Frederick Holmes, MD
Professor of Medicine Emeritus and of The History of Medicine
University of Kansas School of Medicine

Base Hospital #28 actually had more beds for medical cases than surgical cases, making clear the axiom that war often brings disease and pestilence in greater measure than wounds from battle. A sick soldier can't fight anymore than can one wounded. Thus, the sick were evacuated by ambulance train along with the wounded. Triage began immediately as the trains arrived at Base Hospital #28 and unloaded, initially assigning soldiers to medical or surgical services. Then occurred immediate further sorting for medicine patients into wards for contagious diseases, gas inhalation, cardiology, pneumonia, suspected tuberculosis, medical observation, general medicine, and neurology. An additional single ward accommodated dermatology, gas contact, and venereal disease patients. Lindsay Milne attended a small ward for patients from the hospital personnel and probably the rare female patient as well.

Some Members of BH #28 Medical and Nursing Staffs

Each ward was attended by one of the medical staff with some attending more than one ward. One of the hundred nurses attached to Base Hospital #28 was in charge of each ward and supervised the work of more junior nurses and of soldiers who functioned as orderlies and assistants of various sorts. The competence, devotion to duty, and managerial ability of these nurses probably were the three most important factors in the excellent record of patient care rendered by this hospital. As can be seen in the illustrations, each patient had a metal cot with linen and a blanket, and the cots were arranged in two opposing rows with little space between them. Each ward had about sixty cots. A cursory examination of the illustrated pages from the comprehensive patient listing shows medical diagnoses somewhat exceeding surgical diagnoses and problems as mundane as bilateral flat feet and as serious as pulmonary tuberculosis. Considering patients were all basically healthy young men the preponderance of serious medical diagnoses were of infectious diseases.

Crowded - But Neat - Medical Ward in PreFab Building


Beginning of Alpha List of Admitted Patients With Their Diagnoses

It is impossible to imagine the challenge that the influenza epidemic of the autumn of 1918 presented to the medical wards of Base Hospital #28. Of the nearly ten thousand patients admitted to this hospital during its functioning from July 1918 through January 1919 there were 1,295 patients with a discharge diagnosis of influenza. Only 24 deaths were recorded for these patients, just about two percent. All of these patients had extensive bacteriological studies and 22 had autopsies. Viral influenza kills in one of four ways: first, acute overwhelming viral pneumonia: second, overwhelming immune response to the virus: third, superimposed pneumococcal pneumonia: and, fourth, other bacterial pneumonias. The 1,295 influenza admissions were selective in that the sickest soldiers, those who had overwhelming viral infection or overwhelming immune response to the virus, surely died before they could be put on the ambulance trains. Compounding the understanding of influenza in 1918, it must be remembered that its viral cause was not identified until the 1930s.

Temporary Cemetery Near Hospital

Physicians in 1918 were adept at distinguishing acute, uncomplicated influenza from garden variety pneumococcal pneumonia, which they accomplished by physical diagnosis skills, now largely lost to Medicine, and the occasional x-ray when there was doubt. Influenza patients were admitted to an Infectious Disease ward and placed at bed rest. Standard laboratory procedures were used as well as quite sophisticated bacteriology. X-ray and fluoroscopy were available when needed. As mentioned previously, the most important part of the patients' management was superb nursing care. The influenza admissions to Base Hospital #28 were distributed as follows: July, 18; August, 16; September, 280; October, 578; November, 221; and December, 182; for a total of 1,295. During this same six months there were 169 admissions for acute bacterial pneumonia.

Visiting Hours at PreFab Ward

Study of the autopsy results of 22 of the 24 Base Hospital #28 influenza deaths provides an interesting picture of the nature of the epidemic and of deaths in young men in the 1918 influenza epidemic. For example, there were no autopsied deaths in July or August but one in September, twelve in October, five in November, and four in December, for a total of 22 of the 24 total influenza deaths. Three autopsies were done in young men aged 15 to 19, five in those aged 20 to 24, eleven in those aged 25 to 29, and three in those aged 30 to 34. The initial white blood cell count was between 5,000 and 10,000 in eight (normal), 10,000 to 15,000 in three, 15,000 to 20,000 in four, and greater than 20,000 in seven. Hospital deaths were distributed in an interesting manner with twelve during the first week of hospitalization, seven in the second, none in the third week, two in the fourth week, none in the fifth week, and just one in the sixth week. The reason for this lopsided distribution is largely explained by the principal cause of death recorded for the 22 autopsies, thus, lobar pneumonia in ten, bronchopneumonia in ten, pneumonia from another organism in one, meningitis in one, and no principal cause of death listed as influenza alone. Finally, to complete the picture, with more than one bacteria being found in a few cases, lung cultures at autopsy grew a pneumococcus (S. pneumonia) in sixteen, another streptococcus in one, Friedlander's bacillus (K. pneumoniae) in two, Pfeiffer's bacillus (H. influenza) in three, a gram negative organism in seven, a M. catarrhalis in two, and a staphylococcus in five. The major cause of death in young men with influenza who reached this base hospital was lobar or bronchopneumonia, a superimposition of the pneumococcus on a viral damaged lung. During the 1918 influenza epidemic the world searched, in vain, for 'the bacteria' presumed to cause epidemic influenza.

Bacteriology Laboratory in August 1918

In summary it can be noted that the Medicine Department of Base Hospital #28 was manned by highly competent physicians who dealt with both serious and mundane medical problems in an efficient and compassionate manner. The sudden imposition of the 1918 influenza epidemic was a challenge not anticipated but met expeditiously and effectively without antibiotics or even oxygen therapy for those with respiratory compromise. Medicine wards were organized by disease, nursing management and delivery of care was to a very high standard, and patients actually enjoyed medical care quite comparable to what they would have received in a large metropolitan hospital in America.