# Armed Forces Institute of Pathology: Its First Century 1862-1962/Chapter IX

CHAPTER IX
The Museum in a World at War
With the entry of the United States into what was then called simply the World War, there being as yet no need to identify such conflicts by number, there came a profound change in the affairs of the Army Medical Museum.
In his annual report for the fiscal year ending 30 June 1917— a report which reflected for the most part conditions before the declaration of war on 6 April of that year— Surgeon General William C. Gorgas noted that the Museum, with its nearly 48,000 specimens, was "one of the largest, most instructive, and valuable collections in existence." A year later, in a report prepared at about the time the "bridge of ships" was beginning to move American combat outfits into France in significant numbers, The Surgeon General reported that in the past year the Museum had "taken on new life." 1
At first, however, the rush of preparing for a war, which was to see the size of the U.S. Army increased nearly fortyfold, seems to have bypassed the Museum and left it in a quiet backwater, with its annual appropriation for the "preservation of specimens and the preparation and purchase of new specimens held down to the $5 thousand-a-year figure which had come to be customary. 2
"With this meager sum," Dr. Charles H. Mayo of Rochester, Minn., said in addressing the Surgery Section of the American Medical Association, the officers in charge of the Museum had, over the years, "accomplished much," maintaining a record of the "progress of medicine of past ages" and accumulating "many valuable historical specimens," while materials accumulated during the war would "make the collection modern, and one of the best in the world." These medical records of the war," he added, "will be of the greatest value, not only to the glory of medical accomplishment, but also as a means of interesting and educating the public in scientific matters pertaining to health and disease." 3 ​ The accumulations to which Dr. Mayo referred were the result of strenuous efforts to interest and instruct medical officers in the field, both in the camps at home and in the American Expeditionary Forces overseas, in the exacting work required in the proper preparation of anatomical and pathological specimens and forwarding them to the Museum in Washington. Despite such efforts, "most of the good material, and all the first-class specimens received at the Museum, with few exceptions, were brought there by men sent from the Museum to get them" — thus repeating, half a century later, the experiences of the staff of the early Museum in the Civil War.
For this, there were plenty of real reasons as well as good excuses. Summing up the situation, the eminent Dr. James Ewing of the Cornell University Medical School in New York, who is widely regarded as the "father" of oncology in the United States, and who, serving the Army as a contract surgeon in 1918, was assigned to the staff of the Medical Museum, said that this business of collecting pathological material was "one of the least urgent matters claiming attention in an army whose task was to win the war and win it quickly." A succession of epidemics, both at home and in the AEF, and the care of the wounded in the AEF overtaxed the laboratory forces and left "neither time nor force to collect suitable pathological specimens and preserve them according to modern methods." Furthermore, Dr. Ewing said, the "number of men in the American medical profession trained in the methods of the pathological laboratory, and especially in the methods of museum preparation, proved to be extremely small, and few of these were available to the army." 4
Making Pathologists in a Hurry
The shortage of pathologists led to a certain amount of shortcut improvisation, such as the way in which Maj. C. Judson Herrick of Grand Rapids, Mich., found himself in charge of the pathology department of the Army Medical Museum. As Dr. Herrick tells the story, he was commissioned as a major on 18 January 1918, and charged with the business of assembling personnel for assignment to Army hospitals to collect neuropathological materials for delivery, with their accompanying records, to the Museum. In April, when he had rounded up about 20 enlisted men with some training in histology and pathology, his original order was rescinded and shortly thereafter he was ordered to report for duty at the Medical Museum. Major Herrick continues: ​ Upon reporting at the Museum to Col. W. O. Owen the only order I received was, "Go see Capt. Cattell." Henry W. Cattell was then in charge of pathology at the Museum. When Major Herrick reported for duty to Captain Cattell he was naturally disconcerted. The Captain knew that I knew very little about pathology and I knew that he knew very little about neurology. Accordingly I suggested to him that he carry on exactly as before except that he deliver to me all neurological material for processing as it came in. Shortly after my arrival at the Museum, Col. Owen said to me, "Capt. Cattell has been transferred. You will take over his space and all his duties." "Very well, Sir. You understand that I am not a pathologist." "Perhaps you weren't yesterday," Colonel Owen replied. "You are today." 5
Dr. James Ewings Mission
The task of collecting suitable material and getting it to Washington in usable form was, in the opinion of Dr. Ewing, "almost insuperable," even though, in 1917, "orders had been given that all pathological materials received at camp hospitals should be sent to Washington. Under the existing conditions it was practically impossible to carry out such orders, and they fell down at nearly every point. At one time permission for the performance of autopsies was suspended, but this situation was shortly relieved by the Surgeon General's Office. Accordingly the only material from 1917 cases was sent by one or two pathologists whose attention to the needs of the museum had been specifically and urgently directed."
Failure of material to arrive from most of the camps prompted Colonel Owen to send Dr. Ewing to visit some of the cantonments in the eastern part of the United States in the early summer of 1918. "On these visits," said Dr. Ewing, "it became apparent that the laboratories had been built, equipped and manned chiefly for clinical microscopy, and not for pathology. There was always an impressive array of test tubes, Wasserman trays, blood counters, urinometers, etc., and a rather superabundant personnel trained in their use, but I found the pathologist at only one of die seven hospitals visited, and he was busily engaged as admitting officer of the hospital.
Autopsies had been performed, however, and at two camps efforts had been made to collect a local camp museum of interesting cases, but frequent transfers and changes of the acting pathologists had worked "against the effective preservation and control of material."
The "most obvious" handicap to the success of Dr. Ewing's missionary efforts was "lack of knowledge of the methods of museum preparation." 6 As ​ a means of improving this situation, The Surgeon General issued a circular letter of instructions on preparation and shipment of materials for die Museum. Before such a circular of precise and detailed instructions was issued the question of military authority for the making of post mortem examinations had to be cleared up.
The Autopsy Question
In an opinion of the Acting Judge Advocate General of the Army, issued on 6 October 1917, it was held "that there can be no question but that military authority over all persons who are members of the Army of the United States is sufficient to authorize the performance of a necropsy * * * if there is sound military reason therefor." But, he added, "it is not within my province to express my opinion upon the question whether such military reason exists."7
On 25 February 1918, The Surgeon General of the Army advised the War Department that while it was "impracticable to state in detail the specific circumstances which would justify post mortem examination in each case," he regarded such examinations as essential in the management of epidemics and in cases where medicolegal questions were involved, and as desirable in all cases. Even in cases where the cause of dealth was from well-recognized processes of disease, The Surgeon General said, an autopsy "almost invariably yields information which is instructive and of great value and importance in the treatment of the living," and that "great good to the service and [to] medical science would result" if it were "practicable to hold post-mortem examination after all deaths."
In publishing this correspondence to the medical officers, on 1 March 1918, The Surgeon General added the requirement that commanding officers of hospitals would be held responsible for the determination of the necessity for performing post mortems, for the manner in which they were performed, and for the proper preparation of the bodies thereafter, as required by Army regulations. 8
The question of whether or not autopsies should be performed was dealt with again on 12 June 1918, in a circular letter from the War Department in which The Adjutant General, noting that there had been complaints that "autopsies have been held on [the] bodies of deceased soldiers in various camps and cantonments," ruled that while military authority was sufficient to authorize them, "if there be sound military reason therefor, they should not be ​ resorted to, unless such reason exists." Commanding officers of hospitals or the senior surgeons present were charged with responsibility for compliance with the ruling. 9
On 18 June, 6 days after this promulgation from the War Department, The Surgeon General sent this further appeal for greater activity in preparing and shipping pathological specimens:
1. The Surgeon General expects that all medical officers will collect and ship pathological specimens to the Army Medical Museum, as provided in paragraph 135, Manual for the Medical Department, and in previous circulars from this office. The specimens should be accompanied by histories, and officers will receive credit for their contributions.
2. A statement is desired as to:
    (1) Whether your laboratory has already sent specimens to the museum.
    (2) Whether you have collected specimens and have them ready to ship to the museum.
    (3) Whether you have material on hand for making Kaiserling solutions.
3. Have you collected large containers for storing and shipping specimens, such as 5-gallon oil cans, crocks, and kegs? 10
Apparently there was some uncertainty in the minds of the hospital commanding officers whose responsibility it was to authorize autopsies in individual cases, for on 30 September, The Surgeon General issued another circular letter which undertook to define more explicitly the "sound military reason" required for authorization of the procedure. This, said the circular, was the "same as the reason for performing an autopsy heretofore; that is, the study of the natural history of the disease in question * * * even when the cause of death in that particular case is known. It is essential from a military point of view that autopsies be performed until the causes of the prevailing diseases are well understood and until suitable therapeutic and prophylactic measures have been elaborated to cure and prevent the lesions found at autopsy."11
Procurement of Specimens
With the nature of the authority for making autopsies thus clarified and defined, and with the somewhat disappointing results of Dr. Ewing's mis​ sionary journey to the camps in mind, it was decided to "issue a pamphlet containing explicit directions for collecting, preserving and shipping gross anatomical material." The resulting circular, which was reviewed and revised with the help of leading pathologists, stated explicitly what material was wanted by the Museum and how it should be prepared and shipped. It was undated, but was not distributed to the hospitals whose autopsy methods it sought to improve until December 1918, after the armistice. 12
In its efforts to procure suitable specimens, the Museum did not depend wholly on either this definitive circular or the earlier promulgations of The Surgeon General or the War Department. Appeals had been addressed to "many camp pathologists personally known to members of the Museum staff," and such letters had produced some results. Dr. W. G. MacCallum, of the College of Physicians and Surgeons, for example, had sent in "a large number of pneumonic lungs which formed the sole representatives of the epidemic of 1917-1918." 13
At the same time, therefore, that it was seeking to enlist the interest and assistance of pathologists in the field, the pathology department of the Museum was building up and training its own staff in the work of receiving and caring for the specimens which were sought.
Dr. Daniel Smith Lamb, who had stood "as a lone sentinel guarding the interests of pathological anatomy, crowded into two small rooms, but faithfully performing his function day by day as he has been doing year by year," no longer stood alone. "With rare generosity," Dr. Ewing wrote, Dr. Lamb "placed at the disposal of the staff of new men his valuable museum collection of microscopes and laboratory utensils." More rooms were secured and were transformed into an active laboratory of pathology, a transformation due, says Dr. Ewing, to the efforts of Major Herrick, who had been so summarily metamorphosed into a general pathologist by Colonel Owen. 14
In assembling and training a staff for the work in pathology, Major Herrick was fortunate in being able to use the services of some of the men whom he had previously enlisted for the Medical Department's section on brain surgery. Ten of these university-trained histologists, who had entered military service by voluntary induction for neuropathological laboratory work, were assigned to the Museum, and by the time hostilities ended were giving excellent service. ​ One of the nonmedical members of the staff, detailed to Camp Wheeler, Ga., during the period of the dread epidemic of influenza in 1918, "secured through the cooperation of the pathologist at the camp hospital, most of the really good specimens of influenza lungs that were in the Museum." This man, wrote Dr. Ewing, "was permitted to remove the organs from the body and preserve them before random incisions were made. He worked over them day and night until fixation was perfect, packed them himself, rode on the wagon that carried them to the station, and saw them off on the train." With the help of such devoted members of the staff, the Museum's pathology department was, in the opinion of the eminent Dr. Ewing, "in fair working order" by the date of the armistice, with "a constant flow of materials of all grades arriving." 15
Two Museums in One
To take charge of the business of classifying and cataloging these accessions to the Museum, Maj. Robert Wilson Shufeldt, a retired medical officer who had served briefly on the staff of the Museum in the early i88o's while it was still housed in the Ford's Theater building, was recalled to active duty in January 1918. The major was a most prolific writer on a variety of subjects, and accordingly was charged with the additional "duty of publishing in medical and other journals of good standing articles describing those activities in the museum about which the medical profession at large and the general public may properly be informed." 16
He took up his task of publicizing the problems and the accomplishments of the Museum with enthusiasm as to the future but with a critical view and a caustic pen in reference to the past. He had made known his views as to the state of the institution in an article published in October 1917, in which he declared that "from the standpoint of antiquity and history, this collection will always be of enormous value, but from the viewpoint of a growing collection and up-to-date exposition of modern medicine in all its varied departments, it has, for only too long a time, been a supreme joke." 17
This opinion of the Museum, as it existed before 1917, expressed before Major Shufeldt's recall to active duty, was repeated in varied language in the articles published by him while engaged in the work of classifying and cataloging its incoming accessions. The pre-1917 museum, he wrote, "was still a ​ teacher, to be sure, but a teacher of the past. It exemplified, with its many thousands of specimens, our knowledge of military medicine and surgery as practiced during the Civil War * * *. In the presentation of its specimens, casing, labeling, lighting and in numerous other matters and details, it is decidedly antiquated; and while it is, upon the whole, tidily kept, it is by no means an exponent of what a live, growing functional museum of the present time should be * * *. It required a World War to awaken this museum * * *. This somnolent institution of yore gradually came out of its lethargic state, and took on new life."
The source of this new life, according to Major Shufeldt, was the appointment to the Museum staff of several men who had had "long experience in museum affairs and management." The effect of "three or four heroic doses of vim injected into the vitals of this medical Morpheus, this sleepy old Museum" he described as "a revolution, a mild upheaval, and a readjustment with an increase in the Museum's staff in various old departments and the establishment of the new ones." 18
The sharp cleavage between the "new" and the "old" museums was exemplified in the scheme of cataloging adopted by the new custodian of the collections. All specimens in the Museum at the time of the declaration of war against Germany were left undisturbed, with their accession numbers unchanged, and were designated as Series A, while items received after 6 April 1917, were accessions under new and separate numbers, designated as Series B. This maintenance, in the same museum, of two separate series of numbers for materials of essentially the same kind was deemed by Major Shufeldt to be "radically absurd," but it was adopted as a temporary measure until such time as it might be possible to revise and reclassify the older materials accumulated over a period of more than half a century. When the time should come to merge all the exhibition materials into "one homogeneous collection," he felt that "no small part" of the Series A materials would have to be set aside and that all of it would be reclassified along "divisional lines * * * very differently drawn. Science will take a hand in the arrangement, and by the application of true principles of museology, material will be exhibited in an orderly and scientific manner— properly cased, labeled, and classified * * *." 19 ​
Launching the Movement for a New Building
This future reclassification, it was hoped, would be made in a new building for the Museum and the Library, which Colonel Owen (fig. 53) had proposed, first to The Surgeon General in 1916, and later to the medical profession at large in an article published in the New York Medical Journal.
The time seemed ripe for such a project when it was launched. A special Public Buildings Commission had been set up pursuant to a 1916 Act of Congress, to "ascertain what public buildings are needed to provide permanent quarters for all the government activities in the District of Columbia." This Commission, reporting in December 1917, included in its plans a site on the south side of the Mall between 4½ and 6th Streets, SW., for a building of 175,000 square-feet capacity, to house the Museum and the Library. Cost estimates for building and ground ranged from $2½ to $4 million. Preliminary plans for such a building, of classical design, were approved by the Fine Arts Commission as part of the move for a more beautiful Capital City.
The zeal of Major Shufeldt, seconded by Colonel Owen, led the major to write letters to the deans of the principal medical schools of the country; to state, county, and city medical societies; and to individual physicians and surgeons of prominence, soliciting their endorsement of the plan to provide, without delay, suitable quarters for housing the materials to be collected on the battlefields of Europe. With his letters, which went out in February and March 1918, he sent reprints of an article from his pen, published in the Medical Record of 2 February, in which he described the existing Museum as a "mummy" stagnating in its "sarcophagus" but retaining still the "essential life spark" which made possible "revivification" and future usefulness."
The response to his letters was gratifying to him. The plan was endorsed by more than a score of medical college deans and faculties, a like number of medical societies, and three times as many individual practitioners, including some of the leaders in the medical world, representing in Major Shufeldt s somewhat overly optimistic opinion, "the voice of practically all the profession in America." The letters were bound in a handsome volume placed on the desk of The Surgeon General, and were reproduced for wider circulation.
Figure 53.—Col. William O. Owen, tenth Curator of the Museum, 1916-1919.
States but should also be a teaching center in the truest sense * * * housed in a building with a dignity commensurate with the service to be demanded of it."
Figure 54.—Colonel Owen's "dream" of a new Museum and Library building, as pictured by Lt. Morris L. Bower, October 1918.
believe that a mere collection of anatomical and pathological curiosities for exhibit to the curious and the prurient should be permitted. A medical museum should be, in my judgment, a great library of history and pathology, where the student of medicine may come and study the history of disease and its pathology, for the benefit of himself, his patients, and his nation."
With a war to be won, however, and with money, materials, and manpower in short supply, the time was not propitious for the construction of new permanent buildings in Washington, and the project for a new home for the Museum joined the other deferred dreams—not to be realized for yet another 40 years, and then in an entirely different form and at a different place from the proposals of 1918 (fig. 54).
The unrealized dream of a new building, however, in no way diminished the drive of the Museum in expanding its activities to meet the demands of the war of 1917-18. "The present war," said Major Shufeldt, "has had the effect of waking up the old-time spirit in this erstwhile slumbering institution * * *. It is now an active medical concern, reaching out in all directions and absorbing every possible means to become a medical research and teaching center in the broadest sense of those words."
Applying the Graphic Arts to Medicine
One of the new directions in which the Museum was "reaching out" in the war years of 1917 and 1918 was in the extension of its informational services through the wider use of the graphic arts—photographic, pictorial, and plastic.
Medical illustration in the Armed Forces of the United States was not something new in 1917. It had been developed during the Civil War period, when the Museum staff included such medical artists as Hermann Faber and Edward Stauch, and such clinical photographers as William Bell and E. J. Ward, whose graphic plates are vividly reproduced in the "Medical and Surgical History of the War of the Rebellion," in addition to Doctors Joseph J. Woodward and Edward Curtis, who pioneered in photomicrography. The tradition of these pioneers had been carried on by Dr. William M. Gray in photomicrography, and by Dr. J. C. McConnell whose careful drawings of mosquitoes were useful in the practical application to mosquito control of Walter Reed's discovery (fig- 55).
The World War I counterpart of these earlier illustration services was called the Instruction Laboratory of the Medical Museum, a name bestowed to distinguish it from the division of the Museum devoted to work in pathology.
Figure 55.—This laboratory of the nineties was that of Dr. William M. Gray, who carried on the tradition of achievement in photomicrography established by Dr. Woodward and Dr. Curtis.
​ The development of the new services may be dated from the employment, in June 1917, of Roy M. Reeve as photographer— an employment which was the beginning of a career of nearly four decades in the graphic depiction of military medicine by the use of the camera. 25
In November 1917, Lt. Thomas L. W. Evans, head of a New York firm of "commercial cinematographers" and a man of experience in the then young motion-picture industry, was put in charge of the new Instruction Laboratory (fig. 56). The operations of the Laboratory grew to include Mr. Reeve's section of still photography ; a section of motion pictures, headed at first by Lt. Robert Ross and later, after Lieutenant Ross had gone to France, by Lt. Charles W. Wallach; an anatomical art service headed at first by Lt. William T. Schwarz, then by Lt. Morris L. Bower, and at the end of the war by Lt. Raymond O. Ellis; and a section of wax modeling under Capt. James Frank Wallis." 26
Through these various graphic methods the Instruction Laboratory sought to reach and inform a threefold audience — troops in training, medical officers, and the civilian world, including especially civilian medical men.
Motion Pictures
A major activity of the Laboratory was the production, reproduction, and distribution of motion-picture films. Altogether, 137 such films, including both those produced by the Laboratory and those produced by other organizations and distributed by it, were listed as available for showing in camps and cantonments and through civilian outlets." 27
The films offered for showing to the various "publics" ranged in length from one-half reel to a nine-reel production on the diagnosis of tuberculosis. The picture most widely shown and frequently discussed was a four-reeler, "Fit to Fight," described as a "venereal disease photo play" which in three reels of dramatic action told a story and, in one reel showing clinical consequences, pointed a moral (fig. 57).
"Fit to Fight" was designed primarily for showing in the training camps but was also shown, in a somewhat revised form, to selected civilian audiences. Such showings were arranged by the Commission on Training Camp Activities,
Figure 56.—Instruction Laboratory, World War I. A. Drying racks for motion-picture film.
Figure 56.—Continued. B. Cutting and polishing room for motion pictures.
Figure 57.— The best known and most controversial production of the Instruction Laboratory was the film dealing with venereal disease.
​ The film was shown before the convention of Rotary International held in Kansas City in late June 1918, with the result that many of the constituent clubs arranged meetings at which the film was shown in their communities, usually for men and boys over 16.
A typical example of such showings and the reaction to them is the experience of the Rotary Club of Dallas, Tex. Showings were first planned for September or early October, but the spread of the appalling influenza epidemic in city, country, and camps brought a ban on public gatherings and forced postponement until late November. The reaction to the film when finally shown is thus described in a report from W. C. Temple, secretary of the Dallas Rotary Club, upon returning the film to the Army Medical Museum: 28
The first showing, by invitation only, was made to about one hundred and fifty men. We did this to feel out the local situation, and after those invited had witnessed the film, they were unanimous in their opinion that it should be shown to as many males as possible, so we gave another showing of the picture, giving the matter publicity through the local press, at which time the film was shown to something like two thousand men and boys over fifteen years of age * * *. In my opinion this is just such education work as should be carried on throughout this country.
Pictures as Training Methods
Most of the motion pictures made by the Instruction Laboratory, however, were of an instructional nature, as the name of the organization implied, and were aimed at perfecting procedures and standardizing training methods. For example, Colonel Owen corresponded with both Brig. Gen. H. P. Birmingham, in command of the great Medical Officers Training Center at Camp Greenleaf, Fort Oglethorpe, Ga., and Col. W. N. Bispham, commanding the Medical Officers Training Camp at Fort Riley, Kans., advising them of the availability of moving-picture production crews at the Museum and inquiring as to the desirability of having them make pictures of such training features as an ambulance company or a field hospital breaking camp, moving on the road, setting up a dressing station or a field hospital, bringing in and caring for the wounded, and making camp.
Colonel Bispham responded with a letter approving the project, and on 1 May 1918, wired Colonel Owen asking for a man to make the pictures about the middle of that month. Lt. Robert Ross was sent to Fort Riley where, despite weather and lighting difficulties, he shot a satisfactory picture which was completed by mid-June. 29 ​ Meanwhile, in May 1918, Colonel Owen received a reply from General Birmingham in which he agreed that the moving picture suggested would be of "great value in giving ideal demonstration and the technically correct methods of foot drill, litter drill, with the loaded and unloaded litter, as well as the use of improvised litters and the handling of the wounded without any apparatus whatsoever, ambulance drill, Field Hospital dress, tent drill, gas defense, first-aid, principally dressings and splints, sanitation in camp and in the field, surgery and surgical treatment under field conditions, principally operating and preparation of patients and materials for same, the giving of hypodermic injections, and the use of the catheter."
To this thoughtful letter Colonel Owen replied immediately, saying that the pictures covering base, evacuation, and field hospitals, and ambulance companies were being made at Fort Riley, but that the other subjects referred to in the general's letter would be made at Camp Greenleaf whenever the troops which it was intended to photograph would be ready for the shooting of the pictures. 30
Among the most successful and valuable of the films produced by the forces of the Instruction Laboratory at the camps, and with the aid of the Medical Department, was "Training the Medical Officer," directed at the thousands of new medical officers taken from civilian life and passing through the medical officers training courses.
Two films directed at the practical matter of insect control, and reflecting the longtime preoccupation of the Museum with entomology, were "Mosquito Eradication" and "Fighting the Cootie." Each U.S. military post had received directions from The Surgeon General to collect mosquitoes in its vicinity, and to forward the specimens collected to the Medical Museum for identification.31
At the Museum, the mosquitoes— and other insect carriers of disease as well— were examined by the Museum's entomologist, Dr. Clara S. Ludlow, whose distinction in the field is indicated by the fact that two strains of anopheles mosquitoes bear her name as A. ludlowi. Identification of the mosquitoes, together with any information that might be useful in controlling the pests, was reported to the surgeon at the post from which the specimen was received. Compliance with the order was far from universal, and was not always in conformity with the directions for collecting and forwarding the specimens. Fleas, ​ lice, ticks and bedbugs" were asked for in one instance, but somehow only cockroaches and flies were received, while from some posts nothing at all came in, but enough specimens were received to keep the entomology staff of the Museum busy in identifying them and making recommendations for their eradication or control. 32
Use of Animated Drawings
Among the films prepared by the Museum's force were several made with what was described as "stop-motion pictures," producing the effect of animated drawings in which every step in an operation was reproduced by sketches. "The knife appears, without any hands, goes to the proper position and makes the proper incision; the retractors appear, holding the wound apart. The needle appears, armed with the thread, goes to the right place, puts the suture in the right position; the suture rises up and ties itself and sloughs off its own ends. Purely impersonal surgery, the patient being impersonal likewise * * * as the schematized operation proceeds, legends are thrown upon the screen explaining the steps and pointing out the names of the essential structures as they are successively exposed to view during the operation" — this being just before the day of the motion picture with sound. 33
One of the skilled artists who worked on the production of animated pictures was Sgt. (afterward Lt.) Paul H. Terry who, upon his discharge after the armistice, opened an office in New York for the production of cartoon comedies and, in time, originated the famous "Terrytoons," to the delight of millions. 34
A third branch of the Instruction Laboratory, the Anatomical Art Department, grew out of this work of making sketches in series for use in animated cartoon moving pictures, in which the artists were at first largely engaged. In the spring of 1918, however, the brush and pencil came to be independent of the camera, with the issuance of an attractive announcement, designed by Sgt. V. B. Sisson, of "the establishment of an official department [in the Army Medical Museum] for the handling of such surgical and anatomical illustration as is
Figure 58.—The Museum offers its services to those requiring assistance in the development of illustrative medical art.
Figure 59.—Headquarters for medical art in the Army Medical Museum, World War I, with staff members dutifully posing for the photographer.
included dissecting experience on cadavers in a dissecting room set up in the Museum. Additional experience was had in the making of a large number of drawings illustrating various stages in surgical operations at the Walter Reed General Hospital and elsewhere, and participation in performing numerous autopsies at the Government Hospital for the Insane (St. Elizabeths), in Washington, D.C., where the pathological service had been taken over for instruction purposes by the Museum.
The output of the Museum's staff of artists found use in the program of medical instruction of officers and men in the training camps, in the shape of lantern slides, for projection on the screen, to illustrate lectures on medical topics. Through these lectures, declared Major Shufeldt, the fitness and health of the army was "vastly improved." This was probably an exaggerated estimate of the effectiveness of these educational efforts, but there can be no doubt that the ​ attempt to add to the medical knowledge of officers and men through anatomically accurate medical art helped to make the army of 1917-18 the first in United States history in which deaths from disease were fewer than those from battle-field casualties (fig. 60).
A separately organized branch of medical art in the Instruction Laboratory dealt with making casts and wax models of the lesions of wounds and disease. Capt. James Frank Wallis, a Washington dermatologist and an experienced modeler in wax, was in charge of the work and was assisted by Miss Eleanor Courtenay Allen of Milwaukee, who had studied at the Chicago Art Institute, and who joined the Museum staff in March 1918. 39
The Museum had had for many years a collection of several hundred wax models, for the most part produced by the famous Baretta studios in Pans, and part of the work of the new division was to rehabilitate some of the French models which had deteriorated from prolonged exposure to direct sunlight.
The Museum Goes Abroad
With all the new developments and extensions of the service of the Museum in the United States, the goal of the organization was to be of service overseas, whether in pathology, photography, or anatomical art. First steps to that end were taken in January 1918, when The Surgeon General at home sought from the Chief Surgeon overseas authorization to send over a medical museum unit.40
The oversea work of the Museum was to be in charge of Maj. (afterward Col.) Louis B. Wilson, in civil life pathologist and director of laboratories for the Mayo medical organization at Rochester, Minn. Dr. Wilson was ordered to England— first to study what was being done along the line of collecting specimens in the British and Colonial Forces, and then to France for duty with the AEF as an assistant director of the Division of Laboratories.
In England, where he spent the last 3 weeks of April, Major Wilson conferred with Sir Walter Morley Fletcher, secretary of the National Research Committee; Prof. Arthur Keith of the Royal College of Surgeons; and Lt. Col. J. C. Adami, in charge of the historical bureau of the Canadian Medical Corps, with reference to methods of collecting pathological specimens. He talked also with officers in charge of military orthopedics, concerning casts, models, paintings, and drawings; with officers in charge of the cinema service; an with those in charge of the indexing and filing of medical records and their ​ statistical use. On 1 May 1918, he reported to Colonel Owen on his stay in London, with a separate memorandum covering each subject discussed, and proceeded on to France. 41
Before Major Wilson's arrival in France, the then Chief Surgeon of the AEF, Brig. Gen. A. E. Bradley, had issued Circular No. 17, 2 April 1918, "Instruction Concerning Autopsies," in which the attention of medical officers was called to the importance of the post mortem examinations and under which Major Wilson was to build up the necropsy service in the AEF. The circular, issued in order to "secure proper records of causes of death of American troops in France, and specimens of scientific value for the Army Medical Museum," gave directions as to procedures in autopsies, which "should be performed whenever possible." With this encouragement to the adoption of the autopsy as a routine procedure, to be done as a matter of course in all cases rather than as a special procedure to be done only on express authorization, the number of autopsies performed in the AEF rose from less than 25 percent of all deaths in hospitals, which it had been in 1917, to 57 percent in the early months of 1918, and 92 percent in August and September. It held up to 85 percent even in the peak month of the influenza epidemic, October 1918, when the laboratory facilities and staffs, like every other hospital facility, were "overwhelmed by the enormous number of deaths from influenza and the battle casualties of the Argonne offensive." 42
Necropsy Service in the AEF
Writing shortly after the event, Colonel Wilson pointed out that in May 1918 there were, in the AEF to serve 72 hospitals and laboratories, but "fifteen pathologists capable of making post-mortems and intelligently interpreting the results" — a condition due in part to the "long neglect of autopsies in many civil institutions in the United States" and in part to the "overshadowing status of bacteriology in military laboratories." He continued:
Figure 60.—Samples of scenes and messages from lantern slide sets developed for instructional use by the Army Medical Museum, using material furnished by the Office of the Surgeon General.
peutic measures of medical and surgical officers, became rapidly apparent during the summer of 1918. Surgeons were called upon to diagnose and treat, with little time for study or reflection, many gunshot wounds with the like of which they had little or no previous experience. Even those who were well grounded in the general principles of surgery were ​ forced to make decisions and institute treatment thereon without sufficient basis or study. As a result, there were errors in diagnosis and errors in treatment. The worst of these could be determined only by the pathologist. In like manner, attending medical officers, e.g., in cases of war gas poisoning and especially in the widespread epidemic of influenza and pneumonia, were brought face to face with conditions with which they were totally unfamiliar, and were frequently forced to make diagnoses and institute treatment with a very meager knowledge of the facts. Here autopsies were of tremendous importance in securing for the attending man a knowledge of the pathologic lesions, which knowledge he could use in his diagnosis and treatment of subsequent cases. 43
The Director of the Division of Laboratories, AEF, Col. Joseph F. Siler, requested in June 1918, that 10 competent pathologists be cabled for from the United States, in addition to those coming over with organized hospital units. The needed pathologists, or rather eight of them, came over in due course and, with their help, centers for pathologic service were established at Baccarat, Toul, Souilly, and Paris, staffed by medical officers who acted as consultants in pathology for the surrounding areas. 44
Less successful was the request, made in May, for a museum unit of photographers and artists to be sent to France. This request was approved by General Bradley, Chief Surgeon of the AEF, but was turned down by the General Staff, AEF, "in view of the existing tonnage situation," and because it was believed that the "requirements of the Medical Corps could be met successfully in this particular by the personnel and facilities already available, in both the Signal and Engineer Corps." " 45
The interests of the Museum were not forgotten, however, for on 27 July 1918, Brig. Gen. Merritte W. Ireland, who had succeeded General Bradley as Chief Surgeon upon his retirement for disability, issued Circular No. 42 "for the information of those branches of the service whose cooperation and assistance are necessary to enable the Army Medical Museum to discharge its duty of collecting all those things which may be used for medical education and research, or which may be of historic interest."
Circular No. 42 noted the responsibility of all medical officers to direct into proper channels all desirable material coming to their notice; stressed the duty of the pathologist in each unit to collect, preserve, and ship all such ​ material as was obtainable; and gave detailed directions for the fixation and preservation of pathological specimens.
The circular covered a broad field, including microscopic materials as well as gross organs and tissues; such pathogenic bacteria as might be isolated in the American Expeditionary Forces; specimens of animal parasites, preferably alive; helmets and other bodily protections; instruments and apparatus; and paintings, drawings, and diagrams of medical interest.
"For the psychic effect, a missile removed from the body of a wounded soldier may be given to him if he wishes to keep it," said the circular in paragraph 12. In view, however, of the desirability of securing such material for the Museum, the hope was expressed that when the scientific value of the comparative study of such missiles was explained to them, soldiers might be induced to give up these intensely personal souvenirs of service.
Medical Photography in the AEF
Reference was also made in the circular to General Orders No. 78, General Headquarters, AEF, dated 25 May 1918, in which the earlier prohibition against the use of cameras by anyone other than the Signal Corps was liberalized, and the Medical Department was given responsibility for "technical photography connected with the recording of photographic processes of surgical and pathological matters." 46 The change in the orders as to the use of cameras had little immediate effect. Only a few of the medical units in France had qualified medical photographers in their ranks. Because of the earlier ban on making photographs, still fewer units had suitable cameras among those which had been brought over in spite of the bar to their use. These were put to work; a few others were secured from the French; 3 were borrowed from the Signal Corps; and 24 were secured from the X-ray Department of the Medical Corps itself. This was enough to make a start on the business of securing a photographic record for information and study. 47
Whether because of the relaxation of restrictions upon non-Signal Corps photography, or because of some easing of the ship-tonnage situation, or because of an increasing recognition of the value and importance of the Museum's program, or because of a combination of all three, the ban on Museum Unit No. I getting to France was lifted.
This was done in Courier Cablegram No. 7, 20 July 1918, from the Com​ manding General, AEF, to The Adjutant General of the Army. Paragraph 2 of this message read:
Request that the Museum Unit, one Cinema Camerist, one photographer and four artists with complete equipment and adequate supplies for at least six months be sent to France. Item M 941 K. Consult Curator Army Medical Museum. 48
It was the end of August before the unit asked for could be assembled and dispatched overseas, but by the middle of September, two groups sent from the United States arrived in France. Captain Ross and seven photographers reported to the headquarters of the Division of Laboratories, then at Dijon, and Lieutenant Schwarz, Lt. W. H. French, and Miss Allen, illustrators and modelers, who had come over attached to Base Hospital No. 115, were sta- tioned at the hospital center in Vichy. 49
Before the General Staff, AEF, allowed Major Wilson to ask for talent from the United States, he had "managed to scrape up in the Base Hospitals some fifteen to twenty men who had had more or less training in medical illustration," as he wrote Colonel Owen, on 5 October 1918. "A few of these," he continued, "such as Coleman and Jarrett, of whom you wrote, are good Brödel-trained artists. Most of them have been landscape painters, interior decorators or white-wash brush artists. A few of them we will be able to train to do fairly good work. I propose to do this by ordering them to Vichy, where Schwarz, French and Miss Allen will be permanently stationed."
As to the photographic work, Major Wilson wrote Colonel Owen that "a number of units" had come to France with "fairly good amateur photographers" but that most of them, "having nothing to do, had been put into work entirely foreign to photography" and "had to be blasted loose by slow and diplomatic methods. Some are still grown fast to non-photographic jobs but we are slowly getting the work in operation."
Colonel Owen was intensely interested in the use of moving pictures for instruction purposes and doubtless had impressed his views upon Major Wilson. It must have been with some degree of disappointment, then, that the major reported, "up to date I have not been able to arouse any interest whatsoever in moving pictures in the Medical Department of the A.E.F. * * *. Most of the surgeons say they do not see any value in moving pictures of surgical operations except to advertise the operator and that they do not want them taken * * *. However, I am very far from disheartened, especially since ​ Captain Ross and other motion picture men have arrived and believe that before long this side of the work will be going satisfactorily." 50
Today's acceptance of moving pictures of operations as a familiar procedure in medical training has vindicated the interest taken in this technique by Colonel Owen and Major Wilson. Such pictures are shown as part of modern medical training, and have even made their appearance on television. They still inescapably "advertise the operator," but this minor objection is more than counterbalanced by the greater facility with which the observer can see and understand what is done as it is done.
By the end of September, the photographers were at work in the zone of the advance, covering the activities of the divisions at the front. With the signing of the armistice of n November 1918, and the cessation of hostilities, the Museum staff was concentrated at Dijon until 29 November, when Captain Ross, with three photographers, was ordered to Paris to set up a photographic bureau for the Medical Department of the AEF. The bureau was housed in the Elysee Palace Hotel, where three large bathrooms were converted into photographic darkrooms. 51
Despite difficulties and delays in securing sufficient supplies, some of which had to be procured from the French, the photographic staff made, captioned, filed, and cross-indexed about 10,000 still photographs and turned out some 40,000 feet of motion-picture film showing medical and surgical activities around the hospitals, in addition to prints of 20,000 feet of film made by the Signal Corps. In the same period, the artists and modelers produced 35 casts of surgical subjects, about 200 drawings and paintings, and 1,000 photographs of technical subjects. 52
Lieutenant Schwarz conceived the idea of making life masks of the principal figures at the Peace Conference then in session. Working with Miss Allen, he made a "bully mask" of Ambassador Sharp, who put him in touch with Col. E. M. House who, in turn, introduced the lieutenant to M. Andre Tardieu, the French High Commissioner for Franco-American affairs, whose mask was also made. Through M. Tardieu, Lieutenant Schwarz was presented to Marshal Joseph J. C. Joffre, who consented to have his mask taken on the evening of 7 January 1919, and who made arrangements for the taking of a mask of Marshal Ferdinand Foch on 9 January, and of President Raymond Poincare ​ and Premier Georges E. B. Clemenceau on the 10th. King Albert of Belgium was slated to have his mask taken on 13 or 15 January, while Field Marshal Douglas Haig, Prime Minister David Lloyd George, and Mr. Herbert H. Asquith were to be taken sometime between the 13th and 17th of the month. Whether any more of the masks were made, and what became of those which were, does not appear in the Armed Forces Institute of Pathology files other than the statement of Major Ross, in a letter of 21 January 1919, to Colonel Owen that he understood that Lieutenant Schwarz had "been pulled off the plaster masks proposition and it was turned over to an officer of higher rank to handle." 53
The Museum's Major Aim
The major aim of the Museum was not, however, in the making of life masks of notables, nor in graphic presentation of Medical Department activities, nor even in the collection of weapons and other materials used by the armed forces of allies and enemy nations — important as these were.
The major function of the Museum was the collection and preservation of pathological materials. As to this, Major Wilson, after he had been overseas for 6 months, wrote Colonel Owen that :
It is of course useless to talk about collecting pathological specimens except through the men who are making the pathological examinations and there were very few such men over here when I came. Most of the work was centered on bacteriology. At the same time there was great need for the development of an autopsy service. One of the first steps, therefore, was to cable back for a supply of pathologists * * * Since then we have made a thorough combout of the A.E.F. for pathologists, placed good men in the most advantageous positions, and talked the necessity of autopsies not only to laboratory men but also to clinicians and surgeons most insistently, until today we have a very high grade necropsy service in smooth working order. We still are very short of competent pathologists but those that are here * * * are securing the fullest cooperation from the attending physicians and surgeons. 54
The severe influenza epidemic, coinciding as it did with the great final American offensive in the Meuse-Argonne, put such a strain on medical personnel and facilities that "only relatively slight attention could be given to the collection of specimens." Nevertheless, despite the limited personnel and the lack of equipment, of supplies, of containers, and in fact of everything except ​ a multitude of specimens, upward of 6,000 pathological specimens were collected, preserved, and shipped to the Army Medical Museum. 55
With the signing of the armistice on 11 November, the tremendous flow of men and materials across the Atlantic had to be reversed, with consequent confusion and delays. Recognizing that the specimens being shipped home- ward would be subject to unpredictable delays, Col. Walter D. McCaw, who had succeeded General Ireland as Chief Surgeon of the AEF, when he had become Surgeon General on 14 November 1918, upon the retirement of General Gorgas, issued, on 2 December, his Circular No. 58 supplementing and reinforcing Circular No. 42, and giving specific directions as to methods of packing and shipping specimens so that they would not deteriorate even if they should not be delivered for a couple of years. 56
The flow of materials collected in France had little more than begun to reach the Museum, and most of the eager young men whom Colonel Owen had sent overseas were still over there, when the colonel reached the statutory age of compulsory retirement. Regretfully, in mid-January 1919, he yielded the curatorship to become, after his retirement, professor of anatomy at the Georgetown University School of Medicine.
Succeeding him as Curator was Col. Charles Franklin Craig, who was to be called upon to deal with the problem of handling the incoming flood of specimens and materials with no increase in the space in which they were to be processed and exhibited, and with a staff which, almost daily, was shrinking toward pre-war levels as the wartime additions were demobilized.
* ↑ 1 Annual Reports of the Surgeon General, U.S. Army, to the Secretary of War, for fiscal years ending 30 June 1917, p. 325, and 1918, p. 434.
* ↑ 2 War Department Bulletin Number 30, 22 May 1917. In The Medical Department of the United States Army in the World War. Washington: Government Printing Office. 1923. vol. I. p. 532.[Hereinafter cited as Medical Department History, World War I, volume I.]
* ↑ 3 Mayo, Charles H.: Educational Possibilities of the National Medical Museum. Journal of the American Medical Association 73: 411-413,9 August 1919.
* ↑ 4 Ewing, James: Experiences in the Collection of Museum Material from Army Camp Hospitals. International Association of Medical Museums Bulletin VIII, December 1922, p. 27. [Hereinafter cited as Ewing.]
* ↑ 5 Original letter, Maj. C. Judson Herrick, to Brig. Gen. Elbert De Coursey, 10 October 1953. On file in historical records of AFIP.
* ↑ 6 Ewing:, p. 28.
* ↑ 7 Medical Department History, World War I, volume I, pp. 1020, 1021.
* ↑ 8 Ibid., p. 1021.
* ↑ 9 Ibid., pp. 1021-1023.
* ↑ 10 Ibid., p. 1296.
* ↑ 11 Ibid., p. 1021.
* ↑ 12 (1) Ewing, p. 28. (2) Surgeon General's Office: Review of War Surgery and Medicine, volume 10. Number I, December 1918, p. 72. [Hereinafter cited as Surgeon General's Office Review.]
* ↑ 13 Ewing, p. 29.
* ↑ 14 Idem.
* ↑ 15 Ewing, pp. 29, 30.
* ↑ 16 Surgeon General's Office Review, p. 74.
* ↑ 17 Shufeldt, R. W.: Army Medical Museums. Medical Record 92: 664, 665. 20 October 1917.
* ↑ 18 Shufeldt. R. W.: Value of the Army Medical Museum as a Teaching Factor. Proceedings of the American Association of Museums, 1918, p. 209.
* ↑ 19 Shufeldt. R. W.: On the Classification Adopted for the Material Constituting the Collections in the Army Medical Museum of the Surgeon General's Office at Washington. Medical Review of Reviews 24: 728. December 1918.
* ↑ Owen, W. O.: The Army Medical Museum. New York Medical Journal 107: 1034-1036. 1 June 1918.
* ↑ Shufeldt, R. W.: War Material at the Army Medical Museum. Medical Record 93: 180. 2 February 1918.
* ↑ (1) Mimeographed copies of letters on file in historical records of AFIP. (2) Shufeldt, R. W.: The New Army Medical Museum on the Map. Medical Review of Reviews 24: 596-599. October 1918.
* ↑ Owen, New York Medical Journal, 107 (1918), p. 1036.
* ↑ Shufeldt, R. W.: Vertebrate Types Below Man in the Collections of the Army Medical Museum. Medical Review of Reviews 24: 274, May 1918.
* ↑ 25 Creer, Ralph P.: Medical Illustration in the United States Army; Historical and Present Considerations. Journal of Laboratory and Clinical Medicine 28: 651-661, February 1943.
* ↑ 26 Memorandum, Colonel Owen to Lieutenant Colonel Fulton, 25 October 1918. On file in historical records of AFIP: Evans, Ross, and Schwarz.
* ↑ 27 Medical Department History, World War I, volume I, p. 515. 713-028-— 64 --13
* ↑ 28 Letters. 11 October and 29 November 1918. On file in historical records of AFIP.
* ↑ 29 Correspondence between Colonel Owen and Colonel Bispham. On file in historical records of AFIP.
* ↑ 30 Correspondence between Colonel Owen and General Birmingham. On file in historical records of AFIP.
* ↑ 31 Directions for Collecting and Forwarding Mosquitoes, Office of the Surgeon General, 21 March 1918. Copy on file in historical records of AFIP.
* ↑ 32 Letter, Dr. Ludlow to Curator, Army Medical Museum, 21 August 1922. On file in historical records of AFIP.
* ↑ 33 Surgeon General's Office Review, p. 70.
* ↑ 34 Letters, Lieutenant Evans to Lieutenant Ross, 4 September 1919 and Lieutenant Ross to Colonel Owen, 18 December 1918. On file in historical records of AFIP.
* ↑ 35 Shufeldt, R. W.: The Art Department of the Army Medical Museum. Medical Review of Reviews 24: 391,July 1918.
* ↑ (1) Letter, Lieutenant Schwarz to Dean John Heffern, Syracuse University, 28 May 1918. On file in historical records of AFIP. (2) Shufeldt, Medical Review of Reviews, 24 (1918), pp. 391, 392.
* ↑ (1) Annual Report of the Surgeon General, U.S. Army, fiscal year 1919, p. 1066. (2) Surgeon General's Office Review, p. 72.
* ↑ Shufeldt. Medical Review of Reviews, 24 (1918), p. 392.
* ↑ 39 Shufeldt, R. W.: Wax Modeling Department of the Army Medical Museum. Medical Record 94: 663, 19 October 1918.
* ↑ 40 Wilson, L. B.: Museum and Art Service of the American Expeditionary Forces. The Surgeon 46: 165, February 1920.
* ↑ 41 Letter, Maj. L. B. Wilson to Col. W. O. Owen, 1 May 1918, with eleven memoranda attached. On file in historical records of AFIP.
* ↑ 42 (1) Wilson, L. B.: The Pathologic Service of the American Expeditionary Force. The Military Surgeon 45: 700, 702, December 1919. (2) Medical Department History, World War I, volume II, pp. 918-919.
* ↑ 43 Wilson, The Military Surgeon, 45 (1919), p. 701.
* ↑ 44 (l) Ibid., pp. 701-702. (2) Letter, Maj. L. B. Wilson to Col. W. O. Owen, 5 October 1918. On file in historical records of AFIP.
* ↑ 45 (1) Letter, Commander in Chief, G—1, to Commanding General, Services of Supply, 4 June 1918. On file in historical records of AFIP. (2) Medical Department History, World War I, volume II, p. 222.
* ↑ 46 Ibid., pp. 961-964.
* ↑ 47 (1) Ibid., pp. 222-223. (2) Wilson, The Military Surgeon, 46 (1920), PP- 165-168.
* ↑ 48 Copy of cablegram, on file in historical records of AFIP.
* ↑ 49 Medical Department History, World War I, volume II, pp. 224, 225.
* ↑ 50 Letter, Maj. L. B. Wilson to Col. W. O. Owen, 5 October 1918. On file in historical records of AF1P.
* ↑ 51 Memorandum, Maj. Robert Ross, 17 April 1919. On file in historical records of AFIP.
* ↑ 52 (1) Medical Department History, World War I, volume II, p. 225. (2) Wilson, The Military Surgeon, 46 (1920), p. 172.
* ↑ 53 Letters, Lieutenant Schwarz to Colonel Owen, 23 December 1918, and Major Ross to Colonel Owen, 19 December 1918 and 21 January 1919. On file in historical records of AFIP.
* ↑ 54 Letter, Maj. L. B. Wilson to Col. W. O. Owen, 5 October 1918. On file in historical records of AFIP.
* ↑ 55 Medical Department History, World War I, volume II, pp. 223-224.
* ↑ 56 (1) Ibid., p. 226. (2) Letter, Maj. L. B. Wilson to Col. W. O. Owen, 21. December 1918. On file in historical records of AFIP.