CHAPTER XVIII
THE GENERAL HOSPITAL (NEW)
GENERAL HOSPITAL NO. 3, COLONIA, N. J.a
In June, 1917, a resident of Colonia, N. J., offered his home to the Surgeon General for hospital purposes. This elegant place was situated on the Lincoln Highway, 22 miles from New York City, and about 1 miles from the Pennsylvania Railroad, with which it was eventually connected by spur. On the property was a large house which the owners wished used as a hospital for 100 beds. The original intention of the owner was to equip the building with beds, linen, china, etc., and the Mercy Committee of New Jersey had volunteered to continue its maintenance.
PHYSICAL CHARACTERISTICS
Terrain.-The country in this section of the State is rolling, with wooded portions; the site of the hospital buildings is at an elevation of about 126 feet above sea level. The soil is sandy with an overlying surface of clay. As a result there is practically no high-flying dust in dry weather, but a considerable amount of sticky and easily carried clay-mud following rains.
Climate.-The climate is moderate, as in northern New Jersey. The hospital site was not exposed to winds.
Hospital environment.-In the hospital neighborhood were many farms of the poor sort whose owners lived in a most primitive manner, earning their livelihood as best they could by small trucking or day laboring. In the immediate vicinity of the hospital there was a high class residential district, comprising several country estates. The hospital environments were satisfactory from a sanitary standpoint; the buildings were on a broad plane of about 70 acres with a gentle southeast slope, affording good drainage and the desired sun exposure.
HOSPITAL CONSTRUCTION
A hospital of but 100 beds was deemed too small for practical purposes; consequently, plans for a 250 or a 500 bed hospital, to be designated Reconstruction Hospital No. 3, modeled and organized like the Boston reconstruction hospital, was contemplated. Even so late as November, 1917, tentative plans for a small special (reconstruction) hospital persisted. Meanwhile, the Secretary of War authorized the acceptance of the Colonia place, providing the Medical Department appropriation would cover all the expenses. A nominal lease, at $1 per year, was executed.
By December, 1917, the plan for the utilization of special hospitals was largely given up and preliminary plans for a 1,000 bed hospital at Colonia had been provided and sent to the Quartermaster General for construction.
aThe statements of fact appearing herein are based on the "History, General Hospital No. 3, Colonia, N. J.," by Col. Fred H. Albee, 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.
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Construction began on February 2, 1918, and while in progress a 500-bed addition was planned, the construction of which was requested on February 23. Here, as at General Hospital No. 2 and many other general hospitals, the buildings pertaining to physical reconstruction work were not built for some time. The plans for these buildings were in process of constant revision in the Surgeon General`s Office, due to indefinite requirements for equipment, and were not suitable for release at the time. Later, however, these special buildings were secured, and, from time to time, additional small items of construction were added. These additional items were relatively few, however, and by June, 1918, a 500-bed section was opened for patients, the designation "General Hospital No. 3" being given.
Unlike the first two general hospitals (Nos. 1 and 2), General Hospital No. 3 was constructed upon relatively unimproved land; and considerable road construction was necessary; water was brought from a distance; a laundry was constructed; and a complete sewerage system and sewage disposal plant (septic tank, filter bed, and humus tank) were installed.
FIG. 117.-View of front of General Hospital No. 3
Much of the expense and delay in the construction of this hospital resulted because no railroad spur connected the railroad siding 2 miles distant; and all materials for this large project were hauled by trucks over a road which, in the spring of 1918, became almost impassable. After the construction period was over such a spur track was put in operation.
By October the major portion of the construction had been completed and 1,700 beds were available for use. Approximately 100 buildings were constructed. The total cost was $2,750,000.
This was a typical general hospital, complete in every department, but in addition certain special work was provided for. Full physical reconstruction facilities were installed, many in the reconstruction division where special attention might be given amputations, organic diseases of the nervous system, injuries of the brain, spinal cord, and peripheral nerves, and orthopedics.
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HOSPITAL ORGANIZATION
The commanding officer of the hospital arrived for duty about March 30, 1918. The quartermaster and the medical property officer reported at about the same date. The organization of the surgical service was undertaken by the chief of service on June 5, 1918. During the month of June members of the medical and surgical staffs reported, the nurses were assigned to duty, the wards were put into readiness, and the hospital was practically complete and prepared for the reception of patients at the end of the month. The first patients were admitted on July 5, 1918. The first overseas patients were received on August 1, 1918.
Occupation of hospital buildings.-The occupation of any part of the hospital first occurred when the commanding officer took one of the wards temporarily as an office. The offices of the quartermaster and the medical property officer were also established in this ward, pending the construction of the quarter master buildings.
FIG. 118.-Convalescent wards, General Hospital No. 3
The buildings of the hospital were practically complete and ready for occupancy July 1, 1918. By September 15, 1918, the day the acute surgical wards became filled, it was necessary to open the first two wards of the convalescent section.
The buildings were of the pavilion type of construction, according to the usual military hospital standard. Those pertaining to the immediate care of the patients, and for their use, were connected by inclosed corridors. The general arrangement of the buildings is shown in Figure 116.
Hospital water supply.-The water supply for the hospital was furnished from an 8-inch main by the Middlesex Water Co.; it was very satisfactory.
Sewage.-Ultimate disposal of the hospital sewage was by means of a septic tank and sprinkler filters; each building was fitted with modern plumbing fixtures adequate to its needs.
Disposal of wastes.-Kitchen wastes and other forms of garbage were at first disposed of by means of an incinerator, or were fed to hospital hogs. Later, the hospital garbage was sold, on contract, to a near-by stock farm.
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Lavatories and baths.-These were located in each building in adequate numbers.
Heating.-A central heating plant, consisting of eight 150-horsepower Kavanel boilers and operating by the return vacuum system, furnished steam heat with pressure to all the buildings and at the same time supplied them with hot water.
Hospital lighting.-The buildings were completely wired for electricity, which was furnished by a local service company.
Hospital kitchen and mess.-There were five messes and kitchens. As originally constructed the general mess was much too limited in capacity, as was also the mess for the detachment men. These were enlarged to meet the
FIG. 119.-Bakery, General Hospital No. 3
demand. The kitchen of the general mess was especially a very complete unit, being equipped with steam cookers, vegetable peelers, dishwashers, refrigerating boxes, ice machines, and bakery. The officers` mess was very adequate, as was also that of the nurses.
Hospital laundry.-This plant was very successfully operated. It handled all the hospital linen and the clothing of the enlisted men, operating in two shifts of eight hours each, with men on duty at the hospital and a few female laundresses for ironing purposes.
Quarters.-The original officers` quarters were destroyed by fire on October 10, 1918. During the months following, in the interval of rebuilding, it was necessary for the officers to occupy temporary quarters in one of the convalescent ward buildings. New quarters, consisting of dormitory and a mess
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in near-by rooms, were built in March and proved satisfactory and adequate in every particular. The nurses` quarters were adequate, but the barracks for the enlisted men, five in number, were not adequate, two additional buildings being in almost constant service.
Hospital chapel.-The first building used as the chapel at the hospital was opened in the fall of 1918. This was used not only for religious services but also for amusement purposes by the Young Men`s Christian Association before the completion of its building in December, 1918. A separate chapel was constructed in the spring of 1919, and was open for religious services early in May, 1919.
Hospital storehouse.-There were three quartermaster storehouses, including one medical supply depot.
PROFESSIONAL SERVICES
Because of the fact that General Hospital No. 3 was designated principally for the treatment of surgical cases the medical service of the hospital was correspondingly small and was limited to cases incident to the hospital personnel and the medical complications of the surgical patients.
SURGICAL SERVICE
The type of cases received at this hospital was largely that involving injury of the extremities, either previous amputations or injuries from shrapnel or high explosives. An exceptionally large number of cases of gunshot wounds showed extensive loss of bone which had been either shot away or removed at an early operation. A great percentage of these required one or more preliminary operations for the removal of dead bone, foreign material, etc., before the final plastic work could be undertaken. Of the cases of amputations treated, all, with very rare exceptions, received the primary operations before admission to this hospital; usually these had occurred in France. These cases were assigned to General Hospital No. 3 for further care, incidental to the ultimate application of artificial limbs. Many pathological and traumatic conditions of the spine were also treated. Cases of nerve injury, including many with loss of substance, were common. The various types of cases treated in the different departments of the surgical service are briefly considered under their respective heads.
The history of the surgical service of the hospital dates from June 5, 1918, at which time the chief of service, with an original staff of three assistants, undertook its organization, with the purpose of formulating an efficient working plan for the administration of a large reconstruction service handling great numbers of wounded men. During the following month additional officers reported for duty and the nurses likewise were assigned. Organization of the various departments was begun; the operating pavilion was equipped; the pathological and X-ray departments were opened by the respective chiefs; and the 11 acute surgical wards just nearing completion, to which the officers who had reported were assigned, were put into readiness. By June 30, 1918, the hospital was practically completed and prepared for the reception of patients.
The first patients from overseas, 17 in number, arrived on August 1, 1918. In September the number of patients began to increase rapidly and by December, 1918, the 11 surgical wards for acute cases being entirely filled, the opening
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of wards in the convalescent section was necessitated. The number of patients on the hospital records continued to grow until February, 1919, when active enrollment reached its height, approximately 2,000 patients being recorded at that time as having received treatment at the hospital. At the height of the work the surgical staff included 50 officers. The personnel of the operating pavilion regularly consisted of eight nurses and eight enlisted men.
During the early fall months in 1918 the operative work at the hospital consisted principally in cleaning out sinuses, removing dead bone, fragments of shell, or even bits of clothing and wood. The surgical cases were for the most part those recently wounded and showing bad infections. It was not until December, 1918, that bone-graft operations for restoration of lost substance could be undertaken in any number. The great amount of plastic work at this hospital subsequent to that time was done for a wide variety of conditions. A large percentage of the cases of this group were treated by the bone graft for loss of bone resulting from gunshot wounds or from osteomyelitis, a total of 149 cases having been operated upon. Cases of special interest included three instances of synthetic transplantation of tissue for the formation of new digits, whereby the usefulness of the disabled member was restored to a great extent. In the large group of shoulder cases, restoration of substance and shoulder-joint motion and function were accomplished. Extensive loss of substance in the long bones, such as the humerus, ulna, and tibia, was replaced by the bone graft, with the resultant return of function. In another group the bone graft was used to relieve affections of the spine, in such conditions as compression fractures of the vertebral bodies, and Pott`s disease.
ARTIFICIAL LIMB SERVICE
The artificial limb service at General Hospital No. 3 was organized on January 1, 1919. Although primarily not so designated, in the fall of 1918, the Surgeon General decided to include cases of amputation among the patients treated at this hospital. At the time of the organization of the special amputation subservice there were in the hospital nearly 400 such cases which had been sent for the application of an artificial limb and for preliminary treatment incident to its proper fitting.
February 10, 1919, General Hospital No. 3 was classified as one of the two amputation centers of the East. The number of such patients admitted increased very rapidly, reaching its height in April, 1919, when approximately 750 patients with amputations were enrolled. This number remained practically unchanged during May. During the summer many discharges were made and the number of patients admitted was constantly decreased until the latter part of September, when the amputations in hospital numbered only about 200.
With the exception of five primary operations performed at the hospital, all the operative work in the amputation subservice was on stumps. These operations consisted of re-amputations to secure a satisfactory stump for the application of the artificial limb, occasional sequestrectomies when necessary, and the final plastic work. At the height of the work in April, 1919, the number of operations performed on stumps totaled in that month 138. A very large percentage of the cases requiring re-amputation were those preceded by the guillotine operation in France; in these instances further operative treatment was necessary before a successful fitting of the artificial appliance.
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Most of the patients arrived with open stump wounds, badly infected, which, after being sterilized by the Carrel-Dakin method, required re-amputation or plastic operation on the stump. In many instances patients were received with the stump healed and large scars present, in which excision of scar and plastic closure were necessary.
As a form of postoperative treatment after the healing of the stump, the patient was sent to the department of physiotherapy for massage and stump calisthenics, in preparation for the temporary artificial limb which was applied at this hospital. Having been fitted with this, he was returned to the gymnasium to be given walking exercises. The final disposition of patients was either by transfer to a convalescent hospital nearer their homes, or by discharge through the hospital discharge board. The total number of cases of amputation admitted to the hospital is briefly summarized in the following table. Of the 16 double amputations recorded there was only one instance of loss of both arms; there were several cases in which arm and leg on the same side had been amputated; in one case both legs and one arm were lost.
Number of cases of amputation admitted to United States General Hospital No. 3.
|
Legs |
1,089 |
|
Arms |
246 |
|
Total |
1,335 |
|
Double amputations |
16 |
THE ORTHOPEDIC WORKSHOP
Coincident with the growth of the artificial-limb service, a part of the subservice of amputations, the demands upon the orthopedic workshop at the hospital increased. This department, which was organized in November, 1918, was opened primarily for the manufacture and fitting of splints and braces. With a subsequent increase in the working force and equipment, the fitting of the artificial limb was also undertaken. In the early part of March, 1918, the orthopedic workshop was still further enlarged to make possible the manufacture of arms as well. At its height this service employed a total working force of 28 men, including the officer in charge and his assistant. Over 1,000 patients, on an average, were fitted each month; this number included cases of application of braces and splints, as well as of artificial arms and legs, and their adjustment. In the 11 months of its history, from November, 1918, to September, 1919, inclusive, the department handled over 11,000 patients.
Work done by the orthopedic workshop.
|
Appliance: |
Number fitted |
|
Legs |
843 |
|
Arms |
75 |
|
Splints and braces |
2,745 |
|
Total number of appliances |
3,663 |
ANESTHESIA
In the large amount of operative work done at this hospital it was found that nitrous oxide-oxygen and minimum ether was the anesthetic of choice. The rapid induction period and quick recovery (from 5 to 10 minutes), with very little unconscious nausea and vomiting, attending the use of this
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anesthetic, permitted dispensing with at least two anesthetists. The immediate postoperative care, so necessary following ether narcosis, was not required.
The operations varied in length from periods of less than five minutes to three and four hours, and ranged from brief sequestrectomies and forcible manipulations, to intricate plastic work involving bone and nerve repair. In operative work of less than five minutes` duration, gas-oxygen was generally used. In operations lasting five minutes or longer, some in fact, extending over a period of four and one-half hours, gas-oxygen and minimum ether were administered with constantly good results. Indeed, in many cases gas-oxygen alone was found sufficient to maintain the proper degree of surgical narcosis. The small amount of ether used, however, in this type of anesthetic, did not seem to retard recovery.
The work with ether anesthesia was done largely by the Mayo method. Ethyl chloride-ether sequence was used when nitrous oxide-oxygen was not available. Ethyl chloride was administered to patients in the wards when surgical dressings were found to be very painful. The Ohio Monovalve, Connel, and Heidbruch apparatus were used. The Ohio Monovalve was found the most satisfactory because it was stable and did not get out of adjustment; in other words, it was always in good order.
With few exceptions all the operative work at the hospital was handled by two anesthetists.
SURGERY OF THE HEAD
For this branch of surgery there was no separate building at the hospital.
The eye service and the ear, nose, and throat departments, at several times in the history of the hospital, were combined under the supervision of one chief. The eye service was inaugurated May 10, 1918. The work consisted of the examination of patients from the detachment and the nursing staff, the first overseas patients being treated August 19, 1918. With the influx of large numbers of overseas patients, and the consequent heavy demands of the surgical wards upon staff members, it was found possible to again combine the eye and otolaryngological departments.
The eye and the ear, nose, and throat departments at no time had a sufficient number of patients warranting the setting aside of a ward for their special care. In the otolaryngological service, tonsillectomies represented the bulk of operations performed. There were a few cases of ethmoiditis and mastoiditis, necessitating operation. In the ophthalmological service refractive errors formed between 70 and 80 per cent of the cases received.
THE NEUROSURGICAL SERVICE
This department was organized the last week in January, 1919. The neurosurgical cases which were not complicated with infected bone or soft part lesions, were concentrated in two wards, ward 14 being used for preoperative, postoperative, and bed patients, and ward 28 being set aside as a convalescent ward. The offices of the neurosurgical service included the administrative department and the examining rooms, both of which were located in ward 28.
Subsequent to the organization of this service, 240 peripheral nerve injuries, 10 head injuries, and 8 spinal injuries were examined and treated. All cases having a definite involvement of peripheral nerves were completely
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examined in regard to motor and sensory function, and complete records of the findings, with subsequent changes, as seen in the process of degeneration and regeneration, were made and kept on file. After studies of these cases, if spontaneous regenerative changes were not observed, they were recorded as operative cases.
The department operated upon 80 cases requiring operation of a neurosurgical nature as follows: Amputation neuromas, 16; median nerve, 5; ulnar nerve, 8; musculospiral nerve, 12; posterior interosseus nerve, 2; brachial plexus, 6; lesions of two or more nerves in the upper extremity, 6; sciatic nerve, 6; external popliteal nerve, 10; facial anastomosis, with hypoglossal nerve, 2; tendon transplant, 2; spine, 1; brain, 3; and aneurysm (arteriovenous), 1. Sixteen operations were performed for the removal of painful neuromas for the amputation department. Of the 240 cases of peripheral nerve injuries examined 57 were operated upon.
BRAIN SURGERY
Ten head cases, referring primarily to skull and brain, were treated in this service. Two were operated upon. In one case a decompression operation was performed upon an officer on duty at the hospital, who had sustained a very severe fracture of the skull. The second operation was for the removal of a foreign body from the brain, the result of a battle casualty. Only one spine case was operated upon: the removal of a foreign body from the body of the fourth lumbar vertebra. In no case of spinal injury was it considered advisable to perform any operation upon the spinal cord.
THE DENTAL SERVICE
The dental clinic was organized July 24, 1918. In November, 1918, the staff was increased from one to three dental surgeons, and during the major portion of the subsequent time the dental service consisted of that number of operators and a survey officer, with an enlisted personnel of three men, an assistant for each operator.
Over 1,340 patients were treated in this service, with a total of more than 26,000 sittings. In addition to the regular routine work, many interesting plastic cases were handled, 11 following gunshot injuries. The latter included two cases involving loss of substance in the hard part and one distance of loss of bone in the right mandible, all of them being successfully treated in cooperation with the chief of the surgical service.
THE GENITOURINARY SERVICE
The number of patients treated in this department was very small, the total under treatment at no time exceeding six or seven. A portion of one of the convalescent wards was set aside for the care of such patients.
THE X-RAY DEPARTMENT
The roentgenological laboratory was established coincident with the organization of the surgical service, and was located in the operating pavilion at the special request of the chief of the surgical service, who personally drew up the original plans to include both services, for greater cooperation and efficiency in handling the large number of cases. The plan was worked out successfully; owing to its proximity to the operating rooms, the X-ray service
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frequently rendered valuable assistance during the progress of an operation, in throwing light on unforeseen conditions as they arose.
The laboratory, as planned, contained a complete United States Army roentgenological equipment, capable of every variety of X-ray examination, including fluoroscopy.
The personnel for the main part comprised two officers and four enlisted men.
Examinations totaling about 8,000 were made on about 6,000 patients. The examinations and the making of plates constituted the bulk of the work, with a small amount of film work and some fluoroscopy. By far the greater part of the examinations were for bone pathology. Just as bone work was the predominant feature of the hospital service, so it was in the X-ray laboratory. The patients were closely studied both before and after operation, and the growth of new bone following the surgical procedure was carefully studied.
THE LABORATORY
The laboratory building, adjoining the operating pavilion, included, besides the usual pathological and bacteriological sections, a well-equipped animal
FIG. 120.-Chemical laboratory, General Hospital No. 3
research annex which had been added at the request of the chief of the surgical service. Coincident with the clinical bone work, experimentations were made possible by such resources in equipment and technical assistance, and were carried on in bone growth and allied subjects, under the supervision of the chief of the surgical service.
The laboratory was organized May 25, 1918. The staff included the chief of service, two officer assistants, and nine technicians.
The work accomplished in the pathological and bacteriological departments comprised the usual blood tests, urine analyses, Wassermann reactions, etc., as
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well as analyses of milk and water, the preparation of vaccines, and inoculations. Subsequent to August, 1918, 1,481 wound cultures were taken and bacteriological counts of wounds numbered 9,896; 10,260 liters of Carrel-Dakin solution were prepared; 114 histological sections were preserved; and 80 sections were completed and examined.
AUTOPSIES
Facilities for conducting post-mortem examinations were excellent; the morgue consisted of an autopsy room, containing an autopsy table, with drain pipe, and two sinks.
HOSPITAL RECREATION
Besides the amusements and recreation provided for the various groups of the hospital personnel and patients in the houses of the Red Cross, the Young Men`s Christian Association, and the Knights of Columbus, a certain amount of welfare work was done by several organizations located without the hospital grounds. The Mercy Committee of New Jersey conducted a small canteen for the hospital personnel, the patients, and their guests; representatives of the National League for Women`s Service were very active in furnishing recreation and entertainment for patients and enlisted men at a canteen in the vicinity, to and from which guests were regularly conveyed by motor; and a local branch of the Motor Corps of America. under the supervision of the Red Cross, was active in serving the patients.
Outdoor sports on the athletic field proved one of the most popular and valuable features of the hospital social life. This field, made possible through funds provided by the Mercy Committee, was opened in May, 1918, and thereafter it was in almost constant use. Numerous field meets were also held in which opportunity to participate was afforded patients and personnel.
Besides the hospital ball team, interest was shown in other sports, particularly in boxing matches. Tennis and some golf were played. Clubs were formed to stimulate dramatics among the enlisted men and patients. There were several musical organizations, including a patients` orchestra and an officers` orchestra. Numerous organizations of a purely social nature included the officers` club, the nurses` club, and the club for noncommissioned officers.
Great interest in the welfare of the patients and enlisted personnel assigned to duty were shown by many societies in near-by towns, as well as by individuals. Special entertainments were permitted at the post, from time to time, and invitations were frequently extended to various hospital groups to participate in social affairs outside of the hospital.
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