Part 13

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.

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.

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.”

As soon as it was found that the immediate cause of death in the fatal gas cases was acute congestion of the lungs, the surgeons were able to treat it upon special and definite lines. Means were devised for insuring the expulsion of the excessive secretion from the lungs, thus affording much relief and making it possible to avert asphyxiation. In some apparently hopeless cases the lives of the men were saved by artificial respiration. The inhalation of oxygen was also tried with favorable results, and in cases where the restlessness of the patient was more mental than physical, opium was successfully used. So that even the poison-gas, perhaps the most dreadful death-dealing device which the war has produced, neither dismayed nor defeated the men whose task it is to save life instead of to take it.

To the surgeons and nurses at the front the people of France and England owe a debt of gratitude which they can never wholly repay. The soldiers in the trenches are waging no more desperate or heroic battle than these quiet, efficient, energetic men and women who wear the red badge of mercy. Their courage is shown by the enormous losses they have suffered under fire, the proportion of military doctors and hospital attendants killed, wounded, or taken prisoner, equalling the proportion of infantry losses. They have no sleep save such as they can snatch between the tides of wounded or when they drop on the floor from sheerest exhaustion. They are working under as trying conditions as doctors and nurses were ever called upon to face. They treat daily hundreds of cases, any one of which would cause a city physician to call a consultation. They are in constant peril from marauding _Taubes_, for the German airmen seem to take delight in choosing buildings flying the Red Cross flag as targets for their bombs. In their ears, both day and night, sounds the din of near-by battle. Their organization is a marvel of efficiency. That of the Germans may be as good but it can be no better.

In order that I may bring home to you in America the realities of this thing called war, I want to tell you what I saw one day in a little town called Bailleul. Bailleul is only two or three miles on the French side of the Franco-Belgian frontier, and it is so close to the firing-line that its windows continually rattle. The noise along that portion of the battle-front never ceases. It sounds for all the world like the clatter of a gigantic harvester. And that is precisely what it is—the harvester of death.

As we entered Bailleul they were bringing in the harvest. They were bringing it in motor-cars, many, many, many of them, stretching in endless procession down the yellow roads which lead to Lille and Neuve Chapelle and Poperinghe and Ypres. Over the gray bodies of the motor-cars were gray canvas hoods, and painted on the hoods were staring scarlet crosses. The curtain at the back of each car was rolled up, and protruding from the dim interior were four pairs of feet. Sometimes those feet were wrapped in bandages, and on the fresh white linen were bright-red splotches, but more often they were incased in worn and muddied boots. I shall never forget those poor, broken, mud-incrusted boots, for they spoke so eloquently of utter weariness and pain. There was something about them that was the very essence of pathos. The owners of those boots were lying on stretchers which were made to slide into the ambulances as drawers slide into a bureau, and most of them were suffering agony such as only a woman in childbirth knows.

This was the reaping of the grim harvester which was at its work of mowing down human beings not five miles away. Sometimes, as the ambulances went rocking by, I would catch a fleeting glimpse of some poor fellow whose wounds would not permit of his lying down. I remember one of these in particular—a clean-cut, fair-haired youngster who looked to be still in his teens. He was sitting on the floor of the ambulance leaning for support against the rail. He held his arms straight out in front of him. Both his hands had been blown away at the wrists. The head of another was so swathed in bandages that my first impression was that he was wearing a huge red-and-white turban. The jolting of the car had caused the bandages to slip. If that man lives little children will run from him in terror, and women will turn aside when they meet him on the street. And still that caravan of agony kept rolling by, rolling by. The floors of the cars were sieves leaking blood. The dusty road over which they had passed no longer needed sprinkling.

Tearing over the rough cobbles of Bailleul, the ambulances came to a halt before some one of the many doorways over which droop the Red Cross flags, for every suitable building in the little town has been converted into a hospital. The one of which I am going to tell you had been a school until the war began. It is officially known as Clearing Hospital Number Eight, but I shall always think of it as hell’s antechamber. In the afternoon that I was there eight hundred wounded were brought into that building between the hours of two and four, and this, mind you, was but one of many hospitals in the same little town. As I entered the door I had to stand aside to let a stretcher carried by two orderlies pass out. Through the rough brown blanket which covered the stretcher showed the vague outlines of a human form, but the face was covered, and it was very still. A week or two weeks or a month later, when the casualty lists were published, there appeared the name of the still form under the brown blanket, and there was anguish in some English home. In the hallway of the hospital a man was sitting upright on a bench, and two surgeons were working over him. He was sitting there because the operating-rooms were filled. I hope that that man is unmarried, for he no longer has a face. What a few hours before had been the honest countenance of an English lad was now a horrid welter of blood and splintered bone and mangled flesh.

The surgeon in charge took me upstairs to the ward which contained the more serious cases. On a cot beside the door was stretched a young Canadian. His face looked as though a giant in spiked shoes had stepped upon it. “Look,” said the surgeon, and lifted the woollen blanket. That man’s body was like a field which has been gone over with a disk harrow. His feet, his legs, his abdomen, his chest, his arms, his face were furrowed with gaping, angry wounds. “He was shot through the hand,” explained the surgeon. “He made his way back to the dressing-station in the reserve trenches, but just as he reached it a shell exploded at his feet.” I patted him on the shoulder and told him that I too knew the land of the great forests and the rolling prairies, and that before long he was going back to it. And, though he could not speak, he turned that poor, torn face of his and smiled at me. He must have been suffering the torments of the damned, but he smiled at me, I tell you—_he smiled at me_.

In the next bed, not two feet away—for the hospitals in Bailleul are very crowded—a great, brawny fellow from a Highland regiment was sitting propped against his pillows. He could not lie down, the surgeon told me, because he had been shot through the lungs. He held a tin cup in his hand, and quite regularly, about once a minute, he would hold it to his lips and spit out blood. Over by the window lay a boy with a face as white as the pillow-cover. He was quite conscious, and stared at the ceiling with wide, unseeing eyes. “Another shrapnel case,” remarked a hospital attendant. “Both legs amputated, but he’ll recover.” I wonder what he will do for a living when he gets back to England. Perhaps he will sell pencils or boot-laces on the flags of Piccadilly, and hold out his cap for coppers. A man with his head all swathed in strips of linen lay so motionless that I asked if he was living. “A head wound,” was the answer. “We’ve tried trepanning, and he’ll probably pull through, but he’ll never recover his reason.” Can’t you see him in the years to come, this splendid specimen of manhood, his mind a blank, wandering, helpless as a little child, about some English village?