Yes; this is inevitable. There can be no privacy. Despatch is everything. Nowhere is rapidity so urgent as in the theatre of a C.C.S. It means lives. The hideous gas-gangrene forms and suppurates in a single hour. This is the worst enemy of the field hospital surgeon. Half an hour's postponement of operation—even less—may mean death. And in other cases, if the preliminary operation is not performed in time for the case to move by A.T. for finishing at the base, it may cost a life equally. The surgeon has not time to fortify his victim by explanation or exhortation. He is lifted from stretcher to table; the anæsthetist takes his seat at the head, sprinkles the mask and applies it; the surgeon moves up (he has already seen the case in ward); the stertorous breathing begins; the Sister attends and places ready to his hands what the surgeon requires in swabs and implements; and with the impressive directness of long and varied experience the incision is made and the table is in a moment stained. But let there be no confounding of rapidity with haste, despatch with carelessness. As much time as is necessary, so much will be given; but not more. Most striking feature of all is the curiously impersonal and scientific thoroughness of the surgeon here; this, and the providential faculty of humour in both surgeons and Sisters in the throes of it all, without which the tragedy of the place would be overwhelming. The case is treated with the impersonality (and the persistence) due to a scientific problem, and as such is wrestled with. Three hours will be given, if necessary; and sometimes they are. It is a grim and continuous fight with death, without intermission. But, like any successful warrior, the surgeon jokes in the midst of it. A smile—even a gentle guffaw—comes with a strange effect in this place of blood, but it "saves the situation." This, with the marked impersonality of the surgeon, can be nothing but reassuring to the potential victim, waiting his turn on the adjacent table.
One does not realise until he sees it what hard physical labour an amputation involves, with scalpel and saw; nor how bloodless it can be; nor how revolting is the warm stink of steaming human flesh suddenly exposed; nor how interest swamps repulsion as you watch a skull trephined; nor how utterly strange, for the first time, is the sight of a man lying there with his intestines drawn forth reposing upon his navel.
A man can suffer many wounds and still live—one man with multiple bomb and shell wounds; not a limb untouched; an arm and a leg gone; a skull trephined; fragments extracted from thigh and chest and shoulder; the other hand shattered; to say nothing of wounds and bruises and putrefying sores innumerable. Human endurance and survival can become incredible.
There are sessions in the theatre at which an orderly is kept almost busy passing between the M.O.'s, registering, for purposes of record, the nature of the operation.
"What shall I enter, sir?"
"Appendicitis, acute—abdomen closed," says P——.
"If you had not added abdomen closed," says R——, "would one be at liberty to infer it had been left open?"
"Get your head read!" says P——.... The orderly passes on.
"What's this, sir?"