SECTION III
ORGANIZATION, ADMINISTRATION, AND CONTROL
CHAPTER VI
DIFFERENTIATION OF GENERAL, BASE, AND CAMP HOSPITALS
Prior to the war, provision had been made for the establishment of various kinds of immobile hospitals, in the event of war, to care for the sick and wounded. The differentiation of these hospitals was based primarily on the military reasons for their separate existence at a given locality, which necessarily also predetermined their character and magnitude; and, secondly, the character of the care and treatment it reasonably could be presumed they would be enabled to furnish those admitted to them. The military elements which influenced their location and their character placed them roughly into two groups, viz: Those in the service of the interior and those in the field of operations.1The hospitals in the service of the interior included camp and general hospitals; base hospitals were intended for the theater of operations in the zone of the line of communications.1
CAMP HOSPITALS
The designation camp hospital referred to a partially immobilized unit, organized and equipped for use in camps where the care of sick would otherwise result in the immobilization of field hospitals or other sanitary formations pertaining to organizations.2
The equipment and personnel of a camp hospital varied with the requirements of the situation. The essential feature to be borne in mind is that the activities of a camp hospital were ordinarily restricted to the camp in which it was located.
GENERAL HOSPITALS
General hospitals were maintained for the following purposes:3(1) To afford better facilities than could be provided at ordinary military hospitals for the study, observation, and treatment of serious, complicated, or obscure cases. They were equipped with the best and most modern apparatus for the study and treatment of such cases and maintained a specially qualified personnel.(2) They offered opportunities for the performance of the more difficult or formidable surgical operations, facilities for which were ordinarily lacking at other classes of hospitals.(3) To study and finally dispose of cases that resisted prolonged treatment elsewhere and to determine questions of existence, cause, extent, and permanence of mental and physical disabilities of long standing or unusual obscurity.(4) To instruct and train junior medical
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officers in general professional and administrative duties. (5) To form a nucleus for the development of the larger hospitals required in the home territory in time of war.
General hospitals were under the exclusive control of the Surgeon General, except in matters pertaining to the administration of military justice, and were governed by regulations prescribed by the Secretary of War.4The senior medical officer commanded and was not subject to orders of local commanders other than those of territorial departments to whom specific delegation of authority may have been made.4
The standard size of general hospitals, contemplated prior to the war, was 500 beds.5Complete plans and specifications for the erection of temporary hospitals of this capacity, for use in time of war or other emergency, were prepared and kept on file in the Office of the Surgeon General.6Generalhospitals were ordinarily self-contained: being apart from concentrated troops they were of necessity provided an independent water supply, sewage disposal system, power plant, electric service, etc.; whereas in hospitals erected for local service, these utilities were a subsidiary part of those provided for organizations served. Being established apart from other troops, general hospitals cared for sick and wounded from diverse localities in which commands were operating, and for this reason were known as general hospitals, rather than from the fact that within them diseases and injuries of a diversified character were treated. In the former sense, the term was first used in America in application to the general hospital instituted at Cambridge, Mass., for troops of the Colonial Army during the American Revolution.7
BASE HOSPITALS
The designation base hospital was primarily intended for the class of hospitals, of 500-bed capacity, normally established in the line of communications-apart of the theater of operations-for the reception of patients from the field and evacuation hospitals, as well as cases originating in the line of communications, and to give them definitive treatment. It was intended that they should be well equipped for such treatment, so that it would be necessary to send to home territory only patients requiring special treatment, or those who might be in such condition as to be regarded as either permanently disabled or likely not to recover within a reasonable time.8It was presumed that these base hospitals would remain more or less fixed, geographically; but provisions were made for their replacement in some more advanced situation, made essential by the movements of armies. For this reason the housing equipment was normally tentage,9but existing buildings were to be used when suitable and available.10
The first application of the designation, in peace times, was to the post hospital, Fort Sam Houston, Tex.,when, on November 3, 1915, it was officially designated a base hospital by the Secretary of War.11On September 28, 1916, this hospital became the Department Base Hospital No. 1;12and shortly thereafter four more department base hospitals were established, Nos. 2 to 5, inclusive, in the Southern Department.13 All these base hospitals functioned to give definitive treatment to members of variously situated commands within the department in which they were located, which was presumed to be more highly
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specialized than was possible of attainment in the smaller hospitals. They operated under the supervision of the department surgeon. In this respect they differed from general hospitals, which, as has been mentioned, were supervised directly by the Surgeon General, as well as in the fact that patients might be transferred from them to general hospitals for more formidable operations or more highly specialized treatment. The general hospitals represented the Army`s ultimate recourse in hospitalization.
MODIFIED APPLICATION OF THE DESIGNATION BASE HOSPITAL DURING THE WAR
The plan for National Armycantonments14and National Guard camps15contemplated the provision of a base hospital of 1,000 beds for each cantonment and camp.
The numerical designations of these hospitals were selected from blocks of numbers as follows:16For base hospitals in National Army cantonments, in a series beginning with 101;for base hospitals in National Guard camps, in a series beginning with 301. Later, this system of designation was changed to provide a single series of numbers for all base hospitals, beginning with number one.17To eliminate the confusion that arose incident to base hospitals in the United States and those intended for, or actually with the American Expeditionary Forces, bearing the same designation numbers, instructions were issued by the War Department directing the designation of all base hospitals, other than those on or destined for service overseas, by the locality in which they weresituated.18 A numbered base hospital at a given cantonment or camp then became officially known as United States Army Base Hospital, Camp Blank, by practice abbreviated to Base Hospital, Camp Blank. As a class these base hospitals at the large cantonments and camps were frequently referred to as camp base hospitals, to distinguish them from the department basehospitals.19
DIVIDING LINE BETWEEN BASE HOSPITALAND CAMP
Army regulations gave to territorial department commanders the command of all military forces within the limits of their respective commands, except those exempted by the Secretary ofWar.20The War Department, in the summer of 1917, included divisions to be organized among forces exempted from departmental command;21and, in October of the same year, added troops "attached thereto," to the exempted list,22placing the latter under the jurisdiction of the camp or division commanders.23This latter provision made the base hospital clearly a unit of the camp; and gave to the camp surgeon, on the staff of the commanding general of the camp, supervisory control of the sanitation of the hospital.24
It was the desire of the Surgeon General that camp surgeons should not interfere in any way with the internal administration of base hospitals,25but that the commanding officers there of should be given every opportunity to function independently, as contemplated in Army Regulations.26He therefore issued instructions early in the war period defining what connection base hospitals would have with the War Department, both directly and indirectly.27 In these instructions it was specified that the sick and wounded reports should
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be forwarded to the Surgeon General`s Office direct, that the hospital fund statement should be approved by the commanding officer of the hospital, that no separate sanitary report would be made by the hospital but that the hospital should be included in the general camp sanitary report. It was further specified that commissioned personnel of base hospitals would be assigned by War Department orders, which fact precluded reassignment except by the same authority.
REFERENCES
(1) Manual for the Medical Department, 1916, par. 586.
(2) Ibid., par. 602.
(3) Ibid., par. 283.
(4) A. R. 1439, 1913.
(5) Manual for the Medical Department, 1916, par. 289.
(6) Plans and specifications for base and stationary hospitals. Surgeon General`s Office, October 30, 1906.Copy on file, Historical Division, S. G. O.
(7) Brown, H. E., Medical Department of the United States Army, 1775-1873. Office of the Surgeon General, 1873, 15.
(8) Manual for the Medical Department, 1916, par. 762.
(9) Ibid., par. 892.
(10) Ibid., par. 757.
(11) Letter from the Surgeon General to The Adjutant General, October 9, 1915.Subject: Base Hospital at Fort Sam Houston; and third indorsement thereon. On file, Record Room, S. G. O., 154274 (Old Files).
(12) Letter from the Surgeon General to The Adjutant General, September 7, 1916. Subject: Designation of base hospitals; and indorsements thereon. On file, Record Room, S. G. O., 154274 (Old Files).
(13) Letter from the Surgeon General to The Adjutant General, June 29, 1916. Subject: Base hospitals. On file, Record Room, S. G. O., 154274 (Old Files). Also, letter from the Surgeon General to the Department surgeon, Southern Department, August 26, 1916. Subject: Base hospitals. On file, Record Room, S. G. O., 154274 (Old Files).
(14) Memo. No. 1, Office of the Surgeon General, August 22, 1917.
(15) Memo. No. 2, Office of the Surgeon General, August 22, 1917.
(16) G. O. No. 115, W. D., August 29, 1917.
(17) G. O. No. 20, W. D., February 21, 1918.
(18) G. O. No. 35, W. D., April 15, 1918.
(19) Letter from the Surgeon General to all camp base hospitals.(Undated.) Subject: Appointment of morale officers. On file, Record Room, S. G. O., 211, Medical Record Division.
(20) A. R. 91, 1913.
(21) G. O. No. 96, W. D. July 20, 1917.
(22) G. O. No. 137, W. D., October 30, 1917.
(23) Bull. No. 67, W. D., November 30, 1917.
(24) A. R. 1387, 1913.
(25) First indorsement, Surgeon General`s Office to commanding officer, Base Hospital, Camp MacArthur, December 21, 1918. On file, Record Room, S. G. O., 322.3 B. H., Camp MacArthur (D).
(26) A. R. 13 to 19, 1913.
(27) Letter from the Surgeon General to division surgeons. (Undated) Subject: Regulations, base hospitals. On file, Medical Record Division, S. G. O., 188799-27 (7).
