Sanders Marble, Ph.D.
Former Command Historian, Walter Reed Army Medical Center

Having a large medical system allowed the concentration of categories of patients; this provides better care by bringing patients to facilities with the best equipment and building expertise among staff. In essence, specialized hospitals were an extension of the ward system used in the Great War period (where a ward was designated for, say, fracture cases) and is the same as specialty units or centers in today’s hospitals. Having separate cancer centers and labor-and-delivery units allows better care for both groups of patients.

The AEF organized a substantial number of specialized hospitals. A few were designated from the very top, by the Chief Surgeon of the AEF; showing the high level of concern for shell-shock patients, two of the designated hospitals were for “war neuroses” what today would likely be diagnosed as traumatic brain injury and/or post-traumatic stress disorder but were not then differentiated. Base Hospital 117 was “established, and an ambulance service has been provided in connection with this hospital by which cases can be received directly from tactical divisions at the front. At this hospital the resources found most useful in the British and French special hospitals for these cases are employed.”

Base Hospital 117, established as a neuropsychiatric hospital.

The personnel of Base Hospital 33, designated as a neuropsychiatric center by the Chief Surgeon of the AEF.

Other specialized hospitals were organized within the AEF’s hospital centers. Hospital centers were first an administrative convenience, a way to group a few base hospitals who would share support services – for instance a central laundry or delousing facilities. That easily expanded so that clinical areas were shared, for instance X-ray equipment (and personnel) centrally located, the compounding pharmacy shared, or a central dental clinic created. Eventually hospital centers commanding officers were given full authority in many matters. They were authorized to transfer and assign commissioned and enlisted personnel within their center without reference to higher authority, to promote or demote enlisted men up to and including the grade of sergeants, first class, Medical Department, to assign all supplies received, to request American Red Cross support, to employ civilian labor (under certain limitations), to spend Medical Department funds, and convene special (but not general) courts-martial and issue necessary travel orders for patients transferred.

A view of part of the Mars-sur-Allier hospital center.

Practically, that meant they could move staff and equipment from one hospital to another, building specialized hospitals. They would consult with the commanders of the various hospitals to learn what special skills there were, consult with the AEF medical staff to see what treatment types were likely to be needed (perhaps orthopedic injuries or venereal diseases), and with the eighteen “consultants” the AEF had. These were senior physicians with deep knowledge in their specialty who supervised the professional work of the doctors serving in their respective specialties and recommended assignments. Beyond coordinators for both surgery and medicine, there were consultants in: surgical research; Roentgenology; neurological surgery; orthopedic surgery; ear, nose, and throat surgery; general surgery; venereal and skin diseases and genitourinary surgery; maxillofacial surgery; ophthalmology; general medicine; infectious diseases; neuropsychiatry; poisoning by deleterious gases; cardiovascular diseases; and tuberculosis.

Thus, all hospital centers (twenty-one were planned, although some were still getting organized when the Armistice was signed) had specialized hospitals. The most common were surgical, orthopedic, eye, ear, nose, and throat, maxillofacial, psychiatric, neuropsychiatric; some centers had contagious disease hospitals. The center at Savenay had a special hospital for the treatment of tuberculosis patients and that at Vichy had special facilities for maxillofacial cases, to which other specialized hospitals referred their most complicated cases. Hospital center plans provided for a separate hospital, located at a quiet point on its outskirts, where psychiatric cases would be cared for, but in a number of centers this was never completed. As resources allowed, reconstruction facilities, such as those afforded by shop and art work for the rehabilitation of the neuropsychiatric cases, were rapidly developed, especially in the centers at Beau Desert and Kerhuon. Occupational work shops were established in some hospital centers, brace shops for orthopedic patients more commonly. Centralization was not a cure-all: at Allerey orthopedic appliances were made in several shops so that doctors would not lose time travelling to a central workshop.

A general ward at Base Hospital 18.

A maxillo-facial ward at Base Hospital 15, Chaumont.

A contagious diseases ward organized at Base Hospital 64, which was designated for gas and infected surgical patients. Preventing spread of contagious diseases was especially important where patients already had weakened lungs from gas poisoning.

Specialized hospitals improved care for patients in many categories: orthopedic, maxillofacial, psychiatric, neuropsychiatric, contagious diseases, eye-ear-nose-throat, ophthalmological, venereal and dermatology, gas injury, influenza and pneumonia, tuberculosis, and neurosurgery. Some centers grouped their seriously wounded (as a general category) and some grouped the lightly wounded; that was presumably an administrative convenience, since those wards could have fewer staff assigned.

A patient being treated at the ear-nose-throat center in Base Hospital 20.

An orthopedic ward at Base Hospital 1 in the Vichy hospital center.

A patient is fitted with a temporary prosthesis at Base Hospital 69 in the Savenay hospital center.

Centers usually also organized a convalescent camp so that the hospitals did not have to waste beds and staff time taking care of patients who were largely recuperated. They could also offer graduated exercise programs – more strenuous as men recovered – that sped up a soldier’s return to duty, but also offered extra time to men who needed it, and identified men who could not return to frontline service before they arrived back in an infantry division. 

Sources:

Volume II, Administration, American Expeditionary Forces , The Medical Department of the United States Army in the World War (Washington, D. C. 1927)
Images courtesy of the National Library of Medicine.