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General Information II

Contents

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GENERAL INTRODUCTION.

II. DEVELOPMENT OF RED CROSS MEDICAL DEPARTMENT UNITS.

During the two years and eight months that the, United States occupied the difficult role of a neutral, many of our distinguished medical men went abroad to render service to humanity by assisting in the care of the wounded. They learned, at close range, some of the complexities of medical organization, the difficulties attending the operation of improvised medical units, and the enormous delays in the procurement of adequate equipment under war conditions. The necessity for preparedness in the matter of the more complex medical units in the same way as for batteries of artillery and regiments of infantry began thus to be recognized by individuals in the medical profession outside of the Army medical staff. A number of small surgical groups from American medical schools in 1916 had served in succession at the American Ambulance at Neuilly, a suburb of Paris; and the British war office, at the suggestion of Sir William Osler and Hon. Robert Bacon, had invited various American university medical schools to send similar units to serve in British hospitals. A considerable number of leading men in the medical profession in the United States in this way gained a knowledge of medical conditions in war and of the new problems of military surgery which were later of much value in the building up of the medical service of our Army.

BASE HOSPITALS RECOMMENDED.

Maj. Karl Connell, M. C., of the New York National Guard, returned with the lesson that the organization and equipment of base hospitals could not, without disaster, be postoned until war was upon us. Dr. George W. Crile, who had taken to France a surgical group from the Lakeside Hospital at Cleveland, made the valuable suggestion I that base hospitals should be organized from the staff of large, well-organized hospitals. "These units will be most efficient if they are exclusively made up of men who have had similar training and who know each other well, and if they have associated with them a nursing staff familiar with their methods." Doctor Crile brought these ideas to the attention of the Surgeon General, who was impressed by them, but, it seemed, attached more importance to the idea of personal leadership than of a parent institution as the organizing agency. He authorized, accordingly, three members of the Medical Reserve Corps, Dr. G. W. Crile, Dr. Harvey Cushing and Dr. J. M. Swan, to proceed to organize base hospitals. Doctor Crile was professor of surgery in the Western Reserve University; Doctor Cushing held a like position in the Harvard Medical School; and Doctor Swan was a prominent internist of Rochester, N. Y., not connected with any medical school or medical group.

This new departure on the part of the Surgeon General caused a protest from the headquarters of the American Red Cross in Washington, based on the provision of their charter, by which they were charged with the furnishing of


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volunteer aid to the sick and wounded of the armed forces in war, and also on the understanding which had previously subsisted between the Red Cross and the Surgeon General's Office, that the Red Cross should undertake the organization of medical units from civil life. As evidence of such an understanding, they called attention to Circular No. 8 of the Surgeon General's Office, dated September 10, 1912, in which the details of organization, as approved at that time, were laid down.

ORGANIZATION OF 1915.

In the annual meeting of the National Red Cross at Washington, in December, 1915, the by-laws were amended so as to divide the entire field of Red Cross activities into two great departments of civil and military relief. The latter included the bureaus of medical service, nursing service, and supplies, and furnished the machinery by which the Red Cross could operate effectively as the auxiliary of military medical services. After much discussion as to whether the first director general, upon whom should fall the responsibility of organizing the Department of Military Relief, should be a general of the line or a medical officer, it was recognized that the problems to be solved were predominantly medical and a medical officer of the Army, Col. Jefferson R. Kean, was selected.

The question between the Surgeon General and the Red Cross as to who should organize the base hospitals was decided by a compromise. It was determined that the Red Cross should organize them, but that it should be on strictly military basis, and that the personnel should be commissioned and enlisted men of the Reserve Corps, so that, when called into active service by the President, they should pass actually and completely into the Army, the authority of the Red Cross ceasing as completely as does the parental control in the case of the young recruit when he enlists and marches away with his company. 2

ORGANIZATION OF BASE HOSPITALS.

Colonel Kean reported at Washington on January 15, 1916, and in February had the organization of the new Department of Military Relief sufficiently advanced to be able to leave Washington for a visit to several, medical schools which had been selected as desirable "parent institutions" for future base hospitals.

In the Spanish-American War, and all of our previous wars, base hospitals were built up slowly and painfully, as personnel and equipment could be got together. Members of the professional staff were strangers to each other and to their commanding officers, and many of them were appointed for political rather than professional reasons. The solving of their personal equations and the fitting of each to the duties for which he was best qualified presented, there-fore, a slow and difficult problem, which apparently it was impossible to solve by any preparatory steps in time of peace, since these large units had no peace existence. It was determined to shorten and facilitate this slow process of integration by adopting the suggestion of Crile, above mentioned, to utilize the cohesion and training of the staffs of the great hospitals by using these as the nuclei of the base hospitals. In this way could be obtained units in which the medical officers and nurses were picked groups, known to each other and accustomed to work together, and, so far as professsional work was concerned, always in training.


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EQUIPMENT.

Equipment for base hospitals had never been provided by the War Department in time of peace, though Surgeon General O'lReilly, who took to heart the lessons of unpreparedness of the Spanish-American War, had established separate depots for medical field supplies, and had set to work to accumulate the complete equipment of field hospitals and other medical units of the service of the front. This had been carried on by his successors, and the Medical Department found itself, at the beginning of 1917, prepared to equip all such units prescribed by the Tables of Organization for the maximum army then contemplated, about 300,000 men. But equipment of base hospitals with the beds, mattresses, bedding, furniture, and utensils was not only very costly but exceedingly bulky, requiring for a 500-bed hospital about 10,000 cubic feet. Storage space was a difficult question in the Army and was not to be had on such a scale. In fact, it had been a matter of much difficulty and patient insistence through years to get storage for the field units above mentioned. The limitations of both the annual appropriations and of available storage thus stood in the way of such provision. Yet it was recognized that when war comes, base hospitals are needed long before it is possible to purchase this elaborate equipment. The conversion of appropriations into hospital equipment is an even slower process than the conversion of casual medical personnel into trained and disciplined units, being, under the disordered trade conditions of war, a matter of many months. Therefore, it was evident that as personnel without equipment is useless, the Red Cross would have to provide the equipment also. It was determined that the local Red Cross chapters in the cities where base hospitals were to be organized should be asked to furnish the money for the equipment in the same way that the medical schools or great hospitals were to furnish the personnel. It fell to the new director general to persuade the parent institutions to harbor and cherish within themselves a military organization which, when called into activity, would deplete their professional staff nearly to the point of paralysis, and also to induce the chapters to raise large sums of money for these new medical units.

FIRST BASE HOSPITALS.

On February 1, 1916, two weeks after he had reported in Washington for duty with the Red Cross, Colonel Kean started visiting different cities with the view to making arrangements, with prominent representatives of the medical profession, for the organization of the following base hospital units:

New York City: The Presbyterian Hospital Unit (Base Hospital No. 2),under Dr. George E. Brewer; The Bellevue Hospital Unit (Base Hospital No.1), under Dr. George David Stewart; The New York Hospital Unit (Base Hospital No. 9), under Dr. Charles L. Gibson.

Boston, Mass.: The Harvard University Unit (Base Hospital No. 5),under Dr. Harvey Cushing; The Massachusetts General Hospital (Base Hospital No. 6), under Dr. Frederick A. Washburn, superintendent of the hospital; The City Hospital Unit (Base Hospital No. 7), under Dr. J. J. Dowling, superintendent of the hospital.

Rochester, N. Y. : The Rochester General H ospital Unit (base Hospital No. 19), under Dr. John Nf. Swan.


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Cleveland, Ohio: The Lakeside Hospital Unit (Base Hospital No. 4), under Dr. George W. Crile.

It will be observed that the numbers designating these units do not correspond with the order in which their creation was initiated, the reason being that a hospital was not given a number and its existence officially recognized until satisfactory arrangements had been made with the local chapter, or otherwise, for its equipment.

FUNDS FOR EQUIPMENT.

The difficult question of the donation of equipment was first taken up with a chapter on February 17, 1916, when the director general appeared before the New York chapter, which met at the house of Mrs. Whitelaw Reid, the venerable Joseph H. Choate presiding. The whole question of the relation between the Red Cross and the medical services of the armed forces was fully discussed, and the natural and obvious question was asked, why the Government did not furnish the equipment for these units which, in time of war, would become incorporated into the Army and Navy. In reply it was pointed out that it was idle to criticize Congress or the War Department for this lack. Congress did not prepare the military estimates, and those who did were deeply interested in what they believed to be more important needs. The Army was in need of a vast number of costly things for the arming and equipment of troops for war, and until these were provided it was most unlikely that the military authorities would be willing to see large sums expended and precious storage space absorbed for these bulky base hospitals. It was also pointed out that, granting in theory the obligation of the War Department to furnish this equipment, yet the most logical theories did not equip hospitals or relieve the sufferings of wounded men; and so, in order that they might be promptly cared for, the Red Cross or some similar agency must provide, in advance, the necessary means. The matter was finally decided favorably by an earnest speech of the Hon. Robert Bacon, lately Ambassador to France. He had personally assisted in the rescue of the wounded in the Battle of the Marne and had seen the pitiful results of medical unpreparedness. To his view the matter was not only obvious, but urgent, and he called upon those present to accept the responsibility for the equipment of the proposed hospitals and to begin immediately to meet it. When the meeting adjourned it was found that nearly $30,000 had already been pledged. So prompt and hearty a response not only placed the project on its feet, but set an example which could not but exert a potent influence upon other chapters.

This, in truth, was a fair beginning, but many difficulties remained to be surmounted.

The cost of the equipment was estimated by the Surgeon General's Office, with peace-time markets and the rather Spartan standards of the Regular Service, at $25,000, but this made no allowance for the fads and fancies of surgical experts, or even for such valuable luxuries as portable laundries and ice plants, so this figure was soon found inadequate. Some of the units ultimately expended from three to five times this amount. These large sums were contributed mostly by men of affairs who were accustomed, when they put money into any undertaking, to acquire a voice in its organization and


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control. Thev naturally expected, therefore, to have a voice in the selection of directors and chiefs of service, and, of course, in the purchase of equipment. It seemed, however, not the part of wisdom to admit such influence, and so it was announced that these units, being military, should be immediately under a military authority, and being, at the same time, medical, their medical and nursing staffs would desire and expect that the direct control over them would be of a professional character. Their organization, therefore, was managed directly from the office of the director general in Washington, who was constantly in touch with the wishes of the Surgeon General. The chapters accepted, with good grace, the relation of " Big Sister " to the medical units, which carried the obligation to help without any parental authority.

The feeling that purchases should be made locally, as far as possible, was natural and strong, and was deferred to, but any efforts to standardize, especially in surgical instruments and appliances, caused trouble. Among distinguished surgeons in civil life individual taste in the patterns and designs of surgical instruments had as wide and unquestioned a latitude as in the designs of ladies' bonnets, and they were agreed in the belief that all Army equipment was antiquated and all Army methods of administration were "red tape."This conflict of opinions was finally solved by the Medical Advisory Board of the War Council, which appointed a board of surgeons of national reputation to select standard types of instruments and appliances, and then forbade the manufacture of any other.

STORAGE OF EQUIPMENT.

Storage was another difficult question which pressed for a solution as soon as deliveries of equipment began to be made, and it was claimed, with insistence, that the War Department, for whose use this material had been purchased, should at least be willing to store and care for it. This was readily admitted in principle by the Secretary of War, who authorized it wherever it could be done without detriment to the interests of the military service, but it brought practically no relief, because there was no storage room to spare and there were apparently no funds available for renting storage. Permission to use the buildings at one or more unoccupied posts was finally obtained, and the equipment of four New York base hospitals was stored at Fort Schuyler. Most of the chapters, however, had to obtain and pay for their own storage until the entrance of the United States into war brought a solution of the difficulty by its employment of the equipment in active service and its ultimate donation to the United States.

The many difficult and vexatious questions connected with the purchase of the base hospital equipment for both Army and Navy were worked out with admirable patience and intelligence by Medical Director T. W. Richards, U.S.N., who was detailed July 1, 1916, to report to the director general of military relief, as his assistant for the purpose of taking charge of naval Red Cross activities, and particularly for the organization of naval base hospitals. The necessities of our Navy in this matter were definite and important, and are stated by Commander Richards in a report 3 which should be read by those having special interest in the development of Red Cross medical units for that service.


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NATIONAL GUARD ON THE BORDER.

Popular interest in the Red Cross Was much stimulated during the summer of 1916 by our disturbed relations with Mexico, which resulted in the calling into active service of the National Gtlard and in its being stationed, together with the bulk of the Regular Army, along the Mexican border. No Red Cross units were called into active service at this time, as the Medical Department believed that its resources were adequate for the expansion necessitated by this mobilization, and also because of an opinion given by the Judge Advocate General of the Army that under the law the President of the United States is not authorized to call into active service the Red Cross units except in case of war or when war is imminent. A number of nurses, 117 in all, however, were furnished by the Red Cross nursing service acting in its role as a reserve for the Army Nurse Corps, and these did excellent service in the temporary hospitals on the Mexican border.

COMMITTEE OF MEDICAL ASSOCIATIONS.

The by-laws of the Red Cross, il the amendruents which provided for the department of military relief, provided also for a National Committee on Red Cross Medical Service. This committee, composed of distinguished members of the medical profession in all parts of the country, was intended to be the principal agent through which the department of military relief would act in the enrollment and organization of the Itedical profession for service with the Red Cross in time of war. This was recognized as a very difficult and delicate undertaking. A new and powerful agency, however, which at first appeared to thwart the efforts of the Red Cross for such organization, resulted in making it possible. The presidents of the five great medical associations of the United States-The American Medical Association, the American Surgical Association, the Congress of American Physiciarts and Surgeons, the Clinical Congress of Surgeons of North America, and the American College of Surgeons-jointly appointed a committee to make a comprehensive survey of the medical resources of the country, including all data required for mobilization of the medical profession, and this committee, as stated elsewhere, on April 26, 1916, made an offer of its services and of those of the 70,000 medical men which it represented to the President to assist the medieal development of the Army and Navy.,The director general of military relief, who was invited to be present at the meeting of this committee, pointed out that the work proposed by it covered ground which was assigned to the American Red Cross by its charter and by the presidential proclamation of August 22, 1911, and proposed that this committee should work either through the Red Cross or in conjunction with it. This suggestion, after due deliberation on the part of the committee, was accepted to the extent that an agreement was entered into that they should cooperate with the American Red Cross through its National Committee on Red Cross Medical Service, which committee should be made an interlocking one with the committee of the associated medical societies by having as members all the members of the committee of the ftssociated societies. At a meeting of the National Committee on Red Cross Medical Service, held at Detroit at the time of the meeting of the American Medical Association, in June, 1916, various


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questions connected with the organization of base hospitals were discussed. It was pointed out that there was in the public mind a fixed conception of a hospital as a building occupied for the treatment of the sick rather than a vital unit which could be transported wherever the Government might need it, and the medical profession, as well as the public at large, found it difficult to visualize these organizations or to appreciate them at their true value and importance until one should be demonstrated to them by an actual mobilization. The national committee, therefore, requested the Red Cross authorities to mobilize one of its newly organized units in Philadelphia on October 28, 1916, at which time and place the committee would have a called meeting.

FIRST MOBILIZATION OF A BASE HOSPITAL.

The purposes of this mobilization were primarily to demonstrate that the organization existing on paper was a practical and serviceable one; secondly, to ascertain what difficulties would stand in the way of such a mobilization, in order that they might be met and removed; and thirdly, for the instruction in medical preparedness of the great body of surgeons who would be in Philadelphia at that time in attendance upon the Clinical Congress of Surgeons and the American College of Surgeons.

The Lakeside Hospital Unit from Cleveland, Ohio, Base Hospital No. 4,was selected for the purpose of this mobilization. It was asked to furnish a staff of 16 medical officers (including specialists), 25 nurses, and the necessary administrative personnel. The equipment was brought from the Red Cross depot at the Bush Terminal, Brooklyn, and was complete in all respects, so that every necessity of the wounded man could be promptly and efficiently met. The housing was furnished by tentage supplied by the United States Government from its Philadelphia depot; and the camp was erected by a detachment of the United States Medical Department sent over from Washington. The location of the camp on the Belmont Plateau, in Fairmount Park, Philadelphia, was an ideal one in all respects. The tentage, in as compact arrangement as the convenience and administration permitted, covered an area 1,000 feet long and 500 feet broad, being about 12 acres in extent. The mobilization of this hospital marked an important step in Red Cross development as concerned the obligations of the Red Cross to assist the medical service of the armed forces in time of war. It was the first practical and concrete demonstration of the ability of the Red Cross to do so. It took the scheme of Red Cross military units out of the domain of theory into that of accomplished fact.

FURTHER ORGANIZATION.

The five months intervening between the mobilization of Base Hospital No. 4 at Philadelphia and the declaration of war against Germany constituted a period of great activity and development in all branches of Red Cross organization relating to the military establishment. There was active correspondence with the various medical centers, many of which were anxious to organize units but had very vague notions as to what was required, in spite of the fact that the organization of Red Cross base hospitals had been quite fully explained in an article published in The Military Surgeon for May, 1916, reprints of which had been liberally distributed to correspondents. Before athorization was


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given for the creation of a base hospital at an institution, it was necessary to ascertain whether it had a staff large enough to furnish the 23 medical officers needed, and whether it was sufficiently representative to insure a capable and efficient staff. Then, too, the very delicate question had to be decided as to the selection of the director to whom the task of organization should be in- trusted, as the success of the unit would depend upon his possession of sufficient professional reputation and leadership to insure that his premiership would be recognized by his professional associates. The question, too, of financial backing of the proposed unit by the local Red Cross chapter had to be taken up in order to furnish funds for the purchase of equipment. If no local Red Cross chapter was in existence, steps were taken in some cases to organize one with this special object in view.

The question of equipment caused great delay before authorization was given a number of excellent units. After the declaration of war, however, this difficulty disappeared, because funds were much more readily obtainable and because later, as soon as war appropriations for the Medical Department became available, the furnishing of equipment by the Red Cross was no longer required. Much embarrassment was caused by the desire of prominent or ambitious medical men to receive authority to organize a unit without the support of a parent institution. Such offers, although frequently backed by strong political and social influences and the offer of funds for equipment, were always refused.

SMALLER UNITS.

The reasonable and patriotic offers of medical institutions too small to be the parents of base hospitals were met by authorizing those who fulfilled all requirements to organize hospital units. These units were only one-half the size of base hospitals, but were intended for a service of 250 beds, with a staff of 12 medical officers and 20 nurses. They were intended either for the establishment of small hospitals, such as camp hospitals, or for the rapid expansion of base hospitals. They were found to be very valuable for both purposes in the service of the American Expeditionary Forces. They were designated by letters of the alphabet to prevent confusion with base hospitals. A less elaborate equipment was required for these small units than for the base hospitals.

AMBULANCE COMPANIES.

During this period the organization, training, and equipment of ambulance companies were rapidly and successfully pushed, this work being in the hands of an officer of the Medical Corps, who had been for several years on duty with the Red Cross and who had organized the Bureau of Medical Service. This service, besides organizing ambulance companies, was in charge of a great system of first-aid instruction, not only in connection with chapters, but with railroads, mines, and the large industrial concerns. Forty-five ambulance companies were organized,5 which passed into the service of the United States, most of them being assigned to sanitary trains of the various divisions. A number of those earliest organized joined the camp established by the Surgeon General at Allentown, Pa., for the organization of ambulance sections for service with the French Army, and later saw service in France with the United States Ambulance Service with the French Army


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DECLARATION OF WAR.

When war was declared 33 base hospitals had been authorized, and their organization was well under way, and 14 more were authorized by July 26.'The total number which the American Red Cross had been authorized to form had been limited to 50 by the War Department, upon the recommendation of the General Staff, and this number was probably not far short of the number of medical schools and hospitals in the United States which were qualified in size and other respects to become suitable parent institutions.

PERSONNEL.

Another difficulty, besides the question of equipment, which was removed by the declaration of war, and even more promptly, was the securing of adminstrative personnel. This personnel in its Red Cross enrollment had to be pledged to enlist in case of war in the Enlisted Medical Reserve Corps and the number so enlisting in time of peace was required to be one-third of that authorized at war strength. It was with the greatest difficulty that even this comparatively small number could be secured in time of peace, but under the stimulus of patriotism and the prospect of immediate active service, the complement was readily made up as soon as war was declared.

Many of the units, when war came, were complete as regards their Red Cross enrollment, but not ready to be called into active service because of delays in the issue of commissions to their officers. It had been clearly understood between the directors of the units, the director general, and the Surgeon General that these units, being organized for service in war, the officers of the Medical Reserve Corps composing their staffs would not be called into active service to meet the needs of the service in time of peace.8 This was a matter of much concern, not only to the individual officers but to the teaching faculties and hospital authorities, who were naturally unwilling to be exposed to such disruptions except to meet the great emergency of war. But there was at this time no special subdivision of the Surgeon General's Office charged with the administration of the affairs of the Medical Reserve Corps, and the names of these attached to units were thrown into the general file instead of being kept separate. This led to frequent violations of the agreement, to which was added the fact that the chief surgeon of the Eastern Department found in the officers of these units a convenient supply of highly efficient men to meet temporary needs in his department. This produced much dissatisfaction, especially for commissions in the Medical Reserve Corps, on the part of many members of the staffs of base hospitals, although already enrolled with the Red Cross. It was thought by all of the parties concerned that this postponement was not important because these commissions could be issued promptly when the need appeared. Experience, however, later demonstrated the error of this assumption. When diplomatic relations were broken off with Germany, efforts were made to push these commissions through, but the War Department was suddenly subjected to great expansion and an enormous pressure of work which broke down the old clerical force from overwork and produced a period of much confusion. Great delays and many errors resulted, which added greatly to the difficulties of mobilizing the first units called into the military service.


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HOSPITALS TO BRITISH ARMY.

Great Britain at the beginning of the war had failed to take steps to conserve her supply of medical men, and had placed no restrictions on the employment in the line of medical practitioners and students, and so, by the spring of 1917, was confronted by a shortage of medical officers. On April 27 the British medical liaison officer, then stationed in Washington, requested that the British medical service be furnished six base hospitals and 116 other medical officers. He expected to have to go through the slow and difficult procedure of organization ab initio, and was much surprised and pleased to find that completed units were available, with selected personnel from the best medical centers in the country. There was great competition to be chosen because it was felt that these units were regarded as representatives of the medical and nursing professions of the United States, and especially because they were the first Army units to take our flag across the sea. Each was given a commanding officer and an adjutant, picked men from the regular Medical Corps, and a quartermaster furnished by the Quartermaster Department. The following were the six units selected:

    Base Hospital No. 2, from the Presbyterian Hospital, New York City; director, Maj. George E. Brewer, M. C.

    Base Hospital No. 4, from Lakeside Hospital, Cleveland; director, Maj. George W. Crile, M. C. This unit was the first to go; it sailed two weeks after receiving the order.

    Base Hospital No. 5, from Harvard University; director, Maj. Harvey Cushing, M. C.      

    Base Hospital No. 10, from Pennsylvania Hospital, Philadelphia; director, Maj. R. H. Harte, M. C.

    Base Hospital No. 12, from the Northwestern University, Chicago; director, Maj. F. A. Besley, M. C.

    Base Hospital No. 21, from Washington University, St. Louis; director, Maj. Fred. T. Murphy, M. C.

As no uniform or individual equipment or mess outfit had been procurable for the personnel until they should be called into active service, this had to be obtained in great haste, and for at least one unit their uniforms were issued to the men on shipboard, after the unit had sailed. As, too, the directors were quite ignorant of the procedures necessary to obtain these supplies and of the numerous other things that had to be done upon the induction of their units into the Army and into active service-a task in that time of turmoil not easy for even veteran officers-they had to await the arrival of the regular administrative officers before progress could be made. Base Hospital No. 4, helped by its mobilization of six months before, was the first to be ready, and sailed on May 5,10 landing safely in England on May 17. It was followed by Base Hospital No. 5, on May 11,11 and by Base Hospital No. 2, on May 12.12 The remaining units followed rapidly. Base Hospital No. 12 returned to port on May 2113 because of a singular accident in the firing of one of the guns on deck, by which a metal disk, which separated the powder charge from the shell, struck a wave at such an angle as to cause it to make a parabolic curve back to the


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deck, where it struck a stanchion and broke, the fragments killing two of the nurses and wounding a third.

DIRECTOR GENERAL RELIEVED.

Col. J. R. Kean, M. C., left the American Red Cross on July 15, 1917, for service in France. He was succeeded as director general of military relief by Mr. John D. Ryan, president of the Anaconda Copper Co. By this time the work of the Red Cross as an organizing agent for the medical departments of the military services was practically completed, except for the nursing service and the service in France, and it was left free to take up and extend its various welfare activities for the military services as a whole, and to carry assistance to other nations. At this time 46 of the 50 Red Cross base hospitals had been authorized and were either ready to be called into service or were in the course of organization. In July, 1917, it was decided to increase their capacity from 500 to 1,000 beds, which required the procurement of more personnel and addi- tional equipment. Many of these units were not called into active service until the spring of 1918. All of them saw service abroad, except No. 16, organized from the staff of the German Hospital in New York, which, on account of the Teutonic origin of many of the members of its staff, was utilized for service at home.

VALUE OF RED CROSS HOSPITAL UNITS.

It is not too much to say that the Red Cross base hospital and hospital units constituted the backbone of the hospital service in France. The extent to which this is true is shown by the following facts. At the time when the Allies began the great offensive which resulted in the final defeat of the German armies on July 18, 1918, the American Army had 26 divisions in France. For the medical service of these, there were only 8 evacuation hospitals and 42 base hospitals, which latter had been organized as follows :14

By the Surgeon General's Office, from casual personnel .....................................4

By the chief surgeon, American Expeditionary Force, from casual personnel............2

By the Red Cross, from parent institutions .....................................................36

The Red Cross base hospitals furnished to the service a large proportion of the consultants and specialists. The deficiency in evacuation hospitals made a critical situation, which was met by stripping these base hospitals of their best operating surgeons and nurses to form operating teams for the rapid expansion of the evacuation hospitals. This occurred at the very time when the base hospitals were undergoing an enormous expansion and were receiving a multitude of wounded. That this could be done without a breakdown is sufficient evidence of the self-devotion and patriotic spirit of these admirable organizations.


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Army Red Cross base hospitals.

Hospital Units


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Ambulance companies16

Organization of Red Cross base hospitals for the Army


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REFERENCES.

(1) Crile. G. W.: The Unit Plan of Organization of the Medical Reserve Corps, United States Army, for service in Base Hospitals. Surgery, Genecology, and Obstetrics, Chicago, 1916, xxii, 68.
(2) Letter from the Surgeon General to First Lieut. Lewis A. Conner, M. R. C., New York, February 29, 1916.  Subject: Formation of Red Cross Units. On file, Record Room, S. G. O.,

155420-F (Old Files).

(3) Richards, T: W.: The Organization and Equipment of Navy Hospital Units. United States Naval Med. Bull.. Government Printing Office, Washington. D. C., 1918, xii, No. 2, 184.
(4) Letter from committee of medical profession appointed by joint action of the presidents of five national medical bodies to the President of the United States, April 26, 1916. Subject: Offer of Services toward the Medical Welfare of the Army and Navy. On file, Record Room, S. G. O., 156772 (Old Files).
(5) Memo. for Colonel Munson, September 4, 1917. Subject: Red Cross Ambulance Companies. On file, Record Room, S. G. O., 171059 (Old Files).
(6) Memo from Col. J. R. Kean, M. C., to the Surgeon General, April 1, 1917. Subject: Organization of Base Hospitals. On file, Record Room, S. G. O., 15542-117 B (Old Files).
(7) Mimeographed list of American Red Cross Army base hospitals, July 26. 1917, showing name and place of organization of 47 hospitals. On file, Record Room, S. G. O., 172158 (Old Files).
(8) letter from Col. J. R. Kean, director general of military relief, American Red Cross, to Dr. N. E. Brill, director, Red Cross Base Hospital No. 3, New York, October 23. 1916. Subject:  Duties and obligations of personnel. On file, Record Room, S. G. O., 155420-78 (Old Files).
(9) Letter from the Surgeon General to the Chief of Staff, May 1, 1917. Subject: Memo by Col. T. H. Goodwin, Royal Army Medical Corps. On file, Record Room, S. G. O., 172158A (Old Files).
(10) Letter from Maj. Harry L. Gilchrist, M. C., to The Adjutant General, May 8, 1917. Subject: Departure of Base Hospital No 4. On file, Record Room, S. G. O., 159-144 (Old Files).
(11) Summary of Troop Arrival Data of G-1, G. H. Q., On file, A. E. F. Record Section, Historical Division. Army War College.
(12) Telegram from Colonel Richards, Governors Island, to the Surgeon General, May 16. 1917. Subject: Personnel Base Hospital No. 2. On file, Record Room, S. G. O., 164987 (Old Files).
(13) Telegram from Maj. C. C. Collins to the Surgeon General, May 21, 1917. Subject: Accident on Board Ship. On file, Record Room, S. G. O., 165902 (Old Files).
(14) Hospitalization, A. E. F., Office of the Chief Surgeon, Hospitalization Division. 4th edition. On file, Record Room. S. G. O. (322.3 A. E. F.) Y.
(15) Hospitalization, A. E. F., Office of the Chief Surgeon, Hospitalization Division; 7th edition. November 1. 1918. On file, Record Room, S. G. 0. (322.3 A. E. F.) Y.
(16) Shown on Reports of Organization. On file, Record Room, S. G. O., 322.0 (number of ambulance companics). A.
(17) Memorandum for Muster-In of Red Cross Base Hospital Units. From Director General of Military Relief. American Red Cross, July 14, 1916. On file, Record Room, S. G. O., 155420-59

(Old Files).