LETTERMAN GENERAL HOSPITAL 1919

HISTORY OF LETTERMAN GENERAL HOSPITAL

The Orthopedic Service

Pages 24, 52a, 52b

Orthopedic surgery was given a separate service at Letterman Hospital in June, 1918. Before this time orthopedic cases were handled by the general surgeons, who when occasion arose called in Contract Surgeon Dr. J. T. Watkins of San Francisco as a consultant.

Major Robert L. Hull of Oklahoma City reported for duty at Letterman on June 11, 1918, and proceeded to orize (sic) the service. He was given one and half wards of 40 beds each, one being used for clean cases and the other for suppurating ones; there were additional cases scattered about through various wards, so that by August the Hospital had about 150 orthopedic beds. Captain S. L. Haas, still at Letterman, was assigned as Major Hull’s first assistant.

The size of the service rapidly increased and additional wards were assigned to it, until from one and half wards, in June 1918, it occupied twelve 40-bed wards in May, 1919, and had additional patients in the officers’ and womens’ wards besides. On May 1, 1919, there were, including men on furlough, 661 patients in the orthopedic service of Letterman Hospital, almost one-half of all the patients in the Hospital being orthopedic. Towards the end of the war the service was engaged in the orthopedic training of medical officers. Captain Ely gave lectures on orthopedic topics twice a week during December, 1918, and Captain Zimmerman of the X-Ray Department gave a short course on the interpretation of X-Ray plates. Cases were discussed at the daily clinics with a view to instruction of the junior officers. There were frequent changes in personnel, officers being detached and ordered to various stations as orthopedic surgeons after they had received a certain amount of preparatory training.

The personnel of the service from its inception in June, 1918, to June, 1919, has been as follows:

Major R. L. Hull, Chief of Service, from June 11, 1918 to date of his death, January 4, 1919.

Captain S. L. Haas, still at Letterman. Captain Haas’ stay was interrupted from October 30, 1918 to February 24, 1919 by duty at the army Medical School as organizer of the Laboratory for Surgical Pathology.

Capt. H. V. Hoffman, Lieut. F. J. Schick, Lieut. E. R. Cox, Lieut. C. A. Craig, Lieut. John Swancott, Lieut. T. B. Cunname, Capt. W. C. Baker, Capt. N. T. Enloe, Capt. J. T. Whitty, Capt. E. M. Pallette, Capt. M. W. Brachvogel, Lieut. D. R. Wilson, Capt. J. I. Boyer, Major L. Elloesser, Capt. R. F. Tomilson, Capt. W. T. Phy, Lieut. L. Dozier, Capt. R. J. Henderson, Lieut. V. L. Rocho, Lieut. W. R. Anderson, Major W. N. Keller, Capt. W. W. Mackenzie, Capt. R. H. Pyles, Lieut. A. N. Scholz, Lieut. A. O. Waller, Lieut. A. F. Maine, Lieut. T. J. Nolan, Lieut. Col. C. F. Elkenbary, Lieut. O. R. Myers, Capt. Sterling Bunnell, Lieut. Col. W. I. Baldwin, Capt. C. L. Lowman, Capt. H. O. von der Leith, Lieut. H. D. Barnard, Capt. E. C. Bull.

Major Hull worked incessantly as Chief of Service from his arrival at Letterman in June, 1918 to the day of his death, January 4, 1919. In spite of a bronchitis he gave himself no rest, and had no thought for his own welfare. While on a short Christmas leave he contracted pneumonia and died at Letterman Hospital after an illness of four days. His upright and far-seeing character made it possible for him to plan the organization of the orthopedic service so that it was easy to continue its development after his death. He was beloved by all who knew him.

A hydro-therapeutic ward had existed at the Hospital for several years, and in September, 1918, Major Hull began its enlargment and equipment for extensive physio-therapy. He gathered about him a number of Reconstruction Aides under the supervision of Miss D. Neel, and this corps gradually increased until it now numbers 25 aides and 3 enlisted men. The physio-therapy department, fully equipped with apparatus for massage, hydro-therapy, light-therapy (violet ray, quartz lamp, etc.), radiant heat, and apparatus for exercises was separated from the orthopedic service and given an independent status upon the arrival of Captain Henderson in December, 1918. Captain Henderson was ordered to another station on May 5, 1919, when the physio-therapy department again reverted to a closer connection with the orthopedic service, being placed in charge of Captain Lowman, an orthopedic surgeon who had had a large experience with this kind of treatment.

Up to the beginning of April the orthopedic service included cases of injury to the peripheral nerves and spinal cord. These were segregated under Major W. N. Keller in January, 1919, but were still kept under the general supervision of the orthopedic service until the arrival of Lieutenant Colonel Nafzigger, when the neuro-surgical service was divided from the orthopedic one.

The appliance shop was opened with the simple as possible equipment in a small shed near the hospital garage in July, 1918. It rapidly outgrew its quarters and was moved to a concrete basement ward on November 1, 1918. A few months later it was doubled in size and now occupies two concrete wards with an adjoining corridor. The shop now busies five civilian employees and nine enlisted men. It is fully equipped for the manufacture of braces, splints, steel, leather and wooden appliances and artificial limbs. More completely treated elsewhere in this issue.

Cases of weak, deformed or wounded feet needing shoe-corrections, plates or other appliances are segregated in a special ward under the care of First Lieutenant Nolan. In May, 1919, the foot-appliance maker was removed from the general orthopedic shop and given a special shop in the wards of the Educational Service. Each patient is encouraged, as far as his abilities warrant, to make his own apparatus in this shop. He is thus educated to keep his own braces in condition and to care for his feet after discharge.

This sketch would be incomplete without grateful recognition of the help given the orthopedic service by the educational service, under Major Cullimore. General and special gymnastic exercises, athletic games, special training for the amputated and curative work, designed to strengthen and make pliable weak and stiff limbs and joints has been carried on under the direction of the Educational Service in their gymnasium courts, and work shops.

In February, 1919, films were made by the Pathe Corporation, following the course of a patient from his admittance to Hospital to his discharge. These films graphically represent the varied means at the disposal of the Hospital for the care of its patients. The most hearty support of the Surgeon General’s Office and the constant personal interest and co-operation of the Commanding Officer, Colonel Thornburgh, have extended the orthopedic service every opportunity and encouraged its development and expansion.

No civil hospital has the means for getting together such manifold curative agencies, apparatus and personnel. Competent surgical care, good operating service, splints, braces and appliances made in the Hospital to suit every need, a well-equipped shop at instant reach, electro-therapeutic apparatus, baths, light-cabinets, massage, exercises, curative work shops, gymnasia, tennis, volley-ball and baseball courts and fields, provision for education, amusement, mental and physical recreation, an energetic and uncommonly efficient staff of medical officers, nurses and enlisted men—all these work in harmony and without the jealousies of civil practice to make the wounded at Letterman as well cared for and contented patients as are to be found anywhere in the land.

Orthopedic Appliance Shop

The orthopedic appliance and artificial limb shop at Letterman was first organized under the late Major Hull in June of last year. It was equipped with a few simple wood and metal working tools and installed in a small shed in back of the Hospital buildings, with Sergeant (first class) Hittenberger in charge. By November, 1918, it had outgrown its quarters and was moved to a concrete basement ward. The service of civilian employee Joseph Marea, an expert leg maker were secured, and the fitting of temporary legs was begun. From this small beginning, the shop has grown until it employs five civilians and nine enlisted men as follows: Sergeant (first class) Hogg, non-commissioned officer in charge; Sergeant (first class) Hittenberger, in charge of metal working department; Sergeant Jack Wilson, Corporal H. Castle, Pfc. G. B. Roderick, Pfc. J. P. Rogers, Pfc. F. J. Berner, Pfc. L. L. Pedersen, Pfc. C. A. Daigneault.

Civilian employees, Joseph Marea, in charge of artificial limb department; Fred Haenen, Clarence Wyndham, Wm. Byrne, Wm. Replogle.

Last May the shop turned out twenty permanent artificial limbs, and about twice as many temporary limbs; 119 braces, splints and other appliance; 91 shoe-corrections, and numerous repair jobs, and adjustments, representing in all a cash value of $5000 to $6000.

From November 15^th Major Eloesser took charge of the shop and work was begun on the new Letterman Leg. This leg is accurately fitted to each case, the socket being made over a plaster of paris cast which is taken of each individual stump. The leg for below the knee amputations is fitted not only to the stump, but to the thigh, so that it stays firm on the stump and does not tend to drop away when the wearer’s foot is off the ground. This prevents chafing and sores. The ankle joint is hollow and packed with grease like the bolts of an automobile; by turning down a screw, the joint can be kept lubricated. About ninety per cent of the stumps are end-bearing.

The first leg was turned out December, 1918. The original model had a steel frame, this was replaced in later models with a wooden shin piece, otherwise the leg has proven so satisfactory that no further changes have been necessary. Artificial arms are also constructed in the shop and considerable experimental work has been done on various forms of appliances.

Of late, patients with arm amputations above the elbow have been given two arms—one of the ordinary shape, fitted with a detachable work-hook and a separate hand—the latter mainly for dress—and a short, strong arm without elbow joints, but with a strong work-hook for hard use in the shop and on the farm. Each patient is given a course in training in the manual work shops and gardens of the Educational Department before discharge, so that he thoroughly understands the use of his artificial limb.

Besides artificial limbs, the shop manufactures all kinds of appliances for the correction and support of deformed and weak limbs; braces to prevent weak bones and bending before they are firmly knit; splints and frames for bed patients; plates for weak, deformed or wounded feet, appliances to be attached to beds for treatment of fractures, belts, back braces, in short, any of the articles purchaseable at surgical brace and appliance makers. The shop also has a cobbler who turns out about 90 shoe-corrections a month.

Transcribed by Sharon Walford Yost.

Source: ”The History of Letterman General Hospital, Pages 24, 52a, 52b. Published by the Listening Post, Presidio, San Francisco, Cal. 1919.