rocking and swaying over those agonizing _pavé_ roads. The throbbing of
his head and the pain in his arm and the pitching of the vehicle made
him nauseated. There were three other wounded men in the ambulance and
they had been nauseated too. It was not a pleasant journey. After what
seemed to Emile and his companions in misery an interminable time, the
ambulance came to a stop in front of a railway-station. At least it had
once been a railway-station, but over the door between the drooping Red
Cross flags, was the sign “Hôpital d’Évacuation No. 31.” Two
_brancardiers_ lifted out Emile’s stretcher—the same one, by the way, on
which he had been carried from the trenches twenty-four hours before—and
set it down in what had been the station waiting-room. It was still a
waiting-room, but all those who were so patiently and uncomplainingly
waiting in it were wounded. Two women, wearing white smocks and caps and
with the ever-present red cross upon their sleeves, came in carrying
trays loaded with cups of steaming soup. While an orderly supported
Emile’s head one of the women held a cup of soup to his lips. He drank
it greedily. It was the best thing he had ever tasted and he said so.
Then they gave him a glass of harsh, red wine. After that he felt much
better. After a time a doctor came in and glanced at the tags which had
been tied on him at the _poste de secours_ and at the field-hospital.
“You’ve a little fever, my lad,” said he, “but I guess you can stand the
trip to Paris. You’ll be better off there than you would be here.” If
Emile lives to be a hundred he will never forget that journey. It was
made in a box-car which had been converted to the use of the wounded by
putting in racks to hold the stretchers and cutting windows in the
sides. In the centre was a small stove on which the orderly in charge
boiled tea. In the car were fifteen other wounded men. On the journey
four of them died. The car, which was without springs, rolled like a
ship in a storm. The jolting was far worse than that in the ambulances
on the _pavé_ roads had been. Emile’s head reeled from weariness and
exhaustion; his arm felt as though it were being held in a white-hot
flame; he was attacked by the intolerable thirst which characterizes
amputation cases, and begged for water, and when it was given him
pleaded desperately for more, more, more. Most of the time he was out of
his head and babbled incoherently of foolish, inconsequential things. It
took twenty hours for the hospital train to reach Paris, for a great
movement of troops was in progress, and when well men are being rushed
to the front the wounded ones who are coming away from it must wait.
When the train finally pulled under the sooty glass roof of the Paris
station, Emile was hovering between life and death. He had a hazy,
indistinct recollection of being taken from the ill-smelling freight-car
to an ambulance—the third in which he had been in less than forty-eight
hours; of skimming pleasantly, silently over smooth pavements; of the
ambulance entering the porte-cochère of a great white building that
looked like a hotel or school. Here he was _not_ kept waiting. Nurses
with skilful fingers drew off his clothes—the filthy, blood-soaked,
mud-stained, vermin-infested, foul-smelling garments that he had not had
off for many weeks. He was lowered, ever so gently, into a tub filled
with warm water. _Bon Dieu_, but it felt good! It was the first warm
bath that he had had in more than a year. It was worth being wounded
for. Then a pair of flannel pajamas, a fresh, soft bed, such as he had
not known since the war began, and pink-cheeked nurses in crisp, white
linen slipping about noiselessly. While Emile lay back on his pillows
and puffed a cigarette a doctor came in and dressed his wound. “Don’t
worry about yourself, my man,” he said cheerily, “you’ll get along
finely. In a week or so we’ll be sending you back to your family.”
Whereupon, Corporal Emile Dupont turned on his pillow with a great sigh
of content. He wondered dimly, as he fell asleep, if it would be hard to
find work which a one-armed man could do.
From the imaginary but wholly typical case just given, in which we have
traced the course of a wounded man from the spot where he fell to the
final hospital, it will be seen that the system of the Service de Santé
Militaire, as the medical service of the French army is known, though
cumbersome and complicated in certain respects, nevertheless works—and
works well. In understanding the French system it is necessary to bear
in mind that the wounded man has to be shifted through two army zones,
front and rear, both of which are under the direct control of the
commander-in-chief, to the interior zone of the country, with its
countless hospitals, which is under the direction of the Ministry of
War.
As soon as a soldier falls he drags himself, if he is able, to some
sheltered spot, or his comrades carry him there, and with the
“first-aid” packet, carried in the breast pocket of the tunic, an
endeavor is made to give the wound temporary treatment. In the British
service this “first-aid” kit consists of a small tin box, not much
larger than a cigarette-case, containing a bottle of iodine crystals and
a bottle of alcohol wrapped up in a roll of aseptic bandage gauze.
Meanwhile word has been passed along the line that the services of the
surgeon are needed, for each regiment has one and sometimes two medical
officers on duty in the trenches. It may so happen that the trench
section has its own _poste de secours_, or first-aid dressing-station,
in which case the man is at once taken there. The medical officer
dresses the man’s wound, perhaps gives him a hypodermic to lessen the
pain, and otherwise makes him as comfortable as possible under the
circumstances. His wounds temporarily dressed, if there is a dug-out at
hand, he is taken into it. If not, he is laid in such shelter as the
trench affords, and there he usually has to lie until night comes and he
can be removed in comparative safety; for, particularly in the flat
country of Artois and Flanders, it is out of the question to remove the
wounded except under the screen of darkness, and even then it is
frequently an extremely hazardous proceeding, for the German gunners
apparently do their best to drop their shells on the ambulances and
stretcher-parties. As soon as night falls a dressing-station is
established at a point as close as possible behind the trenches, the
number of surgeons, dressers, and stretcher-bearers sent out depending
upon the number of casualties as reported by telephone from the trenches
to headquarters. The wounded man is transported on a stretcher or a
wheeled litter to the dressing-station, where his wounds are examined by
the light of electric torches and, if necessary, redressed. If he has
any fractured bones they are made fast in splints or pieces of zinc or
iron wire—anything that will enable him to stand transportation. Though
the dressing-station is, wherever possible, established in a farmhouse,
in a grove, behind a wall, or such other protection as the region may
afford, it is, nevertheless, often in extreme danger. I recall one case,
in Flanders, where the flashing of the torches attracted the attention
of the German gunners, who dropped a shell squarely into a
dressing-station, killing all the surgeons and stretcher-bearers, and
putting half a dozen of the wounded out of their misery. As soon as the
wounded man has passed through the dressing-station, he is carried,
usually over very rough ground, to the point on the road where the
motor-ambulances are waiting and is whirled off to the division
ambulance, which corresponds to the field-hospital of the British and
American armies. These division ambulances (it should be borne in mind
that the term _ambulance_ in French means “_military_ hospital”) do as
complete work as can be expected so near the front. They are usually set
up only four or five miles back of the firing-line, and have a regular
medical and nursing staff, instruments, and, in some cases, X-ray
apparatus for operations. As a rule, only light emergency operations are
performed in these ambulances of the front—light skull trepanning,
removal of splintered bones, disinfection, and immobilizing of the
wounded parts.
At the beginning of the war it was an accepted principle of the French
army surgeons not to operate at the front, but simply to dress the
wounds so as to permit of speedy transportation to the rear, for the
division ambulances, being without heat or light or sterilizing plants
of their own, had no facilities for many urgent operations or for night
work. Hence, though there was no lack of surgical aid at the front,
major operations were not possible, and thousands of men died who, could
they have been operated on immediately, might have been saved. This
grave fault in the French medical service has now been remedied,
however, by the automobile surgical formations created by Doctor
Marcille. Their purpose is to bring within a few miles of the spot where
fighting is in progress and where men are being wounded the equivalent
of a great city emergency hospital, with its own sterilization plant,
and an operating-room heated and lighted powerfully night and day. This
equipment is extremely mobile, ready to begin work even in the open
country within an hour of its arrival, and capable of moving on with the
same rapidity to any point where its services may be required. The
arrangement of these operating-rooms on wheels is as compact and
ingenious as a Pullman sleeping-car. The sterilization plant, which
works by superheated steam, is on an automobile chassis, the surgeons
taking their instruments, compresses, aprons, and blouses immediately
from one of the six iron sheets of the autoclave as they operate. Six
operations can be carried on without stopping—and during the sixth the
iron sheets are resterilized to begin again. The same boiler heats a
smaller autoclave for sterilizing rubber gloves and water, and also, by
means of a powerful radiator, heats the operating-room. This is an
impermeable tent, with a large glass skylight for day and a 200-candle
power electric light for night, the motor generating the electricity.
Another car contains the radiograph plant, while the regular ambulances
provide pharmacy and other supplies and see to the further
transportation of the wounded who have been operated on. Of seventy
operations, which would have all been impossible without these surgical
automobile units, fifty-five were successful. In cases of abdominal
wounds, which have usually been fatal in previous wars, fifty per cent
of the operations thus performed saved the lives of the wounded.
Leaving the zone of actual operations, the wounded man now enters the
army rear zone, where, at the heads of the lines of communication,
hospital trains or hospital canal-boats are waiting for him. The
beginning of the war found France wholly unprepared as regards modernly
equipped hospital trains, of which she possessed only five, while Russia
had thirty-two, Austria thirty-three, and Germany forty. Thanks to the
energy of the great French railway companies, the number has been
somewhat increased, but France still has mainly to rely on improvised
sanitary trains for the transport of her wounded. There are in operation
about one hundred and fifty of these improvised trains, made up, when
possible, of the long baggage-cars of what were before the war the
international express trains. As these cars are well hung, are heated,
have soft Westinghouse brakes, and have corridors which permit of the
doctors going from car to car while the train is in motion, they answer
the purpose to which they have been put tolerably well. But when heavy
fighting is in progress, rolling-stock of every description has to be
utilized for the transport of the wounded. Those who can sit up without
too much discomfort are put in ordinary passenger-cars. But in addition
to these the _Service de Santé_ has been compelled to use thousands of
freight and cattle cars glassed up at the sides and with a stove in the
middle. The stretchers containing the most serious cases are, by means
of loops into which the handles of the stretchers fit, laid in two rows,
one above the other, at the ends of each car, while those who are able
to sit up are gathered in the centre. Each car is in charge of an
orderly who keeps water and soups constantly heated on the stove. Any
one who has travelled for any distance in a freight or cattle car will
readily appreciate, however, how great must be the sufferings of the
wounded men thus transported. Taking advantage of the network of canals
and rivers which covers France, the medical authorities of the army have
also utilized canal-boats for the transport of the _blessés_—a method of
transportation which, though slow, is very easy. Every few hours these
hospital trains or boats come to “infirmary stations,” established by
the Red Cross, where the wounded are given food and drink, and their
dressing is looked after, while at the very end of the army zones there
are “regulator stations,” where the “evacuation hospitals” are placed.
Here is where the sorting system comes in. There are wounded whose
condition has become so aggravated that it is out of the question for
them to stand a longer journey, and these remain. There are lightly
wounded, who, with proper attention, will be as well as ever in a few
days, and these are sent to a _dépôt des éclopés_, or, as the soldiers
term it, a “limper’s halt.” Then there are the others who, if they are
to recover, will require long and careful treatment and difficult
operations. These go on to the final hospitals of the interior zone:
military hospitals, auxiliary hospitals, civil hospitals militarized,
and “benevolent hospitals” such as the great American Ambulance at
Neuilly.
No account of the work of caring for the wounded would be complete
without at least passing mention of the American Ambulance, which,
founded by Americans, with an American staff and an American equipment,
and maintained by American generosity, has come to be recognized as the
highest type of military hospital in existence. At the beginning of the
war, Americans in Paris, inspired by the record of the American
Ambulance in 1870, and foreseeing the needs of the enormous number of
wounded which would soon come pouring in, conceived the idea of
establishing a military hospital for the treatment of the wounded,
irrespective of nationality. The French Government placed at their
disposal a large and nearly completed school-building in the suburb of
Neuilly, just outside the walls of Paris. Before the war had been in
progress a month this building had been transformed into perhaps the
most up-to-the-minute military hospital in Europe, equipped with X-ray
apparatus, ultra violet-ray sterilizing plants, a giant magnet for
removing fragments of shell from wounds, a pathological laboratory, and
the finest department of dental surgery in the world. The feats of
surgical legerdemain performed in this latter department are, indeed,
almost beyond belief. The American dental surgeons assert—and they have
repeatedly made their assertion good—that, even though a man’s entire
face has been blown away, they can construct a new and presentable
countenance, provided the hinges of the jaw remain.
Beginning with 170 beds, by November, 1915, the hospital had 600 beds
and in addition has organized an “advanced hospital,” with 250 beds,
known as Hospital B, at Juilly, which is maintained through the
generosity of Mrs. Harry Payne Whitney; a field-hospital, of the same
pattern as that used by the United States Army, with 108 beds; and two
convalescent hospitals at St. Cloud; the staff of this remarkable
organization comprising doctors, surgeons, graduate and auxiliary
nurses, orderlies, stretcher-bearers, ambulance drivers, cooks, and
other employees to the number of seven hundred. Perhaps the most
picturesque feature of the American hospital is its remarkable
motor-ambulance service, which consists of 130 cars and 160 drivers. The
ambulances, which are for the most part Ford cars with specially
designed bodies, have proved so extremely practical and efficient that
the type has been widely copied by the Allied armies. They serve where
they are most needed, being sent out in units (each unit consisting of a
staff car, a supply car, and five ambulances) upon the requisition of
the military authorities. The young men who drive the ambulances and
who, with a very few exceptions, not only serve without pay but even pay
their own passage from America and provide their own uniforms, represent
all that is best in American life: among them are men from the great
universities both East and West, men from the hunt clubs of Long Island
and Virginia, lawyers, novelists, polo-players, big-game hunters,
cow-punchers, while the inspector of the ambulance service is a former
assistant treasurer of the United States. American Ambulance units are
stationed at many points on the western battle-line—I have seen them at
work in Flanders, in the Argonne, and in Alsace—the risks taken by the
drivers in their work of bringing in the wounded and their coolness
under fire having won for them among the soldiers the admiring title of
“bullet biters.”
The British system of handling the wounded is along the same general
lines as that of the French, the chief difference being in the methods
of sorting, which is the basis of all medical corps work in this war.
The British system, which, as some one has sarcastically remarked,
involves reference to “Burke’s Peerage,” “Who’s Who,” and the “Army
List,” is in itself extremely exhausting and entails much needless
suffering. The method of sorting in the French army is, on the other
hand, simplicity itself, and throughout all its stages is as rigidly
impartial as the customs examination at an American port, a wounded
officer receiving neither more nor less attention than a wounded
soldier.
[Illustration:
“Two soldiers lifted him onto a stretcher and carried him between
interminable walls of brown earth to the dressing-station.”
]
Sorting, as practised by the British, starts at the very first step in
the progress of a wounded man, which is the dressing-station in or
immediately back of the trenches, where only those cases absolutely
demanding it are dressed and where only the most imperative operations
are performed. The second step is the field-hospital, where all but a
few of the slight wounds are dressed, and where operations that must be
done before the men can be passed farther back are performed. The third
step is the clearing hospital, at the head of railway communication.
Here the man receives the minimum of medical attention before being
passed on to the hospital train which conveys him to one of the great
base hospitals on the coast, where every one, whether seriously or
slightly wounded, can at last receive treatment. To the wounded Tommy,
the base hospital is the half-way house to home, where he is cared for
until he is able to stand the journey across the Channel to England.
[Illustration:
_From a photograph by Meurisse._
Unloading wounded at a hospital in northern France.
“The clearing hospitals must always be ready to receive that unceasing
scarlet stream which, day and night, night and day, comes pouring
in, pouring in.”
]
The real barometer of battle is the clearing hospital, for one can
always tell by the number of cases coming in whether there is heavy
fighting in progress. As both field and clearing hospitals move with the
armies, they must not only always get rid of their wounded at the
earliest possible moment, but they must always be prepared for quick
movements backward or forward. Either a retreat or an offensive movement
necessitates quick action on the part of the Army Medical Corps, for it
is a big job to dismantle a great hospital, pack it up, and start the
motor-transport within an hour after the order to move is received. It
would be a big job without the wounded.
In the French lines the _hôpital d’évacuation_ is frequently established
in a freight station or warehouse in the midst of the railway yards, so
as to facilitate the loading of the hospital trains. This arrangement
has its drawbacks, however, for the hospital is liable to be bombarded
by aeroplanes or artillery without warning, as it is a principle
recognized—and practised—by all the belligerent nations that it is
perfectly legitimate to shell a station or railway base in order to
interfere with the troops, supplies, and ammunition going forward to the
armies in the field. That a hospital is quartered in the station is
unfortunate but must be disregarded. At Dunkirk, for example, which is a
fortified town and a base of the very first importance, there was
nothing unethical, from a military view-point, in the Germans shelling
the railway yards, even though a number of wounded in the hospital there
lost their lives. The British avoid this danger by establishing their
clearing hospitals in the outskirts of the rail-head towns, and as far
from the station as possible, which, however, necessitates one more
transfer for the wounded man.
In this war the progress made in the science of healing has kept pace
with, if indeed it has not outdistanced, the progress made in the
science of destruction. There is, for example, the solution of
hypochlorite of soda, introduced by Doctor Dakin and Doctor Alexis
Carrel, which, though not a new invention, is being used with marvellous
results for the irrigation of wounds and the prevention of suppuration.
There is the spinal anæsthesia, used mainly in the difficult abdominal
cases, a minute quantity of which, injected into the spine of the
patient, causes all sensation to disappear up to the arms, so that,
provided he is prevented by a screen from seeing what is going on, an
operation below that level may be performed while the patient, wholly
unconscious of what is happening, is reading a paper or smoking a
cigarette. Owing to failure to disinfect the wounds at the front, many
of the cases reaching the hospitals in the early days of the war were
found to be badly septic, the infection being due, curiously enough, to
the nature of the soil of the country, the region of the Aisne, for
example, apparently being saturated with the tetanus germ. So the
doctors invented an antitetanus serum, with which a soldier can
inoculate himself and, as a result, the cases of tetanus have been
reduced by half. It was found that many wounded men failed to recover
because of the minute pieces of shell remaining in their bodies, so
there was introduced the giant magnet which, when connected with the
probe in the surgeon’s hand, unerringly attracts and draws out any
fragments of metal that may remain in the wound. Still another ingenious
invention produced by the war is the bell, or buzzer, which rings when
the surgeon’s probe approaches a foreign substance.
Though before the war began European army surgeons were thoroughly
conversant with the best methods of treating shell, sabre, and bullet
wounds and the innumerable diseases peculiar to armies, the war has
produced one weapon of which they had never so much as heard before, and
the effects of which they were at first wholly unable to combat. I refer
to the asphyxiating gas. If you fail to understand what “gassing” means,
listen to this description by a British army surgeon:
“In a typical ‘gassed’ case the idea of impending suffocation
predominates. Every muscle of respiration is called upon to do its
utmost to avert the threatened doom. The imperfect aeration of the blood
arising from obstructed respiration causes oftentimes intense blueness
and clamminess of the face, while froth and expectoration blow from the
mouth impelled by a choking cough. The poor fighting man tosses and
turns himself into every position in search of relief. But his efforts
are unavailing; he feels that his power of breathing is failing; that
asphyxiation is gradually becoming complete. The slow strangling of his
respiration, of which he is fully conscious, at last enfeebles his
strength. No longer is it possible for him to expel the profuse
expectoration; the air-tubes of his lungs become distended with it, and
with a few gasps he dies.
“If the ‘gassed’ man survives the first stage of his agony, some sleep
may follow the gradual decline of the urgent symptoms, and after such
sleep he feels refreshed and better. But further trouble is in store for
him, for the intense irritation to which the respiratory passages have
been exposed by the inhalation of the suffocating gas is quickly
followed by the supervention of acute bronchitis. In such attacks death
may come, owing to the severity of the inflammation. In mild cases of
‘gassing,’ on the other hand, the resulting bronchitis develops in a
modified form with the result that recovery now generally follows. Time,
however, can only show to what extent permanent damage to the lungs is
inflicted. Possibly chronic bronchitis may be the lot of such ‘gassed’
men in after life or some pulmonary trouble equally disturbing. It is
difficult to believe that they can wholly escape some evil effects.”