George Thompson, M.A., M.F.A.
Adjunct Associate Professor
Historian
History and Philosophy of Medicine
The University of Kansas Medical Center

The United Sates Army began preparing for war in 1916. Their combat doctrine based on experience stressed that the army must be prepared to fight a war of movement. It was expected that all combat and support units should be organized and prepared to operate within an ever changing battlefield environment.

This concept was not feasible in 1917 on the Western Front when the Americans arrived due to the complex and layered fortified lines that ran from the North Sea to Switzerland. However, the Americans, their allies and their German enemy expected that a war of movement could be achieved if their opponent's line was ruptured, which is what happened in 1918 first to the allies and then to the Germans.

In response to army doctrine and the reality of the Western Front the army's Medical Department established their treatment and evacuation system so it could operate in both a static and mobile combat zone. Based on their history of success in the American Civil War and a study of the best practices of the French and British armies the department created specific units designed to provide a sequence of managed care from the front line to the rear area for both a static and mobile environment.

Base Hospital Number 28 is an example of one of these units. Its placement in Limoges France, about 200 miles from the front, with two other base hospitals indicates it is a rear area unit. And because it was sited with two other hospitals it indicates that it was a Hospital Center. These units were assigned to a system of commands that the Medical Department created to efficiently provide the right type of care within what the army identified as the Theatre of Operations.

The Medical Department implemented its mission in the theatre by dividing the delivery of medical care into two commands that were the Zone of the Armies, located in the combat zone, and the Services of Supply, located in the rear areas of France.

Base Hospital Number 28's location with other hospitals indicates it reported to one of the two commands in the Services of Supply organization. The hospital would have been part of the Sections of Services of Supply command. Other medical units in this group were:

• Medical supply depots
• Hospital centers (base hospitals, convalescent camps, supply depots)
• Base Hospitals
• Trains and barges
• Casual camp for sanitary troops
• Medical Department concentration area
• Fixed laboratories
• National Red Cross units
• Sanitary inspectors
• Consultants (professional)
• Veterinary hospitals (base)

The location and types of these rear area units indicate their purpose was to provide support to the Zone of the Armies medical units that delivered the first level of treatment to the sick and wounded. These units, such as Base Hospital Number 28, would remain in place to receive patients or to provide medical support, supplies and services to medical units in the Zone of the Armies area.

The other command that belonged to the Services of Supply was the Special Units which were:

• Mobile operating unit
• Aviation medical unit
• Aviation ophthalmo-otological unit
• Medical classifying unit
• Museum unit
• Rontgenological unit
• Ophthalmological unit
• Medical Department repair shop unit
• Central optical unit
• Neuropsychiatric unit
• Rodentological unit

The department's Sections of Services of Supply medical units would have been the last level of medical care for a sick or wounded soldier in Europe. If his condition was such that he could not be returned to service he would be evacuated to the United States, or the Zone of the Interior, for treatment at a General Hospital or specific unit specializing in the care he required.

The sick and wounded men that arrived at Base Hospital Number 28 would have received their initial care and evacuation from medical units that operated within the Zone of the Armies. The zone consisted of a hierarchy of commands that were established at three levels: the division, corps and army.

At each level the Medical Department deployed units appropriate to the combat environment they were in so as to provide the right type of treatment from emergency to intermediate care leading to more sophisticated types of treatment and methods of evacuation.

Dressing station operated by Ambulanc Company no. 102, 26th Division, near Samogeneux, Meuse, October 23, 1918

A sick or wounded soldier received his first care from medical units that were assigned to his infantry division. The specific units that provided treatment, evacuation and support at the division level were:

• Medical Department personnel on duty with division troops, i.e. the Regimental Aid Stations
• Sanitary train: Ambulance section, Field hospital section, Camp infirmaries, Divisional medical supply unit
• Mobile laboratory
• Mobile surgical unit
• Sanitary squads

Unloading severely wounded at Field Hospital No. 28, Varennes Meuse, October 2, 1918

At the next higher level, or corps, there was:

• Medical Department personnel on duty with corps troops
• Consultants
• Sanitary train: Ambulance section, Field hospital section, Camp infirmaries, Divisional medical supply unit
• Mobile hospital
• Mobile veterinary hospital

At the highest level, or army, there was:

• Medical Department personnel on duty with army troops
• Consultants in special subdivisions of surgery and medicine
• Sanitary train: Ambulance section, Field hospital section, Camp infirmaries, Divisional medical supply unit
• Evacuation hospitals, including Red Cross
• Mobile hospital
• Evacuation ambulance companies
• Hospital trains
• Mobile laboratory
• Mobile veterinary hospital
• Army supply park
• Convalescent depot

Hospital train; method of loading

It is within these three levels that the wounded and sick were collected, treated and either returned to their units or evacuated to a base hospital upon treatment at one or more units in these three levels. It is within the Zone of the Armies that Medical Department personnel were most exposed to danger and it is within this zone that a progressive level of life saving treatment and evacuation was performed to sustain the morale and fighting strength of the army.

This system as outlined was the plan that evolved by 1918. It was logical on paper. However, in practice due to the rapid expansion of the army, a lack of trained personnel, and shortages of medical supplies or equipment plus an untried doctrine there were periods of confusion and even poor performance. The department was not alone in struggling to adjust to these circumstances. All branches, even commanders, faced periods of confusion caused by growth, equipping itself and mastering a battle environment against a sophisticated and determined foe.

Sources:

Gillett, Mary C. The Army Medical Department 1917-1941, Center of Military History United States Army (Washington, D. C. 2009)

Jaffin, Colonel Jonathan H. Medical support for the American Expeditionary Forces in France during the First World War (Fort Leavenworth 1990)

Volume VIII, Field Operations, The Medical Department of the United States Army in the World War (Washington, D. C. 1925)

Volume XI, Section I, General Surgery, The Medical Department of the United States Army in the World War (Washington, D. C. 1925)