Anthony L. Kovac, MD
Kasumi Arakawa Professor of Anesthesiology
University of Kansas Medical Center
Kansas City, Kansas

Early in 1919, after Base Hospital #28 ceased clinical functioning, its registrar, Dr. Sherman Hibbard, compiled an alpha list of all of its patients with admission dates and discharge diagnoses included. One of the most common diagnoses was GSW, apparently including all battle wounds by both bullets and shrapnel. A total of 2,066 surgeries were performed for the diagnosis of GSW: 961 involved upper extremities, 963 lower extremities, 332 head and neck, 68 abdomen and genitals, 130 back and side, 92 chest, and 114 multiple wounds. Six operations were for gas gangrene. Other surgeries performed included 178 ear, nose and throat (ENT) procedures, 53 eye operations, and 1,744 dental cases.

For surgery at Base Hospital #28, anesthesia was administered by four corpsmen who were trained by the physician/anesthetist, Dr. W. H. Clark. The majority of cases were general anesthesia and no mortality related to anesthesia was reported. The type of anesthesia selected and administered depended on patient, surgery, and anesthesia requirements. As WW I soldiers were mostly young men, they were generally in good physical condition with few medical problems. However, smoking was a prevalent practice at the time and many soldiers had some degree of lung disease and chronic bronchitis. Because of their pulmonary problems, these soldiers were sometimes difficult to anesthetize using an ether or chloroform technique. Similar to present day surgical and anesthesia practice, patients underwent a physical exam and preoperative workup. For preoperative medications, morphine (1/6 grain) and scopolamine (1/150 grain) were commonly given IM before surgery to potentiate the effects of general anesthesia. Scopolamine was used as a drying agent to minimize oral secretions and morphine was given for its analgesic effects

Agents available for general anesthesia included chloroform, ether, ethyl chloride, and nitrous oxide/oxygen mixtures. Chloroform and ether were initially given by the open drop mask method and titration of nitrous oxide/oxygen mixtures by anesthesia gas machines. At Base Hospital #28, the Connell and Heidbrink anesthesia machines were used to administer both nitrous oxide/oxygen and ether.

Figure 1 – Minor Surgery Operating Room


Figure 2 – Major Surgery Operating Room

There were three operating areas at Base Hospital #28, located in the Bellaire Seminary building and the temporary wooden hospital buildings (Figures 1 - 4). Figure 1 shows a Bellaire operating room used for minor surgeries. On the table at the left, ether cans are seen. The hanging glass container was probably used for administration of IV blood transfusion. A Bellaire operating room used for major surgery is shown in Figure 2. On the back wall can be seen a blood pressure apparatus, thus, a BP cuff and stethoscope. A variety of ether masks are obvious and large oxygen and nitrous oxide cylinders are seen standing at the back of the room (Figures 2 & 3). The operating table in this room is larger than operating tables in the other areas of the hospital. Figure 3 shows the anesthesia apparatus in the work area of the physician anesthetist, Lt. W. H. Clark. The small cart includes a suction apparatus and an assortment of ether cans and Schimmelbush ether masks. On the bottom shelf, an ethyl chloride bottle can be seen, as well as additional ether cans. The anesthesia gas apparatus on the left of Figure 3 is a Connell anesthesia machine. This type of gas machine was commonly used by both US and French hospitals as it enabled the anesthetist to give various amounts of nitrous oxide and oxygen mixtures, with or without ether. The Connell oxygen apparatus shown is a brass "War SP Model" made in 1917 and was also called the "officer's" version. The War SP Model had a rotary-type flowmeter. English and French instructions for use were standard on these machines.

Figure 3 – Anesthesia Apparatus

The machine on the right in Figure 3 is a Heidbrink anesthetizer gas machine, originally developed by Dr. J. Heidbrink (a dentist). This machine allowed the combined administration of nitrous oxide and oxygen gas mixtures. A rebreathing bag equalized oxygen and nitrous oxide pressures and eventually incorporated a variety of pressure reducing valves. When ether and chloroform were administered by the "drop method", Yankauer, Gwathmey or Schimmelbush masks were used. For general anesthesia, the combination of chloroform and ether was frequently administered. Because of the rapid onset of action of chloroform, two separate masks were often used to induce anesthesia. Chloroform was initially given by the drop method to initiate anesthesia, followed by ether. The first mask for chloroform was commonly a Schimmelbush mask using a single layer of gauze. The second mask for ether had two layers of gauze. Patients breathed spontaneously and management of airway obstruction was accomplished using the jaw thrust technique or forceps to pull the tongue out of the mouth. Oxygen was available if the patient turned blue. To continue and maintain general anesthesia, ether was used.

Figure 4 – Simple Operating Room in PreFab Building


Figure 5 – Anesthetized Patient, Ready for Surgery

A third operating room (Figures 4 &5) was located in one of the wooden hospital structures on the grounds of Base Hospital #28. It appears to be a room for minor surgery and anesthesia was performed using drop ether. A Sorenson vacuum machine was used to suction secretions that developed, common during ether/chloroform anesthesia. Dr. Clark is the physician anesthetist standing at the far left.

Figure 6 – Kansas City Star Jan 18,1919

Of specific interest, noted in the Kansas City Star newspaper of January 18, 1919, (Figure 6), is an interview with Cpl. Clyde Morris, who worked as one of the corpsman/anesthetists at Base Hospital #28. The article describes his impressions while giving anesthesia for operations performed by Dr. John Binnie. Morris mentions that Binnie, after one of his consultations, returned to Base Hospital #28 and operated on nine patients. Morris was one of the corpsmen who gave the first anesthetic. Because of the problem of doing multiple surgeries in a short amount of time, anesthetists worked in teams. Cpl. Morris worked with another corpsman/anesthetist, Cpl. Neal Woodruff. Morris stated that by the time he started the first anesthetic, Woodruff had the next man ready and brought to the operating room. As Morris finished the anesthetic on his patient, Woodruff started the anesthetic on the next patient. Morris noted that in this way no time was lost and that Dr. Binnie, the surgeon, merely had to change his gloves and gown before starting the next case. Cpls. Morris and Woodruff noted that the opportunity to serve as anesthetists in Base Hospital #28, under Drs. Binnie and Milne, afforded them a rare opportunity to work with these fine doctors and how much they appreciated this opportunity. They also reported that, while many doctors or students had observed Dr. Binnie operate at home in Kansas City, they were able to observe and to give anesthesia for his patients in the challenging circumstances at Base Hospital #28 in France in 1918.

Photographs of Figures 1 to 6 courtesy of the National World War One Museum, Kansas City, MO