APPENDIX
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REPORT ON GAS HOSPITAL, JUSTICE HOSPITAL GROUPa
[By Lieut. Col. Harry W. Goodhall, M. C.]
The gas hospital, Justice hospital group, was a provisional hospital and not an organized unit. Its formation was hastily planned in anticipation of the activities in the St. Mihiel sector to meet the requirements of an emergency. The hospital performed an active and useful service from August 29, 1918, to October 8, 1918, when it was taken over by Base Hospital No. 87.
On August 29, 1918, Lieut. Col. Harry W. Goodhall, M. C., Base Hospital No. 51, was temporarily relieved from duty with that organization by verbal orders of Lieut. Col. H. C. Maddux, commanding officer of the group, to assume command of the gas hospital. This order was confirmed by paragraph 1, S. O. No. 11, J. H. G., August 31, 1918.
On August 30, 1918, First Lieut. George W. Papen, M. C., Base Hospital No. 51, was temporarily relieved from duty with that organization and reported for duty at the gas hospital, in compliance with verbal orders confirmed by paragraph 2, S. O. No. 11, J. H. G., dated September 31, 1918. He was assigned to duty as adjutant, detachment commander, and mess officer.
On August 30, 1918, First Lieut. Russell M. Wilder, M. C., Evacuation Hospital No. 2, in accordance with telegraphic orders, commanding general First Army, reported to the commanding officer of the group and was assigned to the gas hospital for duty. He was assigned as chief of the gas service and as supply officer.
These three officers were the only permanent officers assigned to the hospital during its existence, and all of the administrative work and the burden of the medical work was carried on by them.
On August 30, 1918, 50 enlisted men from the special training battalion stationed at St. Aignan, then on duty with Evacuation Hospital No. 3, stationed at Toul, reported at the gas hospital in compliance with S. O. No. 7, Hdqrs. J. H. G., dated August 29, 1918.
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On August 31, 1918, the following civilian help was engaged:b
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All of these women had been employed by the French hospital which occupied these buildings prior to their being taken over by the American Army. They worked from 7 a. m. to 11.30 a. m. and from 1 p. in. to 5 p. m. They had one day per week off and they were paid 6 francs a day. This arrangement was the same as that under which they had been employed by the French.
To supply the lack of noncommissioned officers, the following Medical Department men were assigned to the hospital:b
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The buildings selected for the gas hospital were those known as the Lamarche Annex and adjoined Caserne Lamarche. These buildings were originally constructed for hospitalization and in times of peace had been used by the French as the hospital for the entire garrison stationed here. On this account they were perhaps better arranged than the buildings that were occupied by the other hospitals in the group.
BUILDINGS
There were four large ward buildings, constructed of stone and concrete, a small administration building, two kitchens, and a large Bessonneau tent.
These ward buildings were not entirely fireproof, inasmuch as the floors were constructed of wood.
They were divided into rooms that would accommodate about 15 patients without crowding, and these rooms were well ventilated antI very light. The possibilities of isolation were very good. The corridors and stairways were spacious. The four buildings would accommodate comfortably 1,000 patients, but owing to the lack of storerooms and mess accommodations it was only possible to prepare for a normal capacity of 650 beds.
a Copy on file, Historical Division, S. G. O. bNames omitted.- Ed.
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In certain respects the buildings were very poorly arranged for hospitalization. Running water was to be found in but one room in each building, and there were no rooms fitted up as service rooms. There was no arrangement whereby even a liquid diet could be prepared. There was no arrangement in the buildings for the disposal of waste matters.
The administration building was sufficient for the purpose and also served as quarters for the officers. Both kitchens were equipped with French ranges, which were not suited to our methods of cooking. To add to this obstacle the grate in one range was broken, and it was not until September 15 that it was repaired. During the latter part of September an Army range was installed in one of the kitchens, which added much to the service rendered, but even this was not sufficient to meet the demands made upon this department. The distance between the kitchens and the wards was a distinct handicap to good service. Liquids transported in bulk could be kept hot, but special measures had to be adopted with other foods. There was no means of keeping food hot once it arrived at the wards or of heating food in the wards until early in October, 1918.
The large Bessonneau tent was in excellent condition and well located for the purpose for which it was used, namely, as a triage and reception ward.
There was one small laundry operated by hand that could do a limited amount of small work.
The latrines were of the usual French type of can latrine, and these were emptied by French civilian contractors.
The water supply was from two sources. A tank situated on the area received water from the wells located on the area of Caserne Fabvier, and pipes had been extended from a tank situated on the area of Caserne Lamarche, which received water from the Moselle River, passing through a filter.
The sewer system consisted of a series of pipe lines and drains which received, through catch basins, rain water and liquids from the kitchens, baths, and urinals.
French civilian contractors had been employed to carry away garbage, and there was a good incinerator in the rear of the area.
As has already been stated, this hospital was formed in anticipation of activities in the St. Mihiel sector, and as originally planned it was intended to give initial treatment to gas casualties. Later events showed that this was a miscalculation, which experience would have recognized immediately, inasmuch as Toul was about 15 miles from the nearest point to the front line. As a matter of record only 169 cases out of a total of 1,281 came to the hospital without first passing through a field hospital where the initial treatment was given. Furthermore, it was thought that the gas casualties would be the first to arrive in the group, and the commanding officer was instructed to have the hospital clean and with 650 beds set up and ready for patients within 72 hours.
Lieutenant Wilder was assigned to the hospital because he had had long and intensive experience in the handling of gas casualties at Baccarat, where Evacuation Hospital No. 2 was located. For this reason the plans as to the arrangement of the hospital and the selection of the equipment were left largely in his hands.
Within 48 hours the hospital was clean and the required number of beds set uip and ready to receive patients. Within 11 days, the date the first patient was admitted, the hospital was fairly well equipped and the weak points of the hospital had been recognized.
The arrangement of the hospital was as follows:
The Bessonneau tent was used as the triage and as a receiving ward. In one corner of the tent a room was screened off for the treatment of cases of phosgene-gas intoxication. In this way the patient was spared unnecessary handling, oxygen could be administered promptly, and, if necessary, phlebotomy done at once. This room was promptly fitted iup and all the necessary equipment obtained.
Building B was set aside for these cases as soon as their condition permitted their being moved. Cases of severe mustard-gas intoxication were also sent to building B inasmuch as this was the only building equipped with bathing facilities. Each of the four large buildings had in one end, on the lower floor, what was called the "bathroom," but these rooms were only equipped with small faucets, and there were no facilities for bathing. In the building B, however, a French portable bath had been installed in the bathroom, and this shower would bathe six persons standing, but only one lying. It was evident that no large mumber of cases could be handled, and another portable shower that would bathe eight persons standing was installed before the first patient was admitted.
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Building A was set aside for officers and for the less severe cases of mustard-gas intoxication. Building B was set aside for walking cases in order to facilitate evacuations, and building C was the overflow ward.
EQUIPMENT
The equipment was supposed to be complete and was fairly complete according to the original French inventory, but some of the other hospitals on duty in the group had taken many of the supplies to make up for their own deficiencies before these buildings had been specified for hospital purposes.
There were about 700 beds that had been left by the French. These were iron beds with boards in place of springs and mattresses made of straw. These mattresses were clean and had been recently sterilized. There were sheets and blankets for making up the beds, but not enough sheets for changes. There were very few towels and pajamas. There were sufficient cooking utensils and dishes to meet the emergency, but they were not adapted to our needs. There were enough bedpans, urinals, etc., to meet the requirements.
The pharmacy was stocked with a large variety of excellent drugs and dressings and later, when medical cases were admitted, as well as gas cases, this proved to be a most fortunate acquisition. In these early days many difficulties presented themselves, and some of them were never entirely overcome.
ADMINISTRATION
There was a lack of clerks and stenographers. It was attempted to make up for this lack by appealing to the other units on duty in the group, but the men that were sent were inexperienced, and at no time did the hospital have a man that could do any of this work satisfactorily. It was necessary for the officers to do much of the typewriting, and the record work had to be constantly supervised.
There was no office equipment. Everything had to be purchased in the open market. There were no typewriters available with the exceptions of two small machines that officers attached to the hospital had brought with them. It was not until the middle of September that a standard machine was obtained, and that was borrowed from an individual.
Blank forms were difficult to obtain, and inasmuch as it was late in the month before they were obtainable, this added much to the necessary typewriting.
ENLISTED PERSONNEL
The enlisted men from the special training battalion were all classified as class B men, and none of them was strong and vigorous. Ten of the number were not physically equal to the demands that were made on the others. None of them had ever been attached to the Medical Department, and none of them had any special qualification that made him useful to the hospital. It was evident from the start that each man would have to be taught the particular work he had to perform. The majority of the men did not enter into the work with enthusiasm, and their discipline was very poor. They were very much disgruntled, and the idea of working with the Medical Department was not pleasing to them.
For the first 10 days it required constant watching in order to get the work performed; it meant constant disciplinary action to make them realize the task that was before them. After this time, however, the majority of them worked faithfully and cheerfully, and it is in a large measure due to the strained efforts of these men that the hospital was a success.
Nine enlisted men were assigned to the hospital from another unit in the group to act as noncommissioned officers, but these men, for the most part excellent, had not been trained, and it was hardly to be expected that under the circumstances another organization would voluntarily give up its best men.
It was hoped that these deficiencies would be overcome in a large measure by the employment of civilian help, and especially in the kitchen, but it was soon found that the French cooks were not accustomed to our methods of cooking, and they were far from being in sympathy with our ideas of sanitation. It was necessary to let them go and begin training our own men to cook.
Difficulty was experienced with all of the civilian help with the exceptions of the woman in the pharmacy, the woman in charge of the linen room, and the seamstresses. All these women proved to be very valuable.
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SUPPLIES
In the early days of the group the problem of supplies was a serious one. There was not enough to go around, and division on a basis of equality, according to needs, was attempted, but did not work out very satisfactorily. Our supply officer had various duties and could give only a portion of his time to this duty. The other hospitals had their supply officers, who were constantly on the alert. This was compensated in a large measure by the fact that Lieutenant Wilder had seen long service in France and knew better what was wanted and where to get it than most of the other supply officers. The spirit of the moment is well illustrated by the notation that there was a tendency on the part of some officers to help themselves to whatever they wanted, regardless of where they saw it. On one occasion a noncommissioned officer was found removing a valve from our shower bath, and it was necessary for the man in charge of the bath to call an officer before he could be induced to stop. He was found to be acting under orders from a superior officer.
KITCHENS
The kitchens were inadequate, even with the repair of the second French range. Fortunately gas cases are given nothing but liquid foods in the early days of their treatment, so that the only ones suffering from the deficiency were the personnel of the hospital.
With the installation of the Army range much better service was rendered, although another range should have been set up in order to render the service that should have been rendered. Effort was made to prepare food, especially hot, liquid food, in the various buildings, but it was late in September before small stoves were obtainable and some time later before oil could be procured.
WATER SUPPLY
The water supply was very limited and so much so that in running the bath it was necessary to see that the bath was used at its full capacity at the hours during which bathing was permitted. It was planned to be able to give baths to the cases of mustard-gas intoxication whenever they came in, and we were able to do this throughout the life of the hospital. This would not have been so had all the cases required bathing. This was obviated by the preliminary treatment given at the field hospitals.
Several times the water supply was entirely cut off on account of shortage of water, but by keeping a reserve in the bathroom it was possible to see that all necessary treatment was given.
Again, the spirit of the moment was seen when an officer from another unit cut the tank of the gas hospital area out of the circuit during pumping hours, hoping to get the extra amount in his own tank. Fortunately, the water system was so arranged that any interference with the supply system made itself evident throughout the group and the trick was discovered.
None of the water was safe for drinking purposes, and it was all boiled or chlorinated before it was used. This matter was tinder the constant supervision of one of the officers, and no case of illness due to the water occurred at the hospital.
WASTE MATTER
A good deal of trouble was experienced in getting the latrines emptied and the garbage carried away. At one time the situation was so bad that trenches for disposing waste matter were dug, but it was never necessary to use them. Before the rush of work came the contractors were more regular in their work, but at no time was it entirely satisfactory.
LIGHTING
The hospital was lighted with electricity and for the most part the service was good. It was, of course, necessary to camouflage the entire plant; and although a good deal of difficulty was experienced in getting the necessary materials to do this work, it was completed before the activities began. Here again it was necessary for the officers to personally put tip the first covers and teach the men in order that the work could he completed.
By September 7, the hospitals were fairly well equipped and supplied; the men had been assigned to their various duties and had been started in their training. The entire plant has been camouflaged and everything was ready for action.
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About 7 p. m. on this date brilliant flashes of light and sounds of heavy firing was seen and heard in the north. The firing continued at intervals all the next day and at 4 p. m. on September 8, the first patient, Second Lieut. Paul Odom, Company D, 341st Machine Gun Battalion, arrived and was diagnosed as phosgene-gas intoxication, slight.
On September 8, 15 nurses were assigned to the hospital for temporary duty per S. O. 40, Headquarters, J. H. G. These nurses were attached to Base Hospital No. 45, and while they were quartered at the gas hospital they were messed and carried on all reports and returns of their own organization.
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On September 11, Capt. Paul Dejains, Evacuation Hospital No. 2, reported at headquarters, Justice hospital group, in compliance with telegraphic orders of the commanding general of the First Army. He was assigned to duty with the gas hospital.
At 7. p. m. on the evening of September 11, commanding officers of the various hospitals were called to group headquarters and informed that activities were to begin in the St. Mihiel sector within 24 hours, and we were given our final instructions as to preparations for the drive. About 12 hours later the activities in the north, which could be distinctly seen, heard, and felt, indicated that the drive had begun. The next morning cases began to come to the group over the road, but only one case was admitted to the gas hospital on September 12 and only 38 cases on September 13. All these cases had been sent back from field hospitals. The early rumors were to the effect that little or no gas was being used. By this time it was evident that the gas hospital was destined to act as an evacuation hospital and there would be comparatively little initial treatment here. For this reason Captain Dejains returned to his hospital, Evacuation No. 2, the night of September 12.
First Lieut. William J. Kiane, M. C., Evacuation Hospital No. 14, reported for duty on September 12, 1918, as per S. O. 45, Hdqrs., Justice hospital group, but was relieved by S. O. 63, Hdqrs., J. H. G., September 19, 1918. On September 14 General Gorgas made an official inspection of the hospital. On the afternoon of September 18, cases began to arrive at the hospital in large numbers; and from 12 o'clock noon on the 17th until 12 o'clock noon on the 18th, 416 cases were admitted and 466 cases were evacuated. Fortunately, the few cases that had been coming into the hospital in the five previous days had given the personnel some experience in the duties that they had to perform, otherwise the mechanism of the hospital would have broken down with this large number of cases that had to be handled by this small number of men. During the evening and also during a very active period, General Gorgas made an unofficial visit and watched the operation in the triage with much interest, after which he made a rather complete visit of the wards. His interest seemed to be entirely in the soldier, as he was critical of the attention given to the men in the triage, making special note as to the methods of keeping them warm, feeding them, and of the initial medical treatment that they were receiving. On the morning of the 18th, it was evident that this small force could not keep on with the work, and in consequence 40 additional enlisted men from the same special training battalion reported for duty on the evening of September 18, 1918.
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On the afternoon of September 18, 1918 * * * These officers were ordered to report for duty to this group from the schools at Langres. It was not possible to have the advantage of their undivided service as each had to spend a part of the time at this headquarters in service at the front. The uncertainty of their service made it undesirable to assign adminisrative work to them, but they rendered most excellent medical service, and arrived just in time to prevent disaster owing to lack of officers.
It was on this same day that the hospital was instructed to admit medical as well as gas cases. At this time a severe epidemic of influenza had made its appearance, and owing to the crowded condition in the other hospitals it was necessary to admit some of the cases to the gas hospital. This presented a rather serious problem owing to the danger to gas cases of secondary infection. All of the respiratory gas cases were immediately segregated, and in so far as possible the cases of influenza were isolated.
The installation or cubicles was immediately begun and, while materials were lacking, the work was pushed as rapidly as possible, cubicled observation wards being established in each building within 24 hours.
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After September 20, the number of gas cases admitted began to diminish and the number of medical cases to increase. Medical cases were almost entirely respiratory and enteric. On September 25, Maj. Albert Francine, M. C., reported for duty as per S. O No. 81, Hdqrs. J. H. G., and was assigned as assistant chief of the medical service. On the same date First Lieut. Walter F. Bleifus, M. C., Base Hospital No. 78, was assigned to duty in compliance with S. O. No. 88, Hdqrs. J. H. G. On September 30, 1918, First Lieut. John W. Blake, M. C., Base Hospital No. 55, was assigned to duty as per S. O. No. 106, Hdqrs. J. H. G. Both of the last-named officers became ill shortly after they reported for duty and were not available again for service.
About this time a rather severe epidemic of pneumonia, due to the streptococcus hemolyticus, made its appearance and assumed severe proportions. The severity of the epidemic added very much to the work of the very limited personnel, both officers and men, and repeated attempts to have more officers, nurses, and men assigned to the hospital were made but the demand was so great in other units of the group that none could be spared, and on October 8, 1918, the patients and property of the hospital were turned over to Base Hospital No. 87, which had just arrived in the group.
Inasmuch as the hospital was originally intended for the treatment of gas cases, the summary will only touch on that subject. The work done by the hospital is shown by the following table:
CHART
Of this total number of cases, only 169 came directly from the front, and these found their way by accident and were not sent back by medical direction. There were but 5 deaths, all following intoxication with mustard gas. Post-mortem examinations were made and showed the following condition:
Pvt. Hels Malgren, 2855737, Company D, 360th Infantry, died September 24, 1918. The autopsy showed marked burns about the eyes and mouth, burns on the forearms, scrotum, and buttocks. Beginning at the larynx and extending down the entire trachea was a thick, frothy, greenish-gray membrane covering the entire mucous membrane. This was easily removed. There was marked hyperemia and edema of the pulmonary tissues. Scattered throughout both lobes were man dark red, almost black, areas of consolidation. The bronchi were filled with a greenish, purulent material extending down to the smallest bronchioles. Anatomical diagnosis: Gas intoxication, severe, mustard; bronchopneumonia.
Marius Albade (French), private 151st Regiment 6A, October 2, 1918: Conjunctivae hyperemic. Around the eyes, over the lips, and around the nose the skin is ulcerated and covered with a thick red scab. Similar excoriation on the scab over scrotum. Areas of broncho-pneumonia in both lungs The bronchi contained pus and the numerous membrane from the primary bronchi to the smallest bronchioles were covered with a thick green membrane. Anatomical diagnosis: Gas intoxication, severe, mustard; bronchopneumonia. Charles Beneck (French), private, 151st Infantry, F. A., October 2, 1918: Thick brownish red scabs around the eyes, lips and nose. External genitals hyperemic. Areas of
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bronchopneumonia in both lungs. The bronchi contained pus and the mucous membrane from the primary bronchi to the smallest bronchioles were covered with a thick greenish membrane. Anatomical diagnosis: Gas intoxication, severe, mustard; bronchopneumonia.
Private Fred Hoffman, 93596, Company D, 166th Infantry, October 3, 1918: Conjunctivae congested. Some excoriated areas around the eyes, nostrils, and mouth. The larynx and trachea were covered with a thick yellowish membrane. Areas of broncho pneumonia in both lungs. Anatomical diagnosis: Gas intoxication, severe, mustard; bronchopneumonia.
Private Robert Grundon, 93377, Company D, 166th Infantry, October 8,1918: Conjunctivae red. The skin around the eyes, nose, and mouth covered with a thick adherent reddish scab. Similar scabs around the genitals. Pharynx and soft palate covered with a thick greenish membrane. A similar membrane extended from the epiglottis to the finer bronchi. There was a large amount of bloody froth in the trachea. Lungs hyperemic. Anatomical diagnosis: Gas intoxication, severe, mustard.
Some very interesting facts developed in this very short experience. Unfortunately there was not time to take careful notes and collect statistics, but many of the patients were closely questioned, and the general impression is probably not very far from correct.
First of all, one is impressed by the fact that the large majority of the cases, fully 75 percent, were not severely gassed. Of this number 20 percent were probably not gassed at all. They were rather victims of exhaustion, shell fume, etc. Fully 25 percent of the cases could have been returned to duty within 24 hours, and fully 50 per cent could have been returned to duty within from four to six days. Of the 828 mustard-gas cases the 5 that died were the only cases that were considered seriously ill. In only about 20 percent of the mustard cases was the condition severe enough to confine the patient to bed for more than 48 hours.
The division between respiratory cases and contact mustard-gas cases was about equal. While some of the skin burns were severe and extensive, in none did it appear that the healing would be prolonged to any degree. The eyes were affected in about 40 percent of the cases to a degree to require treatment, but the rapidity with which they improved was surprising, and in no case was there real danger to the sight.
In about 20 percent of all the cases the diagnoses were by no means certain. They had been sent back with a diagnosis of mustard-gas intoxication. On the field card the history was mustard-gas intoxication, but the signs at the time of admission were the ones that one might expect of man's being exhausted. They had been without sleep and their eyes had been irritated by dust.
Of the phosgene cases, less than 12 were sick enough to be confined to bed for more than two days, and in only one case was it necessary to do a phlebotomy. Of the other cases of the gas intoxication, none was sick enough to require any treatment. The cause of the casualty was always determined in the general way, and it is the opinion of the officers of the hospital that the great majority of the casualties was the lack of discipline in the use of the gas mask and the lack of precaution against gas bombardment. Many of the men said that they took their masks off, as they would rather take a chance without it than fight with it on. A good number had their masks knocked off in one way or other. Some admitted that their masks were defective and that they knew it before going into action. One convoy that was brought in was shelled in the night and caught in the dugout. No alarm was sounded until it was too late to protect themselves.
Several of the more severe contact cases were seen in men who were burned in helping their comrades out of danger, or who had taken cover in a shell hole that was contaminated.
The work done at this hospital was in reality work that could have been handled in any of the units of the group. Had the cases that were admitted to the hospital been cases requiring initial treatment, the personnel and the equipment would not have been sufficient to have rendered proper service. It is believed, however, that this particular hospital served a very useful purpose, possibly a service that none of the others could have rendered, and that is the isolation and protection of respiratory gas cases from accidental secondary respiratory infections.
