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.