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Base Hospital 21 During World War I – 1914-1918

Base Hospital 21 and the Great War

By Donna Bingham Munger

“They asked for hospital units and they got us. We were too surprised to be scared,” remembered Dr. Arthur Proetz. It had been only two weeks since the United States government had declared war. Dr. Fred Murphy, commanding officer, had just received a wire from the surgeon general: “ ‘Can your Unit go to Europe and how soon?’ Fired with pride and patriotism he might have replied, ‘Lafayette, we are here,’ if he had thought of it, but even Gen. Pershing only came up with that one two months later, so he answered simply, ‘Yes – in one week.’” [1]

What he was thinking about was hard to say for he had no unit. Base Hospital No. 21, Washington University School of Medicine,xisted only on paper. There were no men to carry stretchers, blow bugles or cook slum, whatever variety it might be for that day. Technically, there were no officers either. Nota single commission had arrived. Even Dr. Murphy’s rank as major and commanding officer was unofficial. He did not have his commission. In fact, he had never met together with the entire group of officers.

In St. Louis, Missouri, few people had thought of military matters before 1917. They had talked vaguely about service in Mexico where Pancho Villa had raided back and forth across the border, and they had watched a few regular troops, bound for the Mexican border, go through the city on flat cars equipped with machine guns. They seemed to be more concerned over the safety of relatives in Europe and over the Germans prodding the Mexicans to go to war with the United States than with the possibility of military service for themselves or members of their family. [2] When the Red Cross, in July 1916, had called for the formation of a base hospital unit at Washington University School of Medicine, all of the faculty members had volunteered. No one in the medical school had thought that any base hospital would ever see duty overseas, and the closest they were to come to a unit meeting prior to the U.S. declaration of war was “around the luncheon table in the bay window at the old University Club” where many of them had always gathered daily. [3]

Then, Arthur Proetz remembered, one night shortly after the surgeon general’s telegram, “two unimpressive lieutenants from the Army Medical Corps showed up” to give physicals to the hospital unit officers. The lieutenants “herded [everyone] . . . into a chilly clinic room and in a no-nonsense tone one said, ‘Strip!’”

“All the way?” questioned Dr. Fred Murphy, a professor of Surgery, who would be commissioned commanding officer of the St. Louis unit.

“All the way,” snapped one lieutenant.

Proetz recalled that two dozen of the medical school faculty stepped forward:

from the loftiest professors down, naked as frogs, hopping on the cold floor, being inspected, palpated, auscultated and undergoing any other manipulations that occurred to the inquisitors. Not a man had a temperature over 97 or a pulse under 100. It was a leveling experience, . . . it broke down all barriers and began to teach them to live as one happy family for the duration. [4]

American hospital units such as No. 21 at Washington University had come into existence largely through the efforts of a few surgeons who had taken small, volunteer, surgical units to France during the first two years of the war. In 1914, a group of Americans living in Paris established a hospital at Neuilly, France. In order to staff the hospital, known as the Ambulance Américains, they urged several American universities to form surgical units, which served on a three-month rotational basis. Through these experiences a few influential men in the American medical profession quickly grasped the importance of having ready, on a standby basis, efficient surgical teams composed of men who had had similar training and who knew each other well. [5]

Dr. George Crile, who had led the Western Reserve unit, the first to serve at Neuilly, and Dr. Harvey Cushing, a member of the Harvard unit also stationed there, spearheaded a medical preparedness drive after their return home. Their ultimate goal was to organize self-contained hospital units at every possible medical school in the United States. They hoped that these units could be mobilized rapidly if or when the need arose. [6]

Colonel W. C. Gorgas, then surgeon general and head of the Army Medical Corps, reacted favorably to the idea. The Wilson administration’s insistence on technical neutrality had stymied his earlier efforts at medical preparedness. Gorgas also well remembered from his own experiences the problems of cooperation which dissimilarly trained doctors had faced during the Spanish-American War. [7]

Before the Army Medical Corps could implement any type of organization, however, the American Red Cross entered the scene. They contended that since the United States was not officially at war, they alone had responsibility for organizing and furnishing volunteer aid to the sick and wounded. After considerable negotiation, the two groups reached a compromise. The Red Cross would organize the base hospitals on a strictly military basis, and the commissioned and enlisted men of the Army Medical Reserve Corps would provide the personnel. [8]

By April 1917, the Red Cross had organized 33 base hospitals. Fortunately they had acquired authority to solicit funds for the equipment since base hospitals had never received provisions from the War Department in times of peace. [9] In St. Louis, alone, the Red Cross had raised over $60,000 for beds, blankets, instruments, medicines, portable laboratory and kitchen equipment and other necessary items. [10] All of this had been put safely into storage without the doctors at Washington University giving much thought to its use.

The British, however, had other thoughts about the matter. As soon as the United States entered the war they dispatched a mission to Washington. Headed by Arthur Balfour, most of its members had overseen England’s prosecution of the war. Acutely aware of the best ways in which the United States could help, they first requested: “Send us Doctors.” Unfortunately the British had failed to conserve their supply of physicians and surgeons, allowing both doctors and medical students to fight in the lines. By spring 1917, a serious shortage of medical officers confronted them.

On Sunday evening, April 22, 1917, the members of the British mission gathered with a group of Washington officials in the octagonal room of the White House. When the first doctor was introduced to Balfour that evening he retained his hand, grabbed his coat lapel and held the receiving line at a standstill while he asked, “You were introduced as ‘Doctor’. Have you to do with the enrollment of medical officers for your army?”

“I have much to do with it, sir,” replied Dr. Franklin Martin of the president’s advisory committee. “What can we do for you?”

Balfour earnestly replied: “Our soldiers are in great need of doctors. We have exhausted our supply. Our people at home have released more than they can spare. Our wounded are suffering. I charged my mind that my first request of your government would be — Send us Doctors. Can you do this?”

“Yes,” Martin replied eagerly, and he asked how many Balfour wanted. The Englishman asked: “Could you send us a thousand?” Martin answered: “Two thousand.” [11]

Six base hospitals were immediately selected for mobilization. As Balfour requested, they would be sent ahead of American fighting forces and directly to the aid of the British. Each consisted of a fully equipped 500-bed unit staffed by at least twenty medical officers and an even greater number of nurses. Although totally unprepared for war, the six selected units were quite proud of the honor. Common opinion in medical circles regarded these units as the best representatives of the medical and nursing profession in the United States. [12]

Base Hospital 21, at Washington University, was one of the first six units. While relatively well prepared, it lacked only commissions, orders, uniforms and enlisted personnel. Uniform kits hastily were ordered from Indianapolis, and the local St. Louis newspapers ran full-page advertisements for enlisted men. As Arthur Proetz remembered, “all sorts of people” answered the ads. “The citizenry was pretty well roiled up over the U-boat atrocities, a perfect recruiting medium supplied by the enemy at just the right moment, as the angry young men rushed in regardless of military status.” [13] Within a few days the roster was complete. For stretcher carriers the unit had a banker, a barber, a professional gambler, a number of businessmen, six medical students, a surgical instruments salesman and an incipient rabbi who was never known by his messmates as anything but “Deacon.” [14]

The slow arrival of the uniform kits actually delayed the sailing date of the unit, a date which became more competitive among the first six units with each passing day. Later, Arthur Proetz related, he did not know what blissful ignorance had kept him from jumping out of his skin as he sat around waiting for uniforms, orders and commissions. When the uniform kits did arrive, their contents provided more than a little joking and merrymaking. They contained water bottles, shoes, blankets, candle lanterns, bedding rolls and spurs. The leather puttees puzzled everyone, especially distinguishing right from left, and some never did. All in all, “it was like dressing up for a show and the men strutted about self-consciously trying not to laugh at themselves and one another.” [15]

Finally the officers’ commissions arrived and the unit formally was placed under the military command of Major J. D. Fife of the regular Army Medical Corps. Fife was one of the few non-local men added to lend a military atmosphere to a unit which had never suffered a drill. The unit consisted of 28 officers, 65 nurses and 185 enlisted men. [16] Marshall Joseph Joffre headed the French mission to the United States, which proposed to arouse sympathies among the Americans. He reviewed the unit in St. Louis and presented it with several flags – American. British and French – all donated by local citizen groups. After a consecration and farewell service at St. Louis’s Christ Church Cathedral, the unit left the next day, May 17, 1917, for New York.

Upon reaching the city the following evening, the unit immediately boarded ship, an old White Star liner named the St. Paul. There, it was greeted by Base Hospital No. 10 from Philadelphia, a group of orthopedic surgeons, a committee from the Red Cross busily passing out nurses’ uniforms and an “odorous curry and rice reception.” [17] The nurses’ uniforms consisted of a dark blue serge dress; a long, heavy, double-breasted, dark blue military coat; a dark blue felt hat with hat pins; caps; armbands and a heavy, dark brown blanket, “all of which looked very shipshape although a little somber.” [18] The curry and rice reception gave a perfect climax to the “gorgeous Pullman and Fred Harvey service” which the unit had received on the train to New York and provided “the last and best impression of an enlisted man’s view of the land of all good things.” [19]

The following morning, Saturday, May 19, 1917, just a month and a half after the United States had declared war, the St. Louis hospital unit steamed out of New York harbor toward the U-boat infested Atlantic. The “ancient tub” proved to be quite comfortable for the eight-day crossing. Armed fore and aft with a couple of cannons left over from the Spanish-American War and with the portholes screwed shut, the vessel offered no difference between the inside and outside rooms. [20] The officers and enlisted men found room enough on deck for all to have some regular drill everyday. Much to the delight of the spectators and perhaps, even to those participating, the nurses incorporated some setting-up exercises along with the military drill. The doctors found themselves trying to stand on shipboard on one foot while raising the other knee and hoping all the time a swell would not arise. By the end of the voyage even the “fat doctors” had acquired more or less proficiency in lying down on their stomachs and getting up very fast. [21]

After an uneventful voyage, the St. Paul docked at Liverpool early in the morning of May 28. Both the Philadelphia and St. Louis hospital units were dispatched immediately to training centers for short courses in British medical procedures. The enlisted men and a few officers were sent to Blackpool, the Royal Army Medical Corps training center. The remaining officers and nurses went on to London for a two-week conditioning course on the medical tragedies of war. Perhaps the seriousness of their situation was offset by a round of receptions, teas and theater performances. One day might have been spent discovering how 1,700 war-handicapped young men were learning new occupations in an attempt to return to civilian life, while that same evening officers and nurses might have attended a musical comedy performed on the London Stage. [22]

Receiving more specific orders in England, Base Hospital No. 21 was assigned to No. 12 General Hospital of the British Expeditionary Force. To prepare for the tasks ahead, the Washington University medical group observed the methods used in British military hospitals. The St. Louis group, however, did not know that their unit, equipped to handle a 500-bed hospital, had been scheduled to take over a 1,300-bed hospital, in tents, on a racetrack near Rouen, reputed to be the wettest spot in Europe.

After two weeks of hospitals, receptions, teas and reviews, the officers, nurses and enlisted men of Base Hospital 21 met together again at Southampton. That same rainy night they crossed the channel in a large hospital ship and early the next morning steamed noisily into the harbor of Le Havre. The luggage was unloaded, but the unit remained on board for breakfast while suspense concerning their destination began to mount. Wounded soldiers were brought on board for their trip back to “Blighty.” [23] The lunch bells had just sounded when, without warning or lunch, the nurses were ordered off the ship and into the motor ambulances which had transported the wounded soldiers. Two medical officers were sent along, for protection, and/or moral support. The rest of the unit ate lunch and dinner and the complete round of meals the next day, still pondering their destination and wondering what had become of their nurses. After dark and without warning, but with some relief, they were ordered off the ship and experienced the dubious pleasure of their first ride on a French troop train. By morning their apprehension was finally calmed when they were welcomed by their nurses at Rouen, France. [24]

Rouen was the center of the southern line of British hospitals in France. Fourteen base hospitals in the vicinity, among them B.E.F. No. 12, served as receiving stations for the wounded mainly from the area of the Somme. After treatment at one of these base hospitals, the British wounded were evacuated down the Seine to England; the French, and later American wounded, were sent to Southern France. B.E.F. General No. 12, to which the St. Louis unit had been assigned, was one of the earliest British hospitals established in France. It had been situated on the racetrack, the Champs des Courses, at Rouen since August 1914, with the exception of one brief period during that first year when an advancing German army forced it to flee down the Seine River. The sandy, gravel-covered ground of the racetrack provided the best drainage in Rouen for a 1,300-bed hospital built in the midst of the rain belt of the Seine Valley. Even the local cards described the town as the “pot de chambre de France.” [25]

As the doctors and enlisted men from St. Louis looked about that June 12 morning they saw only an establishment of moss covered bell tents illuminated by comic candle lanterns. Only two huts of about 30 beds each and a small ward of 10 beds attached to the operating room accommodated patients not under canvas. These facilities would prove to be marvelous in spring and summer. However, the one stove in each tent hardly provided sufficient heat to keep the patients, doctors or nurses warm in winter. The water inside the tents froze every winter night despite the fire in the stoves. Often the day nurse’s first duty in the morning was to thaw the solutions and medicines in the bottles before she could administer them. [26]

The permanent buildings of the racetrack, such as the pavilions, paddocks and cafe, had been put to use, but for administrative purposes rather than patient care. The hospital office was located in the racetrack office, the laboratory in the Post de Police, the office of the commanding officer in a Vestarie under a pavilion and the officers’ mess in the Salon. The medical officers had established quarters outside the pavilions in small bell tents, similar to those used for the wounded. The racing turf remained free of buildings until later in the war. With a surrounding line of trees, it gave a picturesque appearance to the hospital and served as an excellent ground for tennis, cricket and other ball games, as well as drills and parades. Grass covered the ground between the tents and flowers bloomed here and there. The British attempted to make the surroundings in all military hospitals as pleasant and attractive as possible. Thoughtfully given special attention, the nurses were ensconced in wooden huts located inside the protective barrier of the paddock fence.

As soon as the Washington University unit arrived, the British hospital staff withdrew. This left the 1,300-bed B.E.F. hospital in the hands of an American medical team set up to handle 500 beds. Virtually the first order of business after unpacking was to send for reinforcements from Washington University via the proper channels. Temporarily, the British did leave several voluntary aids and enlisted corpsmen with the hospital, but no doctors. The British commanding officer also stayed on for a few weeks in order to familiarize the Americans with the British hospital administrative procedures. When he left, the American commanding officer, Major J. D. Fife, became, for all intents and purposes, a British commanding officer. British military authorities regarded him as such. Two other British officials remained with the unit throughout the rest of the war to serve as registrar-liaison officer and quartermaster. The technical and medical aspects of the hospital administration continued to he handled by the British. Medical records were kept on British forms, with a duplicate set on American forms for each American patient. American patients amounted to only 4 ½ percent of the total patient load for the base hospital during the entire war. With few exceptions the British furnished all medical and surgical supplies and all rations and fuel. However, Americans paid the staff and personnel, kept their own quartermaster department and handled all military procedures and decisions. This unusual arrangement, between the British and Americans, proved cumbersome at times. Because of severe British needs, these arrangements existed throughout the war.

Although chronically understaffed, Base Hospital 21 developed new procedures, methods and techniques. The developments, plus the staff’s efficiency, kept the hospital functioning remarkably well throughout the war. Fortunately, during the summer of 1917, right after the Americans took over, the fairly light patient load at the hospital gave the unit ample time to adjust to war conditions. The wounded usually arrived in large groups, at night, after a long train ride from the battle zone. The men were not labeled according to the nature of their wounds, but this posed few problems during periods of light fighting. During heavy fighting with numerous casualties, however, it proved inefficient. Towards the end of the summer, as the fighting and the patient load increased, advance casualty clearing stations provided an answer to the problem. These stations screened the wounded and labeled them according to type of wound, administered emergency care to the critical and, when possible, assigned all patients to an appropriate base hospital. Each base hospital, on rotation, was responsible for staffing these casualty clearing stations.

During the Flanders offensive in the fall of 1917 several doctors from Base Hospital 21 served in casualty clearing stations with advance British fighting units. The front line experience of the St. Louis doctors proved particularly valuable in helping them to refine the procedures used at the racetrack. [27] Essentially two different techniques were needed, one for the ambulatory wounded and one for the stretcher wounded. Although more of the wounded from Flanders were evacuated through the northern part of the British lines, the Rouen hospitals experienced a sudden rise in admissions resulting from the German drive toward Amiens in spring 1918. Since most of the fighting occurred during daylight hours, the wounded generally arrived at the base hospital at night. Most of them had been screened at the clearing stations and labeled. Usually the ambulatory wounded had received dressings or splints for their injuries and had been sent right along to the base hospital wearing the same clothing in which they had been fighting. They arrived dirty and often infected with vermin. Instead of assigning them directly to a ward, as the British had done, the Americans required all ambulatory wounded to enter the hospital through the bath house doors. There they stripped of clothing, devermined, bathed and reclothed in a hospital suit of heavy blue material. Only then did they go off to bed and a much needed rest. They were not examined, nor their dressings changed until morning. About 100 patients an hour could pass through the bath house, when the water was warm. The next 100 patients waited an hour for the water to reheat. [28]

In the case of the severely wounded, early diagnosis proved essential to the patient’s survival. Under the British system, the stretcher wounded also had been taken directly to the wards, bathed and reclothed. Often hours went by before a doctor saw him again. The Washington University doctors quickly realized that both diagnosis and treatment had to be speedily expedited, particularly during heavy patient load. Consequently, instead of taking stretcher wounded to tents, they were routed directly to the X-ray hut. There, Captain Edwin C. Ernst, with the aid of the Royal Engineers, German carpenters from a nearby prison camp and his own scavenging, had designed and constructed the best and safest fluoroscopic apparatus in the Rouen area. The operators’ hands, feet and body never contacted the roentgen rays, an unusual precaution for the time. [29] The attendant placed the stretcher and patient on two wooden horses. A foot-controlled, roller-bearing, lead-lined X-ray tube holder, otherwise called a trochoscope, sat between the two wooden horses. As the examiner’s hands placed a lead-rubber strip against the patient’s body in the region to be examined, his left foot guided the trochoscope to the proper spot beneath the stretcher. His right foot then held the base of the unit steady for a fluoroscopic examination. Immediately thereafter his left foot shifted the upper carriage, which held the tube, a fixed distance of 10 centimeters. That way he could make a double exposure on the fluoroscope during a single examination – one on a bony landmark and one on the foreign metallic fragment. Their relationship, based on the 10 centimeter displacement shift, cut the time to localize a foreign body from minutes to seconds. [30]

After taking X-rays, the examiner classified the seriousness of the soldier’s wound, pinned a report on his tunic and sent him off to an adjoining operating room. There five surgical teams efficiently shared three nurses and three orderlies. A surgeon and an internist reviewed the fluoroscopic report and made a final assignment. The emergency cases required immediate operation. Other, less serious cases were deferred until the emergency load cleared. The less seriously wounded were rerouted immediately to other hospitals. The English stretcher wounded, diagnosed as non-operative cases were sent home to “Blighty”; the French and Americans were sent to southern France.

This method of expediting the care of the stretcher wounded, which Base Hospital 21 developed, actually showed that patients suffered less pain and trauma when examined on their original ambulance stretchers. It also avoided unnecessary congestion in the wards by classifying the patients before assignment to a hospital bed. However, the most significant contribution to wartime medicine was the roentgenological apparatus. For the first time, a simply designed, portable X-ray machine, safe in both direct and secondary roentgen exposure, had been designed for field work. The extent to which the hospital made use of Dr. Ernst’s equipment may best be realized from the fact that Base Hospital 21 used more X-ray plates than all the other base hospitals of the A.E.F. combined. [31]

Base Hospital 21 treated military patients with all types of diseases. The A.E.F. had designated it the center for neurological disorders in the Rouen area. Therefore, it handled a great variety of war neuroses cases, often as many as 250-300 at a time. [32] The operating room arrangement, whereby the chief surgeon could direct five tables at once, accommodated a large number of surgical cases. For example, during one offensive the hospital averaged sixty operations a day. In addition to the neurological and surgical patients, the other most common medical problems handled by the base hospital included trench fever, bronchitis, gassing and, in the fall of 1918, influenza. Only during the influenza epidemic did the institution function as a base hospital; influenza patients were kept until they recuperated or died. [33]

At all other times the hospital functioned as a clearing station. Patients were moved as soon as their condition permitted. During the last German offensive in the west and the allied counteroffensive, many patients came directly from the battlefields, because several of the casualty clearing stations had been lost. Sometimes the “turn-over” rate ran more than 500 a day. One day of extremely heavy fighting, admissions and discharges went up to 930. The grandstands, recreation huts and other available areas provided space for the wounded. During its 18 months in Rouen, Base Hospital 21 handled over 60,000 patients. [34]

More efficient procedures and new techniques primarily accounted for the unit’s ability to handle such a large number of wounded. Medically trained reinforcements from Washington University also provided a necessary component. They had arrived in Rouen, November 1917, before the heaviest fighting of the war. The nine doctors, 29 nurses and 47 enlisted men supplied welcome additions and replacements for original staff transfers. Vainly, the medical school at Washington University attempted to have a few original unit members released for teaching duties. The chief nurse and five of the higher ranking doctors, who had won wide recognition for their particular competence, were transferred to administrative or laboratory positions with the A.E.F. Even Major Fife, the only member of the unit from the regular army, moved to the A.E.F. Chief Surgeon’s Office. Dr. Murphy, who had directed the medical work, succeeded him in military command. Murphy later transferred to the A.E.F. and subsequently became head of the medical and surgical service of the Red Cross. Major Borden Veeder’s appointment as commander of the unit finally quieted the clamor from Washington University. If a specialist like Veeder, a pediatrician, proved more valuable on the front lines than at home, there would be no hope for the return of internists and surgeons. [35]

Several fourth-year medical students who had been part of the original group of enlisted men filled gaps in the medical strength of the base hospital. Their instruction had been of quite some concern to the medical school. However, they had been given on-the-spot discourses by the displaced faculty, in addition to receiving a tremendous amount of clinical experience. In March 1918, they officially were graduated “in abstentia” from Washington University School of Medicine. [36] After a course at the Sanitary Training School, they received commissions in the medical corps and assignments with their own unit.

Although the stress of war kept the St. Louis group constantly at work, their unusual situation, in the midst of British forces occasioned considerable socializing as well as necessary constant readjustments. Hardly any American entertainment groups reached the racetrack. However, concert and theater huts in the camp helped develop an interest in amateur theatricals. The men organized a jazz orchestra and gave a number of concerts. Of course, they had a few opportunities to parade on the racing turf when official dignitaries inspected the hospital. Socializing with the French in their homes was not officially open to Americans until after the armistice. As special thank yous following the end of war, the French invited the American doctors to teas and musicals. Base Hospital 21 joined with the group from Cleveland and reciprocated with a special dasant shortly before they left Rouen.

After the armistice on November 11, 1918, the hospital continued to function as it had during the war, however, it now cared for sick and repatriated prisoners of war. At the end of January 1919, the last of the patients were discharged or transferred and the hospital began to demobilize. All hospital and medical equipment was returned to the British. The nursing staff dispersed. Some remained in France, others, in the Army of Occupation, went to Germany; the rest were sent to the Vannes Hospital Center in Brittany where the American medical personnel gathered in preparation for their return home. The enlisted personnel and medical staff also went to Vannes, but accommodations had not been prepared ahead of time. Since there was no place for the men to stay, part of the unit resided in the Grand Hotel at Carnac-Plage on the Brittany coast and part in the monastery at Pleuharnel. After several weeks of awaiting orders, cleaning and preparing quarters for future units, the St. Louis group was sent on to Brest. They spent another two weeks there, finally embarking on the German armistice ship, the Graf Waldersee. Certainly their demobilization had not been conducted with the same urgency as their mobilization.

The Red Cross base hospitals had constituted the backbone of the American hospital service in France. Ultimately 36 Red Cross-organized base hospitals served there. After the war the surgeon general’s office sought to keep these units intact. Consequently, unit 21 formed a base hospital association at Washington University. In the interval between the wars the association functioned chiefly as a pleasant social organization in which everyone held an equal rank. At the beginning of World War II, it was reorganized as the 21st General Hospital with aspirations to carry on the traditions of its predecessor. It began, and remained throughout World War II, as the largest single medical organization in the U.S. Army.

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Published by the Bernard Becker Medical Library