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THE FUNCTION OF
   THE MILITARY ORTHO-
           PEDIC HOSPITAL.
Fred H. Albee, M. D.,
    New york.
       Reprinted from the

New York Medical Journal
       incorporating TBI

 Philadelphia Medical Journal and
      The Medical News
         July 7. 1917.
 
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Reprinted from the New York Medical Journal for
                 July 7, 1917.
  THE  FUNCTION OF THE  MILITARY
          ORTHOPEDIC  HOSPITAL.
            By Fred H. Albee, M. D.,
                    New York,
  Major, Medical Officers' Reserve Corps, United States Army.
  The data upon which  this paper  is based  were
obtained by the writer as the result of an extensive
personal  study of a  score of  operative clinics in
various war hospitals of France and a careful sur-
vey  of similar hospital facilities  in  England and
Canada.    In the  summer of 1916, the  writer was
invited by the French War Office to visit France to
demonstrate his surgical methods in her various war
hospitals, and during this visit he was given excep-
tional  and  unlimited  opportunity  for an  intimate
study  of the  very problems with which our own
Government will be confronted upon  the advent of
American troops on the firing line in France.
  There are many aspects of the situation, of which
the  following are of vivid  interest:   1. Intensive
specialization  of   surgical practice has been devel-
oped and stimulated by the present world war.  2.
The value of  specialized hospitals for the efficient
application  of special surgical  procedures is inesti-
mable.   3.  Specialized orthopedic hospitals are ab-
solutely  indispensable when it is considered that a
large percentage  of the base hospital cases which
will  be returned to the  United  States for further
treatment will be  bone, joint, tendon,  and nerve  in-
juries.   4. It can readily be appreciated  that many
of the  soldiers suffering from crippling injuries will
be permanently debarred from the pursuit of  their
previous  occupations, and unless reeducated and
fitted for remunerative work of a new order, will
become a burden  upon the State.   We  are there-
Copyright, 1917, by A. R. Elliott Publishing Company. 
  Albce: Function of the Military Orthopedic Hospital.

fore face to face with a very  serious sociological
and economic situation.  If we are to discharge our
duty as guardians of the public health and tollow
the standards  of  foresignt and ability displayed by
our country's President and by the various arms of
our  military  service, we  must  intelligently  and
promptly prepare to restore our crippled American
soldiers to  the highest degree of efficiency possible.
  Closest attention is invited to the following de-
tails of the situation:   I, a  medical  and  surgical
"clearing house"  hospital; 2,  a classification of or-
thopedic conditions as recognized by the Canadian
Government; 3, muscular reeducation of the crippled
soMier; 4,  qualifications of a plant for a  military
orthopedic  hospital; 5, the necessary elements of an
ideal orthopedic war  hospital; 6, the estate of  Mr.
Charles D. Freeman at Colonia,  N. J.,  which he has
tendered to the United States as an orthopedic  war
hospital.
  A medical and  surgical "clearing house" hospital.
—The establishment of a medical and surgical clear-
ing house hospital at  the chief port of entry to this
country  and in  its  metropolis, seems imperative.
Here the cases may  be sorted out on the basis of
their surgical and medical requirements and sent to
the special hospital best designed  for the treatment
of their several needs.  This  has been arranged for
by the Columbia War Hospital.
  A classification of orthopedic  conditions as recog-
nized by the Canadian Government.—The demand
for a purely orthopedic military war hospital is appar-
ent when we consider  that from seventy to ninety per
cent, of the wounded returning from  this war will
have orthopedic lesions coming under  the following
heads, as shown  by statistics of the European  bat-
tlefields, according to the Canadian Military  Hos-
pital  Commission of Orthopedic Conditions:   1.
derangements and disabilities of joints,  simple and
grave, including  ankylosis; 2, deformities and dis-
abilities of feet, such as hallux rigidus,  hallux val-
gus, hammer toes, metatarsalgia, painful heels, and
2 
  Albce: Function  of the Military Orthopedic Hospital.

flat and claw feet; 3, malunited and ununited frac-
tures; 4,  injuries to ligaments,  muscles,  and  ten-
dons ;  5, cases requiring tendon transplantation or
other measures for irreparable destruction; 6, nerve
injuries  complicated by fractures  or stiffness of
joint; 7, certain complicated gunshot  injuries of
joints; 8, cases requiring surgical appliances.
  This list is the index to the classes  of cases
which the Canadian  Government requires shall be
entirely  committed  to  the  care  of  the orthopedic
surgeon in the military orthopedic hospitals.
  Reeducation of  the  crippled soldier.—Of equal
importance  with  the  physical reconstruction  of the
soldier's deformities is the  vital problem of his re-
education, both psychological and vocational.  This
aspect of the situation is of paramount importance
from  a  sociological,  governmental,  and  personal
standpoint.   That the infirm soldier who has  been
injured while fighting to uphold his country's honor
is a dependent upon the State until his remunera-
tive powers are partially or completely  restored, is
selfevident.  The decision as to the particular voca-
tion for which the individual soldier is  to  be re-
educated  is  of  such importance  that it should be
rendered  by a  board  of examiners—a  vocational
bureau—after  due consideration  of the  merits of
the case.
  The peculiar psychological  attitude of these in-
jured  men requires close attention.   A soldier  who
has  been injured  while fighting for his country
often  feels  that  the  burden of his  future mainte-
nance and  of  his  dependents will  necessarily fall
upon the State.  From  long reflection upon  his in-
juries he  has been brought  to believe that he is un-
able to resume his  former occupation and he  is cer-
tain to become introspective, unhappy, and dissatis-
fied with hi? lot,  and with this mental obliquity is- a
burden to society.  Dependence and idleness are the
natural foes of ambition and productive labor.  The
problem  of  reeducation  is very broad. Its solution
involves  functional and  vocational reeducation, and
3 
  Albcc: Function of the Military Orthopedic Hospital.

in the  process the distorted psychological state be-
comes  automatically  dispelled.
  Functional reeducation comprises the restoration
to a normal working condition of joints whose move-
ment is restricted by adhesions, of tendons shortened
by adaptive contracture, of  muscles weakened  by
atrophy and disuse, the coordination of  muscular
movements,  and of the greatest importance, the use
of artificial  limbs,  particularly complicated artificial
hand and fingers.  This functional or  therapeutic
reeducation  should be executed by means of hydro-
therapy, electricity, and  massage.   Special appara-
tus  and training by  individual instructors  to en-
courage physical movements and  mental processes
disturbed by injury or shock, are equally necessary.
Psychotherapeutics can also be administered during
orthopedic convalescence under the direction  of  a
psychologist appointed for the hospital for the treat-
ment of  psychoneuroses, hysterical paralyses, tre-
mors, etc.
  Having secured  the confidence of the  soldier and
otherwise restored his mental equilibrium,  and hav-
ing trained  his  reconstructed limbs to the highest
point of  efficiency, he must  now  be prepared for
some   remunerative  employment.   In  determining
the occupation for which he is best suited,  the men-
tal adaptability and capacity of the individual must
be considered, as  well as the particular infirmities
which  he has sustained from injury or disease con-
tracted on  the battlefield.  As has  been said, this
question is of such vital importance that it should
be decided by a board of examiners after very care-
ful consideration.  A vocational bureau  working in
connection  with the hospital may  arrange courses
leading to remunerative occupations of which the
following  are examples:  Care and operation  of
automobile;  general  course in  electricity; machine
shop practice; telegraphy, traffic orders, train rules ;
testing of cement  and steel;  cabinet making, wood
turning, construction carpentry; commercial courses,
bookkeeping, typewriting,  shorthand; courses  for
4 
  Albce: Function of the  Military Orthopedic Hospital.

those wishing civil service preparation; power ma-
chine operating;  shoemaking and repairing;  draft-
ing,  architectural and  mechanical;  plumbing and
steam  fitting; pottery making; painting and deco-
rating; lettering; designing and illustrating; clay
modeling;  steam  and gas engines; short courses in
chemical analysis; assaying and milling, for former
miners especially; poultry farming; flower growing;
sanitary  inspection; and other courses to be  added
later.
  Qualifications of a plant for a military orthopedic
hospital.—To meet the needs of the crippled soldiers
adequately, as outlined in the preceding pages,  a
plant to be suitable for a military orthopedic  hospi-
tal  must  possess  the following qualifications:  It
should be located in the country away from the noise
and confusion of the city.  The country site should,
however, be  near an important portal of entry and
easy of access by transportation lines from the clear-
ing house hospital of the metropolis,  following the
precedent  of France,  England, and Canada.   It
should be  back in the  interior far distant from  a
possible firing line, where the facilities for food sup-
ply,  sanitation, and transportation are of the best.
In the case of our own particular problem in this
country, the site should be selected on a large  artery
of travel, near an important portal  of  entry from
abroad.  It should have extensive acreage  to allow
expansion  to  meet the complicated requirements of
such an  institution.   Its altitude must be sufficient
to insure good drainage.   Accessibility to reliable
gas, electricity, and water mains is indispensable.
  The necessary  elements of an ideal  orthopedic
ivar hospital.—The patients to be treated in such an
institution are necessarily chronic cases, and hence
an abundance of  fresh air, sunshine, and the quiet
of the country is ideal.   In a general way, the main
building must be  spacious, the beds so arranged that
each patient receives an adequate amount of air.  It
must be high studded, with numerous large win-
dows,  and be provided with ample  veranda space

                        s 
  Albce: Function of the Military Orthopedic Hospital,

which may  be utilized by wheeling chairs or beds
from the  wards to it.   This latter  feature  is ex-
tremely important, because many of these patients
have  major injuries of the bones or joints and in
some instances cannot be moved from their beds for
a period of  months.   The hospital should be thor-
oughly equipped with modern, up to date  materials
of every description.   It must have a traction frac-
ture table, an electrooperative bone outfit,  and vari-
ous materials  for  splints, braces, etc., such as plas-
ter of Paris,  steel, aluminum, aluminum bronze,
Monell metal,  etc.   It must be supplied with adjust-
able superstructures to go over the beds, controlled
by  traction  with pulleys,  weights, counterweights,
etc., in the position of  neutral muscle pull  for frac-
tures.   These have proved of inestimable value in
the French war hospitals.   The best is one devised
by Dr. Joseph Blake, used by him in the American
Hospital at Ris-Orangis.  An outfit for  applying
the Carrel-Dakin  solution to  wounds, and a thor-
oughly up to date x ray equipment with a suitable
localization outfit for the detection of foreign bodies,
bullets, shrapnel, etc., are essential.   A room should
be  equipped with Zander's, or other type of  ap-
paratus, for the mechanical correction of restricted
motion, exercise,  etc.,  in selected cases, and there
should be a gymnasium with selected types of ap-
paratus.   A large athletic field is  a  feature  which
has proved  to be  important in  similar institutions
in France and Germany.   Here the favorably pro-
gressing patient can recover his agility  by playing
football, handball, throwing the discus, putting the
shot,  and innumerable  other games productive of a
mens sana as well  as a corpus sanum.
  The reeducational department requires  the serv-
ices of those versed in  the art of psychotherapy and
muscle training, as well as artisans for each of the
special vocational branches already enumerated.  A
factory for  braces and artificial limbs should form
an integral part of the  institution.   In England and
Canada attempts were  made to have this work done
6 
  Albce: Function of the  Military Orthopedic Hospital.

by  contract with  independent manufacturers.   It
was soon found, however, that some of these con-
cerns were offering rewards to the soldiers for re-
questing their particular make of apparatus.   The
preparation of amputation stumps and the manufac-
ture, application, and use of apparatus and artificial
limbs to fit these stumps  should all be correlated
under the immediate supervision and guidance of the
surgeon.   It occasionally happens that a  stump is
too conical or the bone too directly beneath its bear-
ing surface,  so that after  a patient has  worn an
artificial limb for some time it may be necessary to
perform some  plastic procedure to render the ap-
paratus efficient.   A splendid artificial limb is use-
less unless its possessor can use it freely and pain-
lessly.
  Stirred by a  fine patriotic  fervor and actuated by
motives  of intense  loyalty  and devotion to  their
country, Mr. and Mrs. Charles D. Freeman  have
tendered to the United  States Government, through
the writer, their magnificent estate in  Colonia, N. J.
This estate of 800  acres, of  easy access to  New
York by the Pennsylvania Railroad,  is situated on
high ground,  far  from the noise of  the city, pos-
sesses  all the above mentioned  facilities for ortho-
pedic, vocational, and functional reconstruction and
reeducation,  and  can  accommodate  from 500  to
2,000 men if necessary.  This estate and the details
of  its  transformation into  a war  hospital will be
more fully described and illustrated in  an article
soon to appear in this Journal.
  40 East Forty-first Street.