The First World War began in August of 1914 between the “Central Powers” of Germany, Austria-Hungary, and Italy, and the “Allied Powers” of Great Britain, France, and Russia. The United States joined the Allied Powers early in 1917. In the fifty years between the American Civil War and World War I, medicine, surgery, and public health had changed substantially. The medical personnel of World War I had much greater knowledge and many more tools to work with than their predecessors. These included a scientific understanding of disease and infection; a growing repertoire of surgical techniques and new anesthetics; vaccines to protect against diseases like typhoid and diphtheria, along with tetanus antitoxin to treat the wounded; drug treatments for syphilis and gonorrhea (which sidelined surprising numbers of soldiers); new diagnostic tools, including mobile x-ray units; a more highly trained medical corps; and standard operating procedures that included sanitation and hygiene. Medical units also now included specialists such as dentists, as well as laboratories. The army medical corps in both Britain and the United States had reformed their structures and procedures after suffering embarrassing numbers of disease-related casualties in the South African and Spanish-American wars at the turn of the century (having forgotten many of the lessons of the Crimean and Civil Wars.)

However, there were also some similarities between the two large conflicts: both involved millions of combatants and went on for about four years; in both cases, leaders who had no experience in quickly mobilizing very large forces struggled at first to care for the medical needs of troops in training camps and in the field; and in both conflicts, the Medical Department of the U.S. Army saw a rare opportunity to gather data not just about the numbers of sick, wounded, and dead soldiers, but also about the physical characteristics of those accepted for service and the defects that caused would-be troops to be rejected.

Most of the medical and casualty statistics of the war were compiled and published in 1925 as part 2 of Volume 15 of The Medical Department of the United States Army in the World War. Two preliminary statistical studies were completed and published before the medical department’s larger history: “Physical Examination of the First Million Draft Recruits--Methods and Results,” (1919) and “Defects Found in Drafted Men” (1919). A third study, “Army Anthropology” was published as part 1 of Volume 15, in 1921.

The authors of “Physical Examination of the First Million Draft Recruits,” Albert Love and Charles Davenport, noted that World War I provided the first chance in fifty years to “make a physical census of the people of the United States” although “people” in this case didn’t include any women, children, or men too old for military service. Their study did, however, generate information on over two million men of military age. Of ten million males registered for service in the war, 2,510,000 were examined by local draft board physicians from June to December 1917; of these 730,000 were rejected on physical grounds. Of this first draft, 527,100 men were inducted and sent to mobilization camps. Between January and April of 1918, a second draft inducted 414,000 men; the final draft, May to November 1918, called up 1,871,344. (Authors state that between December 1917 and September 1918 another 3,208,446 men were examined by local boards.) At the mobilization camps, teams of physicians examined the inducted men again, sometimes finding diseases and defects missed by the local draft boards and rejecting the recruits.

The study of the physical exam results from America’s first year of participation in WWI tells two stories. One is about the physical condition and fitness of the drafted men. The other is about how the U.S. Army’s physical exam standards evolved over the course of the war.

The physical exam standards (PES) are basically a risk assessment tool for military services, used to separate out candidates whose physical, mental, or medical conditions could make them liabilities as soldiers. The 1919 report on the first million men noted that these standards varied in severity over time, and evolved to allow some men with defects that precluded combat duty to serve in other capacities.

The standards also varied according to how many levels of evaluation were available. During the first draft, the local draft board decisions on acceptance or rejection of draftees were final. After December 1917, medical advisory boards were formed to receive appeals of draft board decisions. In addition, previously granted exemptions and exceptions from service were annulled and all registrants had to complete questionnaires regarding their industrial status and exemption claims. They were then sorted into five classes based on this information. Group A included men in whom no disqualifying defect or disease was found; Group B included men with remediable defects/diseases, who would qualify for general military service once those problems were addressed; Group C included men with diseases or defects that precluded general military service, but who might serve in limited or special capacities; and Group D included draftees rejected on physical grounds for any military service. (Group Vg in the 1919 report indicated men who had been rejected by local draft boards and were not sent on to mobilization camps.)

The study of the first million recruits also revealed large variations among the mobilization camps in the percentage of draftees rejected by examiners, showing that different standards of fitness were followed by the individual camp medical boards. For example, of the four camps that received recruits from Boston, New York City, Chicago, and Philadelphia (Camp Devens, Camp Upton, Camp Grant, and Camp Meade, respectively), the Camp Devens examiners rejected far more men than the other three, and Camp Meade rejected a significantly smaller number. Did this mean that the young men of Boston were markedly less qualified for military service than those of Philadelphia? Did the local boards in the various cities differ in their ability to weed out defective candidates before sending them to the respective mobilization camps? Or was there a difference in the ideals of the examiners at four camps where the men coming from the four cities were, for the most part, respectively examined? The study authors concluded that, while all three possibilities contributed to the result, the medical examiners’ ideals at each camp were the strongest determinant. That said, the data on particular disqualifying defects and diseases still showed that their incidence varied a lot between different regional populations. Recruits drawn from rural areas were more often diagnosed with epilepsy, mental deficiency, valvular heart disease, and tuberculosis. (The authors noted that epilepsy rates might be due to higher levels of inbreeding, and that mental deficiency correlated with higher numbers of Black recruits.) In urban areas, examiners found higher rates of defective vision (myopia and astigmatism), otitis media, hernia, and flat feet. The authors attributed the rates of vision problems to the fact that “those races most likely to have congenitally defective eyes tend to live in cities.”

Even among the urban areas, there were distinct differences. The Boston-area recruits had a much higher incidence of pulmonary tuberculosis and other respiratory diseases (which the authors attributed to the large number of Irish in the area); New York recruits, in contrast, had very low levels of TB, but notably high levels of drug addiction, mental illness, otitis media, hernia, and defective vision. Chicago-area recruits showed high levels of goiter, varicose veins, and an excess of injuries from bullets and loss of fingers, but notably less mental illness, cardiac or vision problems, hernia, or flat feet. Philadelphia-area recruits examined at Camp Meade had low rates of most diseases; the authors attributed this to the area’s larger number of native-born men and a lower percentage of Irish and Irish-descended stock among the draftees. The authors noted that different rates of disease in different regions were also reflected in medical examiners’ ability to diagnose certain conditions; physicians who had little experience with a given disease in their home cities or states might not readily spot it when doing military exams.

The wartime medical exam process, then, generated sharper definitions of risk factors, and better understanding of the other variables at work (examiners’ ideals, experience, etc.). And the medical exam records enabled the study’s authors to map the various risk factors in all regions of the U.S. for men of military age, and to correlate this information with demographics, and with commonly held beliefs about “race.” By the late 1800s, rising rates of immigration (and its consequences in urban areas) and America’s legacy of slavery both had prompted efforts among scientists (especially geneticists), physicians, politicians, and others to rationally determine and rank the fitness and overall quality of various ethnic groups. Many physicians active in public health and eugenics work served in the medical corps during the war, including Charles Davenport, America’s leading eugenicist.

The second study, “Defects Found in Drafted Men,” again authored by Love and Davenport, took a deeper look at the range of disqualifying defects and diseases. Their introduction clearly expressed common anxieties about national strength and superiority, the evolution (or decline) of civilization, and deficiencies of certain classes or races. Knowledge of the defects present in military-age American men, they stated, was important for several reasons:

“It is important from the standpoint of social and industrial life, since it gives some insight into the availability of this population for the various occupations which our social organization requires. It has social-medical bearings, since it indicates the physical and medical status of the population in different parts of the country and under different sanitary conditions, and with varying opportunities for medical and surgical treatment. It has important military bearings, since it indicates the proportion of men available for military service of different kinds. It has a social-therapeutic bearing, since it indicates the size and nature of the task before those who would seek to improve by better conditions the physical and mental standing of our population. Finally, it has a biological and eugenic significance in so far as it reveals the inherent failures in man to make complete adaptation to the rapidly advancing requirements of a highly artificial civilization, in so far as it throws light on the constitutional limitations of the various races to meet the conditions imposed by that civilization, and in so far as it throws light on the influence of military selection on the breeding stock of the next generation.” (p. 27)