Unit History: 104 British General Hospital

104 British General Hospital
When a new senior consultant in orthopedic surgery (Col. Mather Cleveland) was appointed in the European theater shortly before D-day, one of his first duties was to visit as many hospitals as possible in the United Kingdom. A total of 40 were visited before the invasion occurred. The wards had been stripped of patients, as far as was practical, in all of them, in the expectation of the heavy casualties to follow D-day, and the planned demonstrations of diagnosis and management, including plaster techniques, were necessarily limited.
Otherwise, most of the visits fell into the same general pattern. The qualifications of personnel were reviewed, and notes were made of suggested changes of assignment. General problems of orthopedic management were discussed with the chiefs of the surgical services and of the orthopedic sections, and matters of policy were discussed with commanding officers. It was suggested to the latter that they utilize the services of orthopedic surgeons to instruct all personnel in the management of bone and joint injuries and in the application of plaster.
After D-day, the practice of visiting hospitals was continued as far as time and other duties permitted. The situation in the United Kingdom was not too difficult, because distances were short. On the Continent, however, as the fighting moved farther and farther away from the beaches, distance introduced a considerable problem, and some hospitals were visited only twice in the 11 months that elapsed between D-day and V-E Day.
Below are the extracts with regards 104th General Hospital RAMC:
November 1944:
Patients and Population
Hospital        Total        Surgical (total)    Orthopedic    Holding
104th        861        550        160        ---
Evacuation Time
The time of arrival after wounding of patients transported from the Continent to the United Kingdom hospitals showed a wide range. Up to 3 or 4 weeks before this visit, which was in early November, many of the hospitals visited had received patients within 4 or 5 days. When air evacuation was available, some patients were still being received within a week after wounding. In many installations, however, the average time had lengthened to 2 weeks. The 192d General Hospital received patients from Holland and from Belgium by air within 6 days, and sometimes as early as 2 days, after wounding. These patients, who were mainly paratroopers, were flown in by the British.
At the 104th General Hospital, several patients with compound fractures had recently been received too late for skeletal traction, and 1 patient had not been received for 36 days. The position of the femoral fragments was not too unsatisfactory in another, similarly delayed case, but shortening amounted to almost an inch. Since these patients had already been evacuated to the Zone of Interior, their names and serial numbers were not available. It was stressed to the hospital staff that careful record should be kept of all patients delayed in transit long enough to interfere with their care, so that such errors could be investigated and corrected.
Experience varied from hospital to hospital. At the 106th General Hospital, 4 hospital trains had been received since 25 July, but at the time of the visit patients were chiefly being received by ambulance from the 79th General Hospital and the 110th Station Hospital. Ambulance convoys brought from 60 to 90 patients per trip. At the 121st General Hospital, convoys were received by air, train, and ambulance. In the first 3 convoys, the wounded were received from 24 hours to 5 days after wounding. The timelag for the fourth convoy was 8 to 10 days, and for the fifth it was as long, for some cases, as 21 days. At the 74th General Hospital, a total of 13 trainloads of patients had been received, the most recent from 10 days to 2 weeks after wounding. No patient had ever been received too late to be put in skeletal traction. At the 216th General Hospital, the last trainload of casualties, 50 percent of whom were neuropsychiatric, had previously passed through from 3 to 9 hospitals.
During the last 12 weeks, the condition of the patients on arrival was not as good as it had formerly been. The average timelag after wounding during this period was 12 to 14 days, but some patients had been delayed for 21 days or longer.
Plaster Techniques
Plaster of paris was, on the whole, well applied. At the 67th General Hospital, the circular plasters were rather bulky, but this was because it had been necessary to use cotton batting as a substitute for sheet wadding, which had been unobtainable.
At the 192d General Hospital, it was found that every patient who had been evacuated in a Tobruk splint had suffered a great deal of pain during transit. The chief of the orthopedic section said that in his experience it was as hard to apply a Tobruk splint correctly as to apply a plaster spica, which he thought was much more comfortable for the patient. It was also reported that there was some loss of the skin of the dorsum of the foot whenever the Thomas splint was used with the Army boot strap in place during evacuation.
The surgical coordinator of the 15th Hospital Center, who had recently traveled with a hospital train, said that in his opinion all patients in thoracobrachial spicas should be regarded as class 2. In a few instances, the spicas were too widely abducted. When plaster spicas were used for fractured femurs, he thought that a wicket should always be employed to protect the toes. No foul-smelling plasters were encountered on the train.
When the holding unit was investigated at the 22d General Hospital, 24 patients were found whose status was not considered entirely satisfactory for transportation. Their general condition was good, but the plaster casts in which they were encased were not well applied. Since these patients had all come from the 104th and 106th General Hospitals, it was suggested that the commanding officers and the chiefs of the surgical and orthopedic sections of these hospitals be asked to visit the 22d General Hospital and examine these patients with the chief of the orthopedic section.
Personal Recollection of:      Laurence Simmons
I was enlisted into the army on the 16th July 1942. After infantry training, which applied to all new entrants, I was transferred to the RAMC. I then had further training as a medical laboratory technician (this was my civilian job), this included tropical medicine which was new to me.
After embarkation leave in April 1943 we were completely fitted out with kit for the Far East. We landed in Algiers, handed in our tropical kit and collected a Middle East version. I doubt if the attempted subterfuge was very successful. Our convoy had been subjected to air attack in the Bay of Biscay and the sound of depth charges were heard occasionally. As we passed through the Straits of Gibraltar the voice of Lord Haw Haw (the British traitor William Joyce who was executed in 1946 for high treason) was broadcast over the ship’s tannoy detailing all the ships in the convoy and claiming we would never reach our destination. Nobody showed much concern at what proved to be empty threats.
After a few days lazing on the beach at Algiers we set up a large all tented 104 British General Hospital in some remote area or which I never knew the name. Here, a long way from active warfare, we treated patients for a large range of illnesses including infectious diseases, mental illness and conditions needing surgery. It was hot, uncomfortable (I slept on the laboratory floor), tedious and boring. One memorable thing was a Sirocco, a hot and savage wind, which blew down tents and kept every able bodied person hanging on to the guy ropes to stop the hospital blowing away. Well, it made a change!
Once a week I took two clean buckets and got a lift in a Jeep to a fairly distant Arab village market. Here we had an arrangement that as the butchers cut the throats of goats or sheep I held the buckets under the blood flow until they were full. We used the blood to enrich culture media used for growing a variety of pathogenic bacteria.
Shortly after allied troops captured Naples on the first October 1943 our hospital was dismantled and we made our way to Algiers and boarded a hospital ship which sailed to Naples. This was a pleasant trip. The ship was brightly lit up so it would not be attacked and the accommodation was very comfortable.
We disembarked by walking over the side of one of the wrecks lying in the harbour and were marched to a sports stadium where we were each given a tin of stew before settling down to sleep in the open air on a concrete floor. The next morning we were transported to Afragola, a place in the Naples area overshadowed by Vesuvius.
The 104 BGH was set up again with patients and officers in proper buildings while other ranks were put in two-man tents to keep fit and hardy! The hospital settled back into normal running. I took a couple of opportunities to visit Pompeii.
One afternoon there was a sound of a huge explosion. I stepped outside and saw Vesuvius erupting with a huge plume of smoke. The eruption went on for days and at night glowing lava could be seen flowing down one side of the mountain while lightning played over the peak.
Laurence later served with 18 Casualty Clearing Station.
Westbury Mar 43 to Jun 43; Algiers Jun 43 to Jul 43; Philippeville Jul 43 to Jan 44; Afragola Jan 44 to Jul 44; Rome Jul 44 to 15 Mar 46 the 104th General Hospital was disbanded.

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