Crisis, Community, and Connections: 1918 and 2020

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This is a guest post by Aaron J. Jackson, M.A, Ph.D. Candidate, UCSF History of Health Sciences.

From time to time, events in the present so closely resemble events from the past that the aphorism “history repeats itself” seems feasible. This can be demonstrated by comparing the current crisis of the novel coronavirus with the influenza pandemic of 1918-1919. The similarities are compelling. Like the SARS-CoV-2 coronavirus, the variety of H1N1 influenza that swept across the world in 1918 and 1919 produced a significant shock. It spread like wildfire, was frustratingly resistant to contemporary therapeutics, exhibited novel characteristics, and forced governments to resort to what some considered to be heavy-handed public health interventions. Bay Area residents in 1918 were required to wear masks and practice social distancing, just as they are required to do so today. Such historical similarities are not, however, proof that history repeats itself. But they do provide interesting opportunities for comparison between the past and the present—opportunities that hold the potential to make the past more relatable by building connections through common circumstances. And perhaps, through that understanding, an opportunity for hope to shine in dark times.

This post is not an exhaustive study comparing 1918 and 2020. Rather, it focuses on responses to crises and specifically the ways that communities innovatively addressed shortages of personal protective equipment (PPE). So, of course, it will be about war, pandemics, socks, and sheet protectors. Naturally.

When the United States declared war on the Imperial Government of Germany in April 1917, the nation was woefully unprepared for the conflict. The war represented an unprecedented crisis—one that required the federal government to assume new powers in order to coordinate the resources of the entire nation. President Woodrow Wilson’s administration worked with Congress to institute a draft to raise an army, enacted strict economic control measures to conserve and direct resources towards the production of war materiel, and passed laws that infringed on civil liberties, all in the name of the war effort. To ensure public support for these moves, the government mounted a massive propaganda campaign that appealed to a specific version of American patriotism, appealing to citizens’ sense of duty.

Mustering an army of sufficient size presented significant challenges. The men not only had to be inducted into military service—either by volunteering or being drafted—they required hundreds of training camps, transportation to those camps, equipment to train with, uniforms to wear. Once at the camps, they required food, shelter, and medical support. Military training was and remains a dangerous business, but the most significant medical problem at the cantonments was disease.

Base Hospital No. 30 “Officers and Enlisted Personnel” from the Woolsey (John Homer) Papers, MSS 70-5, UCSF Archives and Special Collections
Base Hospital No. 30 “Officers and Enlisted Personnel” from the Woolsey (John Homer) Papers, MSS 70-5, UCSF Archives and Special Collections

As tens of thousands of American recruits assembled at Army camps across the United States, they unwittingly brought diseases with them, which found ample opportunity to spread in cramped camp conditions. Most of these infections fell into the category of “common respiratory unknown disease”—an unofficial designation among military recruits who learned to add C.R.U.D. to the lexicon of military acronyms they learned. The crud largely consisted of the common cold and other respiratory infections, but cases of measles, mumps, and chicken pox were also common. Most cases of the crud cleared up without need for treatment, but the prevalence of these infections and the fact that new waves of infections would spring up with every new trainload of recruits had the effect of masking a more dangerous threat. Army physicians first identified more than 100 soldiers who had developed a rather severe flu-like illness in March 1918. Within a week, the number of flu cases at Fort Riley was over 500 and climbing. The H1N1 virus that caused the influenza pandemic of 1918-1919 had arrived, but the nation was focused on the war. And as American troops began arriving in France and moving into the front lines—many of them no doubt bringing the virus with them—medical personnel tasked with supporting the war effort shifted their focus from induction screening and camp illnesses to other health concerns.

The First World War introduced a bevy of new ways to mangle and maim human bodies. From high-velocity rifle rounds and machine guns to high-explosive artillery shells, flamethrowers, hand grenades, aerial bombardment, and chemical weapons, the U.S. Army Medical Corps understood that the hospital system it established in France had to be prepared first and foremost for trauma care, which posed significant challenges. Not only did modern weapons cause extensive damage, the risks of sepsis and gangrene in an era before the discovery of antibiotics were high. Complicating this, European battlefields tended to stretch across agricultural land, teeming with bacteria after years of fertilization. Soldiers wounded on the front lines thus ran an extremely high risk of bacterial infection. To address this, the Medical Corps and its affiliates prioritized training Army health care workers in antiseptic wound care.

"U.S. Army Base Hospital No. 30, World War I (University of California School of Medicine Unit)," from The Thirtieth, AR 207-16, UCSF Archives and Special Collections
“U.S. Army Base Hospital No. 30, World War I (University of California School of Medicine Unit),” from The Thirtieth, AR 207-16, UCSF Archives and Special Collections

The experiences of the personnel of Base Hospital No. 30 are instructive in this regard. Base Hospital Thirty was the military hospital unit assembled from physicians, surgeons, and nurses associated with the University of California’s School of Medicine—the precursor to UCSF. Organized with the help of the American Red Cross Society shortly after Congress declared war, the unit spent more than a year training for the anticipated challenges of running a hospital for wounded soldiers in France. The unit’s nurses received orders to depart San Francisco on December 26, 1917 and reported to Army cantonment camps along the East Coast to help care for soldiers who had fallen ill with the crud, gaining invaluable experience in nursing soldiers and recognizing disease presentation. The unit’s surgeons practiced the ancient technique of wound debridement—removing foreign objects and cutting away dead and dying flesh to produce a clean wound—and attended clinical instruction that prepared them for the types of injuries they would face. And the unit’s corpsmen trained in the production and use of the Carrell-Dakin solution, a novel antiseptic more effective than carbolic acid and iodine but also a solution that required careful training and preparation. Thanks to training like this, the base hospital system was able to treat more than 300,000 sick and wounded soldiers with remarkably low mortality rates compared to previous wars.

Indeed, the medical apparatus and personnel organized to support the American Expeditionary Forces were well prepared for the anticipated hazards of the war. But in one of the remarkable parallels to the current coronavirus crisis, their job was perhaps made more difficult by the failure of American logistics in providing adequate personal protective equipment. But the shortage in 1918 was not one of N95 masks; rather, it was a matter of needing socks.

From left to right: “American Red Cross: Our boys need sox; knit your bit,” Hoover Institution Digital Collections; “You can help: American Red Cross,” Charles B. Burdick War Poster Collection, San Jose State University, Special Collections and Archives; Cover of the Priscilla War Work Book, Library of Congress, digitized by the Internet Archive.
From left to right: “American Red Cross: Our boys need sox; knit your bit,” Hoover Institution Digital Collections; “You can help: American Red Cross,” Charles B. Burdick War Poster Collection, San Jose State University, Special Collections and Archives; Cover of the Priscilla War Work Book, Library of Congress, digitized by the Internet Archive

Today, the Occupational Safety and Health Administration defines PPE as “equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses.”[i] Under this definition, and in the context of soldiering, a good pair of socks certainly applies. Trench warfare was a dirty business. It also tended to be cold and wet—the perfect climate for a condition known today as “trench foot.” Afflicted soldiers’ feet would go numb, swell, develop sore and infections, and in extreme cases become gangrenous, possibly requiring amputation. Obviously, this ran the risk of keeping soldiers from the front lines and thus undermining the war effort. But ensuring a plentiful supply of clean dry socks somehow slipped through the cracks of the Army’s logistical efforts to prepare for the war. Fortunately, the American Red Cross and thousands of civilian volunteers found ways to meet the challenge.

Beginning in 1917, the Red Cross put out calls for knitted garments, especially socks. The organization distributed officially-endorsed knitting patterns and free wool to anyone willing to “knit your bit.” The Priscilla War Work Book contains roughly a dozen such patterns ranging from socks to coats and winter hats.[ii] But the demand was greatest for socks. Across the country, knitters worked individually at home and collectively in social groups to try to keep up with the demand. Those who could not knit were urged to purchase or donate wool for the cause. Some organizations turned to mechanical solutions. The Seattle Red Cross utilized a knitting machine to produce long wool tubes that could be cut into 27-inch lengths, requiring only the toes to be stitched by hand.[iii] In this way, those behind the front lines were able to support the war effort by providing the PPE the soldiers needed to keep themselves in fighting shape.

Celebrating the end of the First World War in San Francisco, November 11, 1918. Image from The San Francisco Chronicle files.
Celebrating the end of the First World War in San Francisco, November 11, 1918. Image from The San Francisco Chronicle files.

Celebrating the end of the First World War in San Francisco, November 11, 1918. Image from The San Francisco Chronicle files.

The knitting campaign continued until the war ended with the declaration of the armistice on November 11, 1918. By then, the nation was in the midst of the first wave of the influenza pandemic. On October 9, 1918, San Francisco’s hospitals reported 169 influenza cases. A week later, there were more than 2,000 and the city’s Board of Health issued recommendations for social distancing.[iv] With so many health care professionals supporting the war effort, the Bay Area’s medical infrastructure was stretched to the limit and cities put out calls for volunteers. Hospital space soon became a valuable commodity and many facilities, including the Oakland Municipal Auditorium, were converted into temporary hospitals, and public health officials began recommending the use of face masks, which they later made mandatory.[v] But it is important to remember that these were local efforts to respond to the pandemic. The federal government, which had mustered the resources of the entire nation to fight the war in Europe, was unwilling to do the same to combat the pandemic at home, leaving it up to local authorities, medical institutions, and volunteer organizations to make do as best they could.

Celebrating the end of the First World War in San Francisco, November 11, 1918. Image from The San Francisco Chronicle files.
“Oakland Municipal Auditorium is used as a temporary hospital,” 1918, Oakland Public Library

Unfortunately, we find ourselves in a similar situation today. As the novel coronavirus took on pandemic proportions, stores of PPE for frontline healthcare workers reached critical levels. Before the pandemic, China produced approximately half the world’s supply of medical masks. As the infection spread in China, their exports stopped, and the resulting shortage spurred competition between institutions and governments to secure PPE, which only exacerbated the situation. Thankfully, a multidisciplinary team at UCSF found a way to be a part of the solution, echoing the efforts of American knitters from over a century ago.

Left to right:  UCSF shield frames,; A completely assembled UCSF face shield;  Dr. Alexis Dang wears an assembled face shield over a N-95 respirator. For additional information please read the UCSF Library Makers Lab story.
From left to right: UCSF shield frames,; A completely assembled UCSF face shield; Dr. Alexis Dang wears an assembled face shield over a N-95 respirator. For additional information please read the UCSF Library Makers Lab story. UCSF Library Makers Lab Left to right: UCSF shield frames,; A completely assembled UCSF face shield; Dr. Alexis Dang wears an assembled face shield over a N-95 respirator. For additional information please read the UCSF Library Makers Lab story

Noting the need for face shields, experts at UCSF specializing in biochemistry, engineering, logistics, medical workplace safety, and 3D model design came together in March 2020 to develop something that could help address the PPE shortage. By April, the team completed designs for three different models of 3D-printable face shield frames that, when combined with rubber bands and transparent document protectors, serve as functional and reusable face shields. They then collected seventeen 3D printers from across the university and turned the UCSF Makers Lab in the Kalmanovitz Library into an ad hoc face shield factory that can produce more than 300 shields each day—enough to supply UCSF’s front-line health care workers and then some.[vi] Extra shields are distributed to Bay Area hospitals. Moreover, like the Red Cross with the distribution of the Priscilla War Work Book, the UCSF team is sharing their plans in an open source repository so that others can emulate their efforts.[vii] This allows those with access to 3D printers and a few dollars’ worth of office supplies to contribute to the ongoing PPE shortage by producing face shields that have been designed, tested, and vetted by experts at one of the nation’s leading medical institutions.

Certainly, there are remarkable similarities to be drawn between the modern crisis and those in the past. Once again, the government was unprepared for a crisis despite advanced warning. Once again, people are working in the front lines to save others despite inadequate supplies. And once again, like the First World War and the influenza pandemic of 1918-1919, the coronavirus pandemic is a devastating event likely to be measured in the tally of lives lost. In the face of such grim statistics, it is easy to fall into cynicism and say that history is repeating.

In 1905, philosopher George Santayana explored the notion of progress—the idea that things move toward improvement—and stated that “those who cannot remember the past are condemned to repeat it.”[viii] This is likely the origin of the aphorism “history repeats itself.” But Santaya was not making a hopeless argument; rather, he noted that if progress is to be achieved, it will be because humans not only record the past, they engage with it, learn from it, and seek to understand it. And how that is achieved depends on the ability to draw relatable connections with the past that emphasize human agency. In 1918, knitters took up their needles. Today, a team of scientists, engineers, and others figured out how to make face shields using 3D printers and office supplies. These may seem like small contributions in the grand scheme of things, but they are important examples of positive human agency in the face of crisis.


[i] Occupational Safety and Health Administration, “Personal Protective Equipment.” http://osha.gov/SLTC/personalprotectiveequipment/

[ii] Elsa Schappel Barsaloux and the American National Red Cross, The Priscilla War Work Book: Including Directions for Knitted Garments and Comfort Kits from the American Red Cross, and Knitted Garments for the Boy Scout. Boston, Mass.: The Priscilla Publishing Company, 1917. Available at the HathiTrust Digital Library. https://hdl.handle.net/2027/loc.ark:/13960/t2988wd21

[iii] Paula Becker, “Knitting for Victory – World War I,” Historylink.org, 2004. https://www.historylink.org/File/4721

[iv] “Thirty-Seven New Cases Found in S.F.,” San Francisco Chronicle 10 Oct. 1918, 3; “Hassler Urges Churches and Theaters to Close,” San Francisco Chronicle 17 Oct. 1918, 5.

[v] “Wear a Mask and Save Your Life!” San Francisco Chronicle, 22 Oct. 1918.

[vi] Robin Marks, “Lifesaving Face Shields for Health Care Workers are Newest 3D-Printing Project at UCSF,” University of California, San Francisco. April 7, 2020. https://www.ucsf.edu/news/2020/04/417101/lifesaving-face-shields-health-care-workers-are-newest-3d-printing-project-ucsf

[vii] Jenny Tai, “UCSF 3D Printed Face Shield Project,” UCSF Library, April 1, 2020. https://library.ucsf.edu/news/ucsf-3d-printed-face-shield-project

[viii] George Santayana, The Life of Reason. 1: Reason in Common Sense, Reprint (New York: Dover Publications, 1982), p. 284. Available at the Gutenberg Project. https://www.gutenberg.org/files/15000/15000-h/15000-h.htm

Base Hospital No. 30, One Hundred Years Later – Part Three: The Work of the Hospital

This is a guest post by Aaron J. Jackson, PhD student, UCSF Department of Anthropology, History and Social Medicine.

One-hundred years ago, the First World War raged into its fourth year. Millions perished in the conflict as the armies of the “civilized” nations applied industrial efficiency to the brutality of warfare. The first weeks of conflict in 1914 shattered traditional conceptions of war. While battlefield success once depended on the ability to field more and better-trained men, the machines of the modern age leveled numerical and soldiery advantages. These new weapons wreaked death and destruction on unprecedented scales and forced the survivors to dig defensive trenchworks that quickly stretched from the Alps to the English Channel along Germany’s Western Front. A deadly stalemate ensued as opposing armies attempted to cross the no man’s land between the trenchworks, often suffering enormous losses in futile assaults. The war became one of attrition and soon caught civilians in its machinations as the richest economies in Europe quickly drained their resources into supplying the war machine.

The entry of the United States into the war in 1917 promised a glimmer of hope for the Allies that they would finally be able to overwhelm the Germans, but it would take time for the enormous resources of the unscathed Americans to be brought to bear. Meanwhile, the Russian collapse in March 1918 presented the German High Command with an opportunity to break the stalemate and deliver a knockout blow before the Americans could fully mobilize by shifting more than fifty divisions of troops from the Russian frontier to the Western Front. The Kaiserschacht, or Spring Offensive, would be the largest German assault of the entire war, with more than three million soldiers poised to break through the Allies’ lines and force a peace on German terms.

Figure 11 – Group photo, nurses and soldiers, World War I.

Meanwhile, the men and women of U.S. Army Base Hospital No. 30—the University of California School of Medicine Unit—arrived in France with the expectation of providing expert medical care to the soldiers wounded on the front lines. The hospital unit ostensibly formed before Congress officially declared war on April 6, 1917, and they spent more than a year gathering supplies and personnel, raising funds, navigating the Army bureaucracy, training in the latest medical techniques and military drills, and traveling to France where they expected to set up a hospital and get to “the work” of caring for the wounded. What they found in France, however, was the Herculean task of converting an ancient resort town in the Auvergne Mountains into a modern hospital.

This entry, the third of four planned posts, will cover “the work” of Base Hospital No. 30. After the arrival of the first patient train in June 1918, hospital personnel worked around the clock caring for thousands of sick and wounded soldiers—many of them surgical cases—right through the Armistice of November 11, 1918. These stories are derived primarily from materials kept at the UCSF Archives & Special Collections at the Parnassus Library in San Francisco, and it is with great appreciation to the archival staff there that I write about the experiences of the men and women of the University of California School of Medicine in the Great War. If you have not read them yet, please take a moment to read Part One: Organization, Mobilization, and Travel and Part Two: France for the context they provide.

Figure 12 – Fighting in Belleau Wood.

The German army began the Kaiserschlacht in March 1918 with a massive artillery barrage, dropping more than one million heavy shells on the Allies’ trenches followed closely by lightning-fast stormtrooper assaults to break through opposing lines and create gaps that could be exploited and held by masses of infantry. This strategy allowed the Germans to break the stalemate that had dominated the Western Front since late 1914 and gain ground. They repeated their process in five separate assaults between March and July, gaining enough ground to put Paris under threat.

By June, as the offensive approached the Marne River, American troops including elements of the U.S. Marine Corps rushed to form defensive lines to hold back the Kaiser’s troops at Belleau Wood near Chateau-Thierry. As the Marines dug hasty defensive positions, retreating French troops warned them of the coming Germans and encouraged the Marines to fall back to better ground.

“Retreat? Hell! We just got here!” replied Captain Lloyd W. Williams of the 2nd Battalion, 5th Marines. Fighting from hastily-dug, shallow fighting positions, the Marines took advantage of an 800-yard long wheat field and their training as expert riflemen to halt the German advance and force the Kaiser’s forward elements to dig their own defensive positions in Belleau Wood and the nearby town of Bouresches. Having stalled the Germans, the Americans knew that they had to counterattack before the Germans could dig in too far.

On the morning of June 6, 1918, the Marines charged across the knee-high wheat fields separating them from the entrenched Germans. As they ran, German machineguns opened up, cutting down the charging Americans like the wheat through which they ran. German artillery rained down on the Marines with the high explosive shells shaking the ground and shattering bodies. Despite heavy losses, the Marines managed to reach the edge of the woods and the outskirts of Bouresches before their assault finally stalled, but they paid a heavy price. It was the costliest single day of fighting in the history of the Marine Corps to that date as 228 men gave up their lives and another 859 suffered wounds. And the fighting was far from over.

Over the subsequent twenty days, the Marines fought so fiercely to dislodge the Germans from Belleau Wood that they earned the nickname Teufel Hunden or “Devil Dogs” from their German opponents. The fighting was often hand-to-hand with artillery splintering the trees and filling the air with deadly wooden splinters in addition to shrapnel. Desperate to halt the American advance, the Germans deployed mustard gas, a chemical weapon that painfully blisters the skin, burns the eyes resulting in blindness, and inflames the lungs making breathing impossible if inhaled. As many as 2,000 Marines fell victim to the gas. By June 26, when the Marines finally secured Belleau Wood, they had suffered 1,811 killed and 7,966 wounded.

Figure 13 – Evacuating the Wounded.

The wounded began a journey through a tiered system of medical care established by the Army. The first stage consisted of regimental aid stations located just behind the front lines. Those who were able to do so walked to these stations while stretcher bearers carried the rest. Medical corpsmen and the occasional doctor would dress their wounds, send superficial cases back to the front lines, and coordinate the evacuation of the seriously wounded by motorized ambulance to the clearing stations and field hospitals located further behind the lines.

The field hospitals and clearing stations, while out of range of small arms fire, were often still within range of enemy artillery and aircraft. Despite these hazards, teams of nurses, doctors, and surgeons worked to stabilize their patients, clean their wounds, and prepare them for evacuation to the base hospitals located well out of danger. It was at these facilities that nurses would flush the eyes of gas attack victims with saline solution and surgeons would perform emergency surgeries under extreme conditions, often lacking proper supplies. The wounded who could be stabilized enough for the trip would then be loaded onto hospital trains for the journey to base hospitals like Base Hospital Thirty at Royat, five-hundred kilometers away from the front at Chateau-Thierry.

Figure 14 – The Hospital Trains.

When the first hospital train arrived at Base Hospital No. 30 on June 12, 1918, the hospital was not yet operational as the main kitchen installation was incomplete. Thankfully, the 360 patients aboard that first train were primarily convalescents who were able to help complete the preparations in time for the second train’s arrival on June 17. This second train held 461 seriously wounded patients from the fighting near Belleau Wood. Captain Earnest H. Falconer, Medical Corps (MC), described the scene for posterity in the pages of The Record:

On June 17 a train arrived in two sections, containing many gas cases…. These cases had been gassed on June 14. Many of them had severe skin burns, some comprising as much as one-eighth to one-half the total skin surface. In the more superficial burns the skin was a dusky purplish to reddish purple hue. The deeper burns were pale, translucent, edematous, with many blisters. In most cases serum was drained from blisters. The serum from these blisters was very irritating to the skin of the hands of the dressers, causing in some cases a mild dermatitis to be set up…. Nearly all these cases had burns on the scrotum and penis, which were painful and very slow healing. Also nearly all the cases had burns of the lids and conjunctiva, with occasional burns of the face and scalp. Many cases of bronchopneumonia were already present when the patients were admitted, and a number of these cases developed shortly after admission. These cases were nearly all fatal…. The cases with superficial burns healed for the most part very slowly. New skin formation progressed slowly, and the crusts that formed invariably contained pus beneath them.

Base Hospital Thirty consisted of 25 officers (all physicians), 65 nurses, and about 150 enlisted corpsmen. By June 18, they were treating 821 wounded soldiers, many requiring extra attention due to the nature of their injuries. The staff worked continually performing surgery, cleaning wounds, and feeding the patients, all the while continuing their efforts to improve the hospital’s infrastructure. Thankfully, the surgical cases in the first two trains were less taxing because their wounds had been debrided of foreign objects and dead and damaged tissue at the clearing stations and field hospitals. Amputations were dressed but kept open, allowing hospital staff to manage the healing process and maintain an aseptic wound environment. This was achieved through the Carrel-Dakin method, which involved applying diluted chlorine and bleach solution to wounds and dressings to prevent infections. It must have been an excruciating experience for the patients, but it worked to prevent deadly infections in the era before antibiotics.

Unfortunately, not all patients arrived in similarly good conditions. A train on August 21 contained men who had been kept in the clearing stations as medical professionals attempted to stabilize them enough for travel. They arrived with infected wounds requiring extensive debridement, additional surgery, and the occasional re-amputation of a limb to establish aseptic wound environments.

After the arrival of the first trains in June, hospital staff worked around the clock for months on end. Patient trains would arrive, usually and preferably with some notice, and the wounded would be carried by stretcher into the hospital and sorted. Surgical teams worked continuously, often without the aid of the x-ray machines for a want of electric power. The laboratory was similarly handicapped, making diagnosis and treatment that much harder for physicians. Nurses worked tirelessly to clean wounds, dole out medications, fill out charts, and keep a clean and ventilated environment. Corpsmen carried patients up several flights of stairs to their rooms, hauled water in buckets for want of proper plumbing, cooked meals in the kitchens and delivered them to non-ambulatory patients’ rooms, removed waste from the rooms, made new batches of Carrel-Dakin solution, worked to improve the plumbing and heating in the old hotels, loaded and unloaded hospital and supply trains, and somehow found a way to help keep the streets of Royat clean and the hotel cesspools from overflowing. There was so much work that ambulatory patients were conscripted to assist. And just when the hospital appeared to find its rhythm, events found a way to throw it off.

Figure 15 – The Influenza Pandemic of 1918.

On September 22, 1918, when the hospital was near full capacity, a train full of French patients arrived in the middle of the night without prior notice. Due to the hour, the hospital staff decided that the best course of action was to distribute the new patients throughout the hospital wherever a spare bed could be found. Unfortunately, they discovered that practically all the new patients were suffering from acute respiratory infection. Distributing them through the hospital into crowded rooms exposed other patients as well as the staff to infection.

By the end of September, as many as 40 of the 150 enlisted men assigned to Base Hospital No. 30 had to be hospitalized themselves, and many officers and nurses were also afflicted to a milder degree. Five corpsmen and one officer died from their infections, and as the epidemic spread among neighboring units, the hospital’s local admissions amounted to between 30 and 70 new patients a day. Making matters more difficult, the hospital’s laboratory officer and his assistants fell ill, necessitating a suspension of investigative work on the mysterious disease. Autopsies of the first victims indicated the cause of death to be pneumonia developed as a complication following a likely infection of influenza. The hospital staff could do little to combat the contagious disease other than to reorganize the patients to attempt to hinder its spread.

While Base Hospital Thirty dealt with its share of the Influenza Pandemic of 1918, they received orders to expand the hospital to accommodate anticipated casualties from the ongoing Allied counteroffensive. The Germans’ kaiserschlacht floundered in July and the Allies, their numbers and supplies flush with fresh American troops and materiel, had been pushing the Germans back ever since. Base Hospital No. 30 officers examined potential sites for expansion in Royat and completed leases for new buildings in September. They established another surgical unit and moved their administrative offices into the Royat Palace Hotel on September 26. The new buildings allowed them to finally abandon the old “dungeon” kitchen in the Continental hotel and create a new kitchen in the Grand Hotel, which did not have the Continental’s cesspool problems. The new space also allowed for the creation of a dedicated ward for respiratory and enteric cases, freeing up space in the already-established portions of the hospital for surgical and bed-ridden patients.

Figure 16 – Patient wards at Base Hospital No. 30 in Royat, France, 1918-1919.

The hospital also expanded beyond adding new wards. Corpsmen built warehouses near the rail head to ease the burdens of transferring supplies and coal bunkers to provide a consistent fuel supply for heating the hospital as the days and nights grew colder. The Army assigned more corpsmen to the hospital staff, and the officers organized a small local labor force to help keep up with waste, garbage, and maintenance concerns. Perhaps the most welcome addition to the hospital’s roster was a section of Army engineers to finally improve the hospital’s water, sewer, and electrical supplies. Corpsmen would no longer have to haul buckets of water up stairs or worry about overflowing cesspools, allowing them to do the work for which they trained, and there was plenty of that to go around. By the end of September 1918, Base Hospital No. 30 had roughly 30 physicians, 60 nurses, and 250 corpsmen to take care of a 2,400-bed facility, and the combination of the war and pandemic ensured that the hospital continued to operate near capacity. Beyond the work in Royat, the UC Medical School unit also contributed surgical teams to support the effort of stabilizing the wounded near the front lines. Two such teams, each consisting of two surgeons, two nurses, and three corpsmen, set out for the front lines to work in field hospitals to provide surgical intervention to wounded men, often within only a few hours of their injuries.

Figure 17 – Members of Surgical Team 50: Weeks, Woolsey, Dunn & Ireland.

Surgical Team No. 50 was commanded by Lieutenant Colonel Alanson Weeks, who once played fullback for the undefeated 1898 Michigan Wolverines before moving to San Francisco to become a surgeon. Alongside Captain John Homer Woolsey, Nurses Agnes Dunn and Alta Ireland, and three enlisted men, Weeks set out for the front lines on June 6, 1918. The team arrived at the American Red Cross Hospital at Juilly (today on the northeast outskirts of Paris) at 3 p.m. on the 7th and his team was immediately assigned to an operating room and remained in surgery until 8 o’clock the following morning.  Dr. Weeks recalled the experiences of the team’s time at Juilly in The Record:

The wounds were very severe in type, many fractures and a high percentage were infected with “gas” bacilli. There were also 300 “gassed” cases who were first treated at this hospital. The sight of these gassed men, lying on stretchers and filling the entire courtyard—blinded, hacking, begging for water, for protection from the sunlight for their sensitive eyes, and for something to relieve their pain—gave all of us a craving desire to meet the Hun and kill. June 16 saw the end of this tremendous rush of wounded…. The Team operated for the most part at night and during its watch cared for all neurological cases and approximately a total of 240 wounded.

Surgical Team Fifty specialized in neurological cases, of which there were many. Due to the nature of trench warfare, headwounds were frighteningly common as the soldier’s head was usually the only part of his body exposed to enemy fire. But like all surgical teams, No. 50 dealt with all types of cases as they came in, often without much notice. Victims of gunshots, artillery shrapnel, high explosive shock, chemical weapons, and even bayonet wounds were common sights, and the work kept coming. The seventeen-hour shift the team worked on its first day at Juilly would become routine until the team returned to Base Hospital Thirty in late October.

Before Surgical Team No. 50 could return, Base Hospital No. 30 sent out another surgical team, No. 51, under the command of Major Herbert S. Thomson on September 10 to support the evacuation hospital at Toul, near Nancy to support the St. Mihiel offensive. Accompanying Dr. Thomson was Captain Homer C. Seaver, who had graduated from the University of California Medical School only weeks before deploying to France, along with nurses Adelaide Brown and Kathleen Fores and three corpsmen.

Shortly after arriving at Toul, Surgical Team Fifty-One was put to work and faced similar working conditions to their predecessors, working seventeen out of the first twenty-four hours. They only saw the most serious cases and had no opportunity to follow up on their patients. As soon as they finished working to stabilize one patient, orderlies would take him off the table and another patient would take his place. The pace of work and long days coincided with the military offensives as the team worked sixteen- or seventeen-hour shifts for a week during the St. Mihiel offensive. During the space between assaults, the teams often found themselves traveling to a new front to support a new offensive.

Imagine graduating medical school and within a matter of weeks finding yourself working 16-hour days, seven days a week, doing nothing but intensive surgery on the most severe trauma cases imaginable and not being able to follow up on the results of your work because there are so many patients waiting—and literally dying in the process—for you to save their life. Such was the medical residency of Dr. Homer C. Seaver.

Figure 18 – The Meuse-Argonne Offensive, September 26 – November 11, 1918.

In October, Surgical Team No. 51 received orders to support the offensive into the Argonne Forest. The fighting there resembled Belleau Wood. The Germans had been beating a slow retreat since June, but now that their homeland was imperiled for the first time of the war, they turned and fought hard. In his account of the event for The Record, Major Thomson described the work in the Argonne:

We were ordered from Toul to the Argonne Forest on October 8 and received transportation by ambulances to Evacuation Hospital No. 14, situated in the Argonne Forest near the village of Les Islettes. This hospital was situated in the heart of the Argonne Forest near the line of American advance and in a country that had been completely destroyed by the Germans in their former campaign. The hospital was entirely under canvas except for a small chateau which housed the nurses and senior officers. This country was very wet; it rained nearly every day and there was mud everywhere. The operating tent was pitched on the ground and for the first few days there was considerable mud on the operating room floor. In order to go from the operating room to the wards, one had to wade through about six or eight inches of mud. While at Les Islettes, the Team was busy all the time, working on the twelve-hour shift. There never was a time when anyone had a breathing spell as the triage was always filled with patients and there was frequently a line of ambulances waiting in the road. At this hospital, only the seriously wounded were treated and there was a very large number of gas infections. Many times, patients were brought in from two or three days after being wounded and a patient was rarely operated on within 15 hours of being wounded. At this hospital, we were near the German lines and were treated to the spectacle of anti-aircraft guns shooting at the German planes and could always see the observation balloons over the forest to the north. It was difficult to get supplies in this region and the hospital was rather poorly equipped. On the 25th of October the Team was ordered to return to Base Hospital Thirty.

Thus, the work of Base Hospital No. 30 continued throughout the long months from June to November 1918. Their commemorative book The Record demonstrates just how busy “the work of the hospital” really was by its absences more than its inclusions. The pages of The Record are filled with pictures from the hospital unit’s early days of organization, its travels to France, and its struggles to transform a resort town into a modern hospital. But it only includes a few pictures of “the work.” Perhaps this absence is due to the fact that everyone was too busy caring for their charges to be able to take pictures or jot down notes for posterity. Or perhaps the absence marks a time in the history of Base Hospital No. 30 that needed no commemoration in something like The Record because those who were there remember it well. Perhaps both possibilities are true.

Figure 19 – Armistice Declared, November 11, 1918.

Regardless, when the Armistice went into effect on the eleventh hour of the eleventh day of the eleventh month, and while the world breathed a sigh of relief at the end of the fighting, “the work of the hospital” at Base Hospital No. 30 and other hospitals throughout Europe and the United States continued at a frantic pace. For weeks, wounded men would continue to pour in to Royat.

This concludes Part Three: The Work of the Hospital. One part yet remains in the tale of the remarkable men and women of Base Hospital Thirty. In the final part of this series, we will take a closer look at some of the remarkable people who carried out that work, how they came home again, and what happened to them after the war.

In the meantime, I want to take the opportunity to encourage you to take a moment and visit the collection at the University of California San Francisco’s Parnassus Library in the Archives and Special Collections to read more about the incredible men and women who made up the University of California Medical School Unit in the First World War.

Figures:

11 – “Group photo, nurses and soldiers, World War I,” circa 1917, Mount Zion Photo Collection: Historical Life, UC San Francisco, Library, UCSF Medical Center at Mount Zion Archives, Calisphere, https://calisphere.org/item/ark:/13030/c8028ttx/, accessed July 29, 2018.

12 – Georges Scott, “American Marines in Belleau Wood,” circa 1918, Illustrations, Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Scott_Belleau_Wood.jpg, accessed July 29, 2018; and George Matthews Harding, “Rounding Up German Prisoners,” July 1, 1918, War Department AF.25747, Smithsonian National Museum of American History, http://americanhistory.si.edu/collections/search/object/nmah_448013, accessed July 29, 2018.

13 – Wallace Morgan, “U.S. Medical Officers,” circa 1918, War Department AF.25791, Smithsonian, http://americanhistory.si.edu/collections/search/object/nmah_448030, accessed July 29, 2018; George Matthews Harding, “First Aid Station with American Wounded,” circa 1918, War Department AF.25742, Smithsonian Museum of American History, http://americanhistory.si.edu/collections/search/object/nmah_448015, accessed July 29, 2018; and Wallace Morgan, “Dressing Station in Ruined Farm,” July 19, 1918, War Department AF.25767, Smithsonian Museum of American History, http://americanhistory.si.edu/collections/search/object/nmah_448052, accessed July 29, 2018.

14 – “Loading and unloading patients during World War I,” circa 1917-1919, Base Hospital #30 Collection, UC San Francisco, Library, University Archives, Calisphere, https://calisphere.org/item/d3c4b7a0-ec00-4a29-99bf-b3157799718a/, accessed July 29, 2018.

15 – “The influenza ward at Walter Reed Hospital during the Spanish flu pandemic of 1918,” and “St. Louis Red Cross Motor Corps personnel wear masks as they hold stretchers next to ambulances in preparation for victims of the influenza epidemic in October 1918,” Library of Congress.

16 – “Surgical ward, an average size room, Hotel Metropole,” circa 1918, Base Hospital #30 Collection, UC San Francisco Library, University Archives, Calisphere, https://calisphere.org/item/ad3fa9c8-8d7e-4068-917f-47c7e4217154, accessed July 29, 2018; and “Surgical ward, German war prisoners, Royat Palace,” circa 1918, Base Hospital #30 Collection, UC San Francisco Library, University Archives, Calisphere, https://calisphere.org/item/69deaae8-23af-4dd4-8092-19237319153d, accessed July 29, 2018.

17 – “Alanson Weeks in uniform,” circa 1917-1919, Woolsey (John Homer) Papers, UC San Francisco Library, Special Collections, https://calisphere.org/item/5d2ca217-a521-4573-b693-0610c6019ac3, accessed July 30, 2018; “John Homer Woolsey in uniform,” circa 1917-1919, Woolsey (John Homer) Papers, UC San Francisco Library, Special Collections, https://calisphere.org/item/ceae074e-bff0-42a2-890b-b819e0480062, accessed July 30, 2018; and “Misses Dunn and Ireland leaving Clermont-Ferrand,” 1918, Woolsey (John Homer) Papers, UC San Francisco Library, Special Collections, https://calisphere.org/item/f187f041-1911-4aa9-aa26-be3a96d813aa, accessed July 30, 2018.

18 – “Soldiers of Headquarters Company, 23rd Infantry Regiment, 2nd Infantry Division, firing a 37mm gun during the Meuse-Argonne offensive,” 1918, U.S. Army Photo; Lester G. Hornby, “Argonne-Meuse 1918,” 1918, US Army Art Collection.

The Anatomy of an Archive: The Renée Hoffinger Papers

Introduction by Polina Ilieva

During the spring semester 2018 the archives team co-taught and facilitated a new History of Health Sciences course, the Anatomy of an Archive. The idea of this course was conceived by the Department of Anthropology, History and Social Medicine (DAHSM) Assistant Professor, Aimee Medeiros and UCSF Head of Archives & Special Collections, Polina Ilieva. Kelsi Evans, Project Archivist, co-facilitated the discussion sessions and Kelsi, Polina and David Uhlich, Access and Collections Archivist, served as mentors for students’ processing projects throughout the duration of the course.

The goal of this course was to provide an overview of archival science with an emphasis on the theory, methodology, technologies and best practices of archival research, arrangement and description. The archivists put together a list of collections requiring processing and also corresponding to students’ research interests and each student selected one that she/he worked on with her/his mentor to arrange and create a finding aid. During this 10 week long assignment students developed competence researching and describing an archival collection, as well as interpreting the historical record. At the conclusion of this course students wrote a story about their experience and collections they researched for the archives blog. In the next three weeks we will be sharing these posts with you.

This week’s story comes from Aaron J. Jackson, PhD student, UCSF Department of Anthropology, History and Social Medicine. 

Post by Aaron J. Jackson

In the Spring term of 2018, my fellow History of Health Sciences (HHS) students and I in the UCSF Department of Anthropology, History & Social Medicine (DAHSM) had the opportunity to take a class on archival science with the staff of the UCSF Archives and Special Collections. Led by Archivist Polina Ilieva, Ph.D., and DAHSM Assistant Professor Aimee Medeiros, Ph.D., this class provided us with an overview of archival science with an emphasis on theory, methodology, and best practices of archival research, arrangement, and description. Most of us had used archives in the past—I even had experience with the UCSF Archives and Special Collections through a blog on the experiences of Base Hospital No. 30 in the First World War—but few of us really understood how archives work, how collections are cultivated and maintained, or the considerations that go into archival collection, assessment, processing, preservation, and presentation. This class provided us with a rare insight into a sector of knowledge production that is all-too-often taken for granted by historians.

UCSF Archives and Special Collections Reading Room and Parnassus Storage Facility.

Many historians and other scholars—myself included, before this class—believe that archives are mere repositories of historically-important data, objective interlocutors who merely preserve the past. Material is collected, inventoried, and stored for future researchers to come along and “discover” the contents and subsequently draw out the stories therein; yet, this is a myth, and one that Drs. Ilieva and Medeiros intended to dispel in their students. To achieve this task, students were allowed to choose from a list of as-yet unprocessed collections. We would be assigned an archivist mentor and process the collections while also meeting each week for a seminar discussion on the historical development and modern concerns of archival science. With my own interests rooted in the history of veterans’ care, I choose the Renée Hoffinger papers because the accession record indicated (with my emphasis) “Renee Hoffinger, MHSE, RD worked in the field of substance abuse for over 20 years at the North Florida/South Georgia Veterans Health System in Gainesville, FL.” While I did not find much of use for my own research, what I discovered while processing the Renée Hoffinger papers will undoubtedly prove to be far more beneficial in the long run.

The Provenance of the Renée Hoffinger Papers

Renée Hoffinger, MHSE, RD, image from “Dietetic Career Spotlight: Renée Hoffinger, MHSE, RD,” by Sarah Koszyk, MA, RDN, https://www.nutritionjobs.com/blog/blog/dietetic-career-spotlight-renee-hoffinger-mhse-rd/, accessed June 3, 2018.

Renée Hoffinger has been a dietitian since 1982 and interested in nutrition and HIV/AIDS since pursuing a health sciences education in the 1990s. While processing her collection, I had the pleasure of being able to correspond with Renée about her collection and why she donated her papers to UCSF’s AIDS History Project. She noted that her experience of researching HIV/AIDS and providing care for patients in Gainesville was vastly different—in terms of support and information availability—than that of health professionals in larger cities like New York, San Francisco, and Miami. During her volunteer work at the North Central Florida AIDS Network, Renée said she was “given a desk and access to patients at the HIV clinic at the local health [department], and spent a lot of time at the medical library tracking down any information I could get my hands on…. Not feeling like I knew very much, I soon unwittingly became the local ‘expert’ on nutrition and HIV.” Renée spent the rest of her career working with other dieticians interested in HIV/AIDS, and even after her retirement in 2013, she has continued writing about and leading hands-on nutrition education workshops. She had heard about the UCSF AIDS History Project and reached out to Archivist Polina Ilieva to find out how she could contribute, and so she decided to donate her papers to the archive.

This story reveals more than just the background of how Renée Hoffinger’s papers ended up at UCSF to be processed by a first-year Ph.D. student in the HHS program. It provides an anecdotal example of how collections end up in archives. Polina Ilieva’s background as an archivist does not make her an expert in HIV/AIDS nutrition, but it does give her training and insight into what future researchers may look for when investigating the history of AIDS and how contemporary medicine attempted to address it. Renée Hoffinger’s papers are stored at UCSF because they provide a small window into how parts of the country outside the urban epicenters of the disease and aspects of medicine not usually associated with the disease dealt with the epidemic’s effects. Thus, Ilieva decided to choose to take on the archival responsibility for the Hoffinger papers—to assess their potential value, to inventory and process their contents, to build finding aids that would serve future researchers, and to be responsible for maintaining the artifacts in the collection for the use of future generations. But she could have just as easily chosen to leave the responsibility to others for any number of reasons including limited archival space and funding, or because the archivist felt the collection would be a better fit elsewhere. In other cases, archivists actively solicit new collections, seeking permission to preserve the data. The decision to donate/accept the papers was therefore only the first step in the archival preservation of data, and it calls to question: what is missing from archival collections, and why?

Archival Concerns and Overhead

A Selection of HIV-AIDS Nutrition Documents from the Hoffinger (Renée) Papers at UCSF.

The story of how the Hoffinger papers came to reside in UCSF’s archives was only the beginning of a journey in what, at times, could seem like a foreign country. The archives have a unique vocabulary and vernacular. Archivists may speak of the accession or deaccession of artifacts or collections. Their language includes terms like “provenance” and “fonds” as well as concepts like “original order” and “finding aids.” Many of these terms may seem somewhat familiar, but their meaning within the archival space can often be different than the assumptions of those outside it, and those meanings can change over time, which is only one of the difficulties that archivists have to navigate in their mission to collect, preserve, and process archival collections. They put a great deal of work into cultivating collections, processing their contents in accordance with laws, regulations, and industry standards, and making the product of that work available to their target audience, which is often the public but may be restricted in some cases. For example, archivists at healthcare institutions like UCSF must pay special attention to the privacy restrictions of the Health Insurance Portability and Accountability Act (HIPAA). They also need to concern themselves with copyright protections and dozens of other concerns, including securing funding and finding the manpower to process and reprocess miles of archival material. For reference, a 12 x 10 x 15 inch banker’s box contains only 1.25 linear feet of material by archival measurement standards—all of which requires storage space that not only protects the archived data but makes it available to public access. Digitization of archival material puts more stress on archivists’ time and resources, not less, as someone has to digitize the materials and provide for electronic storage and access points, often in addition to caring for the original documents. And all of this can be further complicated by unwilling donors. Some communities, particularly those who have been traditionally marginalized, are difficult to archive, requiring archivists to build long-neglected relationships and partnerships to preserve those aspects of history. In other cases, such as the UCSF Industry Documents Library, many of the contents are collected through court order from institutions who are less than thrilled to be forced to hand over internal documents. Such collections often require extraordinary processing efforts precisely because the donors are uncooperative, leaving the archivists to do their best to understand and arrange the documents in a useful manner.

The Contents of the Renée Hoffinger Papers

The Hoffinger Collection Contains AIDS Line Documents and Industry Publications.

In the case of the Hoffinger papers, the process was relatively straightforward. Renée Hoffinger, being alive and well at the time she deeded her papers to UCSF. The collection includes no patient records, so HIPAA was not a concern. Some of the documents are protected under copyright and therefore not likely to be digitized and posted online, but researchers are always welcome to view the documents in person. Regardless of the relative simplicity of this collection, I realized that what goes into the archives is very much the result of a creative and complicated process of selection, compliance, and access on the part of both the author of the papers and the archivists who collect and process them. In other words, archivists play an important role in precisely what is preserved, and this is something that researchers should keep in mind.

Patient Handouts & North Central Florida AIDS Network Newsletters.

The Hoffinger papers contain information chronologically ranging from 1980 to 2006, topically from the concerns of nutrition on AIDS/HIV wasting syndrome, lipodystrophy, prescription medications, substance abuse, alternative medicine, steroids, protocols, and phosphatidylethanolamine drug combinations known as AL-721 and COQ. Hoffinger also included various publications including many AIDS Nutrition Services Association conference materials and presentations, industry and lay press publications, presentations, course syllabi, and patient handouts and publications. Her papers reflect more than twenty years of professional work in the interests of her patients. How future researchers use these materials is impossible to predict, but it is important that when they access this collection, they understand the role played by everyone involved in the collection, from Renée Hoffinger’s selection of materials to donate and UCSF’s willingness to preserve the papers, to a relatively inexperienced history Ph.D. student who helped process the collection and build the finding aid—the collection of metadata that helps researchers find useful materials within the archives—all played an important role in creating, processing, and preserving this information. If you are interested in this collection or others, you can visit the Renée Hoffinger papers at the UCSF Archives and Special Collections. I would also highly encourage anyone interested in the wealth of information available in this collection to provide feedback to the archivists about this collection or any others that you may explore. Would a certain keyword or phrase be useful to others if included on the finding aid? Did you encounter confidential information that was not flagged as such? Did the archives raise questions about potential gaps in the record? These things and others are useful bits of information that the archivists would appreciate.

The Anatomy of an Archive course in the Spring term of 2018 provided students with an invaluable insight into the behind-the-scenes processes of archival work. It helped us identify some professional blind spots and to think critically about archival data. It also helped us earn a profound appreciation for all the work that our archivists do for their fellow scholars and for their role in helping to create, not just preserve, the historical record. And if there is one invaluable piece of advice I can pass along, it is this: when starting your research, always ask an archivist for help. They know their archives better than anyone else and asking their advice will likely save hours of frustration and/or bear unforeseen fruits. And when you ask them for help, make sure to ask about the provenance of the collections you research. It will not only show that you appreciate their work but also provide you with invaluable information in how you approach your research.

Acknowledgements

This blog post was possible not only because it was a requirement on the syllabus, but because this course provided the author with a novel opportunity to peek behind the curtain. It is with the sincerest thanks to Dr. Aimee Medeiros and archivists Dr. Polina Ilieva, Kelsi Evans, and David Uhlich for making this experience possible and to Renée Hoffinger for being so indulgent with a graduate student’s questions. I would also like to extend appreciation to UCSF digital archivist Charlie Macquarie and Dr. Mario Ramirez of Indiana University for taking the time to join our seminar session discussions and to the members of the Archivists and Librarians in the History of Health Sciences association for so warmly welcoming a historian like me among their ranks. I will endeavor to do for my students what all of you have done for me. Thank you.