CARING FOR THE WOUNDED
The method of caring for the wounded
at the front depends a great deal upon
whether a battalion is holding a set of trenches
on a standing front, or advancing, either in a
big push, or in a raid. The medical officer to a
fighting battalion is the member of the Army
Medical Corps who is closer to the firing line
than any of the other officers of that corps in
the whole theater of war. He is served by the
nearest field ambulance, whose stretcher
bearers not only evacuate the wounded from his
R.A.P.--regimental aid post--but also keep
him supplied with medicines, dressings, splints,
and other medical and surgical necessities.
His food is sent up with that of the remainder
of his battalion from his own battalion transport.
The field ambulance evacuates the severe
cases to the nearest C.C.S.--casualty clearing
station--which is the closest hospital to the
lines. It is at the C.C.S. that the necessary
operations are performed. Here the real
surgical work of the medical corps begins, for up to
that station it is much a matter of first aid.
From the casualty clearing station cases that
look as if they will require protracted attention
are transferred to ambulance trains, which
convey the cases fifty, sixty, or more miles to the
base hospitals at the rear, perhaps about
Boulogne, Havre and other towns reasonably well
out of danger. And from these hospitals the
wounded or sick may be transferred again, this
time to hospital ships which cross the channel
to one of our channel ports. At these points
they are once more put aboard ambulance
trains and distributed to hospitals in London,
Manchester, Canterbury, Edinburgh or any
of the other large hospital centers.
Suppose that a battalion is holding a part
of the entrenched front, roughly one thousand
yards square. The medical officer always
travels with his battalion. In an area such as this
his R.A.P. would be in a dugout somewhere
in the vicinity of the one which is used as
headquarters for the battalion. A medical officer's
position is toward the rear of his battalion
whether the men are on the march, in an
advance, or holding the lines, for the reason that
the wounded and sick are naturally sent toward
the rear. Very commonly the R.A.P. is about
half way from the rear support trench to the
firing line.
The dugout of the M.O. is generally of the
superficial variety. It has a roof made up of
two or three layers of bags of sand piled on
top of a layer of boards, just sufficient to give
one a feeling of security in a most insecure
position. A straight hit from a shell on the roof
of this type of dugout means that a new medical
officer will be required for that battalion
at once. I have a vivid recollection of my
first experience in such a dugout, long before
I had become accustomed to living in them by
the week. It was on a fairly active front near
Bully Grenay. I had been sent from a field
ambulance to relieve the regular M.O. while
he took a well earned leave. His palatial
residence was only about two hundred yards from
the front line, its ceiling was less than six feet
from the floor, for my head hit it whenever I
stood up, and the rain which poured for days
trickled down our necks as it filtered through
the roof in many places. The shells kept
dropping most annoyingly that first day, hitting
everywhere except exactly on the center of
the roof, and I knew it was only a matter of
minutes till one landed there. Then to add to
my uneasiness the sergeant lit a fire with wet
wood which made a black smoke that poured
from the bit of tin which was used for a pipe
in the roof. This was the finishing touch, for
I felt certain that every gunner on that front
was using that smoke for a target. Turning
to the sergeant, I asked with as cool a manner
as I could command:
"How close do those shells have to come before
you would consider it advisable to move out?"
"To move out? Oh, coming through the
roof, I guess," he answered, with a blank stare.
I did not dare to ask any more questions, but
I thought to myself,--"what a nice, healthy
time to move!" It took some time for me to
become accustomed to that billet, but out there
one learns to become accustomed to anything.
In front of the Medical Officer are the men
who hold the line. There are four platoons to
a company, four companies to a battalion; and
with each platoon is one stretcher bearer,
making sixteen bearers to each battalion. These
stretcher bearers are trained in first aid,
dressings, setting fractures and so forth by the
M.O. of their regiment when they are out at rest
billets behind the lines. In the lines they
accompany their platoons and companies, and
when the men go over the top in raids and
advances the stretcher bearers go with them,
stopping to dress and care for the wounded
as they cross the battle area.
No finer set of men serve out there than the
stretcher bearers, whether they serve with a
battalion, an ambulance, or any other unit.
Their work is without the stimulation or
excitement the fighting men get, but has the same
dangers and hardships. They go over the top
as do the others, and it is their duty to carry
wounded with all haste through heavily
bombarded areas. The fact that, out of thirty-two
stretcher bearers used by me in three days,
thirteen were hit, well illustrates the dangers that
these boys cheerfully go through. A good
story is told of one of them, a chap who in civil
life had been a "tough" in the slums of one of
our large cities, and who had seen the inside
of a jail more than once, but who as a stretcher
bearer faced coolly, even gayly, any extraordinary
danger to get his wounded to the rear.
He was in charge of a squad for Number
---- Canadian Field Ambulance one day. He
and his men were taking a stretcher case over a
ridge which was under constant and heavy shell
fire. Tiring, he commanded his squad to stop
and rest. They obeyed, but demurred, saying
that it was too dangerous a place to rest.
"Naw," he said, lighting a cigarette after
handing one to the wounded man, "there ain't
no danger. Sit down an' take it easy."
"But, look here now, Tom," the others
argued, "you may be the first to have one of
those bally shells blow you into Kingdom
Come."
"Not--by--one--damsite," he slowly
replied, "I've got a hunch dat I'm goin' to slip
me arm round Lizzie once agen before dey
get me;" and he lay on the ground and thoughtfully
puffed at his cigarette. So the others
joined him, for their bravery was unquestioned;
and with the philosophy so common out there,
one said,--"Well, I guess we can stand it if
you can." Tom had puffed at his fag a few
moments with the shells dropping dangerously
near, when, without changing his position, he
asked:
"Did you mugs ever hear de story of de two
specials wot met in Lon'on de oder day?
Naw? Well, I'll tell yez. Two special
constables met, an' one o' dem had no hat, coat
all torn to rags, bot' eyes black, an' some hair
gone. 'Hello, Brown,' says de oder, 'wot-a-hell's
wrong wid yez?' An' de first answers:
'Ye know dat purty little Missus Smit wot
lives behind de Lion an' Dragon whose husban's
gone to de front? Well, he ain't gone!'"
Even the wounded man joined the laugh.
They all finished their smoke without even
glancing in the direction of the shells bursting
nearby, when the stretcher was picked up and
carried safely to the rear. His officers all say
that they would as quickly trust Tom in a
ticklish job as any other man in the world. But
he is just an example of the thousands of loyal,
life-risking stretcher bearers--some, like Tom,
rough, uneducated, uncouth; many others with
the culture acquired in college halls and
drawing rooms--who are daily and nightly giving
of their blood and their service to the men in
the lines.
These bearers wear a red cross on the arm,
are non-combatant troops and carry no rifles.
Each two of them carry a stretcher, and all of
them carry a little haversack slung over the
shoulder and filled with large and small
surgical dressings, bandages, scissors, splints, and
perhaps a bottle of iodine. Being non-combatant
troops they are supposed to be allowed to
carry out their work in comparative safety, but
they really run the same risks as the combatants.
This is to be expected in severe actions,
for a machine-gunner or artilleryman cannot
even try to avoid the stretcher bearers when
they are mixed up, as they always are, with
the fighting troops.
But, at any rate, the Germans get the reputation
of caring as little for red crosses or white
flags as they do for scraps of paper. One
afternoon I stood in a trench one-quarter mile
from Willerval which was held by our troops,
and in the ruins of which there was an advanced
dressing station of a field ambulance. For
some reason two ambulances came over the
crest of Vimy Ridge in broad daylight, in
plain view of the Germans, and ran rapidly
down into Willerval. They arrived without
mishap, but one-half hour later I saw them
start back over the ridge a few minutes apart.
The first one had got one-half way up the steep
side of the ridge when a heavy German shell
lit thirty feet behind it. And then shell after
shell dropped behind it all the way up the
steep slope. Fortunately the gunner's aim was
short, for the car disappeared from view over
the crest. Then the second car made the trip,
the German shells falling behind it just as they
had with the first one. They both got out in
safety, but no thanks were due to the Huns
who had done their best to get them with heavy
shells. That was one instance in which I saw
the Germans shell two ambulances which could
not have been mistaken for any other type of
vehicle.
Suppose a soldier is hit by a piece of shell
or sniper's bullet while he is in a trench which
his battalion is holding. He is first attended
by the stretcher bearer nearest to him at the
time, who should use the man's own aseptic
dressing which each soldier is compelled to
carry in the lining of his coat or tunic. The
injured man is then taken to the dugout of the
M.O., if necessary on a stretcher, where the
M.O. rearranges the dressing, gives a dose of
morphine if pain is severe, and after seeing that
all hemorrhage is stopped and the man is
comfortable, he hands the case over to the field
ambulance stretcher bearers who always serve him
and live in an adjoining dugout. This squad
carries the case back--through the trenches if
there is no hurry, but overland if haste is
important--to the advanced dressing station of
the field ambulance. If this should be a
particularly hard trip it may be done in relays.
For there relay post dugouts are established
with other bearer squads.
The A.D.S. is usually situated a mile or so
in the rear of the trenches, preferably in a large
cellar, but at any rate in a fairly well sheltered
area where cots are ready to receive fifty or
more patients. At the A.D.S. one or two of
the medical officers of the field ambulance are
stationed with a large staff of men. The
patient is here made comfortable; given coffee or
cocoa; name, number and battalion recorded;
and finally he is inoculated with anti-tetanic
serum. This has practically wiped out tetanus,
or lock-jaw, which was very prevalent at the
beginning of the war. He is kept here till a
convenient time, which may be after dark,
when he and any others who may have come
in are put into ambulances and taken to the
M.D.S.--main dressing station--of the field
ambulance, another two or three miles behind.
The M.D.S. may be in some old château, or
in a group of huts, or, if the weather is mild,
in tents. Here a light case, or slightly
wounded man, may be kept for a few days and then
sent back to the line or to a rest station to
recover his stamina and quiet his nerves. But
if the case should be a serious one, such as a
shattered leg or arm or a large flesh wound
that will take a considerable time to heal, he is
again transferred by ambulance to the
C.C.S.--Casualty Clearing Station--another two to
four miles back.
The C.C.S., usually in huts or tents, is the
first real hospital behind the firing zone. It
may have accommodation for a couple of
hundred patients; is supplied with X-Ray
equipment, a well-arranged operating room with
expert surgical assistance, and is the nearest place
to the line that trained nurses are sent. Here
for the first time since he left the line the
patient gets all those little motherly attentions
that only a woman can give. The injured man
may be kept here days, weeks, or even months
if he happens to be a case that would be
endangered by moving. All immediately
necessary operations are at once performed, and
often a seriously wounded man from the firing
line may be lying anesthetized on the operating
table of a C.C.S., being operated upon by
expert surgeons within two or three hours of
receiving his injury--practically as good
attention as this type of injury would receive in
civil life.
This is particularly the case where a man has
been wounded in the abdomen, from which
wound he may quickly develop peritonitis and
reach the valley of the shadow of death in a
few hours if prompt attention is not given. It
is also done in cases of head or lung injuries,
or in any wound causing uncontrollable
hemorrhage. In any of these emergencies, after
the M.O. in the line has given all immediately
necessary attention, the patient is ticketed
SERIOUS by him, and he is rushed with all
speed to the A.D.S., perhaps at great personal
risk to the stretcher bearers. Here he is
quickly transferred to an ambulance which may have
to rush him over heavily shelled roads, missing
the main dressing station altogether, and taking
him direct to the C.C.S. for his life-saving
operation.
After varying periods in the C.C.S. the
patients are sent by ambulance trains, which run
almost to their doors, to base hospitals at the
rear. From here they are re-transferred to
hospital centers in England and Scotland.
So much for the methods used in caring for
the wounded in the lines during stationary
periods. The same principles and methods are
employed during big advances, but of course
on a larger and more thorough scale. All the
arrangements are made during the weeks
preceding a push; extra stretcher bearers are
trained; the field ambulances increase their
staffs, particularly just behind the firing lines,
in order that the field may be cleared of wounded
at the first lull in the fighting. The whole
intricate system is so complete and so well
arranged that hundreds of cases may be rushed
through in a few hours, some of them being
comfortably in bed in English hospitals the
evening of the day on which they received their
"Blighty."
It must be remembered that in actions of a
severe nature, such as great advances, the first
object of the advancing troops is to obtain
their objective and to hold it. Therefore care
of the wounded may not be possible till the
action is over. But during these hours the
wounded are by no means without attention.
It is here that the battalion stretcher bearers
do their finest and most self-sacrificing work.
They go over the top with the fighting troops,
and as the men are hit it is their duty to give
them first aid, while the fight still goes on, with
machine-gun bullets whistling by their ears and
shells bursting all about them. Their duty it
is, and nobly they perform it, to dress the
wounded, stop bleeding if possible, and
temporarily set fractures. Then they place the
wounded men in the most protected side of a
shellhole, or in any other sheltered spot, and
pass on to the next needy one, after placing
any bit of available rag on a stick or old bayonet
to attract the attention of the field clearing
parties who come over that area. In the
meantime the wounded who can walk--walking
cases--make their way to the point at which
the M.O. is caring for the injured. After
getting the required attention, they walk on back
to the A.D.S. of the field ambulance.
At the first lull in the fighting it is the duty
of the medical officer to see to the clearing of
the field of those wounded who cannot walk.
Any men going to the rear for supplies, and
any German prisoners, are commandeered by
the M.O. as stretcher parties. In big actions
his own trained stretcher bearers are employed
only as dressers. In the battle of Vimy Ridge
which began at 5:30 a.m., it was twelve hours
later ere all the wounded on our front were
evacuated to the field ambulances. That was
quick work when one considers that some
battalions, including my own, had 35 per cent. of
their men hit. One hundred German prisoners
were sent up under escort to act as stretcher
bearers, and gradually the field was cleared.
The only difference between the handling of
the wounded during actions and during
stationary warfare is the fact that in the former
more unavoidable congestion takes place,
though this is prevented as far as possible in
the forward areas by rushing the cases to the
rear or to England. In big actions, where
many wounded are expected, this is always
done.
After hospital treatment in England or
Scotland the men are sent to convalescent
homes in Ramsgate, Herne Bay, Whitstable,
Sturry, Brighton, or any of the hundred and
one other points that are suitable in the
British Isles. Later these men are sent before
medical boards which decide as to their
disposal thereafter. They may be sent directly
back to duty; to prolonged rest; to have some
weeks, P.T.--physical training--which is not
popular with the men, but is often needed; or,
they may be marked P.B.--permanent base
duty--which means that they are not fit for
general service, but are able to perform some
duties at the base or at home. Lastly, they
may be discharged as permanently unfit for
further service, the amount of their pensions
being decided by the pension board.
Until the wounded man reaches the C.C.S. his
wounds are dressed in very rough surroundings,
not the aseptic dressing rooms of peace
times. Dugouts, cellars or open trenches are
employed for dressing stations. After the
battle of Vimy Ridge my boys and I dressed our
men for four days in an open, muddy trench,
with the shells dropping about all the time.
Dugouts are simply holes in the ground, and
may be most primitive dressing rooms. Everyone
knows how aseptic the ordinary cellar could
be made, even with the greatest care on the
part of an M.O.'s assistants. But our
dressings are folded and wrapped in such a
manner that they can be applied, even though the
dresser's hands are covered with mud, without
the aseptic part of the dressing, which is
applied to the wound, being in any way soiled.
I have given one hundred and fifty inoculations
hypodermically for the prevention of typhoid
in a tent in which the men and myself
stood ankle deep in mud. Not one case of
infection of the point at which the needle was
inserted occurred. This illustrates the efficiency
one reaches from being accustomed to working
in filthy surroundings. Your stretcher bearers
and dressers become as skilled in this art as
yourself, so that the men really get good
attention in spite of the many difficulties in the
way. Of course, at the C.C.S., which is five to
ten miles from the trenches, the surroundings
are as good as they are in the average city
hospital. And the base hospitals are often
elaborate in their equipment, though they may be
situated in large tents or newly constructed
wooden huts with stoves to lessen the raw cold
of the French winter weather. The base hospitals
in England are the highly scientific city
hospitals, simply put under military control.