HISTORY OF LETTERMAN GENERAL HOSPITAL

 

Surgical History of Letterman

 

 

 

 

 

 

 

Page 12 & 42

 

      In December,, 1898, when the Letterman General Hospital was created by creating by converting the General Field Hospital at Presidio, California, into a general hospital, the present Letterman General Hospital was something beyond the dreams of the most optimistic.  Established as a temporary measure, and at a time when surgery formed a very small per cent of the work of an army hospital, it is not to be wondered at that the hospital had very meager surgical facilities.

      In 1900, when the hospital was installed in its temporary frame buildings, the surgical service consisted of two wards, with an operating room in the end of one of them, with the commanding officer as “operating surgeon,” in additions to his other duties.  The equipment is best described by a quotation from the “History of the U. S. Army General Hospital, Presidio of San Francisco, California,” by then Captain H. H. Rutherford, Medical Corps.  In his report,, he states, “The surgery was quite crude in all particulars, and for the greatest part of the first year, aside from an operating table of cheap pattern, necessary basins, etc., was equipped with nothing more than the ordinary Arnold sterilizer and a scant supply of instruments and appliances, a number of which were old and obsolete.”

      From the beginning until 1902, all operations were performed by the commanding officer, Major Girard, with one assistant.  This, in addition to his other duties, administrative and medical.  But in 1912 a separate service was established with Colonel, then Major W. P. Kendal, M. C., as “surgeon,” with two assistants and an anesthetist.  At this time there were three wards, two for clean and one for infected cases.  From 1902 until 1917, the increase in personnel and equipment was gradual.  But since the fall of 1917 the service has advanced with enormous strides, until at present there is a Chief of Surgical Service with thirty assistants, twenty-one wards and an operating pavilion.

      It is of interest to note the rate of expansion as suggested by the number of operations performed yearly during the first few years of the existence of -the hospital and during the year 1918.

     

Year

1900

1901

1902

1903

1904

1905

1918

Operations performed

168

263

263

206

292

272

2414

 

      There was a gradual increase up to 1917, when number of cases suddenly began to go up.  This was due to the mobilization for the war just ended.  The year 1919 promises to surpass 1918 by far, on account of the arrival of patients from the American Expeditionary Forces both in France and Siberia.

      In 1903, the present surgical pavilion was constructed, not with its present equipment of tiled floors, conductive heating systems, dual lights, and modern apparatus, but the operating room was separated from the surgical wards.  And from such a beginning has grown the present plan of the operating pavilion, with a main operating room where two operations can be performed at one time, and operating room for infected cases, two anesthetizing rooms, a dressing room, a supply room, an instrument room and a “scrub” room, all equipped with modern apparatus and conveniences.  With this equipment, and with the present personnel, it can be understood how 573 operations were performed in one month in 1918, as reported in the New York Medical Journal, February 8, 1919, “The Letterman General Hospital, San Francisco,” by Lieutenant Colonel L. C. Mudd, M. C.

      During the year 1918 and the first half of 1919, the surgical service has expanded so that during the latter part of June and the first part of July, 1919, the service took over the entire hospital as it existed prior to the declaration of war against the Central European Powers, with the exception of the isolation, prison and psychiatric wards; besides eight wards which were constructed during the recent emergency.  This gives free access to the operating pavilion to all acute surgical wards.

 

      The service is divided into the following divisions, with their respective quota of wards:

      General Surgical Service—Four wards, besides a part of the Officers’ Ward and a part of the ward for female patients.

      Orthopedic Service—Nine wards.

      Neuro-Surgical Service—Two wards.

      Eye, Ear, Nose and Throat Service—Two wards.

      Genito-Unrinary Service—Three wards.

      Obstetrical Service—One ward.

 

      Each ward will accommodate an average of forty patients, and it is so arranged within the several services, that infected cases are grouped in separate wards.  It is not to be understood that all the patients in one service belong to that service only.  But there may be several different pathological conditions present, and while remaining nominally under the care of one branch of the service, may be treated by several others.         The two branches of surgery which have expanded more than any of the others are the orthopedic and the neuro-surgical.

      The orthopedic service is the largest separate division of the Letterman General Hospital.  Besides having its clean and infected wards, there are wards for specific classes of wounds, i. e., amputation ward (arm and leg), and a ward for diseases of the feet.  Also there is an orthopedic shop where all necessary braces and appliances, including artificial limbs, are manufactured.

      The neuro-surgical service is an entirely new department in the army.  This type of case formerly was taken care of by the general surgical service.

      The executive staff is divided into several divisions.  These divisions with their present incumbents are as follows:

      Chief of Surgical Service, who has supervision of the entire surgical service and direct supervision of the general surgical division, Col. Robt. M. Thronburgh, M. C.

      Chief of Orthopedic Service, Major Leo Eloesser, M. C.

      Chief of Neuro-Surgical Service, Lt. Col. H. C. Naffziger, M. C.

      Chief of the Urological Service, Capt. T. R. Petch, M. C.

      Chief of Eye, Ear, Nose and Throat Service, Capt. Saunders, M. C.

      Obstetrician, Capt. Topping, M. C.

      The development of the service to its present standards should be divided into two periods.  The first, from the beginning of the Letterman General Hospital until the latter part of 1917 to the present time, or the period of emergency brought about by the entrance of the United States into the world war.

      The Chiefs of the Surgical Service from the beginning are as follows:

                        FIRST PERIOD

      Major Joseph B. Girard, 1898 to 1901.

      Col. (then Major) William B. Kendall, 1901 to 1902.

      Lt. Col. (then 1st Lt.) Thomas L. Rhoades, 1902 to 1904.

      Col. then (Capt.) James M. Kennedy, 1904 to 1910.

      Lt. Col. (then Major) Raymond F. Metcalf, 1913 to 1916.

      Lt. Col.  (then Capt.) John W. Hanner, 1916 and 1917.

           

                        SECOND PERIOD

      Major Walter C. Chidester, M. R. C., June 1917 to Aug. 23, 1918.

      Major Clarence G. Toland, M. R. C., Aug. 1918 to Oct. 1918.

      Maj. Samuel Robinson, M. R. C., Oct, 1918 to Dec. 1918.

      Maj. Fred R. Fairchild, M. R. C., Dec. 1919 to April 1919.

      Lt. Col. H. C. Naffziger, April 1919 to July 1919.

      Col. Robt. M. Thornburgh, present incumbent.

 

 

 

OBSTETRICAL DEPARTMENT OF SURGERY AT

LETTERMAN GENERAL HOSPITAL

      Considerable surprise is often expressed on hearing of the number of babies born at Letterman Hospital.  However, when it is taken into consideration that the wife of every officer and enlisted man in the Army as well as those of regular civil service employees have the privilege extended to them, it is reasonably accounted for.  Many persons think it strange that maternity cases should occur in a military hospital, but the Government extends the courtesy in line with broad policy of caring for the welfare of the men and their immediate family.

      The Maternity Ward is well equipped to handle a limited number of cases.  It is well located in a quiet portion on the grounds and operated night and day with a uniform service comparing favorably with the Maternity Department of any civil hospital throughout the land.  The quarters are pleasant; nursing care adequate; the food good, substantial and nourishing, and quiet, cleanliness and efficiency render this department a credit to the Army Hospital.  The present aim is to give but one class of service—the best—whether Colonel’s wife or wife of a private. 

      The babies receive the same care and attention in their nursery—each with its own bed labeled with individual clothes locker underneath.  Here they are bathed and sleep between feedings.  No visitors are permitted to enter this room on account of the possibility of carrying contagion.  We would remind the mothers that every baby born is immediately labeled which label remains until the departure from the hospital.  The delivery room is thoroughly equipped, light and roomy, with sterilizing plant and wash rooms adjoining.           The hospital period in all but unusual cases is two weeks, patients remaining in bed ten days.  They are then carried out on the glass enclosed sun porch or on the open porch as weather permits and instructed when necessary in the care of their babies by our efficient corps of trained nurses.

      In times of peace the cases did not run more than six to eight per month, while in 1918 the increase was more than 100% over 1917, often running 30 per month, 216 cases being admitted to the ward necessitating increasing the ward capacity to 15 beds by utilizing the porch for convalescent cases; the patients sleeping on the porch with great satisfaction to themselves and not interfering with their recovery.  It is not unusual during war time to have two or three babies born here in the twenty-four hours.

      The proportion of enlisted men to officer’s wives is in the ratio of three to four in favor of the enlisted men.  During the epidemic of influenza fifteen fever cases were handled in the ward.  Otherwise there have been no contagions and infections handled in the ward at any time.  Every case is examined and measured prior to admission and kept under observation, and given instructions and advice up to the period of admission when the ambulance is sent to their homes, anywhere in San Francisco, night or day.  The list for the current and three or four months ahead always contains from 50, 60 to 100 cases.  This a service that no civil hospital affords.

 

 

FRANK PIXLEY TOPPING

 

      Born January 8, 1873, in San Francisco, California.  Graduated from Cooper Medical College, San Francisco.  Assistant House Surgeon, German Hospital, San Francisco, 1899-1900.  Post Graduate New York, 1900-1901.  Post Graduate University Vienna, Austria, 1901.  Post Graduate, Rotunda Hospital, Dublin, Ireland, 1902.  Assistant Medical Clinic, Cooper College, 1902-1903.  Senior Assistant Department Diseases of Women, Stanford Medical School until 1914.  General Practice, San Francisco, since 1902.  Commission Captain Medical Sec., O. R. C., June, 1917.  Assistant to Chief of Surgical Service in charge Obstetrical Service.  Commander of Detachment of Patients.  Officer in charge of Baggage Room.  Supervisor of Clinical Records.

 

 

 

Transcribed by Sharon Walford Yost.

Source: ”The History of Letterman General Hospital, Pages 5, 6, 36 & 50. Published by the Listening Post, Presidio, San Francisco, Cal. 1919.

© 2010  Sharon Walford Yost.