By Paul Theerman, Associate Director
The centenary of the United States entry into World War I was this past April. But wars—even those having such sharp cease-fires as this one did, on November 11, 1918—rarely have well-defined beginnings and endings. Even before the official American entry, Americans served in France from the outbreak of the war in 1914. Expats in Paris formed the American Ambulance (the term then meant field hospital), which spun off the American Field Service, charged with transporting wounded soldiers from the front line and providing immediate care. In direct combat, the famed Lafayette Escadrille was founded in 1916, made up of volunteer American air fighters under French command, who battled the Germans up until actual American military deployment two years later. And in the realm of battlefield medicine and surgery, Americans served as volunteers in France from 1914 up to 1917. One of the most noted was Dr. Joseph A. Blake (1864–1937) who, at the outbreak of war, resigned from his prominent surgical positions at Presbyterian Hospital and Columbia College of Physicians and Surgeons, and went to France. There he successively headed up three volunteer hospitals in Neuilly, Ris-Orangis, and Paris, up until his induction to the American military medical corps in August 1917 where he continued his work.Blake had an outstanding reputation, so much so that he readily attracted both funds and workers. One such surgeon was Charles Terry Butler (1889–1980) whose memoir, A Civilian in Uniform (1975), and personal papers are held in the Academy Library. Butler was born in Yonkers, New York, to a prominent family. He was the son of lawyer William Allen Butler, Jr., whose father, William Allen Butler, Sr., both lawyer and author, was himself the son of Benjamin Franklin Butler, U.S. attorney general in the Andrew Jackson and Martin Van Buren administrations. Charles Butler led a life among the New York elite. As one example, he remembers that his family hosted William Howard Taft to dinner during his presidency. Butler went to Princeton University, where he graduated in 1912, and then to medical school at Columbia University College of Physicians and Surgeons. After his graduation in 1916, he was due to take up an internship at Presbyterian Hospital that July. He postponed it to January in order to serve under Blake, then at the Anglo-French volunteer hospital in Ris-Orangis, France, some 25 miles southeast of Paris. As Butler put it:
My two year internship would be put off six months, but here was the opportunity to learn the treatment of serious war wounds under a great surgeon, perhaps my only chance to have such training, and if the United States were forced into the war, I would be much more useful to the Army.
Blake promised Butler scant remuneration, 400 francs travel expenses each way, and 100 francs a month salary, relying on his “contribution” to aid the cause.
Butler left for Liverpool on May 27, and—after a long period of negotiating his credentials to enter France, as authorities were concerned about German infiltrators—he arrived at the Ris-Orangis hospital on June 10. A converted college, long empty before its refitting, the hospital was organized by two English patrons and operated by private donations and support from the French military. The hospital held about 200 beds, with a surgical theater and supporting radiology and bacteriological facilities, as well as, of course, kitchens and laundries.
Butler’s letters home trace his awakening to war and medicine. Within a week, he wrote to his uncle Clare:
The hospital has about 200 beds, and on my arrival I was put in charge of two wards with over 90 beds and some 80-odd patients. It was some contract to start with, and for two or three days I hardly knew whether I was coming or going. I did about forty dressings a morning with three nurses to help me, and two getting their patients ready for dressing ahead of me and bandaging up when I was through. It took over three hours of hard, steady work.
After a month, to his mother:
Last Sunday, 65 new blessés arrive—the majority of them frightfully wounded. They come by ambulance from a distributing railroad station some 6–7 kilometers away. Arriving in bunches of four or eight, they are sent immediately to their beds. Most of the orderlies had been given leave that day, so we doctors had to turn to and help carry them to the wards. (It isn’t particularly easy carrying a large man on a heavy stretcher with his trappings up three flights of stairs.) There they are undressed; their clothes put in a bag, tagged, and sent to be sterilized and cleaned; and then bathed. . . . The next thing is food. Many have not had anything for 24 hours or more while en route from the front or the last hospital. Then the surgeon comes along. Dressings, casts, splints, etc. are removed so as to see the condition and nature of the injury. It would be impossible to describe the state of some of the wounds—many not having been dressed for several days, some even for 10 or 14 days. A hasty and rather superficial cleansing must suffice for the time being, until the patient comes back from the X-ray room. … All the wounds are terribly infected, and a large percentage have foreign bodies (balls, pieces of shell, clothing, stones, dirt, etc., etc.) lodged…. [Surgery followed, aided by X-ray and fluoroscopy.] The recoveries are wonderful. Men whom no one would expect to live, ordinarily, in a civil hospital, hang by a hair for days and come around O.K.
Butler noted that the average length of stay at the hospital was almost 50 days.
Ris-Orangis was considered one of the most successful hospitals in the war. [One of the founders, Harold J. Reckitt, wrote a detailed history of the hospital, V.R. 76: A French Military Hospital (1921)]. Butler spent most of his time dressing wounds, with little occasion for actual surgery. He returned to New York in January 1917 to take up his internship at Presbyterian. But upon the American entry into the war in April 1917, he was commissioned a first lieutenant with the United States Medical Corps, serving into 1919—the topic of a future blogpost. Butler’s experience at Ris-Orangis was crucial to his surgical accomplishments in this second phase of war service. After the war, he entered private practice, but by 1923 ill health—apparently resulting from wartime conditions—led Butler to retire. Moving to the Ojai Valley of Ventura County, California, he became a prominent civic and cultural leader up to his death in 1980.
 Butler, Charles Terry. A Civilian in Uniform. Butler, 1975, p. 28.
 A Civilian in Uniform, p. 49.
 Blake to Butler, 29 April 1916, A Civilian in Uniform, p. 49.
 Butler to “Uncle Clare” [Clarence Lyman Collins (1848–1922)], 17 June 1916, A Civilian in Uniform, p. 57.
 Butler to “mother” [Louise Terry Collins (1855–1922)], 7 July 1916, A Civilian in Uniform, p. 62–64.
Charles Terry Butler, “Ris-Orangis, France, 1916,” photographic album. Charles Terry Butler papers. New York Academy of Medicine Library.