Home of the Brave

Home of the Brave

On a winter evening in 1917, a young Baltimore physician was detained at gunpoint as he attempted to cross the grounds at Fort McHenry. 

Dr. M.B. Levin had previously been turned away when he tried to volunteer for overseas duty, and perhaps thought his attempt to join the war to end all wars would again be thwarted. Once the guard realized Levin was a doctor, however, he took him to meet the adjutant of the hospital the Army was rushing to build among the remnants of the Revolutionary War-era fort.

By the time Levin was transferred to another military installation two years later, U.S. Army General Hospital No. 2 consumed every available inch of bare ground at Fort McHenry, a maze of more than 100 buildings filled with all manner of wounded from the Western Front. It was the largest Army hospital in the nation – more than 32,000 patients underwent 119,000 surgeries here – and moved significant surgical advances from academia into everyday use.  

“It had a profound effect on the way medicine was practiced in the United States,” says Dale C. Smith, professor of military medicine and history at the Uniformed Services University in Bethesda, Md. 

Fort McHenry also pioneered vocational rehabilitation aimed at ensuring injured veterans found meaningful work after leaving the military. And by the time it closed, General Hospital No. 2 had laid the groundwork for the creation of a nationwide health-care system for former servicemembers we now know as VA.

STAR-SPANGLED BEGINNING Fort McHenry’s greatest attribute has always been its strategic location. It guarded the southern entrance to Baltimore Harbor almost from the moment American colonists realized they were going to war with King George III. The initial fortifications were built in 1776 and named Fort Whetstone because it was located on Whetstone Point. A subsequent fort built on the site was named for James McHenry, secretary of war to both George Washington and John Adams. It took part in some of America’s most historic events, enduring the British bombardment that inspired Francis Scott Key to pen “The Star-Spangled Banner” during the War of 1812, and serving as a Civil War detention center for Confederate soldiers and sympathizers. The latter included Frank Key Howard, grandson of the author of the national anthem. 

Ten days before Austrian Archduke Franz Ferdinand was assassinated in June 1914 – triggering the Great War – the city of Baltimore leased the fort from the federal government and turned the grounds into a taboo-smashing co-ed park and swimming beach. 

Despite this rich history, World War I was Fort McHenry’s most active period of military service, says Paul Plamann, who has worked as a ranger at Fort McHenry National Monument and Historic Shrine since he left the Army in 1967. The federal government revoked Baltimore’s lease on Fort McHenry after the United States entered the war. The park was closed in July, and in September the War Department issued plans to build a new hospital among the historic military buildings that had occupied the peninsula for nearly 150 years.

Many of the new hospital buildings were under construction when Levin arrived to run the medical laboratory. So the lab – along with 50 hospital beds and X-ray and surgical facilities – were housed in an immigration center on the fort grounds. 

The first trickle of overseas patients arrived in January 1918, then surged after the Battle of Château-Thierry that July. “The men had wounds of all descriptions but the saddest were those who didn’t bleed – the psych cases,” Levin wrote in a 1974 retrospective for The Baltimore Sun

Again, Fort McHenry’s location was important. The new hospital was close to major ports and served by major railroads, making it an easy destination for wounded troops once they reached the United States. 

General Hospital No. 2 also attracted top medical talent and quickly transformed from a receiving hospital – temporarily housing patients pending their transfer to another facility – into a history-making surgical center.

SPECIALIZED MEDICINE Soldiers who sustained the most significant facial wounds – one of the signature injuries of the Great War – went to Fort McHenry, Smith says. There, surgeons using an ancient Hindu skin-grafting technique teamed up with dentists who stood apart from most of their medical colleagues for their expertise in rebuilding body parts. 

“Dentists were building appliances that attached to bone,” Smith says. “For example, they knew how to make a cartilage bridge that would allow you to attach a new nose.”

Dr. George Schaeffer, the hospital’s chief of maxillofacial surgery, followed that model, teaming up with dentists to make medical history. “American maxillofacial surgery really got its start at General Hospital No. 2,” Smith says.

The dentists did bone and cartilage work while surgeons like Schaeffer moved a flap of skin from the forehead or neck to an area on the soldier’s face shattered by a bullet or shrapnel. Grafting options were limited at the time because the skin flap had to remain attached to the place from which it was taken – the neck, for example – until new blood vessels formed at transfer sites like the nose or chin. 

“You were limited to (taking) skin from the forehead, cheek and neck,” Smith says. “It was a technique developed by the ancient Hindus and known in Europe. But it’s not what’s known as cosmetic surgery.”

Schaeffer went well beyond performing such surgeries. He also put together formal procedures for triaging facial wounds that were distributed to aid stations and field hospitals in France to improve the chances doctors could repair the damage once a wounded soldier reached a general hospital. That included advising front-line medical staff to immobilize the jaw but not try to repair anything, Smith says, or clean facial wounds without cutting away damaged tissue. 

“This was hugely important,” Smith says. “Schaeffer was more responsible for American plastic surgery advances than any other person.” 

LIFE IN COMMUNITY A thriving community developed at Fort McHenry as the hospital grew to 3,000 beds and the medical staff hit close to the 1,000 mark. Catholics, Jews and Protestants conducted separate worship services in the fort’s historic chapel while Methodists met at a weekly “singing service.” A baseball team formed. The leather shop made thousands of pairs of shoes for patients. The patients made plaster-of-Paris bandages used in the hospital.

Baltimore residents turned out in droves to work as nurse’s aides, help with recreational activities and social events and perform other tasks as needed. The Salvation Army and YMCA also had a significant presence. All told, volunteers probably outnumbered the permanent staff, Smith says.

General Hospital No. 2 had its own newspaper – The Trouble Buster – produced and printed by patients. The Trouble Buster reported on the arrival and departure of key medical staff, noted the death of the first Great War soldier married in the Fort McHenry chapel, and chronicled the Spanish flu epidemic that ravaged the hospital in ways the medical staff would never forget.

“The fall and winter became even more of a nightmare,” Levin later wrote of his second year at the hospital. “For weeks, the epidemic took the lives of eight or 10 men every day. It was so devastating that many died within 18 hours after showing the first symptoms.” 

Operating rooms were closed at the peak of the epidemic. Emergency surgeries were done in the patient wards. Antibiotics were not yet available to treat secondary infections that often accompanied the flu, so patients were treated with aspirin, quinine and sodium bicarbonate. The death rate was so high that at one point the chapel became the overflow morgue, Levin wrote. 

The Trouble Buster also attempted to cool media hype about advances in facial reconstruction at General Hospital No. 2. “Newspapers have given a great deal of space to the maxillofacial work and it is regretted that so much has been printed (that) is so greatly overdrawn,” according to a story in the April 26, 1919, issue. “The department does not aim to improve upon nature, but in a feeble way to attempt to restore lost parts of the face and correct defects due to injuries and deep scars which follow them – in a word to give the men faces as presentable as possible.” 

REHABILITATION CENTRAL General Hospital No. 2 also stood out for the quality of its orthopedic surgery. Once again, Fort McHenry’s ability to attract top medical talent paid off.

“Charles Hoffman had been surgeon to the Western Maryland Railroad,” Smith says. “So he had the skills in bone injury and breaks and crushes.” 

Outside the surgical suites, Fort McHenry made significant strides in occupational therapy and vocational rehabilitation, inventing its own programs and drawing on expertise from other hospitals. Patients took jewelry making from Walter Reed General Hospital and carpentry from
Massachusetts General Hospital, Smith says. They learned knitting, metal work, upholstery, auto repair and bookkeeping. 

The most notable vocational rehabilitation program was launched with telegraphy equipment borrowed from the Signal Corps, according to the 1983 book “Fort McHenry: Home of the Brave” by Norman G. Rukert. 

“The telephone was brand-new and the telegraph was still the best way to get a message of importance across the country,” Smith says. “This occupational aid gave you the possibility of getting a job.” It was so successful that similar telegraphy schools were established at other military hospitals.

Patients and physicians alike returned to their hometowns after leaving Fort McHenry, showing the nation significant advances in medicine. General Hospital No. 2 passed into the hands of the U.S. Public Health Service and closed in 1923. The temporary hospital buildings were torn down and Fort McHenry was designated a national park in 1925, but remained under War Department control. It was turned over to the U.S. Park Service in 1933, and designated as a national monument and historic shrine six years later.

Although most physical traces of the hospital have vanished, its profound legacy endures. VA sent its earliest doctors there to train and took over the nursing school that was started after the Public Health Service took charge, Smith says. Ultimately, General Hospital No. 2 was an engine to pass the legislation to build the VA system. 

“It was part of a social contract to return veterans to useful, productive social lives,” Smith says. “We’ve done it with lots of people since World War I. General Hospital No. 2 helped redeem that promise.”  

Ken Olsen is a frequent contributor to The American Legion Magazine.