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| MedGenMed. 2007; 9(3): 10. Published online 2007 July 11. | PMCID: PMC2100082 |
Base Hospital 43: The Emory Unit Margaret A. Clark, MS, RN, RRT-NPS, Editorial Director |
Introduction The concept of a field or base hospital designed exclusively for the support of a military operation was first used by Cardinal Richelieu of France in 1630. [1] Louis XIV, the Sun King, adopted that idea and constructed the Hôtel des Invalides in Paris in 1676. Britain soon followed with the Royal Hospital for Seamen in Greenwich in 1695. [1] Today we think of these facilities primarily as homes for disabled veterans, but they also served as active hospitals in times of conflict on or near home soil. The medical support of troops fighting on foreign soil is always problematic in military expeditions. Before the Spanish American War the United States had engaged in conflicts on or near her home soil. During the French and Indian War, the Revolution, the War of 1812, and the Civil War combat commanders could rely on local hospitals augmented by the populace to care for their casualties. It was not until the Spanish American War that the nation painfully realized its shortcomings in caring for soldiers wounded in battle or felled by disease. [2] Like most countries, the United States had adopted a policy of organizing and mobilizing base hospitals in times of war. While government planners had very extensive and detailed plans on paper, their basic policy was not to implement these plans until hostilities broke out. Doctors were to be enlisted at the same time as infantrymen. This policy did not allow for the reality that the recruitment, supply, training, and deployment of medical personnel took longer than that of combat soldiers. During the Spanish American War this slow, inefficient policy resulted in many deaths. [3]George W. Crile, MD (1864–1943), who in 1921 would cofound the Cleveland Clinic, had seen firsthand the medical problems emerging 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. [4] 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. [5] For the Army, however, there were some political challenges to organizing and recruiting units during peace time. The largest obstacle was that they didn't have the authority to do it. The American National Red Cross did. [6] |
The American National Red Cross 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. [7] 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. [8]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.” [8] 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. [9] 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. On March 25, 1917, they relieved British General Hospital Number 9 in Rouen and were the first unit to hoist the American Flag in support of the allied cause in World War I. [7]In the early summer of 1917, Surgeon General Gorgas gave Major Edward C. Davis, of the Army Medical Reserve Corps, the approval to recruit a 500-bed hospital to be staffed by 24 officers, 65 nurses, 154 enlisted personnel, and 6 female civilians. A native of Albany, Georgia, Davis had served during the Spanish-American War and would stay with this unit as Medical Director throughout the coming conflict. The unit was called into federal service on August 30, 1917, as Base Hospital No 43. [10] But because the professional staff was recruited predominantly from Emory University and Emory Hospital in Atlanta, Georgia, the unit became more commonly known as the Emory Unit. |
The Emory Unit Emory Unit physicians and nurses were recruited primarily through word of mouth and by invitation. [10] Formation of the unit was widely reported in newspapers throughout Georgia and its ranks were swelled by enlisted personnel from the state. [11, 12] Unit officers and professional staff began “war training classes” at various locations almost immediately. [10] They were eager to serve and hoped they would be called up quickly. [13] Believing they would be called within a matter of weeks, many enlisted men quit their jobs after signing up, hoping to spend time with their family before they shipped out. As weeks of waiting stretched into months, they took odd jobs, [14] and unit officers, led by E. C. Davis, began to worry about the unit's morale. To ease some of the worries, a special meeting was convened at Emory Medical School on November 10. In attendance were 10 doctors, 50 nurses, and 40 enlisted men. Although they had heard nothing officially, they discussed their plans for deployment and read patriotic poems. It was not until February 24, 1918, however, that officers were notified of their pending call up. Enlisted unit members were sent telegrams on February 28 ordering them to report for duty at 25 East Linden Street, Atlanta, Georgia, on March 4, 1918. [10] By that point, attrition had already taken its toll on the unit. Several enlisted volunteers had been inducted under the selective service program, and others had failed to pass their physical examinations. Local newspapers printed another round of stories calling for recruits and new members quickly filled the ranks. [11, 12]The officers and enlisted men reported to Camp Gordon, Georgia, on April 2, 1918. [15] While there, unit soldiers were given words of advice like: “It is a great life if you don't weaken.” They conducted 2-mile hikes each day and spent the remainder of their time working in the camp hospital, kitchens, or clearing stumps. The educational level of the Emory Unit was high. Among the enlisted ranks were 25 pharmacists, a PhD, a lawyer, a journalist, an Episcopal minister, and a prep school teacher. [10]They underwent 3 weeks of gas drills and attended classes on A Complete Handbook for the Sanitary Troops of the U.S. Army and Navy and National Guard and Naval Militia by Charles Mason. [16] Some took French classes offered on Tuesday and Friday evenings by Eva Woodberry of the Woodberry School for Girls. She often enlisted the assistance of some of her pupils from Atlanta to help with the classes. [10]It was initially believed that a sum of $25,000 would be sufficient to supply the base hospital units. History would show, however, that on average these units required $75,000 for their initial setup. The 43rd Base Hospital unit was funded by donations, Emory University, and a grant from the US War Department of $40,000. [10]As the unit prepared for deployment, Atlanta newspapers began a drive to raise money for a unit emergency fund. They succeeded in raising $7000. [17] Officers, nurses, and enlisted men were feted at a banquet on April 12 at the Piedmont Driving Club. The ladies of the Atlanta Red Cross presented the nurses and the enlisted men with sweaters and notions as going away gifts. [18] The unit attended a farewell service at Wesley Memorial Tabernacle. The sermon was delivered by Bishop Warren A. Candler. At the conclusion of this, the Atlanta Minister's Association presented the unit with their banner. [19]Following the celebrations, the unit returned to its training regimen at Camp Gordon and an additional 7 officers joined their ranks, bringing the 43rd Base Hospital to its full strength. The unit also experienced its first casualty at this time. Howard Candler Curtis of College Park, Georgia, died of pneumonia. He was buried in College Park with the entire unit in attendance. [10]Male members of the unit (now composed of 35 officers, 200 enlisted men, a quartermaster, and a chaplain) left Camp Gordon for Camp Merritt, New Jersey, on June 2, 1918. For many of the men, the train ride was adventurous. They posted guards at the ends of each coach and kept a lookout for German submarines as they traveled along the coast. Lights were prohibited in the cars after night fall. During a brief stop in Greenville, South Carolina, the local Red Cross provided each man with cigarettes and iced tea. [10]After they arrived in New Jersey, 24-hour passes were available and many men visited New York City and Coney Island. There is also a report of a large crap game occurring the night before their departure. The event was led by William Hopkins of Albany. He would serve as a cook with the unit. It was reported the unit's chaplain, 1st Lieutenant Jackson Allgood, was invited to participate, but declined. [10]Male personnel set sail from Hoboken, New Jersey, for Southampton, England, on June 13 aboard the SS Olympic along with 6000 other deploying soldiers. The 43rd Base Hospital set up a 75-bed hospital and a 24-bed isolation ward aboard ship. They conducted daily physical examinations of the troops and 2 sick call sessions per day. The records show they treated 113 patients including 5 cases of influenza, 6 of measles, 17 potential measles exposures, 3 lobar pneumonias, 7 venereal diseases, and 36 “other diseases.” While en route, the men faced the constant threat of German submarine attack. Their ship was accompanied by an American navy destroyer for the first 36 hours of the voyage. Then the destroyer returned to New York City, leaving the SS Olympic to cross the Atlantic on her own. The ship would join a convoy later in the final leg of the voyage into Southampton. [10]The 43rd Base Hospital's stay in England was brief. The unit arrived on June 21, 1918, and left for Le Havre, France, via the S.S. Nirvana on June 23. The men were transferred to the Le Havre holding camp, known as Rest Camp Number 3, where they played baseball and waited for their time to move to the front. They also reportedly gave a number of German soldiers “the once over.” What was meant by this was never explained. On July 3, 1918, they officially relieved staff at Camp Hospital 25 at Blois, France. The hospital census at the time was 416 patients. |
The Nursing Before the War The Red Cross nursing program was established in 1909 by Jane Delano, then superintendent of the Army Nurse Corps. In the fall of that year, the Red Cross had formed an alliance with the American Nursing Association to develop lists or “registers” of nurses working in the United States. [20] The intent of these registers was to provide a reserve corps that could be called to service in the event of a national emergency or war. These nurses were required to have at least 2 years of training in a hospital that averaged 50 patients per day, be fit, between 24 and 40 years of age, and be registered as nurses in their states. Delano resigned from the Army in 1912 to head the Red Cross Nursing Corps, which would supply nurses to both the US Army and Navy in the coming conflict. They used a highly effective recruiting slogan “American Nurses for American Men.” [20]The Army Nursing Corp was officially established in 1901; however, when the United States entered World War I in 1917, there were only 4093 nurses on active duty. [20] Those numbers would swell to 21,460 Army nurses by November 1918. Most were recruited through the Red Cross Nursing Corps. Nurses were considered neither officers nor enlisted personnel. They were “appointed” to their position by the US Army Surgeon General with the approval of the Secretary of War. On May 15, 1917, nurses were authorized a “Class E” pay allotment of $40 per month for in-country service and $50 per month for overseas duty. They were also authorized a $10 per month clothing allowance. By contrast, in civilian life, their average pay was $75 per month for hospital duty and $35–40 per week for private duty work. [6] |
43rd Base Hospital Nurses On May 16, 1918, nurses from the 43rd Base Hospital Unit under the direction of Caroline S. Dantzler, RN, received orders to report to Lakewood, New Jersey. Dantzler would serve as the head nurse of the unit throughout the war. The nurses took their oaths of allegiance and departed by train for New Jersey on May 17. In New Jersey, they visited Asbury Park, the country home of George Gould, Ocean Grove, and other points of interest. On May 27, they left for the Holly Hotel in Washington Square, New York City, and spent the month of June being fitted for uniforms and shopping for necessities. The nurses attended church services at Trinity Church, and it was there that they received their flag. On July 4th, they joined approximately 15,000 Red Cross Nurses in the largest Red Cross Parade in the history of America held in New York City. [10]The 43rd Base Hospital nurses had planned a tour of the Hudson River on July 10; however, their plans were interrupted by overseas orders and they found themselves moving to their port of embarkation in Montreal, Canada, instead. They were briefly quarantined per regulations in Halifax, Nova Scotia. They departed on July 20, aboard The Durham Castle, as part of a convoy. They were accompanied by men of the 76th Division. On board there were nightly shows performed by the soldiers. The nurses also witnessed 3 battles with German U boats during their trip. Specifically, on July 29 a German submarine surfaced behind their ship. It is not known whether depth charges or The Durham Castle's gunner was responsible for its demise. On July 30, the ship anchored in Cardiff, Wales. Although the nurses' stay here was short, they were among the first American troops in Cardiff and were greeted by the mayor and welcomed into the city. They soon transferred to Southampton and then to the Guildford Castle, a hospital ship, which took them across the English Channel to Le Havre, France. The nurses then traveled to Paris where they met a delegation of their physicians who escorted them to Blois. The 43rd Base Hospital nurses relieved the nurses of Base Hospital 47 (California) and quickly set about providing patient care. In France, the nurses dressed in gray cotton crepe uniforms instead of the starched white that they were accustomed to in the United States. This is attributed to the lack of laundry facilities. In addition, they wore starched white collars, cuffs, and caps with an embroidered red cross. [10]Particular pride was taken in the fact that the nurses were all predominantly from Georgia. Of the unit nurses, 17 had graduated from the Piedmont Sanitarium, 10 from the Grady Hospital School of Nursing, and 14 from Wesley Memorial Hospital School, all in Atlanta. [21] |
Blois, France The 43rd Base Hospital was stationed in Blois, France, an ancient city located on a hill overlooking the north bank of the Loire River, midway between Tours and Orléans. The area is rich in history. In 1429, Joan of Arc began her siege of Orléans from Blois. During World War I, the city was home to a reclassification camp for officers and a concentration/reclassification camp for discharges from the American Expeditionary Forces hospitals. [22] Base Hospital 43 occupied 7 buildings in all including the “Mixte Hospital,” which was constructed by the Benedictine order in 854 AD. [10] Staff were divided into surgical and medical teams that worked together in shifts. Although organized as a 500-bed unit, the normal capacities of the facilities were 1000 beds. In an emergency, it could expand to 1397 beds. [10] By the end of their tour of duty, the census would climb to over 2000 patients. |
Operations Then as now, continuing education was important. Classes were taught by the medical staff Tuesday and Friday evenings. The courses included the treatment of gas patients, war surgery, and the use of Carrell Dakin Solution (a highly unstable mixture of 5% sodium hypochlorite and 4% boric acid used to clean wounds). [23] Classes were also held for the patients 3 days a week and included subjects such as civics, French history, English history, and agriculture. Hospital services were divided among various sections of the hospital. One annex housed the surgical cases; one the orthopedic patients; one the medical cases; and another the nervous, mental, medical, and convalescent cases. Infections, venereal diseases, contagious diseases, and overflow patients were treated at the Mixte Hospital. Nurses were assigned a case load of 10 beds per nurse. Unit members worked long hours while hospital trains brought wounded from the front on a regular basis. Although the work hours were long, unit members were able to visit the town of Blois and other parts of Europe beyond the war zone during their time off. A favorite of unit members was the Debit de Vin in the city, a small café owned by Madame Bedot. Steaks, salads, and French-fried potatoes were the usual fare. Other unit members formed a baseball team under the direction of Captain Frank Andrews. They played games against teams from other units. [10] |
Armistice When the Armistice was signed on November 11, 1918, the AEF operated 153 base hospitals, 66 camp hospitals, 12 convalescent hospitals, 21 hospital trains, and 6875 ambulances. Base Hospital 43's census at the time was 2237 patients. Among their infectious disease cases were 46 lobar pneumonias, 20 bronchopneumonias, 213 influenza cases, 1 dysentery, 1 malaria, 26 venereal diseases, 5 cerebrospinal meningitis, 2 scarlet fever, 4 diphtheria, 33 mumps, 40 not yet diagnosed cases, and 559 other diseases. Among their wounded were 92 injuries, 513 severe gunshot wounds, 574 slight gunshot wounds, 93 gas inhalation injuries, 6 gas burns, and 9 other inhalation injuries. [10]Base Hospital 43 was officially relieved on January 21, 1919, having served for 6 months and 18 days. Members had treated 9034 patients during this time and recorded 102 deaths. They proudly reported being free of cross-infections or epidemics during their tour of duty. [10]Some unit members, however, would be left behind. The army retained 10 medical officers, 1 sanitation officer, and 40 nurses for reassignment to other units. Male members left Blois on February 3, 1919 and arrived in Newport News, Virginia, on March 24. Some were met by family members. [24] The nurses also left France in February and reached New York City aboard the Cartago on March 12. Upon their return to Atlanta, the nurses were met at the train station by a military band. [25]Two nurses, Tressie Fitts, RN, of Atlanta, and Dorothy Burns, RN, of Jacksonville, Alabama, were awarded special insignia denoting their service on hospital trains no 66 and 65 (respectively) in the front/forward sector. [27] Records show the only in-country death of a unit member was Camille Louise O'Brien, RN, of Atlanta. She was killed on April 18, 1919, while serving with Camp Hospital No 25. [6] Her cause of death is not given. Official records of the US Army Nursing Corps show that 136 nurses died in the conflict, none as a result of enemy fire. [26] Because O'Brien's death occurred after the Armistice had been signed, it is likely she was killed in an accident. The unit was mustered out of active Army Service on April 2, 1919. |
Medical Reserve Corps: Then and Now The formation of a military hospital unit staffed and supplied by members of a specific institution has never been attempted again on such a scale in American history. By World War II, the Medical Corps of the Army and Navy were well developed and better able to respond to emerging conflicts. A civilian-based Medical Reserve Corps (MRC) was no longer needed. Some institutions, including Emory University, would sponsor a hospital in the next war, and the 43rd Base Hospital would see service in World War II. But the degree of local enlistment, sponsorship, and participation was not the same. Some of the base hospitals have written their histories, many have not. [27] Some, like the Emory Unit, collected reminiscences that they shared among themselves. [10] Each unit's history is unique; many of these histories are in danger of being lost. Now, in the beginning of the 21st century, a new chapter of MRC units is only just beginning. In January of 2002, President George W. Bush asked all Americans to offer meaningful volunteer service in their communities in the text of his State of the Union address. [28] Then Secretary of Health and Human Services Tommy G. Thompson officially launched the new Medical Reserve Corps in July 2002. The program started with approximately 42 grants totaling $2 million awarded to community-based organizations to begin building local MRC units. [29] A national MRC program office was established in the US Surgeon General's Office to provide national coordination and technical assistance. The MRC program is a partner of the White House's USA Freedom Corps and the Department of Homeland Security's Citizen Corps. Ten regional MRC coordinators have been established and are co-located with the 10 regional Health and Human Services (HHS) offices throughout the country. [30]MRC units in the early 1900s, like the Emory unit, were formed from specific medical facilities or institutions and explicitly intended to have a combat role. Their structure and staffing was predetermined by the Department of the Army. In contrast, modern units are community-based and can address an array of public health tasks established by the US Surgeon General. These include improvement of health literacy, disease prevention, eliminating health disparities, and improving public health preparedness. Modern MRC units can organize themselves to address one or many of these goals. [30]The staffing and unit structure of the modern unit is determined by needs assessments conducted in and by the community. It is intended that these units will augment and strengthen the public health infrastructure of their communities. [29] Volunteers have the option of working outside their MRC units in times of national emergency. In 2005, more than 1500 were deployed outside of their local communities to disaster-affected areas. An estimated 200 volunteers from 25 MRC units were activated by the HHS, while more than 450 volunteers supported the American Red Cross disaster operations in the southern states and Gulf Coast areas. There are no plans to deploy MRC units into a combat situation in support of US troops. Could a specific institution provide a MRC unit as they did 100 years earlier? The Surgeon General's program does not preclude that. |
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References 1. Heizmann, CL. Military sanitation in the sixteenth, seventeenth and eighteenth centuries. Journal of the Military Service Institute of the US. 1893;XIV:30. 2. Garrision, F.H. Notes on the history of military medicine. The Military Surgeon. 1922;L(4):456. 3. Ireland, MW. The Medical Department of the United States Army in the World War. Volume I: Report of the Surgeon General's Office Field Operations. Washington DC: US Government Printing Office; 1923. Chapter IV. Medical Service of the Division in Combat; p. 92. 4. Ireland, MW. The Medical Department of the United States Army in the World War. Volume I: Report of the Surgeon General's Office Field Operations. Washington DC: US Government Printing Office; 1923. Chapter IV. Medical Service of the Division in Combat; pp. 93–179. 5. The Story of U.S. Army Base Hospital No. 5 by a Member of the Unit. Cambridge, Massachusetts: The University Press; 1919. p. 5. Anonymous. 6. Dock, L; Pichet, S; Noyes, C, et al. Official History of American Red Cross Nursing. New York: MacMillan; 1922. p. 301. 8. Davison, HP. The American Red Cross in the Great War. New York: MacMillan; 1919. pp. 81–92. 9. Thwing, CF. The American Colleges and Universities in the Great War, 1914–1919. New York: MacMillan; 1920. p. 128. 10. Harris, JC. History of the Emory Unit: Base Hospital 43, US Army Expeditionary Forces. Atlanta: Georgia; 1919. 11. Emory Base Hospital Calls for More Men. The Atlanta Georgian, August 18, 1917. 12. Places Still Open in Emory Unit Officers Announce. The Atlanta Constitution, August 26, 1917. 13. Emory Base Hospital Is Ready for Service Says Medical Director. The Atlanta Journal, August 18, 1917. 14. Early Service Expected By the Emory Base Unit. The Atlanta Constitution, August 18, 1917. 15. Emory Base Hospital Unit Goes to Fort Gordon for Training Course. The Atlanta Journal, March 4, 1918. 16. Mason, CF. A Complete Handbook for the Sanitary Troops of the U.S. Army and Navy and National Guard and Naval Militia. New York: Wood Publishers; 1917. 17. Atlantians Helping Fund for Emory Hospital Unit. The Atlanta Journal, April 2, 1918. 18. Emory Hospital Unit Dance Big Military Affair. The Atlanta Georgian, April 12, 1918. 19. Banner Is Presented to Emory Base Hospital. The Atlanta Journal, April 14, 1918. 21. Emory Nurses Practically ALL Georgians, Now Overseas. The Atlanta Journal, August 4, 1918. 22. Ireland, MW. The Medical Department of the United States Army in the World War. Volume VIII: Field Operations. Washington DC: US Government Printing Office; 1925. Chapter IV. Medical Service of the Division in Combat; pp. 105–149. 23. Dakin, HD. On the use of certain antiseptic substances in the treatment of infected wounds. BMJ. 1915;2:318–320. 24. Glass, D. Emory Unit Is Welcomed Home. The Sunday American, March 30, 1919. 25. Atlanta Gives Joyous Welcome to Returning Nurses of Emory Unit, Home from Their Service Overseas. The Atlanta Journal, March 23, 1919. 26. Stimson, J. The Medical Department of the United States Army in the World War. Volume XIII: The Army Nursing Corps. Washington DC: US Government Printing Office; 1927. p. 350. 27. Queary, CH., Jr The 29th Base Hospital during World War I. Colo Med. 1989;86:184–185. [PubMed]29. HHS Announces Creation of Medical Reserve Corps - grants to 42 community groups will support new volunteer medical response teams. Medical Reserve Corps Technical Assistance Series. US MRC Program Office: 2005. Available at: www.medicalreservecorps.gov Accessed May 9, 2007. |
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