What is a base hospital?

How did WWI change the way we treat war injuries today? (BBC News)

Base Hospital 50 (BH50) was just one part of a large orchestrated triage system designed to evacuate and treat the wounded during World War I. In her article, Base Hospital 43: The Emory Unit, Margaret Clark describes how the network was developed:

George W. Crile, MD, (1864–1943) had seen firsthand the medical problems which had emerged during the Spanish American War. He urged Army Surgeon General William Crawford Gorgas (1854–1920) to devise a better plan. Crile recommended that medical units be formed from existing medical institutions in the United States. It was hoped that by asking existing medical institutions from around the country to form such units, the doctors and nurses would already know each other and protocols and new procedures would not have to be developed. For the Army, however, there were some political challenges to organizing and recruiting units during peacetime. The largest obstacle was that they didn't have the authority to do it. The American National Red Cross did.
To meet the nation's public health needs, Congress had incorporated the American National Red Cross in June of 1900, under the direction of Clara Barton. Their mission was to provide support in times of national emergency. The Red Cross charter was revised in 1905 to expand that group's role as the national agency responsible for disaster relief and service to members of the military and their families.

On September 12, 1914, although the United States had not yet entered the war in Europe, The Red Cross, a relief ship staffed by volunteer Red Cross doctors and nurses sailed from New York for Europe. Many of these volunteers would only serve 1 year, and return to the United States. By 1916 however, America's entrance to the European conflict seemed eminent. Army Surgeon General Gorgas hoped to build on this volunteer initiative and asked the American Red Cross to organize 50 reserve base hospitals to augment pending military involvement. Academic institutions and large hospitals were specifically asked to form units for a Medical Reserve Corps (MRC). The peacetime registration/organization of military hospitals would include staffing and supplies for a 500-bed hospital. Ideally, the units would have 22 physicians, 2 dentists, 65 Red Cross nurses, 153 enlisted corpsmen, 6 civilians, and a chaplain. The hospital was to be available for immediate duty for up to 2 years. The criteria for the staff selection were listed as “personal knowledge.” Particular care was taken in requests made to medical schools. While it was recognized that these institutions would probably have the practitioners with the highest skill levels available, the War Department did not want to strip the schools of their teaching faculty. Crile organized one of the first of these units from Lakeside Hospital, Cleveland, Ohio as US Army Base Hospital 4, they were among the first American Expeditionary Forces (AEF) sent to France.

In the summer of 1917, Surgeon General Gorgas authorized the organization of base hospitals, under the auspices of the Red Cross. The news was received with enthusiasm, and the fifty units authorized by the Surgeon General were organized so quickly they were ready and waiting for active service before the Army was ready to place them. The University of Washington's Base Hospital 50 was the final hospital authorized for service.

Base hospitals were part of the casualty evacuation chain and established in areas behind the front. The injured were first treated at triage stations near the battle line. They were then transported by ambulance to casualty clearing stations. Once stable, they might be sent by train to a hospital center, like the one near Mesves-Bulcy to which Base Hospital 50 was attached. While in active service in France, the unit received both surgical and medical cases and, in particular, treated compound fractures and joint injuries. By the time it ceased to function on February 19, 1919, the total number of sick and wounded treated by Base Hospital 50 staff was 7,399, with 1,135 operations.

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References:

1. Base Hospitals of the AEF.
2. Clark, Margaret A. Base Hospital 43: The Emory Unit. MedGenMed. 2007; 9(3): 10. PMCID: PMC2100082.

First Patients Arrive

Surgeon and staff operating on a wounded patient,
Base Hospital 50, Mesves, France, ca. 1918-1919

The officers and enlisted men of Base Hospital 50 reached Mesves, France, on Tuesday, August 6. Arriving by train too late to disembark, the men didn't get to the Hospital Center until the next morning when they marched from the station to the complex. The men of Base Hospital 50 were the second unit to arrive, having been preceded by Base Hospital 67.

The Hospital Center was located on the top of a small hill between the towns of Mesves and Bulcy, surrounded by low and rolling countryside. The unfinished buildings were built of hollow tile or concrete blocks, with wooden roofs, covered with tar paper. The men were put in temporary barracks until theirs were completed. Much of the complex was only half-built, building barely started on much of the facility. The center was scheduled to have been completed the following summer, "but the war had progressed so rapidly that it was necessary to have all the work rushed as fast as possible."¹ Intended to have a capacity of 40,000 beds when completed, in the end, the greatest number of patients at the center at any time were 27,000 men at the time the Armistice was signed.

The first task Base Hospital 50 staff undertook was to clear away debris from inside and outside the wards. Time was of the essence to get the wards cleaned and outfitted, as their first patients were expected at any time.

We had only half finished our task when we received our first trainload of patients, at 7:30 p.m., August 15. There were 315, but most of these were only slightly wounded and were called "sitters." There were a few litter cases, who were in rather serious condition. There were no electric lights, water was received only through temporary pipes, and at first, no bathing facilities were available. The Unit itself was handicapped by the non-arrival of a large part of our overseas baggage, which had been selected for any emergency that might arise. The equipment not having arrived, the hospital was equipped by the Medical Supply Depot. It was necessary to crudely construct from rough lumber, beaverboard, tin cans and any material at hand, office equipment, stoves, cupboards, etc., all required but which were impossible to secure at the Center. When the first trainload of patients ar- rived there was not a nurse in camp, and the men were forced to assume these duties, along with their other work, and not knowing much about this, it was very difficult; but with the aid of the doctors they were able to handle the job temporarily.² Just a week after the first patients arrived another train came in with 700 more, and this taxed us to the utmost. A few days later 300 more patients arrived, and this time we were able to get a few nurses from Mars Center, who helped us out a great deal.

Within days of arriving, Base Hospital 50 was a fully functioning part of the Mesves-Bulcy Hospital Center and the strains of overwork were already in evidence by early September when the unit's first casualty, Sam Parker, occurred.

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References:

1. United States. Army. Base Hospital No. 50. The history of Base Hospital Fifty : a portrayal of the work done by this unit while serving in the United States and with the American Expeditionary Forces in France. Seattle, Wash. : The Committee, 1922.
2. The nurses of Base Hospital 50 encountered delays and bad weather during their crossing and didn't arrive at the center until the end of August. 

Collecting Moss for Uncle Sam

The Seattle Star, 3 April 1918, pg 4.

The Red Cross was a relatively small organization – just 107 chapters in 1914 – before the United States entered the Great War. With the outbreak of war, however, the organization experienced phenomenal growth. The number of local chapters grew to 3,864 by 1918 and membership increased from 17,000 to over 20 million adult and 11 million Junior Red Cross members.

A unique activity coordinated by the Red Cross during this period was the collection of sphagnum moss for wound packing. Sphagnum moss played an important part during World War I as a substitute for cotton gauze dressings. Dried moss can absorb up to twenty times its volume of liquid, including blood, and is superior to cotton dressing material for staunching wounds. Moss retains liquids better and distributes liquids more uniformly. It was cooler, softer, and less irritating than cotton, and could be produced more rapidly and more cheaply. Dried moss also has effective antibacterial properties due to its acidity. 

The Seattle Times, 16 June 1918, pg. 3.

Moss was certainly in great supply in the damp Pacific Northwest, which contributed 60% of the sphagnum moss collected for use during the war. University of Washington botany professor and Red Cross Northwest Division director John W. Hotson began identifying moss gathering locations in Washington in March 1918, when the American Red Cross authorized the use of the moss for bandages.

Red Cross volunteers around the Pacific Northwest organized work parties to bring in moss for making into bandages. Between October 1917 and November 1918, 595,540 moss bandages were made by Red Cross volunteers in Washington, Oregon, and Maine. Moss drives took place in South Bend, Long Beach, Ilwaco and Chinook gathering 90,000 pounds of moss which was spread out to dry before being sent to Seattle to be sewn into bandages.

The Sunday Seattle Times, 14 October 1917, pg 5.

In Seattle, and other cities around the Pacific Northwest, university students and women's clubs made bandages out of the dried moss. Women did most of the work of preparing the moss and putting together the bandages, often in addition to working at home or in a workplace all day. At the University of Washington women received course credit for making bandages. Some girls were tasked with picking over the moss while other more experienced girls made the bandages. As the war continued high school students were enlisted to help with picking over the moss so the university girls could devote their time entirely to the making of the bandages.

The doctors and the nurses

Look North with eager eyes,

And call on us to send them

The dressing that they prize

No other in its equal -

In modest bulk it goes,

Until it meets the gaping wound

Where the red life blood flows,

The spreading, swelling in its might

It checks the fatal loss,

And kills the germ, and heals the hurt

The kindly Sphagnum Moss.

Mrs A. M. Smith (1917). A member of the Edinburgh War Dressings Supply organisation.

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Learn more about sphagnum moss:

1. Hotson, John William. Sphagnum as Surgical Dressing. Seattle, WA : Northwest Division of the American Red Cross, 1918.
2. The Home Guard. University of Washington Tyee, 1918, pp. 22-23.
3. Sphagnum Moss - Voices of War and Peace.
4. Sphagnum moss and the 1914–18 war - The Pharmaceutical Journal blog, 26 March 2009.
5. Wound dressing in World War I - The kindly Sphagnum Moss - Field Bryology, No. 110, November 2013.
6. How Humble Moss Healed the Wounds of Thousands in World War I 28 April 2017.