Recovery in the Hospitals (Aug.-Sept. 1918)

William Thomas, “The Rose of No Man’s Land”

“I felt myself going it seemed at every step the second day but I stuck it out until I finished and (then) I went all to peices. You all know what I am when my stomack goes back on me. To sum it all up I was completely all in. Even then I tried to stick it out and not come to the hospital (this lasted two more days) but at last I was driven to this place.”-Letter from Sam Avery, 8/6/18

POISON GAS IN THE GREAT WAR

The use of poison gas in World War I was a major military innovation. The gases commonly used included disabling chemicals such as tear gas, blistering agents such as mustard gas and lethal asphyxiants such as phosgene and chlorine. Mustard gas in particular was designed to pollute the battlefield and would permeate the soil where it remained active for days, weeks or even months depending on weather conditions. This made mustard gas a preferred choice for use against wooded areas, billeting spaces, gun emplacements and all points of cover.

Gas was everywhere in clothing, food and water; corroding flesh, internal organs and even steel armaments. The smells of the different chemicals were pervasive. Both sides understood that repeated area saturations with low vapor concentrations over prolonged periods of time ensured that the toxic environment itself would create casualties all on its own.

While the killing capacity of gas was limited (approximately only 4% of combat deaths were due to gas), the proportion of non-fatal casualties was very high. Different types of chemicals were also frequently mixed together to achieve a greater combined effect, making it impossible to determine which specific poison was responsible for an individual  soldier’s life-threatening condition. Gas projectors were often used prior to ground attacks to create clouds of gas that would blanket the opposing defensive positions. Additionally, gas shells would be used in conjunction with high explosive shells during artillery barrages; the high explosives forcing enemy troops to seek shelter where the gas vapors would then settle and contaminate them (gas was heavier than air, therefore denser near the ground where it affected the wounded and those seeking shelter in earthworks the most).

American Gas Casualties, 1918

Approximately 27% of all AEF combat casualties (including both dead and wounded) were caused by gas. Likewise, a considerable 31% of all AEF wounded were also treated in hospitals for gas injuries. During the course of American involvement in the Great War, the number of gas wounded became so great that one field hospital in four per division (25% of total hospital resources) were dedicated to treating the victims of gas.

“Dressing A Gas Case” by C. LeRoy Baldridge, 1918

Based on Sam Avery’s writings, it appears that he was injured by gas poisoning at the end of the Aisne-Marne Offensive in July, 1918. Along with inhalation, the ingestion of food and water contaminated by gas was a frequent route of exposure. What specific chemicals were involved in Sam’s case is not known, but he suffered from a classic case of delayed symptom onset and resulting toxic shock which was very serious.

One new German concoction known as dichloroethylsulphide was introduced to battlefield use at that time which was toxic in concentrations that could not be detected by smell, the person affected suffered no immediate discomfort at time of exposure, and symptoms did not develop until hours later. Symptoms from mustard and phosgene contamination could also take up to 24 hours or more to develop, with the common occurrence that troops initially exposed were not incapacitated until the following day. Phosgene was particularly insidious in that it was not intensely irritating to the upper respiratory tract which allowed for deeper inspiration into the lungs where it released hydrochloric acid after contacting moist tissue surfaces. As an asphyxiant, phosgene strained the heart and impaired the circulatory system’s effectiveness in moving oxygen through body tissues. Severe gas cases of this nature included a type formally classified by the War Department as the “collapsed” who presented with a poor pulse and gray skin color. In the U.S. Army Medical Services handbook entitled Memorandum on Gas Poisoning in Warfare (1917), the Regulations For Treatment Of Gassed Cases by Regimental Medical Officers stated the following:

“Special attention should be paid to men who complain of feeling collapsed, though they show no manifest features of having been gassed, since these may develop later the serious form of delayed poisoning.” {Page 21, Sec. 6}

Among the delayed symptoms of phosgene poisoning were chest pain, shortness of breath, loss of apppetite with gastric pain, and general lassitude. It was also noted that “gastric derangements” would persist during convalescence. Sam’s own descriptions of his sufferings are identical when compared to these reference notes from the AEF Medical Service.

THE MEDICAL SERVICE

U.S. Army Ambulance, 1918

The Medical Department processed combat gas casualties using procedures similar to those used for the sick and wounded; soldiers were littered to dressing stations, sent in an ambulance to a triage or evacuation hospital, then on to a base hospital. After they had sufficiently recovered, they were then sent to a convalescent area pending return to the front. Whenever possible, gas casualties always rode to avoid exertion which would worsen their condition, and were sent to a specific hospital designated to handle gas cases. During the Aisne-Marne Offensive, 26th Division Field Hospitals No. 101 & 104 were established together in a large school building at Luzancy (Point A) to care for the slightly wounded, gassed and sick. Here the gassed cases received only preliminary treatment and were triaged by the division medical officer.

Chateau Montanglaust

The severely gassed were then evacuated as soon as possible by ambulance or truck to Evacuation Hospital No. 7 at Chateau Montanglaust in Joue-les-Tours (Point B) which had a total capacity of 1,100 beds and good facilities for evacuating patients by train to base hospitals further in the rear. Sam was ultimately transferred to Base Hospital No. 6 at Bordeaux (Point C) to complete his convalescence.

Outside AEF Hospital Train, 1918

Inside AEF Hospital Train, 1918

ORIGINAL FILM OF AEF GAS DELIVERY SYSTEMS IN ACTION

ORIGINAL FILM OF AEF HOSPITAL TRAIN WAITING FOR WOUNDED SOLDIERS IN TOUL, FRANCE.

After admission to the hospital, gassed patients stripped off all clothing and showered. Those with serious symptoms were bathed while still lying on stretchers. After leaving the showers, medics sprayed their eyes, noses and throats with bicarbonate of soda to mitigate corrosion of the mucous membranes. Depending on the diagnosis, patients were also given treatments of oxygen and venesection (bleeding) to counteract the effects of inhaled gas. Those who had ingested gas with contaminated food or water were prescribed olive or castor oil to coat irritated stomach linings. Above all, complete rest was the most important point in the general treatment of gas cases: Physical strain or effort within the first month after being seriously or severely gassed could lead to an often permanent, disabling condition of heart arrythmias known as “irritable soldier’s heart.”

From the time he left the front in an ambulance at the end of July until his return to duty in early October of 1918, Sam Avery was moved through a series of field, evacuation and base hospitals which took him from Luzancy to Bordeaux (see map above). It was the first time Sam had been away from the front in 6 months since first entering the lines in February. Ever-optimistic that his “casual” assignment to medical care would be only a short one, Sam would discover that the serious gassing he had recieved actually required a longer convalescence of about 2 months. Like many others, Sam would also be bothered by its lingering effects for the rest of his life.

Although he did not know it at the time, Sam’s extended hospitalization during the Saint Mihiel Offensive may have quite possibly saved him from being more seriously wounded or even killed, given the heavy casualties sustained by the 103rd Infantry in fierce fighting at Marcheville, Riaville and Champlon during late September…

Read Soldier’s Mail during recovery in the hospitals here: August, 1918; September, 1918.

ORIGINAL FILM OF 26TH DIVISION FIELD DRESSING STATION