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.

Base Hospital No. 30, One Hundred Years Later – Part Two: France

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

One hundred years ago, the men and women of U.S. Army Base Hospital No. 30—the University of California School of Medicine Unit—arrived in France to support the American war effort after more than a year of preparation in the United States. They had already faced many challenges by the time they first set foot in Europe, including navigating the Army bureaucracy, going through extensive military and medical training, traveling from San Francisco to New York, and treating thousands of soldiers who had developed acute infections as a result of the massive mobilization efforts taking place in 1917 and 1918. They crossed the Atlantic in late April and arrived in France in May, expecting to occupy a prepared site, where they could set to the important work of caring for America’s wounded soldiers as the American Expeditionary Forces moved into the Western Front and helped blunt the German Spring Offensive of 1918. But they would still have to overcome significant obstacles before that work could begin. In this entry—the second part of four planned posts—I will cover the experience of Base Hospital No. 30 as they landed in France and made preparations to support the wounded between May and June, 1918. These stories are derived from primary source materials on Base Hospital No. 30 kept at the UCSF Archives & Special Collections, and it is with great appreciation to the archivists there that I am able to write about the experiences of the men and women of the University of California School of Medicine and their experience in the Great War. If you have not done so yet, please read Part One: Organization, Mobilization, and Travel here.

The U.S.S. Leviathan arrived in Brest, France on May 2, 1918. The port city at that time was a bustle of activity as the Americans established supply depots and warehouses and scrambled to offload the massive influx of war materiel and men arriving from across the Atlantic. Base Hospital No. 30 was but one of hundreds of American units transitioning into France at the time. Until that point, the unit managed to keep track of the $100,000 worth of Red Cross supplies and equipment it had drawn from the quartermaster and medical supply depot back in San Francisco. But with everything operating at a frantic pace in Brest, they found it impossible to ensure that these supplies remained with the unit. They received orders to board a train for Royat a mere two days after arriving in Brest, and while they were assured that their supplies would catch up, Lieutenant Colonel Eugene S. Kilgore later recalled that the unit was “dismayed at the apparent rough handling of [their] cargo in shipment, and were not surprised that much of it failed to reach us in Royat.”

Figure 6 – Royat Advertisements ca. 1900-1910.

“Royat les Bains is a small town, situated in the very heart of France, in the Auvergne Mountains,” begins the U.S. Army Hospitalization Report prepared by acquisition officers who scouted the location and rented the buildings that Base Hospital No. 30 was to occupy. Royat was (and remains) a spa town that advertised its natural hot springs and a history dating back to the Roman occupation of Gaul—the Romans constructed baths that utilized the hot springs, making Royat’s tourist heritage a truly ancient affair. Unfortunately, for an American hospital unit interested in operating a modern medical institution, Royat’s ancient roots left much to be desired, despite its charms.

In their hospitalization report, the acquisition officers noted that the town was “clean, quiet and healthful” with plenty of fresh air and sunshine—an atmosphere that attracted a clientele “of a very high class, comprising, as it does for the most part, the wealthy and nobility.” Due to this, the acquisition officers noted that the rents were quite high in Royat, but the environment seemed appropriate to them for a hospital due to the town’s reputation as a health resort and the advertised healing properties of its thermal springs, which “are taken for gout, rheumatism, gravel, kidney and bladder trouble, and… anemia, blood trouble, diabetes and dyspepsia.” With this in mind, the acquisition officers rented eleven buildings—eight hotels, one villa, one casino, and one garage—for the purposes of establishing a base hospital in the town. They left detailed instructions for the officers of Base Hospital No. 30 regarding the costs of tram fares to the nearby city of Clermont, the costs of maintaining and operating telephone service in the rented buildings, and how to go about securing sewage and garbage disposal. They were even so helpful as to provide the locations of local laundries and markets and to coordinate with local restaurants and cafes to ensure that price lists were printed in English as well as French “to prevent the unfair exploitation of foreigners.” However, they advised the officers of Base Hospital No. 30 that, as elsewhere in France, manpower for labor was in drastically short supply as almost all of it was involved in the war effort. They warned that the enlisted men of the hospital unit would likely be tasked with “street cleaning and watering and removal of rubbage and waste,” for which the local municipality would be grateful.

In short, while the acquisition officers obviously considered Royat to be an ideal location for a hospital due to its atmosphere, access to clean water, location relative to a railway, and the availability of seemingly suitable buildings—assuming, of course, that one believes a hospital and a resort hotel are sufficiently alike as to seem suitable—they noted that Base Hospital No. 30 would have its work cut out for it. The acquisition officers had done what they could and moved on. The rest would be up to the medical personnel, some of whom arrived in Royat on the morning of May 7, 1918, and immediately set about the task of transforming the sleepy spa village into a modern medical facility.

The nurses of Base Hospital No. 30 were diverted to Vichy, France for a short stay while the men went ahead to prepare the hospital site. In Vichy, the nurses attached to Base Hospital No. 1, which had organized out of Bellevue Hospital in New York City. While there, the nurses tended to a number of personnel who had contracted measles, which head nurse Arabella Lombard described as “a childhood pleasure evidently foregone in younger days.”

In Royat, Base Hospital No. 30’s officers immediately noted that the requisition team had secured the most undesirable hotels in the town and that the task before them to prepare the site to receive patients was indeed Herculean. The kitchens, primarily located in hotel basements, were particularly bad. Lt. Col. Kilgore later recalled in The Record that the kitchen in the hotel Continental was a veritable dungeon, but it had to be used because the adjoining mess hall was the only place large enough to install the main patients’ kitchen. Unfortunately, concerns about the kitchens were only the beginning.

The electrical supply, generated by hydraulic powerplants and initially reported to be ample, was found to be woefully insufficient in the dry summer months, leaving the hospital without electricity three days out of every seven and without power to run the new X-ray and laboratory incubator equipment. The hospital personnel installed multiple gas lines only to find that France’s coal scarcity reduced the gas pressure to such a point that the lines were practically useless. Worse, the water supply to the hotels, intended for a few dozen tourists, was inadequate for the needs of a several-hundred bed hospital. After installing a make-shift shower and bath system, hospital personnel discovered that it could not be operated without completely depriving at least one of the hotels of water entirely, and it was necessary to carry water in buckets up several flights of stairs in order to operate toilets and wash dishes. In spite of these complications, hospital personnel were able to establish well-prepared surgical clinics and patient wards, but the continuous complications they encountered certainly made the work more difficult than they anticipated.

The many complications were frustrating, “but worse than all these together was the hopeless inadequacy of the drainage system,” reported Lt. Col. Kilgore. Only two of the buildings had direct access to sewer lines with the rest relying on antiquated cesspool systems that were, again, intended to service the needs of at most a few dozen tourists. Kilgore noted that, “even in our condition of what we felt to be disgraceful water economy, it was evident that the numbers we put in the buildings and the use they made of water was greatly in excess of that contemplated by those who have used the buildings heretofore as summer hotels and boarding places. And very shortly after our hospital became open to patients, our cesspools began to overflow.” This problem was compounded on multiple levels. First, the only way to deal with an overflowing cesspool was to have it pumped by the Societe d’Assainissement of Clermont, whose horse-drawn steam pump and tank wagons—dubbed “honey wagons” by the Americans—had to serve the entirety of Clermont and Royat and so required three weeks’ advance notice for services. This was an impossible situation for Base Hospital No. 30 as the cesspools would overflow again as soon as seven days after they had been emptied, and even when the honey wagons could be secured, they were insufficient to empty all the hospital’s cesspools at one time, often leaving the work half done, at best. And if the misery of overflowing cesspools alone was not enough, the pools were often located directly under the hotel basements, where the kitchens were often located, including the main patients’ kitchen in the basement of the Continental. Thus, when the Continental’s cesspool overflowed, it did so directly into the newly refurbished main patients’ kitchen and dining hall. The officers and enlisted men attempted to deal with these issues as they were able, but they often lacked the tools and experience necessary to properly tackle the various tasks. The problems grew so great that the Army was forced to divert an engineer detachment from the front lines in August to install better drainage, additional cesspools, showers, wash troughs and heating stoves.

The nurses arrived from Vichy on May 23 and found that the hospital was far from the promised state of preparedness required. They immediately set to work sanitizing the hotels to “get them ready for the boys from the front,” as Arabella Lombard put it. The nurses scrubbed the rooms so thoroughly that one of the officers remarked that “three coats of paint were scrubbed off before we considered the buildings ready for occupancy.” It was hard work that left the nurses weary and sore, but there were breaks. On May 28, the nurses were invited to celebrate Decoration Day—the precursor to Memorial Day, celebrated in honor of the Civil War dead through the decoration of grave markers—with an aviation unit stationed in nearby Clermont. They observed an afternoon of sports, enjoyed a buffet dinner outside the Red Cross Headquarters overlooking the hills and the setting sun, and were entertained by a band concert, speeches, and dancing after dark.

By June, the men and women of Base Hospital No. 30 were still dealing with the cacophony of unforeseen difficulties associated with occupying Royat. The cesspools were still overflowing from time to time, the water and electrical supplies were still inefficient, the enlisted men were still helping clean the streets of Royat and installing new kitchens, and some of the old hotel rooms remained to be cleaned and refitted for the purpose of housing patients, but the hospital was operational enough to receive its first trainload of patients on June 12, 1918. Thankfully, the 360 patients aboard the train were convalescent for the most part, but even so these men represented a significant difficulty for hospital staff as the kitchen installations were not yet complete.

After more than a year of preparation for the deployment to France, the men and women of Base Hospital No. 30 found themselves scrambling to prepare their ad hoc hospital to receive patients, and time had run out. Patient trains were arriving, and the hospital was about to get very busy indeed. Approximately five-hundred kilometers north of Royat, near Château-Thierry, the German Spring Offensive of 1918 was grinding forward as the Germans attempted to cross the Marne River. Standing in their way were the men of the 5th and 6th Marines and the 9th and 23rd Infantry. The resulting fighting was among the most intense experienced by any Americans in the war, and as Base Hospital No. 30 attempted to figure out how they were going to feed their first trainload of convalescent patients, several more hospital trains carrying troops fresh from the front lines and in need of surgery were making their way to Royat.

In Part Three of this four-part blog installment, we will explore what Lt. Col. Kilgore characterized as the “Work of the Hospital” in treating battlefield casualties and how they dealt with the Influenza Pandemic of 1918. We will also discuss the experiences of the forward-deployed surgical teams led by Lt. Col. Alanson Weeks (Surgical Team No. 50) and Maj. Herbet S. Thomson (Surgical Team No. 51), who operated under extreme conditions between June 1918 and the Armistice in November.

Figures:

5 – “Loading at Brest for a Long Journey,” circa 1918, Woolsey (John Homer) Papers, UC San Francisco, Library, Special Collections, Calisphere, https://calisphere.org/item/8caee2bc-704e-4647-9218-d32ed2a4d9c8/, accessed May 21, 2018.

6 – “Royat Advertisements,” author’s compilation from “Affice Chemin de Fer D’Orleans Auvergne Geo Dorival,” circa 1910 (left) and “Royat Vintage Poster” by Gustave Fraipont, c. 1900 (right).

7 – “Base Hospital #30 at Royat, France,” ca. 1917-1919, Woolsey (John Homer) Papers, UC San Francisco, Library, Special Collections, Calisphere, https://calisphere.org/item/2cb5cbf5-d0c0-412a-9e15-a161a291d1e2/, accessed May 21, 2018.

8 – “Surgical Clinic, Metropole Hotel,” 1918, Base Hospital #30 Collection, UC San Francisco, Library, Special Collections, Calisphere, https://calisphere.org/item/b7ca9276-989e-468f-adb2-ece162e4ad01/, accessed May 21, 2018.

9 – “Base Hospital #30 Nurses,” 1918, Woolsey (John Homer) Papers, UC San Francisco, Library, Special Collections, Calisphere, https://calisphere.org/item/500d7be8-79c5-430e-86f6-f3a15d3a0d87/, accessed May 21, 2018.

10 – “Hospital Train with Hiram Miller and ‘Rug’ Ruggles,” 1918, Woolsey (John Homer) Papers, UC San Francisco, Library, Special Collections, Calisphere, https://calisphere.org/item/f4ec0c1f-b30c-48b4-9746-2d34420fcc4d/, accessed May 21, 2018.

Base Hospital No. 30, One Hundred Years Later – Part One: Organization, Mobilization, and Travel

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

One hundred years ago today, April 24, 1918, the 240 men and women of U.S. Army Base Hospital No. 30—the University of California School of Medicine Unit—left American soil to support the war effort by operating a modern hospital in France. Their stories survive in the UCSF Archives & Special Collections, where they contribute to the rich history of the UCSF and San Francisco communities. In this four-part series, I hope to introduce you to the stories of the men and women of Base Hospital No. 30, and I encourage you to learn more by visiting the UCSF Archives & Special Collections in the Parnassus Library.

Figure 1 – U.S. Army Base Hospital No. 30, World War I

“This book purports to be a record, not merely of the happenings and the activities of Base Hospital Number Thirty, but a permanent record of the personnel with the addresses, that we may always keep in touch with one another and thus preserve the bonds of friendship now existent among us.” – Foreword, The Record

As the foreword to the book they commissioned to commemorate their experience expresses, the men and women of Base Hospital No. 30 formed a tight-knit community during their time in the service in the First World War. When Congress declared war on Germany on April 4, 1917, the American Red Cross Society quickly set to work in establishing, organizing, and supplying medical units in the nation’s leading medical institutions with the intent of creating a system of hospitals in France to treat the inevitable casualties of the war. The American medical community was enthusiastic about the effort. Famed surgeons George Crile and Harvey Cushing had been working with America’s French and British allies since 1915 to establish new medical techniques and organizational methods. Many physicians viewed the war as an opportunity to advance medical knowledge while simultaneously serving their country, and many members of the University of California Department of Medicine felt the same. With the assistance of the Red Cross, Base Hospital No. 30 began to organize in the spring and early summer of 1917. Consisting roughly of twenty-five officers, sixty-five nurses, and one-hundred-fifty enlisted men, the unit marched down Market Street as part of a Liberty Loan parade to raise money for the base hospital and to support the war effort.

Figure 2 – Liberty Loan Parade, San Francisco, Cal.

Unfortunately, the initial excitement of the spring and early summer became a period of uneasy waiting and bureaucratic frustration that dragged into the fall as the unit waited on official orders to arrive. Many members of the unit, including one or two officers and several of the nurses and enlisted men, anticipating immediate entrance into the service, had packed and stored their belongings and quit their jobs, and the commanding officers had to continuously combat rumors that the organization had been broken up or that no more base hospitals would be sent to France. Thankfully, the Red Cross had managed to secure $100,000 in funding, which it used to collect supplies while the Army bureaucracy plodded along. Finally, on November 20, 1917, Base Hospital No. 30 received official orders to muster at Fort Mason in San Francisco.

While the unit drilled and trained in the operation of a military hospital, the nurses received separate orders to travel to New York. They were able to enjoy the Christmas holiday with their friends and family before taking their oath of service at the Presidio on December 26, 1917 and setting out on a five-day, frigid train ride to New York City. They arrived on New Year’s Day and spent the next three weeks on Ellis Island preparing their uniforms and equipment and receiving training. On January 25, they were divided into five groups bound for Army camps in South Carolina, Maryland, Ohio, Georgia, and Virginia, where soldiers gathering from across the nation were coming down with acute infections like measles and mumps in large numbers. While the nurses expressed disappointment at not being able to set out for France immediately, Chief Nurse Arabella Lombard expressed that they were happy to be of service and to gain valuable experience before receiving orders to return to New York in March.

Figure 3 – Nurses of Base Hospital No. 30

Back in San Francisco, the officers spent their time working at clinics in the city and training the enlisted personnel. On March 3, 1918, nearly a year after the declaration of war, the unit received orders to pack their supplies and board the steamship S.S. Northern Pacific en route to New York. The trip took two weeks—a near-record pace at the time—and the unit was assigned temporary barracks at Camp Merritt. While in New York, several of the officers attended clinics on the latest medical techniques, such as instruction on the treatment of pneumonia and meningitis at the Rockefeller Institute and the Carrel-Dakin course on aseptic surgery and wound treatment—essentially the use of diluted chlorine and bleach solution to hasten the separation of dead from living tissue, which was cutting-edge lifesaving technology before the discovery of antibiotics.

On April 22, the nurses rejoined Base Hospital No. 30 as the unit boarded the U.S.S. Leviathan, a former German luxury liner originally named the Vaterland that had been seized by the U.S. government the year prior and converted into a troopship. They set sail on April 24, 1918. More than one year after Congress’s declaration of war on Germany, the members of Base Hospital No. 30 were finally travelling to France. They anticipated the hard but meaningful work of repairing the broken bodies of America’s soldiers, but in France, they would have to overcome a number of unexpected obstacles before that work could take place.

Click here to read Part Two of the series.

Figure 4 – USS Leviathan

Figures:

1 – “U.S. Army Base Hospital No. 30, World War I,” circa 1917, UC San Francisco, Library, University Archives, Base Hospital #30 Collection.

2 – “Liberty Loan Parade, San Francisco, Cal.,” circa 1917, California State Library, California History Section Picture Catalog.

3 – “Nurses of Base Hospital No. 30,” January 1918, UC San Francisco, Library, University Archives, Base Hospital #30 Collection.

4 – “USS Leviathan,” 8 July 1918, Naval History & Heritage Command, 19-N-1707.