Caring for the Sick and Wounded: Establishing the First U.S. Army Medical Units in France and England
Under artillery fire southwest of Arras, France on July 14, 1917, Capt. Louis J. Genella of the U.S. Army’s Medical Reserve Corps, became the first combat casualty of the American Expeditionary Forces (AEF). Wounded in the head and face, he recovered and returned to duty. Genella, like many men of the AEF, was cared for by the base hospitals, casualty clearing stations and aid posts that provided different levels of care to the wounded during World War I. Medical staff assessed and treated the sick and injured. From brutal trench warfare to the Spanish flu epidemic of 1918 to accidents, more than 115,000 Americans would die in service during the war. The loss would have been significantly higher, and the suffering of the wounded greater, without the vigorous, skillful, and compassionate American military medical services.
Medical units arrived with surprising speed after the United States entered the war. Base hospitals began to arrive in Europe on May 18, 1917 and by June 11th the last of an initial six had arrived at their posts in France along with 1200 independent medical officers to serve with British forces. Many more would follow this vanguard of American military medicine. Others stayed to work in camps and hospitals in the United States. At its peak the Army Medical Department would number 264,181 women and men. By the end of the war Army medical facilities could treat 403,000 bed cases. The work went far beyond the war front and hospitals. The millions involved in this vast, modern war called for public health and dental work, aviation medicine, psychiatric facilities, and diverse laboratories.
The base hospitals moved into sites termed general hospitals by the British. British medical staff remained temporarily to orient arriving Americans. These hospital sites differed greatly and included former hotels and sprawling complexes of new temporary buildings in rural fields. Recuperating wounded found themselves in war tents of 60 beds, heated huts for thirty men, or even the opulent ball rooms of former casinos. Maj. Julia C. Stimson, Chief Nurse of the AEF, described “…rows and rows of canvas tents, each of which holds about 14 beds” and the lived in ”huts…made of thin wood and roofed with tarred paper and are divided into single cubicles, … accommodating 16 to 18 people.”
Many sites could accommodate over 2000 patients and expanded in times of need. The hospitals stood on rail lines between the front in Flanders and the English Channel to make movement of patients and supplies as easy as possible. During a quiet time there might be several dozen operations daily and several hundred patients in the wards. The lethality of World War I meant those numbers could suddenly surge. Admitting over 1000 patients and completing over 100 operations in a day was not unusual. American-staffed general hospitals requested and received more staff to increase their patient admission capacity. Although these facilities were beyond the range of enemy artillery fire, they were sometimes the targets of enemy bomber attacks. Some sites sandbagged the sides of structures for protection.
British general hospitals were not the only places that early arriving American medical staff found employment. Some medical specialist officers were sent to Royal Army Medical Corps (RAMC) hospitals in England that required their specific expertise. Many general hospital staff spent time in RAMC facilities for wartime medicine training. Americans in general hospitals or with the RAMC did not only work behind the lines. Like the British, they rotated through tasks closer to the front.
In July 1917 surgery teams were assembled to support forward casualty clearing stations (CCS) several miles behind the forward trenches. The experience familiarized medical department staff with more frequent work and the conditions of soldiers’ lives. At CCS teams often worked with other Allied medical personnel. Threats from air raids, long-range artillery, or capture in an enemy offensive were greater at a CCS. Along with these challenging operating conditions, supply problems existed. Built to accommodate the fluctuating needs of battle, some CCS could accommodate a maximum of 1000 patients. The level of care available was greater than an aid station, but not as complete as a hospital. Some major surgeries were performed. Shattered limbs were removed. And procedures to stabilize patients for transport to the general hospitals were completed.
Further forward were the physicians and nurses at the aide posts of battalions, and regiments. Very basic and emergency medical care was carried out. Here medical officers triaged the wounded into the hopeless, those needing care to survive, and those that would pull through regardless. From there they moved back to where ambulances were stationed at advanced dressing stations.
It was at forward stations like these that Genella became the first American combat casualty among the medical reservists. On August 17, 1917 Nurse Beatrice M. McDonald of the U.S. Army Nurse Corps was wounded by a shell splinter while she worked at a CCS. She lost an eye as a result. McDonald and Genella were both early volunteers, part of the first wave to serve in American uniform at the front. These men and women were a significant assistance to the British Expeditionary Force’s medical staff, and that of the RAMC in Britain.
Many leaders of these early medical units had previous experience as medical volunteers earlier in the war. When the AEF began to arrive in greater numbers, the early arrivals provided experienced at every level of military medicine. Early arrivals, like Stimson, became the trainers and leaders of AEF medicine.
Suggested Reading:
Julia C. Stimson, Finding themselves (Norwood, Norwood Press, 1918)
Michael Rauer, Yanks in the King’s Forces: American Physicians serving with the British Expeditionary Forces During World War One.
Stephen Craig & Dale Smith, Gimpsing Modernity: Military Medicine in World War ! (Newcastle upon Tyne, Cambridge Scholars Publishing, 2016)
The Bulletin of the U.S. Army Medical Department, Earliest American Battle Casualties in the World War. Army Medical Bulletin No. 27, Volume 1 Supplement, July 1932.
Mary C. Gillett, The Army Medical Department 1917-1941 (Washington, Center of Military History, U.S. Army, 2009)