Joffre and His Army

by Charles Dawbarn

THE POILU'S HOSPITAL

There is this wonderful and alluring in France, that, recognising the faults in an administration or department of the public service, she sets to work immediately to effect reform. And it was clear enough that the service de santé, or hospital service, was grievously defective at the outbreak of the war. It was a question that had never been properly worked out. Those who had thought about the subject at all, never supposed that the demands upon the department would be so terrific. Probably they thought, as did most Frenchmen, that the war would be of quick duration and that—well—the inconveniences of the system would be but temporary, and one would do the best one could in so short a time. But the actual facts were to give the lie to this prevision as to many others. The war lasted long, the demands upon the hospital were not only terrific but protracted. But with the spirit of adaptability, of which the French have given so many proofs during the war, they set to work with the resolution to do the best possible. Little by little the gross defects of the earlier days were remedied; the number of doctors, which at the beginning had been hopelessly inadequate, was augmented, and immense improvements were made in the organisation of the hospital trains. Thereupon the evacuation of the wounded developed on scientifically humane lines, in spite of the difficulties of an unexpected kind, mainly brought about by the colossal character of the war. Thus the wounded rapidly received attention in the ambulances and were quickly sent away in trains and motor-cars, and reached the most distant parts of France not later than the morrow of the combat. I was at Biarritz when the Champagne offensive was taking place, and saw arrive at the station wounded men, still powdered with the dust of the trenches, who had been in the fight twenty-four hours before.

The hospitals, however, even the most modern in their equipment, did not equal the English, still less the American, but the reason was not far to seek: a lack of money. A great many "sanitary formations" (as they are called in France) suffered also from a want of motors; in fact the French, by the very nature of the circumstances, had not the immense resources that the English possess. English newspapers raised immense sums for the care of the sick. But if the French had not the money to devote to the niceties of hospital installation they did the best they could with the time and means at their disposal. And although, perhaps, the hospitals were not as clean as would satisfy English tastes, they served their purpose, which was to restore as many men as possible to the firing-line and alleviate suffering.

Eternally to their credit is the manner in which the French resolutely set their house in order after the failure of the system was revealed on the field of battle. It must be remembered that the long duration of battles nowadays prevents the wounded from being removed at once, and often they have to remain the whole of the day where they have fallen until the night comes and they can be transported. Naturally it is of high importance in the saving of life that the wounded should be got away as quickly as possible to avoid the setting in of gangrene.

The Committee, which was formed by M. Millerand at the Ministry of War in the early days of hostilities, to effect reforms in the army medical service, fixed the number of sixty motor-cars per army corps. This number was in direct relation with the accommodation of the hospital trains. But when the war took on the character of a war of manoeuvres it became necessary to employ trains used for ammunition and even for food supply—returning empty to their base—for the evacuation of the wounded. In a general fashion it may be said that the great preoccupation of the military command is to transport the wounded away from the scene of action as rapidly as possible in order to remain unhampered. One could draw a melancholy picture of the first victims of the war and its shambles being sent right across France in crawling trains—the word is applicable in a double sense, a long-drawn-out agony—before the arrival at the base hospital. Never shall I forget the first trainful of British wounded I encountered coming from Mons. The goods train, without seats, benches or beds, crawled and jolted by, passing my train going in the opposite direction. We shouted words of cheer, to which many of the Tommies replied, gaily enough. Some even jumped off the creeping train to pick up the fruit we threw (one fellow, I remember, with a bandaged leg, hopped on one foot in the permanent way, determined not to lose a pear that had fallen there). But others, again, made no reply, and we hushed our voices and bowed our heads as we saw recumbent figures, stretched in cattle trucks on bundles of straw, figures that gave no sign. Would they ever speak again, these men lying alone, untended, in the creaking, jarring train? But these terrible conditions were quickly changed. At the beginning of the war there were only five regular hospital trains provided with beds for the wounded, and a hundred improvised trains, formed to a large extent of the rolling stock of goods trains. The wounded could not be properly attended in such trains, because there was a lack of communication between the different parts, but afterwards, corridor trains were adopted almost exclusively. Nevertheless the number of the wounded was so great, after some of the battles, that every sort of train possible and imaginable had to be pressed into the service. But the Committee, by its wise and careful dispositions, rendered a great service in providing train accommodation for sixty thousand wounded to which the Minister of War added twenty thousand; and which again, I believe, was considerably increased by General Galliéni during his brief but strenuous period at the Ministry of War.

As originally conceived the ambulance of the Front was equipped for major operations as well as the hospital in the rear, but afterwards it was found inadvisable to perform operations in these conditions where the surgeon had not the time or the tranquillity of mind necessary for the purpose; and so by a later arrangement the hospitals for the major operations were placed fifteen or twenty miles to the rear. And so it happened that the first mistakes were rectified. Instead of great and important operations being conducted on the field of battle, subject to the dangers and interruptions from such a propinquity, the more gravely wounded, whose state required amputation, were rapidly transported to these hospitals in the rear after their wounds had been attended to in the first place, and an examination made in the field hospital, or ambulances as they are called in France. This system gave much better results than that adopted in the beginning, whereby the ambulances de l'avant (or advanced ambulances) and the reserve ambulances, the divisional ambulances, and the army ambulances, were interchangeable. They were intended to serve for all the purposes of attending to the wounded. They were used either as a place of temporary relief for the wounded or took on a quasi permanent character according to the necessities of the case. When the advanced ambulances in certain circumstances became stationary, the reserve ambulances followed the army on the march. It seemed in many respects an excellent system, and certainly was very supple and ingenious, for these ambulances became interchangeable; but they possessed the inconvenience, to which I have already alluded—that is to say, the proper sort of attention could not be given to the important cases. Hence the change that the Committee brought about, whereby the grands blessés were transported to the hospital at the rear, where the necessary skill and the instruments required were at their disposal. The present system works in this manner. The battle takes place. The chief medical officer fixes the spot in the rear where the formation ought to be established. The formation establishes itself there in a couple of hours with its motor-cars. An hour after, it has pitched its first tent and is ready to shelter the first wounded which come to it from the ambulances, perhaps in the space of three or four hours. Instruments sterilised in advance permit the surgeons to commence to operate three hours after having received their orders to establish the hospital tent. Other tents can be established to the number of five. A hundred wounded persons can thus be taken care of and treated in the open country. Reserve ambulances can be called upon in case of need. As soon as operated upon, and out of immediate danger, the wounded, in the majority of cases, can be evacuated to permanent hospitals further back in the rear.

In case of retreat, the formation, if warned in time, falls back carrying with it if possible all the wounded and follows the troops. These tent hospitals carry with them the wherewithal to instal an operating theatre and a section d'hospitalisation, composed of a hundred beds, five double-walled tents, and the necessary doctors and male attendants. Of course the problem of removing the wounded from these tent hospitals at the Front is always a grave one. When the war took on the character of a siege war, a train acted as a sort of shuttle from the field ambulances to the station where the "army zone" finished and the "interior zone" began. The two were generally seventy or eighty miles apart. Here the wounded were carried to the other train, where the cases were sorted out and sent to the distant base hospitals. But, as I have said, the tendency was to keep the slight cases as near as possible to the lines, and send only to distant parts either medical cases—infectious diseases, and convalescents—or the more serious surgical cases, which were entering upon a secondary phase.

One of the most interesting aspects of the question of the treatment and recovery of the wounded was the utilisation of the mineral waters which exist in such abundance in France, particularly in the Pyrenees; and all the well-known stations of this delightful region were filled with soldiers recovering from their wounds or illnesses incurred in the service of the country. Magnificent results were obtained also by the same means in '70. Strongly impregnated sulphur waters gave then, as they have given during this second war, most admirable results, particularly in combating the infection of wounds caused by fire-arms. It is not necessary to insist upon the dreadful error of the theory that bullet wounds were clean wounds. Before it was discovered that the bullet infected the surrounding tissue much harm had been done. The mineral waters were also invaluable in the treatment of nervous affections arising from wounds and rheumatism contracted in the trenches. Some really remarkable recoveries have been made in this glorious region irradiated by the sun and full of pure air charged with the balsamic odours of a pine-clad district.

Whilst, as I have said, there was rapid improvement made in the various services, the defect inherent in all administrations, English as well as French, but perhaps more particularly French, subsisted. For instance, M. Joseph Reinach, the well-known Deputy, has inveighed especially against the abuse of red tape in the hospitals. All sorts of dreadful formalities were necessary to be fulfilled to obtain a lemon or a bottle of the simplest medicine. There had to be a proper requisition made with several signatures attached, and this entailed visits to different offices situated in different parts of the building—a formidable waste of time. Some string and nails, value 1 fr. 25, appeared in somebody's report. Immediately there was an imperious demand for details, which were supplied, of course—though purely imaginary. The precious document travelled during several weeks from the bottom to the top of the administrative ladder. Papers even pursue the unhappy doctor or stretcher-bearer right into the trenches—though, of course, every reasonable person would admit that records must be kept. M. Reinach, who, furnished with special powers of investigation, has carried his inquiries into every part, points out that even if the high administration decrees simplicity and the different sub-departments apparently incline, they continue their complicated practices just the same. Says M. Reinach, and his words will serve to depict the unhappy state of the public in this country as well as in any other: "We believe we are governed at one time by this party, at another by that. In reality, we are governed by the departments in the interests of a mysterious syndicate of paper merchants. It will require a revolution more profound than that of '89 to rid us of administrative routine." And it must be remembered also—one feels authorised to mention it since it is admitted by M. Reinach, as well as by other thoughtful Frenchmen—-that favouritism and nepotism have made terrible ravages in this direction as in so many others; but these abuses have been corrected, we must hope, by the touchstone of war.

One of the most pleasing, and at the same time touching, sides of the war is the heroism in the hospitals. The majority of the patients belong to the class of manual labourer, but they were as dignified, as calmly Stoical, in their way as those who had larger opportunities for education. Though they had never read Epictetus or Marcus Aurelius, and were often just simple labourers, they showed invariably a greatness of soul. Women working in the hospitals have given me pathetic instances of soldiers' gentleness and resignation. They calmly watch the surgeon going about his work probing in their own flesh. They look on apparently unmoved, idly smoking a cigarette. Heroic simple souls of France. They are always joking, even before a most serious operation; one cannot overcome their invincible courage and good humour. Often it is touching enough. In the Metropolitain of Paris I travelled with a man who had lost his leg—one of the numerous army of the mutilated. In conversation he had forgotten to alight at a certain station. The train had already begun to move from the platform, and, to the alarm of those next to him, the poor fellow tried to jump out. He was pulled back just in time. "J'ai oublié," he said simply, looking reflectively at the empty trouser leg. In the hospital it is easier, perhaps, to be uncomplaining, to support with appearance of equanimity the pain and suffering of the wounds; it is more difficult in the evacuation stations, where sometimes the wounded have to stay a night exposed to all the discomfort of a provisional arrangement.