MEDICAL CORPS
The battle practice in the French army in handling wounded is as follows:
When a man is wounded he is carried to a dressing station in some partly protected neighborhood within the battle area. He is generally taken there by the stretcher-bearers attached to his company. After field dressing, he is removed to a field hospital one to three miles toward the rear. The means of transportation are varied, and made to suit the particular battle conditions, the principal means being stretcher-bearers, motor ambulances, and horse ambulances. In case of heavy casualties, all the men who can possibly stagger are obliged to go to the rear by themselves and are sent in small parties so that they may assist one another en route.
The field hospitals are nearly always established in village churches with overflow into neighboring houses in case of heavy casualties. All the furniture is removed from the church and the floor is covered thick with straw, upon which the wounded are laid out in long rows. The altar is made the pharmacist’s headquarters, the vestry is converted into an operating room, and a Red Cross flag is hung from the tower or steeple. These field hospitals are generally well within the zone of artillery fire, and are frequently struck by shells.
The men are evacuated from the field hospital to a base hospital in motor ambulances or by a combination of motor ambulances and railway trains. Theoretically, this should be done within a day or two with all cases except the very gravest. In practice, the men frequently lie in field hospitals for weeks before the opportunity of evacuation is found. The base hospitals are in cities or large towns, and serve as clearing-houses. They are well out of the military zone, being from five to fifteen miles behind the zone of artillery fire. I will give a definite example. In October, I saw the front at Albert. There were dressing stations just behind the battle-line. There was a field hospital at Hénencourt. From Hénencourt the wounded were evacuated upon Amiens, which contained the base hospitals for a front extending from a point north of Sus St. Léger to the neighborhood of Guerbigny. Here the railway station had been converted into a receiving center to which all the wounded were brought for examination and classification. Those who could bear travel were immediately placed upon trains and shipped to the south of France. There were four other hospitals in Amiens, and all cases considered too grave for transportation to the south were sent to one of these. They were divided and classified so that cases of a kind were grouped together, each hospital and the various floors of each hospital having a different class of patient. Some of the classifications were: head cases, amputation cases, gangrene cases, cases in which the patient could not refrain from screaming, either because of delirium or for other reasons. It is on leaving the base hospital that wounded are first classified as to nationality.
For the railway transportation of the wounded, luggage vans are used. I estimate the interior length of a French luggage-van or freight-car to be about twenty-five feet, the doors being placed, as in America, in the middle of each side. Wooden racks are built to the right and left of the door in the ends of the car. These racks are arranged to hold two layers of three stretchers each, so that each end of the freight car contains six lying cases. The men who are able to sit or stand and the orderlies in charge are placed in the aisle between the doors, a space about six feet wide between the stretcher handles. On their way to the south of France these trains stop about every twenty-four hours, the first stop being Aubervilliers, a station some two miles outside the gates of Paris. Here a large storage warehouse has been converted into a hospital. Food and water are distributed to the train on its arrival, the dead taken out, and the delirious or very grave cases are removed to the Paris hospitals. The others are allowed twelve hours’ rest before continuing on the next stage of their journey.
The trains are usually made up of from 30 to 50 vans, and each train carries from 500 to 800 wounded. No particular effort seems to be made to isolate gangrene cases from the others, and the wounded invariably remain in the uniforms in which they fought until they reach the home hospital in the south of France. Their dressings, until they reach these home hospitals, are superficial ones. I have seen numerous cases with grave wounds, such as shattered thighs, which have remained in this condition for four and five weeks before finally being undressed and washed at the home hospital.
The whole system of handling the wounded seems to be theoretically well conceived. In practice among the French it worked thus poorly during the early months of the war. The wounded suffered from lack of food, water, attention, and bathing, and the resulting number of mortalities and amputations was exceedingly high. The effect on the morale of those who recovered is very serious, and is in singular contrast to the eagerness to return to the front often shown by British and German convalescents. The care given to the wounded by these two nations is very excellent indeed.
The same stretcher is used throughout the French army, and its universal use is compulsory on all organizations, whether volunteer or regular. It is not unusual for a grave case to be picked up on the battlefield and placed upon a stretcher and to travel on it all the way to the south of France without once being removed. The company stretcher-bearers turn him over to the dressing station with the stretcher upon which they have borne him. Since these stretchers are identical in size and construction they fit all ambulances and all railway equipments. They may be said to be current, like money, and whenever one organization turns over a grave case to the succeeding organization, the stretcher goes with the case, and an empty one is received in return. The number at any one point is thus maintained at a constant figure, and there is a general tendency for battered and infected stretchers to gravitate toward the south of France, and for new stretchers to gravitate toward the front.
There has been much typhoid in the armies in France, and it is on the increase. The wounded men develop it more often than any other class. Inoculation against typhoid is theoretically compulsory in the French army. I have no personal knowledge as to the thoroughness or effectiveness of inoculation in practice.
Lockjaw seems to develop late. Most of the cases occur after the men have reached the south of France. The new French anti-lockjaw inoculation of Doctor Doyen has produced most remarkable results. I have heard, on reliable authority, that with it 80% of the cases treated make a complete recovery. Three of my personal friends have had lockjaw and recovered. This is, in part, due to the fact that in all the hospitals the diagnosis is quick and sure, and the serum always in stock. The injection is made into the spinal cord at the small of the back. The patient is kept on his back on a slightly sloping table, his feet being at the higher end, while his head is allowed to hang unsupported over the end of the table.
A considerable proportion of the French and British troops in France, the Russian, Austrian, and Hungarian troops in the eastern fields, and the prisoners in Germany suffer from lice. Fleas seem to be a comparative rarity in the zones of operation.
The physique and condition of the French troops have greatly improved since the beginning of the war. War conditions seem to have caused a marked change. Many of the men have gained twenty and even thirty pounds, and the younger men have grown inches in height.
The French have well-defined regulations in the matter of sanitation, but these rules are not generally well-observed or strictly enforced. In the French trenches, however, where discipline is best, this matter is very well regulated. The Germans are particularly orderly in this regard. I have never observed that the French mark wells or water supplies in any manner.
I have no observations to offer on the subject of cremation of refuse, but have seen several attempts at cremation of bodies in the French army, all of which were glaring failures.