals in the theater, personal interviews and staff conferences were arranged to assess the professional qualifications and capabilities of all medical officers on the medical services. Alarming discrepancies, both quantitative and qualitative, were disclosed as the reserve of medical officers in the United States was depleted. Some idea of the magnitude of the problem may be gathered from the fact that, in , Colonel Middleton visited and interviewed the officers of the medical sections of general and 11 station hospitals from the Zone of Interior and 4 general and 2 station hospitals from MTOUSA Mediterranean Theater of Operations, U.
Colonel Kneeland likewise surveyed a group of these new units. To meet obvious deficiencies of skilled personnel in these hospitals in , 58 new chiefs of medical services were assigned from the reservoir of qualified and tried internists of the affiliated units of the European theater and those which had been transferred from MTOUSA.
The place of the affiliated hospital fig. Clearly, superior professional qualifications may be anticipated in these units. A natural pride in organization may bias the judgment of responsible officers, but, upon a clear presentation of the problem, cooperation in the release of highly qualified internists seriously required in other units was willingly made in the European theater. Without this source of support, the medical services of the fixed hospitals of this theater would have presented a strange mosaic of professional adequacy, ranging from superb to impossible, and the standards of medical care would have fluctuated immeasurably from one hospital to another.
In this relation, the Personnel Division of General Hawley' office can not be too highly commended for their cooperation. Never was a recommendation for the movement of a medical officer in the interest of better care for the soldier made by the medical consultants without prompt compliance. The professional interchange of the consultants of General Hawley's office with medical officers of the armies was intimate. Frequently, advices in medical matters from the field initiated inquiry or appropriate action at Headquarters, ETOUSA, to the ultimate advantage of the U.
In the movement of personnel, the prerogatives of the army were assiduously respected. Usually, in General Hawley's office the Professional Services Division, upon the request of an army consultant in medicine for personnel to meet certain medical needs of army units, would advise the army surgeon of its willingness to arrange, through the Personnel Division, for replacements from fixed hospitals of the Communications Zone.
As mutual confidence was established, at times the army surgeon, through the intermediation of the Professional Services Division, sought the transfer of medical officers from his echelon to fixed hospitals for the better utilization of their special skills.