Part 13

When he returned to consciousness he found himself again in an ambulance 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: