Grace E. F. Holmes, MD
Professor of Pediatrics and of Preventive Medicine Emerita
University of Kansas School of Medicine

Base Hospital #28, Winter Scene

The personnel of Base Hospital #28 were surprised when they first discovered that their new camp at Limoges consisted of only a single barracks building for officers and a headquarters building. All of the water for drinking, bathing, and sewage disposal flowed through a one-inch diameter pipe. Only one latrine in the headquarters building existed for the entire three-hundred person staff, including female nurses. No building was available to admit patients. However, building supplies were stacked on the premises and all personnel were temporarily detailed for construction. They met the challenge and built their hospital - ground up - from the piles of lumber and prefabricated wooden sides that were scattered about. Help was available from 400 French laborers and with everyone hard at work, the new camp soon expanded to twenty buildings. After one month the hospital construction was essentially complete, furnished, and ready to receive patients. The laboratory building consisted of four walls, a roof, and blueprints which was a most fortunate circumstance. It permitted a number of much desired alterations and additions during the construction, which would have been quite impossible, had the building been completed according to original plans.

Clinical Laboratory in PreFab Building

Illustrative of the planning and ingenuity of this effort was the creation and operation of the medical laboratory, which proved to be of comparable quality to the Kansas University School of Medicine Bell Memorial Hospital laboratories in Kansas City. Firsthand accounts from the typewritten "History of Laboratory, Base Hospital No. 28, Limoges, France," describe the early days of the facility in considerable detail, including the flexibility that was required of the hospital's personnel. In their first days at the site, the staff was unsure even of the capacity of their hospital.

At the time when the laboratory was organized, information from outside sources as to the scope of work and extent of equipment required of a military hospital laboratory was decidedly meager. The original bed capacity for the hospital was calculated to be 500 beds, or "thereabouts," but practical evidence showed that "thereabouts" can be extremely elastic and in the case of Base Hospital #28 permitted a maximum of over 2,900 patients.

Clean Wound, Left Leg

The scope of equipment covered the necessary detail for a fully equipped, large-sized, modern laboratory, doing microscopic pathology, autopsies, hematology, bacteriology, serology, epidemiological work, water and milk analyses, biological chemistry, organic, and inorganic chemistry. Soon this well-equipped hospital laboratory would become very busy. In total, during the seven months that the hospital was in operation, the laboratory performed 16,232 tests. Of 84 malarial smears, only 3 were positive, suggesting this was an uncommon diagnosis. Of 380 stool specimens examined, seven were positive for various infections, signifying that not only smears of fecal material were done but bacterial cultures, as well. Of 100 stool samples specifically examined for evidence of typhoid fever bacteria, all were negative. This evidenced that sophisticated bacteriological tests were in use.

X-Rays Showing Classical Gas Gangrene

Of 409 sputum smears done for tuberculosis just 12 were positive; but of 464 sputum specimens examined for other pathogens, 146 were positive. The bacteriology of sputum, other than tuberculosis, was not well understood at that time but some of the sputa were surely diagnostic of pneumococcal pneumonia. Out of 33 cerebrospinal fluid smears, 18 were positive, indicating 18 patients with meningitis. The hospital laboratory seems to have been state-of-the-art for 1918 and capable of performing a variety of examinations and dealing with a high volume of patients.

In spite of their successes, there had been one problem of particular interest for the laboratory with regard to wound bacteriology, specifically how to identify bacteria that could thrive without oxygen. These organisms-anaerobic bacteria such as the Clostridium species-could cause cellulitis, myositis, and myonecrosis, problems particular to the soldiers who were treated in military hospitals in the First World War. Soldiers were often infected when their wounds came into contact with the bacteria present in the soil of the farm fields upon which they fought. The author of the typewritten "History of Laboratory of BH 28," held by the Archives of the World War One Museum at Liberty Memorial, explained in his discussion, the importance of the identification of anaerobic bacteria, thus: "The mode of most of the fighting in the present war, i.e., position warfare over fields which have been cultivated (with use of manure), for centuries, inevitably resulted in a high prevalence of gas gangrene infections."

Microscopic Slide of Clostridium perfringens Bacteria

These gas-forming bacteria in tissues cause massive swelling in affected muscles and other tissues, and usually cause death. Though rare now, anaerobe wound infection, even gas gangrene itself, can be treated with antibiotics, extremely aggressive early surgery, and hyperbaric chambers. Only meticulous debridement surgery and culture for anaerobic bacteria were available in 1918 and in those circumstances.

The laboratory personnel solved the problem of growing large numbers of anaerobic bacteria on special agar plates - obviously impossible in an ordinary incubator - by building their own anaerobic incubator. After a careful review of the limited medical literature on anaerobic incubators they discovered that the few such incubators described were beyond their attainment. So, using a ten-gallon gasoline can, they created their own custom-built incubator to isolate, grow, and accurately identify the deadly gas gangrene anaerobes that would thrive only in an oxygen-free atmosphere. This simple "gasoline can apparatus" can be seen in the photographic image on the counter to the right of the large incubator.

Bacteriology Laboratory with “Gasoline Can” Anaerobic Incubator at Right

In summary, it can be noted that the laboratory of Base Hospital #28 was as close to state-of-the-art as possible in the challenging circumstances of rural wartime France in 1918. Routine tests, performed in sophisticated metropolitan American hospitals were readily available in large volume, as well as esoteric tests, even those for anaerobic bacteria. The excellent record of patient care reflects the high quality of the laboratory.