Major M.H. Fletcher of Asheville shared his first-hand experiences with his colleagues at the Medical Society of the State of North Carolina, April 16, 1919.
Most doctors and the laity in particular, have an exalted and exaggerated idea of “War Surgery” and also of the benefits one gets from experience in the service.
When the history of the war is written, the list of those unaccounted for, particularly the losses from the so-called Spanish flu, for want of a better name—will be far in excess of the largest number that has yet been placed upon it. The last report placed the total, in the unaccounted-for list, at 5,500, but when the whole story is told it will approximate nearer 10,000.
Overcrowding and lack of ventilation on the ships going over will have to answer for a high death rate from influenza and an increased virulence of the infective agent. When you think of how utterly inadequate the facilities were for handling the sick and the dead in civil life at home, you can multiply this by 10, and you will have some conception of how totally inadequate the facilities were for handling patients at the ports of debarkation, where the flu cases were numbered by the thousands.
Our own hospital center, consisting of four base hospital units located at Kerhuon, receiving influenza cases three weeks before it was supposed to take patients at all. We furnished shelter for 2,850 medical cases when we were supposed to be a surgical institution. We had sent two operating teams (a team consisting of three surgeons, one nurse, and one orderly) to the front. At that time Base 65 was the only one of four units on the ground. We were short of everything in the way of equipment, drugs, and most things necessary to make the sick comfortable. We went over without equipment and our outfit at this time consisted mostly of what was commandeered at the docks. Surgeons make good medical men, and everyone did what he could to make the sufferers comfortable. We were short of doctors, nurses, and attendants of every kind. Every doctor became an expert in the diagnosis of meningitis, pneumonia, empyema, measles, etc. There was not much demand for the highly specialized specialist in this or any other emergency which came under my observation during the service overseas.
On our boat, the Kronland, which landed in Brest September 11th, there were a number of dead when we reached port. The flu gained in virulence on the boat from its inception. This was due primarily to overcrowding; the boat was loaded much beyond its capacity. The ventilators were not working, the men were not undressed for 15 days, the life preservers, which everyone was required to wear constantly, were filthy, and could not be removed, the portholes were always kept closed, by and order from Washington, we were told. Ship odors are always bad, and under the insanitary conditions which prevailed on this boat they were intolerable. The only salvation was an occasional breath of fresh air on deck, and with the decks covered with rafts, lifeboats, etc., deck space was at a premium.
We sent Naval Base No. 1, the night we landed, 32 cases of pneumonia, officers and men, and of these 27 died.
Our first and important work was to handle the flu cases off the Leviathan, 57th Pioneer Infantry from Tennessee, most of them, and about 100 were dead when this boat landed at Brest on this trip. Many died on lighters, ambulances, and stretchers before they reached the wards, where a comfortable bed was provided. We had good woven wire springs, mattress and pillows; three blankets for each patient, but no sheets in the early rush. Forty patients were placed in each ward, and in one day and night we admitted 1,200. It rained all the time, and the mud was our greatest hindrance.
It was impossible for our force to give the necessary attention to these patients, some of our doctors having from two to six wards to look after. Some of our surgeons, orthopedists, eye and ear men, men specially trained to do brain surgery, were doing duty as adjutants, registrars, receiving officers, sanitary inspectors, etc. After the flu subsided we had more doctors than we needed sent to us from the casual camps.
The history of the pneumonia, meningitis, and its various complications will be written by men more competent than the writer. The meningitis situation, I am sure, was as well handled in Base 65 as was possible in any camp, or any other hospital for that matter. We had good laboratory men, the contacts were isolated, and otherwise taken care of. To rid a camp of meningitis, it is necessary to make the diagnosis early and, like everything else, when you know how, it is easy….
I became a convert to the use of the mask as a preventive for the spread of influenza. That you have to inhale or come in direct contact with the influenza germ in order to contract the disease, there can be no doubt. To cough or sneeze during an epidemic without the use of the handkerchief or mask is criminal; but to use the mask improperly or irregularly to prevent germ contact will not do the work. The chain is only as strong as its weakest link, and to leave the gap down is fatal. In army life, however, it is not so difficult to enforce an order of this kind.
I have every reason to believe that we stopped the spread of the influenza on the boat on our return trip home. Flu broke out on ship the fourth day out, on the fifth day we had 15 new cases, on the sixth day 35. An order was issued requiring everyone on board ship to wear a mask, and on the tenth day we did not have a single new case. The only other precaution taken was to spray twice daily the upper air passages with dichloram T.
In Base 65 we had about 40 cases of empyema, all complicated, of course, with pneumonia and all desperately ill; our mortality was about 20 per cent. Two had empyema on both sides. All were trained under local anesthesia….
Our hospital suddenly changed from a 98 per cent medical to a 76 per cent surgical institution about three weeks before the armistice was signed. We got wounded from nearly every hospital in France, some as recent as four days after they were wounded. Practically all of the surgery, such as amputations, debridements, fixation of limbs, brain surgery, etc., was done in the dugouts and evacuation hospitals within 12 hours after injury.
When we began to function as an embarkation hospital, we had four base hospital units and many casual officers, a staff of 157 doctors and 350 nurses at one time, more than we needed, and every kind of equipment imaginable. We had 900 bedridden surgical cases at one time, to be dressed once or twice daily, and 600 who came to the dressing station each day. Every kind of wounds. One of our orthopedic consultants reported that there were 5,000 fractured femurs in the Brest area alone, when as a matter of fact there were only 6,000 among all the American wounded. At that time we had less than 250, and ours was by far the largest of the four hospitals in the area mentioned. Practically all of the fractures were compound, and all the wounds were wide open and all were infected….
As fast as the bedridden cases became ambulatory, we would get them on the passenger list and send them home on the first available ship. Many of our bedridden cases stayed with us for two months.
From Transactions: Medical Society of the State of North Carolina, April 1919