HISTORY OF LETTERMAN GENERAL HOSPITAL
Pages 14, 16, 18, 20
Medical Service of Letterman
Try as one might one could not put into words—especially a few words—a true history of what has been accomplished in the medical service of this hospital. Such facts as shall be recorded are taken from the records. They give an idea of the total of cases handled, the number of cases which have been dismissed and the number of cases still in this hospital. These cold figures do not give an idea of what has really been accomplished, because one cannot, in a brief history, nor in cold figures, give any idea of the sincere hearty cooperation between doctors who have labored so earnestly and so conscientiously in their different wards. One cannot tell the story of the many words of wholesome advice that have been given patients which have struck responsive chords in their hearts and which, no doubt, will prove of great benefit to them when they have entered upon their civil life again where it will make life more worth while.
The work done by the members of the medical staff has not been a duty performed in a perfunctory manner. The members have felt that there are human beings in their care who must be encouraged so that they may be turned back to the world in as good shape as possible to make good citizens.
Much correspondence is carried on with the loved ones of patients keeping them posted as to the condition of their boys. Knowing that these communications are sent out keeps the patients in good spirits, and right here may be mentioned that a great deal of good work along this line is being performed by the ward nurses and by the enlisted men of the Medical Corps in spite of the desire on their part to get back to the civil life. They work faithfully and take pride in their work, each vieing with the other to keep his ward and patients in the best condition.
The following table shows the total cases of 1917 and 1918:
Approximate number of medical cases handled during emergency, up to date.
Total number of patients since emergency…..*14,691
Total number for 1917………………………….4,401
Total number for 1918………………………….7,444
Increase, in one year……………………3,031
The following in the staff of the Medical Staff:
Office of the Chief of Medical Service
Lorenzo F. Luckie, Major, M. C,Chief of Service
Philip M. Thomas, Major, M. C,Asst. to Chief of Service
Arthur L. Brown, Captain M. C.
Frank B. Reardan, Captain M. C.
Glenn E. Myers, Captain M. C.
Don P. Flagg, Captain M. C.
Richard H. Wellington, Captain M. C.
Alfred G. Bower, Captain, M. C.
David A. Conrad, Captain, M. C.
Arthur L. Munger, Captain M. C.
John S. Mason, 1st Lieutenant M. C.
Edward J. Ghidlella, 1st Lieutenant M. C.
On April 6th, 1917, the personnel of the laboratory at Letterman General Hospital consisted of Chief of Services and Sanitary Officer H. R. Oliver, 1st Lt. M. R. C.; one sergeant first-class, W. C. Williams; and six medical enlisted men. On April 21st, 1917, H. J. Nichols, Major, M. C., returned from El Paso as Chief of Service. On June 25th, 1917, he was relieved and H. R. Oliver, Major, M. R. C., again became Chief of Service. Sergeant First-Class J. L. Spangler and ten enlisted men made up the personnel.
On December 28th, 1918, H. R. Oliver, Major, M. C., was assigned as Chief of Service. Since then the personnel has been H. E. Foster, Major, M. C.; J. R. Snyder, 1st Lt., M. C. (discharged in April); M. J. Harkins, 1st Lt., V. C.; W. H. Stabler, 2nd Lt., S. C.; H. M. Warren, 2nd Lt., S. C., and J. G. Scott, 2nd Lt., S. C.; two technicians, Miss Emily Mills and Miss Hazel Henzel, and sixteen enlisted men.
Functions of the Laboratory
The laboratory has served as a Clinical Laboratory for this hospital with its thousands of admissions, and as a Department Laboratory for the Western Department. The work covers parts of chemistry, bacteriology, parasitology, pathology and serology, and all veterinary clinical examinations for the Western Department.
In August, 1917, regular classes of instruction were commenced in all branches of the laboratory work for the enlisted men. These consisted of five one-hour periods each week. Numerous talks, papers and demonstrations of material were made before the Commissioned Personnel of the hospital at the “Weekly Staff Meetings.” All laboratory work was done by this laboratory in installing the chlorine plant at the source of the water supply. The water supply was surveyed, recommendations made in regard to cleaning of the creek, increasing the efficiency of the chlorine plant, which were carried out and the water put into first-rate condition.
The milk supply was thoroughly inspected, water supply at the dairy inspected, sterilizers installed. The dairy is inspected twice monthly. This includes the inspecting of water supply, the milking apparatus, the utensils used, the health of the handlers, and the physical examination of the udders of the cows. Milk was pasteurized on receipt at the hospital. Sanitary surveys were made regularly and deficiencies corrected. Dish sterilizers were installed in all ward kitchens and kitchens where dishes were washed. Proper screening was carried out, and the detection and eradication of breeding places for files. Surveys for carriers of infectious diseases and proper isolation and treatment of cases were made.
The laboratory contains a morgue, a chapel, a large room for sterilizing purposes, the making of media and chemical examination, another for routine blood work and other examinations, an office and private laboratory, and a number of smaller rooms for bacteriology, pathology, sereology and also a store-room. These are all well appointed and equipped for any character of work called for.
In compliance with the plans of the Surgeon General regarding the program of physical reconstruction for the returned disabled, a new service was introduced in this Hospital with the arrival of Major Allan R. Cullimore on July 21st, 1918.
As defined by the Surgeon General “physical reconstruction is the complete medical and surgical treatment carried to the point of maximum restoration, both mental and physical.” It is further noted that “modern treatment does not end with physical care. Functional restoration is the final aim of modern physicians and surgeons, and it is conceded that the physical re-habilitation of disabled men is peculiarly dependent upon their mental attitude. The more serious the disability, the greater the danger of mental depression, and an indisposition to respond to medical and surgical treatment.” It has been the aim, therefore, at this Hospital, for the educational work to begin at the moment that the man has arrived at the stage when he begins to worry about his future.
“Educational Service” is probably a misnomer—“Adjustment Service” might better be supplied. The general public too little realizes the attitude of the average man maimed. If permitted the opportunity, the well intentioned public will lionize, pamper and, eventually, spoil these men who have sacrificed. A “soft job” will be offered out of sympathy to the man with an amputation. However, sympathy has a very short memory and our maimed must be trained to hold their place, both socially and economically, when people begin to hate the memory of a war that has caused an increased burden to humanity.
In the first months of this work the men, both convalescents and bed patients, had to be aroused from this mental depression and indisposition through a strong appeal to them to take up some course of training. This means was effective in reaching only those men who had not become too thoroughly “hospitalized.” However, with the introduction into the service of trained women, reconstruction aides, the problem of arousing the men became much simpler. The reconstruction aides entered the wards, and, without the patients realizing it, gained their confidence. They learned, while keeping the men supplied with some non-vocational form of occupation, such as wood-carving, basket work, weaving, knitting, etc., something of their educational needs and made recommendations not only to the men but to the Chief of the Educational Service, regarding some form of educational work having a definite vocational and remunerative value. Each case became in this way definitely an individual problem.
Observation has shown that it is at this point where the interest of the patient increases, and though they may browse around in a number of different subjects of the sixty odd unit courses now available, they eventually “find themselves,” gain confidence and lose the highly detrimental self-consciousness of the man maimed. The average patient generally learns that he has abilities and aptitudes for certain kinds of work hitherto unknown to himself. His discharge generally comes before he has had an opportunity to complete a course of training; however, the seed has been sown and he has proven to himself with the completion of a full course of training under the liberal provisions of the Government, directed by the Federal Board of Vocational Education that he can not only master the vocation of his choice, but will be able to “carry on” in the future better prepared, thought possibly physically handicapped, that at his former vocation.
The records of the Federal Board and those of the Disability Board at this Hospital show that very large percent of the men are availing themselves of this opportunity.
The property accountability of the Educational Service has grown to amount to about $54,000. Excellent shops fully equipped are provided, among these being a machine shop, wood shop, auto repair shop, vulcanizing shop, metal and jewelry shop, electrical laboratory, linotype room, loom room and various academic and commercial class rooms.
In addition to the general educational program, the Educational program, the Educational Service is responsible to the Commanding Officer, in whole or in part, for the following:
Athletics and Recreation.
From only fifteen patients enrolled in educational work on August 1st, 1918, under the direction of the Chief of the Educational Service and a staff of some five or six enlisted men, the work has grown until at present the staff numbers more than one hundred and men and women.
To Major Allan R. Cullimore, honorably discharged from the United States Army July 9, 1919, must be given the credit for an institution successfully established at this hospital under the direction of the Surgeon General and being another evolution of the Great War. His experience with reconstruction work, both in the United States and in Canada, his unflinching determination to be of the highest service to the disable men, coupled with the courage to stand by and fight for the rights and needs of these men, in an effort to reconstruct them physically, socially and economically, has left the Educational Service in an enviable position. The volume of reconstruction work accomplished by the Educational Service at this hospital must, therefore, be accredited to the efforts of Major Cullimore and his staff.
LIEUTENANT ARTHUR G. WAEDELICH.
Chief of Educational Service.
When war was declared between the United States and Germany, there were two dental surgeons on duty at the Letterman General Hospital, and the Dental Service occupied five rooms.
This service has been expanded in an effort to meet the demands for dental service, so that there are now on duty six dental surgeons, and the Service occupies eleven rooms. This includes waiting room facilities, operating rooms, a dental prosthetic laboratory, and a dental X-Ray laboratory. In addition to the dental surgeons, there has been authorized a dental hygienist, who has been on duty in this service since May 1st, 1919.
Dental services have been rendered to the personnel connected with Western Department Headquarters, San Francisco, Cal.; Fort Mason; Letterman Hospital; Benicia Barracks; Monterey; officers and enlisted men going to and from the Philippines, Hawaii, Siberia and Alaska; retired officers and their families; officers and enlisted men living in the vicinity of San Francisco.
Dental services were also rendered the French officers and men during their stay at the Presidio, November and December, 1918 and January, 1919.
A complete X-Ray apparatus is installed as part of the Dental Service, affording an opportunity of making diagnoses in connection with pathological dental conditions and of checking up on certain classes of dental operations. This service is proving of very great value in carrying on the activities of the Dental Department.
Fuel gas has recently been installed in the rooms occupied by the Dental Service. Nitrous oxide and oxygen, and also conductive anaesthesia are being induced for the extraction of numerous diseased teeth, and the performance of other oral-surgical operations. This has created a necessity for the construction of many artificial dentures, these being made in the dental laboratory in connection with this office.
During the winter of 1918, and early spring of 1919, the Dental Service was considerably crippled as a result of the epidemic of influenza then prevalent. Many patients were unable to report for treatment, and in addition, the dental operators were for a time incapacitated.
Lieutenant-Colonel Julien R. Bernheim, Chief of Service. Major Samuel W. Hussey. Captain James Collins. Captain Howard A. Hall. Captain William F. Blair. Captain Max Wassman Jr. are the commissioned personnel.
THE UROLOGIC SERVICE
The Urologic Service at Letterman General Hospital is charged with the care and reconstruction of all kidney and bladder cases and venereal diseases and maintain four active wards for the cases property assigned to it, also a large consultation and out-patient department. This service is of great importance to the soldiers’ welfare and the percentage of reconstructed soldiers sent back to active duty is large.
The personnel and equipment at Letterman are fully prepared to do the scientific treatment and diagnosis necessary in this specialty. The staff, both commissioned and enlisted, have been chosen for their special training and qualifications and the wards, dressing rooms and operating rooms so equipped that the work done is on a par with that of the best hospitals and follow the modern procedure of well established Genito-Urinary practice.
Much valuable scientific data has accrued from the large clinic necessarily seen and the deductions used to the value of the soldier’s reconstruction. We feel that the value of this department both to the Army and the civic population as well as to the soldier himself has justified our part in the care and reconstruction of those assigned to the care of this service. Capt. T. R. Petch is Chief of Service.
NEURO SURGICAL SERVICE
The Neuro Surgical Service was established as a separate division of the Surgical Service in March, 1919. At this time Lieutenant-Colonel Naffziger was detailed in charge of the reconstruction surgery of the brain, spinal cord and nerve injuries. Captain Harold Wright was detailed to neurologist. At this time there were about one hundred and twenty-five cases of this class in the hospital. Since then there have been many admissions. Many have likewise been discharged. The present staff assigned to this work includes Major Thomas and Captain Utsinger.
A very large proportion of those with brain and nerve injuries have been operated upon. Recovery from paralysis is slow but the progress in all has been satisfactory and most encouraging. Some cases of nerve injury have shown rapid improvement. In all, in whom sufficient time has elapsed since operative treatment was given, progress has been most encouraging.
Brain surgery for brain tumor, fractures of the skull and repair of defects in the skull, has been needed less often than for the relief of epilepsy from the presence of foreign bodies in the brain.
While a considerable number of cases in the hospital still need surgical treatment, the greater part of the work has been completed.
To the Department of Physiotherapy and the Gymnasium as well as the Educational Department, much credit is due for the improvement in the neuro surgical cases, both before and after operation.
Picture: Orthopedic Appliance Shop
It is a far cry from this busy August to that day early in September when Occupational Therapy first made its entrance into Letterman General Hospital. It had the advantage even in that small beginning of a definite plan as to its future. Too often such work is begun in a desultory fashion by those who are inexperienced workers, and wrong methods come into vogue which have to be overturned and changed when the supervisor enters the scene of action. In our case, thanks to the Chief of the Educational Service, the individual who was to plan the work, was the first to take oath.
Within a very few days came Miss Beatrice Butler and Miss Perle Du Bois, our first head aides. Actual work was begun in Ward 8 and we still have on our files that first list of dozen patients made out and signed by Captain Haas, under the direction of our much-loved Major Hull. From this tiny start, with only three aides working in a couple of wards and with scanty materials, we have grown to our present status, where we are sixty-one strong, working with an average of six hundred men in thirty wards, and with two storerooms equipped with all manner of material for work.
While those familiar with our hospital life are all undoubtedly familiar with the blue-garbed aides busy at their duties, it is doubtful if many understand their duties. Under the present organization there is one supervisor, five head aides, and one who gives her entire time to social service work. The other three do both occupational and executive work. Of the remaining fifty-five aides, four act as secretaries. Seven are teachers of elementary school branches, and seven others have certain forms of special class work. In the two psychopathic wards the five aides concentrate on that work alone. All of the rest of the aides with the exception of the one assistant in social service work, do Occupational Therapy work in the wards. It is their duty to become acquainted with the new comers in the wards and to assist them in their physical and mental readjustment to the life which has to follow their experiences in the Great War.
It is in keeping to say just a word concerning the methods used by the Occupational Aides in assisting to bring about such adjustment. They do not necessarily confine their attentions to baskets and trays and similar products of the arts and crafts, in spite of the fact that they are given such endearing names as the “basket lady” and the “bead nurse.” If an aid sews on a patients buttons and chevrons, does business errands for him; writes his letters home; manicures his nails; listens to his ravings about the “one girl on earth,” she is living up to her opportunities just as truly as if she teaches the patient to make a hammock. However, there is a wonderful curative effect in working with one’s hands, and the months which we have spent at Letterman show hundreds of men who have not only passed long hours most pleasantly in arts and crafts work, but who have experienced the keen joy of manufacturing a really beautiful article and have felt that fascinating mental uplift which comes when a man is lifted out of the feeling of invalidism to the place where he is a man of accomplishment once more.
That there have been difficulties during these months no one will deny. The actual buying of materials has been a far more vexatious problem than one uninitiated can imagine. While the Surgeon General’s office has provided funds most generously for such materials, and the Quartermaster’s Department has served us in the most friendly fashion, the materials, themselves, were often like the needles in the proverbial haystack, and when found, were priced most exorbitantly. Such common articles as raffia, very large or very small needles, leather and leather tools, had sometimes to be hunted for many days at a time. And all the time the search was going on our impatient patients forever cried “More, more more!” If the supervisor had not had the good fortune to have had some years of experience in buying, the condition might have been much worse than it was. We realize that our storeroom shelves were often sadly empty, but it was not because of lack of earnest endeavor on the part of the buyers.
From other hospitals we hear of strained relations between the medical workers and reconstruction aides. Perhaps it is not strange that such should have been the fact, for truly, Occupational Therapy enters our army hospitals on trial. It had never been used to any great extent except in hospitals for the insane, and had to prove its value as a therapeutic agent in general medical and surgical work. That its value is now proved is illustrated well by the fact that it is spreading to civilian hospitals. On every hand one hears the statement that Occupational Therapy has come to stay. We feel that it has been a success at Letterman, that even with all the mistakes of a beginning enterprise, it has been worth while.
But along with this comfortable self-gratulation we cannot fail to give due credit to the ward surgeons and nurses, in fact to the whole personnel of the hospital, who have helped us so generously and sympathetically. Perhaps a ward surgeon began by questioning as to whether it was not more bother than it was worth, but he was always man enough to give us the benefit of the doubt, and let us show him that keeping his sick boys busy and happy was in the end beneficial in its effect on his work with them. Perhaps the ward nurse looked askance at the stray bits of raffia which might fall on her immaculate floor. But a warm heart is one of the glories of the nursing profession and every nurse has learned to forgive the bits of raffia beneath the bed if the face of the patient on the bed is full of happy courage.
So you see that Occupational Therapy simply had to succeed at letterman, because everyone conspired to help. The Y. M. C. A. opened their grill to us so that we could have hot lunches; the Red Cross gave our boys “eats” and clothes and helped their families financially when it was necessary. Teachers and school children, friends and strangers, brought us everything from cookies to seed beads. One high school sent candy every week; another little ungraded class far up in a mountain town mailed us long pine needles, gathered by the children’s small hands in their own school yard.
We realize to the fullest extent that the co-operation of our confreres of hospital life has been responsible for the success of Occupational Therapy.
Transcribed by Sharon Walford Yost.
Source: ”The History of Letterman General Hospital, Pages 5, 6 & 50. Published by the Listening Post, Presidio, San Francisco, Cal. 1919.
© 2010 Sharon Walford Yost.