The 21st General Hospital was the successor to Base Hospital 21, among the first American military hospitals to serve in France in World War I. Its officer corps had been drawn in large part from the medical staff of Washington University Medical School and Barnes Hospital (See RG006, Base Hospital 21). After returning to the United States in 1919, Base Hospital 21 was designated a Reserve Officer Corps unit of the General Hospital category. When war broke out again in Europe, the executive officer of the reserve unit was Lee D. Cady, M.D., a 1922 graduate of Washington University School of Medicine and member of the clinical faculty in medicine.
Following the Japanese attack on Pearl Harbor on December 7, 1941, mobilization orders were sent to reserve units throughout the country. Cady, now lieutenant colonel, and an advance party of other medical officers from St. Louis, traveled to Ft. Benning, Georgia. On January 12, 1942, the unit was activated as General Hospital 21. The ranks were increased by officers and enlisted men already in training at Ft. Benning. On February 1 they were joined by fifty-five nurses from Barnes Hospital and the Washington University School of Nursing led by Lt. Lucille S. Spalding. Col. Robert E. Thomas, a Regular Army medical officer, was named as unit commander on February 15. Before General Hospital 21 departed from Ft. Benning, Col. Thomas was replaced as commander by Col. Charles F. Davis.
On October 20, 1942 the unit embarked from New York aboard the SS Mariposa, bound for England. Following a zigzag course through the rough U-boat-infested waters of the North Atlantic, the vessel managed to reach its destination, Liverpool, in safety. From Liverpool, the 21st was sent by train and truck to a billet in a suburb of Birmingham, Pheasey Farms Estate. While in England, plans were announced that the hospital would be a part of "Operation Torch," an Allied offensive to establish control of North Africa. In Liverpool again, the 21st boarded the SS Monarch of Bermuda, which sailed in a convoy south along the Atlantic coast of Europe. From Gibraltar, the convoy crossed the Mediterranean to Algeria and landed at the Port of Mers-el-Kebir, near Oran, on December 6, 1942. Algeria had newly come under Free French control and thus its strategic resources were at Allied disposal.
The 21st bivouacked at Oran. From there, late in December, the unit was transported into the interior of Algeria. The hospital was assigned to establish operations at a hot water spa. The place, called Bou Hanifia, was located at an oasis in the rocky desert plateau sixty miles south of Oran. The largest building in Bou Hanifia, the Grand Hotel, was chosen to house the main medical and surgical functions. Several smaller hotels in town were also taken over for hospital uses. A solitary first patient was admitted December 24. Hospital functions began in earnest on January 2, 1943, when 472 beds were ready. For a time, there was a critical supply shortage. Makeshift instruments were used in the first days of surgical operations. Medicines and bandages were administered very sparingly. The problem was gradually alleviated as more and more Allied convoys reached the Mediterranean Base Section.
Col. Davis was unexpectedly transferred to another unit in late January. Left to assume temporary command was Lt. Col. Cady. Weeks went by without a replacement for Davis named. Ultimately, with the help of friends higher up, Cady was promoted to colonel and given permanent command of the hospital. Cady revealed a considerable talent for public relations. His many efforts to boost morale and to cement good relations with U.S. and Allied commanders paid off in terms of hospital efficiency. Bed capacity steadily increased. When all appropriate spaces in the hotels were full, temporary buildings were erected to house additional wards. A rehabilitation section was established for special treatment of the wounded. Battles in Tunisia in the spring of 1943 led to capture of thousands of German and Italian troops. Up to 200 of the enemy wounded were treated by the 21st at one time. Handling of prisoners of war necessarily increased the complexity of military operations at Bou Hanifia. At its largest while in Algeria, the 21st had over 4,000 beds. The staff was pressed to handle casualties from the American and British forces that invaded Sicily in July. The number of patients gradually began to decrease once the Allies conquered all of Sicily and launched attacks on the Italian mainland. In November, the order came to "cease construction" at Bou Hanifia and restore facilities of the spa to their prewar functions. In a year of service in the North African campaign, the hospital treated 20,989 patients.
With hospital equipment packed into more than three thousand crates, the unit gathered again at Oran. The destination this time was Naples, Italy. The nurses sailed December 4, 1943 on the hospital ship Shamrock. The remainder of the unit boarded the British transport vessel HMS Cameronia two days later. Col. Cady found himself to be the ranking American officer on board and thus in charge of all U.S. personal during the voyage. In Naples, the Allies converted a fair-grounds, the "Prima mostra delle terre italiane d"oltremare," into a medical center and assigned its operation to several units, including the 21st. Near the fairgrounds was another tourist attraction, Terme di Agnano, like Bou Hanifia a hot water spa. There the officers of the 21st were billeted.
After the relative comforts of Bou Hanifia, Naples afflicted substantial hardships again on the unit. Fierce fighting continued only a short distance away. Cold rains drenched the region throughout December and January. A good portion of the fairgrounds buildings were badly bomb damaged. Tents were used to shelter many of the sick and wounded while repairs were being made. During these difficult days, members of the unit were themselves hospitalized with upper respiratory infections and fatigue. But, despite all these problems, the hospital was able to regain operating efficiency within days of arrival at the fairgrounds. In January 1944 Allied forces invaded the central Italian coastline at Anzio. In the weeks that followed, attacks were launched on German positions in the mountains, notably at Cassino. Trainloads and shiploads of casualties from these engagements, as many as three hundred at a time, were brought to the hospital, straining staff and bed capacity to the utmost. In addition, the unit was called upon to help stem a typhus epidemic in Naples. The most critical period of service to the Italian campaign came in June, with battles leading to the fall of Rome. Bed capacity of the 21st at that time reached three thousand.
The success of the D Day invasion of Normandy (June 6, 1944) permitted Allied offensives in southern France in August. By September, territory as far north as Lorraine had been liberated from German control. Orders were sent for the 21st to follow and establish operations anew on French soil. On September 25, the unit pulled out of the Naples facility. Just short of 15,000 new patient records had been added to hospital statistics. The 21st was recognized as one of the finest medical units in the European theater, and not only by Americans. For assistance to the Free French forces, Gen Alphonse Juin awarded the 21st a French unit citation.
The new location for the 21st was a psychiatric hospital near Mirecourt, south of Nancy. Once again, the unit found itself uncomfortably close to a battle zone. On October 21, 1944, less than a month after the 21st had left Naples, it was accepting patients anew. The psychiatric hospital buildings had been in the final stages of construction when the war began. They were not damaged during the German occupation. Now, with finishing touches by American engineers, the facility was admirably suited to the needs of the 21st It boasted spacious wards and central heat. By November, over three thousand patients were being treated daily.
The 21st endured perhaps its hardest test in late December 1944, during the "Battle of the Bulge." The surprise German counteroffensive breached Allied lines in Belgium and Luxembourg and, for then critical days, threatened a new invasion of France. Plans to evacuate the hospital were hastily drawn up. On December 26, the buildings at Ravenel were strafed by enemy planes and one bomb hit the grounds, causing slight damage. On that very day the German drive was stopped. The hospital, of course, accepted a great many of the wounded from the battle. The pressure continued as the struggle crossed the border into Germany itself. In January 1945 the 21st expanded to 4,040 beds. On January 7 the hospital treated its 50,000th patient. The facilities at Ravenel were used to their fullest extent. Sick and wounded were cared for even in the attics of buildings. Ambulatory patients were pressed into service on the wards and in the hospital headquarters.
The early months of 1945 gradually brought an end to this crisis. The long-awaited end of the war in Europe, V-E Day, came May 8. But victory brought a new variety of challenges to the hospital command. The number of patients dwindled, but many severely wounded remained for treatment. Meanwhile, the medical and nursing officers were needed for other assignments and were rapidly transferred out of the unit, creating staffing shortages. Col. Cady and his remaining cadre struggled to maintain hospital services despite daily changes in the duty roster.
On September 20, the U.S. Army bestowed its meritorious Service Unit Plaque on the 21st. The citation read, in part: "The professional skill and tireless devotion to duty demonstrated by the personnel of the 21st General hospital were in keeping with the highest traditions of the Armed Forces of the United States." The award, it is true, came too late to be distributed personally to most hospital personnel. The portions of the staff remaining at Ravenel had, by this date, been relieved of medical duties and were packing for the return voyage.
Final statistics compiled by the unit were impressive. They indicate that the 21st admitted 65,503 patients in its nearly three years of overseas service. The total surgical operations numbered 33,440. Dental treatments amounted to 69,375. The hospital laboratories had run 246,805 tests. Blood transfusions given were 11,258. The Convalescent and Rehabilitation Section treated 21,175 patients. In three years, over 2,200 persons had served as members of the 21st.
After a short period at a staging area near Marseilles, Col. Cady and his staff boarded the victory ship Westminster, which sailed October 28. The ship landed at Boston November 7. The members of the 21st were taken to Camp Myles Standish, given an official welcome, and reoriented for their imminent return to civilian life.
The 21st ceased to exist as an active military unit at this point (it has since been revived as a U.S. Army Reserve General Hospital). Yet the careers of those who had served with the hospital during the war continued profoundly to be influenced by the experience. Cady became a director of Veterans Administration hospitals in Dallas and Houston. Many of the other medical and nursing officers returned to St. Louis, a substantial number to resume practice at the Washington University Medical Center.
*Source: "The Spa, the Fairgrounds, and the Psychiatric Hospital; the 21st General Hospital in World War II," by Paul G. Anderson, Outlook, Spring 1982, 2-9.
