Delivery of Medical Care off of the battlefield
Applying a Thomas Splint
Having a large medical system allowed the concentration of categories of patients. This provides better care by bringing patients to facilities with the best equipment and building expertise among staff. In essence, specialized hospitals were an extension of the ward system used in the Great War period. A ward might be designated for, say, fracture cases. Much the same thing is seen today in specialty units within general hospitals, or specialty hospitals for cardiac, orthopedic, or cancer treatment.
In a military environment, skilled personnel are always scarce. The British army, for example, never had enough orthopedic surgeons. The first American surgeons to go overseas after our declaration of war was a group of orthopedic surgeons who went to fill gaps in British hospitals. Even today, such specialists as neurosurgeons, plastic surgeons, orthopedists, and eye surgeons are often grouped in specialty units where their skills can be used most efficiently.
Operating Room, Base Hospital 20 (University of Pennsylvania)The AEF organized a substantial number of specialized hospitals. A few were designated from the very top, by the Chief Surgeon of the AEF; showing the high level of concern for shell-shock patients, two of the designated hospitals were for “war neuroses” what today would likely be diagnosed as traumatic brain injury and/or post-traumatic stress disorder but were not then differentiated. Base Hospital 117 was “established, and an ambulance service has been provided in connection with this hospital by which cases can be received directly from tactical divisions at the front. At this hospital the resources found most useful in the British and French special hospitals for these cases are employed.”
Other specialized hospitals were organized within the AEF hospital centers. Hospital centers were first an administrative convenience, a way to group a few base hospitals who would share support services – for instance a central laundry or delousing facilities. That easily expanded so that clinical areas were shared, for instance X-ray equipment (and personnel) centrally located, the compounding pharmacy shared, or a central dental clinic created. Eventually hospital centers commanding officers were given full authority in many matters. They were authorized to transfer and assign commissioned and enlisted personnel within their center without reference to higher authority, to promote or demote enlisted men up to and including the grade of sergeant first class, to assign all supplies received, to request American Red Cross support, to employ civilian labor, to spend Medical Department funds, convene special courts-martial, and issue necessary travel orders for patients transferred.
Practically, that meant they could move staff and equipment from one hospital to another, building specialized hospitals. They would consult with the commanders of the various hospitals to learn what special skills there were, consult with the AEF medical staff to see what treatment types were likely to be needed (perhaps orthopedic injuries or venereal diseases), and with the eighteen specialized AEF “consultants”. These were senior physicians with deep knowledge in their specialty who supervised the professional work of the doctors serving in their respective specialties and recommended assignments. Beyond surgery and medicine, there were consultants in: surgical research; Roentgenology; neurological surgery; orthopedic surgery; ear, nose, and throat surgery; general surgery; venereal and skin diseases and genitourinary surgery; maxillofacial surgery; ophthalmology; general medicine; infectious diseases; neuropsychiatry; poisoning by deleterious gases; cardiovascular diseases; and tuberculosis.
Harvey Cushing, Neurosurgeon, in the ORTwenty-one hospital centers were planned, although some were still getting organized when the Armistice was signed. Most included specialized hospitals. The most common were surgical, orthopedic, eye, ear, nose, and throat, maxillofacial, and neuropsychiatric. Some centers had contagious disease hospitals. The center at Savenay had a special hospital for the treatment of tuberculosis patients. That at Vichy had special facilities for maxillofacial cases, to which other specialized hospitals referred their most complicated cases. Hospital center plans provided for a separate hospital, located at a quiet point on its outskirts, where psychiatric cases would be cared for, although in a number of centers this was never completed. As resources allowed, rehabilitation facilities, such as those afforded by shop and art work for the rehabilitation of the neuropsychiatric cases, were rapidly developed, especially in the centers at Beau Desert and Kerhuon. Occupational work shops were established in some hospital centers, most commonly brace shops for orthopedic patients. Centralization was not universal. At Allerey, orthopedic appliances were made in several shops so that doctors would not lose time travelling to a central workshop.
Specialized hospitals improved care for patients in many categories: orthopedic, maxillofacial, psychiatric, neuropsychiatric, contagious diseases, eye-ear-nose-throat, ophthalmological, venereal and dermatology, gas injury, influenza and pneumonia, tuberculosis, and neurosurgery. Some centers grouped their seriously wounded (as a general category) and some grouped the lightly wounded; that was presumably an administrative convenience, since those wards could have fewer staff assigned.Base Hospital 20, Univ of Pennsylvania
Centers usually also organized a convalescent camp so that the hospitals did not have to waste beds and staff time taking care of patients who were largely recuperated. They could also offer graduated exercise programs – more strenuous as men recovered – that sped up a soldier’s return to duty, but also offered extra time to men who needed it, and identified men who could not return to front line service before they arrived back in an infantry division.