CHAPTER XVII
THE GENERAL HOSPITAL (TUBERCULOSIS)
GENERAL HOSPITAL NO. 21, DENVER, COLO.a
PHYSICAL CHARACTERISTICS
Geographic location.-General Hospital No. 21 was located at Camp Miles, due east of Denver, with which place it was connected by two main highways-Colfax Avenue and Mount View Boulevard. Colfax Avenue was a macadam road and Mount View Boulevard had a clay surface. The Kansas City branch of the Union Pacific Railroad passed within 1 mile of the reservation, a spur track having been projected from Sable Junction on that railroad to the hospital. A tramway connected Denver and Aurora, a small town 2 miles from the reservation.
Terrain.-The reservation comprised 595 acres of nearly level plateau, from which there was a splendid view of the neighboring mountains and surrounding country.
Soil.-The soil is a moderately rich loam with a clay subsoil.
Climate.-The following climatic data from the city of Denver, covering a period of 20 years, were secured through the courtesy of the United States Weather Bureau: The mean temperature for 20 years was 50; the minimum, minus 21, and the maximum, 101. The minimum temperature above noted was in January, 1913. The lowest recorded temperature since 1872 was in January, 1875, when the thermometer fell to minus 29. The maximum temperature during the 20-year period was in July, 1910. Only three times within 20 years did the temperature reach 100: in August, 1901, July, 1902, and in July, 1910. The climate was characterized in summer by warm days and cool nights and in winter by a considerable amount of sunshine and the absence of long-continued cold. These data are for the city of Denver, where the temperature was several degrees warmer than at General Hospital No. 21, due partly to the more exposed position of the hospital and partly to its increased elevation-1,000 feet. Humidity ranged from 44 per cent to 50 per cent annual mean. Sunshine varied from 56 per cent to 75 per cent. The greatest annual rainfall for 20 years was 22.96 inches, for the year 1909. The lowest was 7.75 inches, for the year 1911. The annual mean for the 20 years was 14.40 inches. The greatest recorded snow storm was in December, 1918, when 45 inches fell. The prevailing winds were from the south, and while distinctive storms were rare, high winds causing dust storms were rather common. The greatest recorded velocity was on August 6, 1877, when the wind reached 75 miles per hour.
aThe statements of fact appearing herein are based on the "History, General Hospital No. 21, Denver, Colo.," by Col. Henry Page, M. C., U. S. A., while on duty as a member of the staff of that hospital. The material used by him in the compilation of the history comprised official reports from the various divisions of the hospital. The history is on file in the Historical Division, Surgeon General`s Office, Washington, D. C.-Ed.
364
365
Sanitary status of surroundings.-Serious epidemics in the city of Denver were unknown. The greatest annual occurrence of the more important communicable diseases was as follows:
Typhoid fever
|
Year |
Cases |
Deaths |
Year |
Cases |
Deaths |
|
1906 |
884 |
89 |
1909 |
447 |
47 |
|
1908 |
711 |
74 |
1910 |
625 |
59 |
Subsequent to this time there was a gradual immunization against this disease until 1919, when there were but 62 cases and 9 deaths.
Scarlet fever
|
Year |
Cases |
Deaths |
Year |
Cases |
Deaths |
|
1907 |
1,194 |
57 |
1913 |
878 |
51 |
|
1908 |
744 |
30 |
1918 |
773 |
7 |
Smallpox.-This disease appeared to be more prevalent than is consistent with well-enforced health regulations. The year of greatest frequency was 1918, when there were 898 cases; 1919, 567 cases; and 1911, 472 cases.
CONSTRUCTION
On February 14, 1918, the Surgeon General recommended to the Secretary of War that a 995-acre tract of land near the city of Denver be leased at $1 per year. The site had been investigated by a representative from the Surgeon General`s Office with a view to locating thereon a large general hospital for the treatment of tuberculosis. This request was approved by the Secretary of War on February 20, 1918, the lease being made with the Denver City and Commercial Association, and was dated, and became effective, on April 19, 1918. Of the various sites inspected in the vicinity of Denver the one selected was considered the most suitable.
The project for the construction which was to be installed was formally approved by the Secretary of War on March 27, 1918. The ground was broken on the 29th of the month following and construction actually begun on the 2d of May. Generally speaking, the hospital was laid out on a plan providing, in a central area, a large infirmary building for the bed cases, general cooking and messing facilities, administration, surgical, and other professional operative activities; and grouped about this area at intervals of 200 feet were the wards for all but the bed-ridden or infirmary cases. The first group of buildings to be constructed, 48 in all, comprised the administration building, officers` tuberculosis ward, officers` quarters, nurses` infirmary, operating pavilion, garage, officers` recreation building, exchange, central infirmary for 300 bed patients, 12 two-story tuberculosis wards for an average of 60 ambulant patients each, 1 isolation ward, 4 barracks for enlisted personnel, 3 storehouses, chapel, guardhouse, laundry, surgical ward, shop, 5 kitchens, mess for sick officers, duty officers, enlisted sick, nurses, other Medical Department personnel, and other miscellaneous buildings for a total capacity of about 1,000 sick.
366
The second group of buildings was erected later and consisted of 16 open-air wards, 3 officers` wards, nurses` quarters, a barracks, and a storehouse. Still later a third group of buildings, mostly wards, was erected. In addition, a school building and two curative shops for physical reconstruction work were
FIG. 113.-Wards (under construction), General Hospital No. 21
constructed. In all 86 buildings of vile and stucco were constructed, the total cost of the project being $3,205,000.
The foundations of the buildings were of reenforced concrete, the walls above ground being made of terra cotta wall-tile stucco. The roofs were constructed of wood covered with a four-ply tar and gravel material, or with "Elaterite." Interior floors, partitions, and ceilings were of wood, the parti
FIG. 114.-Open-air ward, General Hospital No. 21
tions and ceilings being covered with asbestos plaster board and two coats of wall plaster. The interior woodwork was of white pine covered with two coats of paint. All rooms for toilets, utility, and baths had cement floors.
The large infirmary building accommodated the more serious ill and those confined to bed. This building was connected with the administration building and mess hall by covered corridors. The remainder of the ward buildings were
367
widely separated and were not so connected, consequently patients going to and from mess were exposed to the weather and much inconvenience, and, in some cases, actual suffering. This widespread arrangement of the buildings made the hospital correspondingly difficult to administer and expensive to operate.
Five of the buildings were designed as officers` wards with a central lounging room and two wings on either floor. In each wing there were eight individual sleeping rooms opening on a semi-inclosed sleeping porch.
One of the buildings was designed to accommodate invalid nurses. This building was two-storied, both floors being similarly arranged.
Two buildings were erected as quarters for nurses, each containing 48 bedrooms. Another building, identical with the quarters for the nurses, was constructed and used as officers` quarters.
The post exchange was a one-story building containing, besides the store, a tailor shop and barber shop.
The barracks for the enlisted personnel of the Medical Department comprised five two-story buildings, each designed to quarter 100 men. Each floor
FIG. 115.-Officers` apartments, General Hospital No. 21
was divided into two dormitories, 25 capacity each, and a separate room for a squad leader.
The hospital possessed its own refrigerating and ice-making plant, installed in a two-story brick building. The plant consisted of a 9 by 9 inch Arctic ammonia compressor with a daily refrigerating capacity of 20 tons and an ice-making capacity of 7 tons. In the building there were two large refrigerating rooms: One for meat, with 3,600 cubic feet storage capacity; and one for provisions and fruits, with 3,200 cubic feet storage capacity. The ice storage room had a capacity of 40 tons.
The floors, walls, and ceilings of the rooms of the refrigerating plant were insulated with two thicknesses of 2-inch cork and there was an overhead system of refrigerating coils and air circulation. A small 6-ton refrigerating plant, in addition to that described above, was provided for the general mess.
368
The educational service occupied four buildings, one of which was used as a schoolhouse. Two were used as curative shops and one as a shop building. All were one-storied except the schoolhouse, which had two stories.
Four buildings were designed for the storage and distribution of quartermaster and medical supplies. Each had a small office at one end of the building and there was a wagon platform extending the full length of one side. One building, approximately 13 by 27 feet, was designed for the incineration of patients` sputum and medical and surgical refuse. This building contained a fire-brick incinerating oven of 1-barrel capacity. Flame flues from the fire pot extended from each side over the incinerating chamber. The consumption capacity of the incinerator was 16 barrels for an 8-hour day.
Of the five mess and kitchen buildings the general mess was the most important and was operated for the enlisted patients. This general mess was a one-story building, T-shaped in plan, and was connected with the main infirmary and isolation ward buildings by corridors. The other mess buildings were the Medical Department detachment mess, duty officers` mess, patient officers` mess, and nurses` mess.
An old family residence on the premises was remodeled and converted to use as the commanding officer`s quarters. It was a fairly modern two-story frame structure located near the southwest entrance to the hospital grounds. In connection with it was a good stable and garage, a cow barn, and a chicken house. Sewage from this building was carried to an old abandoned well, 72 feet deep, near by.
The Red Cross building was located in the center of the reservation. Facing this on the south was the administration building. Between the two was the flagpole. South of the administration building were the surgical ward on the east and the operating pavilion on the west. Infirmary buildings were next in order to the south, for which there was an unobstructed southern exposure. The general mess kitchen was located directly east of the administration building, and an inclosed corridor connected the administration building with the infirmary. This corridor was crossed by a smaller one joining the surgical ward and the operating pavilion. Southwest and southeast of the administration building were the semi ambulant and ambulant wards.
Water supply.-Water was supplied from the city of Denver mains which were extended to the hospital from the town of Aurora. Its source was the mountains adjacent to Denver, from which it was piped to the city filter beds. The main to the hospital had a natural pressure varying from 25 to 65 pounds per square inch, which was augmented by the installation of a booster pump. Distribution within the hospital was effected through a 75,000 gallon pressure storage tank and tower. This tank had an elevation of 87 feet and when full its water level was 115 feet above the water main, giving an equivalent pressure of 50 pounds. Because the average depth of frost penetration frequently reached 3 feet all distribution pipes were laid about 5 feet below the surface of the ground, to prevent freezing. There were 59 fire hydrants located about 275 feet apart on the water lines. These hydrants had a 4-inch connection with a twin 2-inch hose coupling, the hose connections being standard with the Denver fire department. The emergency water storage was provided in a concrete reservoir of 1,200,000 gallons capacity.
369
Sewerage system.-The soil pipes from buildings were 4-inch standard cast iron connected without to 6-inch the sewer pipes which were run into 6, 8, and 10 inch collecting mains. Brick manholes 3 feet in diameter were placed at intervals of about 400 feet. All connections between mains and branches, except at manholes, were made with Y branches. The main trunk line sewer was of 10-inch tile pipe, running north to 1,700 feet from the center of the grounds and emptying into a septic tank battery whose total capacity was 240,000 gallons. Each chamber of the battery was 12 by 12 feet square and 15 feet deep, with hopper bottom, all built of concrete. Sludge was withdrawn from the bottom of the chambers and discharged into a neighboring creek through an open ditch. The action of the tank was syphonic, sufficient pressure being collected to automatically operate the sprinkler heads on the filter bed. This filter bed was 55 by 186 feet, built with concrete retaining walls and concrete floor, filled with a crushed slag filter to the depth of 5 feet 9 inches. Distributing mains of the filter bed were connected with either end to 8-inch tile drains leading to the discharge sewer. An 18-inch tile storm sewer drained the low ground of the hospital, terminating in an open ditch which emptied into a draw near the septic tank.
The septic tank was located 938 feet north of the northernmost hospital building. The dosing tank was 500 feet beyond the septic tank and the filter bed was 460 feet more distant, all in a northerly direction. The final sewer pipe from the filter bed was 325 feet long.
Plumbing system.-The plumbing system was a continuous and revent system for the toilets and individual revents for the laboratories, bathtubs, and showers. All soil and waste pipes were carried under the floor or in the ground, the horizontal runs being cast-iron soil pipe. All vertical waste and vent pipes, 2 inches and smaller, consisted of galvanized and screwed drainage fittings.
The hot water for the hospital was furnished by hot-water heaters located in the power house, and was circulated throughout the grounds by turbine driven centrifugal pumps. This maintained a constant circulation and prevented water from freezing during periods of small demand. Hot-water lines were carried in the same tunnels and trenches as the steam lines.
Waste pipes from all sinks in kitchens were carried through specially constructed concrete grease traps.
Lighting system.-The electric current for lighting and power purposes was obtained from the Colorado Power Co. Connection with the lines of this company was made at Utah Junction and transmitted over a 12-mile, 3-phase, 13,200-volt transmission line to a transformer station on the hospital reservation. This transformer station consisted of two sets of three transformers each; either set of transformers, or both, being usable so that either set could be thrown into service to permit repairs without discontinuation of service. The pole lines were of the usual wood pole and cross-arm type of construction. The wire was triple grade weatherproof insulation; no smaller wire than No. 8 being used; and all interior wiring was run inside of black enamel iron conduits. Cut-outs, switches, and fuses were in iron boxes or cabinets. Infirmary wards had plug receptacles to facilitate connection of X-ray machines, electrotherapeutic apparatus, etc.
370
Heating system.-The central plant for heating the hospital buildings was located at the lowermost point to favor returns by the natural grades of the ground. The pressure carried on the heating mains varied from 50 to 60 pounds, readily increased to 100 pounds when necessary. All piping in tunnels and trenches was covered with asbestos air-cell pipe covering. Altogether about 4 miles of underground tunnels and trenches were required to carry the heating lines. Besides furnishing radiation for the buildings of the hospital, the plant furnished steam for use in the laundry.
Roads.-With the exception of the main entrance road none actually existed throughout the hospital grounds. The main road had a gravel surface and was unsatisfactory because it was muddy in wet weather and dusty when it was dry.
Walks.-All hospital walks were constructed of concrete with a width of 5 feet, and, wherever possible, roofing the steam trenches.
Actual construction of the buildings of the hospital began May 2, 1918. The first buildings were occupied and the hospital officially opened for the reception of patients on October 13, 1918. Though occupied by patients, the hospital was not officially completed until well into 1919.
ADMINISTRATION
The staff encountered great difficulties in administration during this constructive period. They were handicapped by inexperienced assistants, and the necessity to contend with numerous difficulties in the nature of complaints from, and active resistance on the part of, many of the patients who, with exalted ego, considered themselves above law and discipline. In this attitude they were unfortunately encouraged by numerous well meaning but misguided civilians and overzealous volunteer welfare workers. In spite of these difficulties real constructive work was done, and of the complaints made but few were found, upon investigation, to be based on fact.
The latter part of the fiscal year 1919 found practically a complete change in the administration of the hospital. Command was assumed by a regular officer of the Medical Corps and a new staff of more experienced officers was assigned. During the earlier days of the hospital`s existence little or no effort was made to classify patients. Toward the end of 1919 a receiving ward was organized, and patients, upon admission, were diagnosed and classified as rapidly as possible and distributed to proper wards. One end of the infirmary ward was set aside for the very sick, which included those with advanced lesions, high fevers, or grave prognoses; another section of the infirmary was set aside for the moderately sick; and a third section was used for ambulant cases. Officers` wards were later similarly divided into an ambulant, a semi ambulant, and an infirmary or very sick ward. In addition, one ward of the infirmary group was set aside for the seriously ill officer patients. The receiving ward was located in the infirmary building and in this ward all new cases were treated until definite classification could be made.
As rapidly as the outside wards were completed patients not requiring infirmary treatment were transferred to them, thus relieving the congestion in the infirmary wards.
371
The maximum bed capacity of the hospital was reached in August, 1919, when approximately 1,400 patients were being treated.
About August 1, 1919, the chief of the medical service instituted a course of lectures and talks to patients on personal hygiene, and tuberculosis, its complications and rational treatment. All lectures were illustrated with lantern slides and talks were made sufficiently plain to be intelligible to the layman.
A school of instruction for the training of medical officers was also inaugurated, having special reference to the diagnosis and treatment of tuberculosis. This course was found essential not only for the general professional advancement of the medical officers but to secure an adequate permanent staff for the hospital, since many of the officers assigned for duty had but limited training in the diagnosis and treatment of pulmonary tuberculosis. This course also provided a selection from among the medical officers on duty of the best available diagnosticians and clinicians for assignment to the more important infirmary wards, boards, etc. The results attending these lectures were most gratifying. Frequent changes in personnel consequent upon discharge of emergency officers and their replacement by members of the regular service necessitated a continuation of these courses.
HOSPITAL SERVICES
LABORATORY SERVICE
The laboratory service was quite active and during the year 1919 made over 75,000 examinations. These examinations included routine analyses, blood chemistry, zoology, histology, and bacteriology. The service was made responsible for the proper conduction of autopsies, tissue examinations, and the preparation and inspection of the bodies of deceased soldiers.
Three officers were assigned to duty in the laboratory department. In addition there were six enlisted men, two female technicians, and a varying number of patient nurses who were given instruction in laboratory technique. This work of giving instruction in laboratory technique to patient nurses was primarily undertaken without specific authority, but with the idea that it would give nurses, upon return to civil life in a partially disabled state, an additional opportunity for earning a livelihood. The results obtained were very satisfactory and authority was later received to make the instruction a definite routine.
SURGICAL SERVICE
The general surgical service was necessarily the smallest in the hospital, the surgical work which was done being principally incidental. The service included general surgery, eye, ear, nose and throat, dental, and genitourinary work. Two officers were assigned to the section of general surgery, four to dental surgery, two to the eye, ear, nose and throat department, and one to the genitourinary department. By far the largest of the sections was the dental service, in which, in addition to the four officers regularly assigned, there were, from time to time, several patient officers. A dental survey was made of all patients, and any necessary treatment was promptly given. Upon its establishment, the dental service occupied three rooms in the administration building. Portable outfits only were at first used and the scope of the dental work was
372
necessarily limited. As the hospital enlarged, however, this service automatically increased until the clinic in the main building comprised six rooms. Three were for operating, one for administrative purposes, one for a reception room, and one for a laboratory. Dental chairs were installed in the infirmary where much of the emergency work for infirmary patients was done. A valuable addition to the dental equipment was the dental X-ray unit. A complete dental examination was recorded on clinical records, and any diseased condition found was promptly treated. The importance of focal infection became great subsequent to the establishment of the hospital, and it was given special attention in the dental service.
EDUCATIONAL SERVICE
This service was instituted in June 1919, with a teaching staff of 23 and an enrollment of 73. The work performed was both curative and educational, the first being considered of paramount importance. The percentage of enrollment in the educational service was very gratifying; approximately 60 per cent of the patients passing through the hospital were enrolled in some branch of the educational work. It was very noticeable that complaints were rarely heard from patients who took an active interest in vocational training. Obviously in infirmary wards little instruction, except in academic subjects, could be given. As the patients became ambulatory, however, classes of instruction and work in shops and crafts were taken up.
In connection with the educational and recreational service an enlisted service club was operated, directly under the chief of the educational service. This department seemed justified, as the club rooms were at all times well patronized and there was an increase in the demand for library books. Dances for enlisted men were given twice monthly and were usually well attended. Ladies of the city of Denver secured and chaperoned young ladies for these dances. Provision was made for various athletic sports which included basket ball, baseball, tennis, wrestling, and boxing.
A "fifty-fifty" league was organized, in connection with morale work, with branches in each ward and in the detachments, representatives of which met in an executive body to take up and recommend to the commanding officer matters of improvement deemed by them advisable. Questions of policy arising from other sources were frequently referred to this body to secure an expression of opinion.
MESSING
From the time of the establishment of the hospital, separate messes were conducted for enlisted patients, officer patients, nurses, Medical Department detachment, and duty officers. With the exception of the last-named class of personnel, the financial accounting for these messes was consolidated, though separate accounts were kept of the cost of operation, income, etc. Subsequently the detachment mess was consolidated with the general mess to secure economy of operation and operating personnel.
During the earlier days of the hospital much unfavorable criticism was directed toward the several messes operated. Investigation, however, conclusively showed that the conditions were never as bad as represented. Errors in management existed, but these were believed to have been due rather to lack
373
of experience than to intentional wrong. This department of the hospital received more attention than any other and every effort was put forth toward securing efficient service. While the messes were at times not quite so good as it was desired to make them, the fact that tuberculosis patients are habitually discontented and inclined to grumble was taken into consideration. Their fickle appetites frequently made them refuse dishes which had been especially requested by them. This psychological condition was not infrequently encouraged by well meaning but misdirected sympathizers who, with laudable desire to cheer the sick, only made them discontented with their lot and environment.
Another difficulty under which the mess was administered was a financial shortage. For the latter half of the year 1919 a large percentage of the patients were beneficiaries of the Bureau of War Risk Insurance, from which it was practically impossible to receive prompt payment.
PERSONNEL
Under this heading may be enumerated the greater portion of the troubles with which the administrative staff of the hospital had to contend. Upon the signing of the armistice, which occurred shortly after the hospital was established, emergency medical officers and enlisted personnel, being desirous of returning to civil life, became greatly dissatisfied with the service. This mental condition was invariably reflected upon the character of work performed. Immense pressure was brought to bear directly and indirectly through Congressmen, governors, legislators, municipal officers, and others to secure release of men from the service. In spite of every effort to maintain morale, the spirit of discontent prevailed. The task of replacing emergency personnel by those of the Regular Army was naturally slow and with the lapse of time the spirit of unrest materially increased. This was especially true of the enlisted personnel. In the summer of 1919 the commanding officer adopted the policy of discharging emergency men according to length of service, deviating from this rule only in cases of extreme emergency or because of misconduct of the soldier. Rosters were prepared according to length of service. Infractions of discipline and neglect of duty were punished by demerits, placing the man concerned lower on the list for discharge. This policy notably improved the character of the services rendered: the men appreciated that their discharge would be expedited by good work but would be retarded by unsatisfactory conduct or neglect of duty.
374
