A Surgeon in Belgium

by Henry Sessions Souttar

The wards were full when we arrived, and I had a wonderful opportunity of studying the effects of rifle and shell fire. Most of the wounds were fortunately slight, but some of them were terrible, and, indeed, in some cases it seemed little short of miraculous that the men had survived. But on every side one saw nothing but cheerful faces, and one would never have dreamt what some of those men had gone through. They were all smoking cigarettes, laughing, and chatting, as cheery a set of fellows as one could meet. You would never have suspected that a few days before those same men had been carried into the hospital in most cases at their last gasp from loss of blood and exposure, for none but serious cases were admitted. The cheeriest man in the place was called Rasquinet, a wounded officer who had been christened "Ragtime" for short, and for affection. A week before he had been struck by a shell in the left side, and a large piece of the shell had gone clean through, wounding the kidney behind and the bowel in front. That man crawled across several fields, a distance of nearly a mile, on his hands and knees, dragging with him to a place of safety a wounded companion. When from loss of blood he could drag him along no longer, he left him under a hedge, and dragged himself another half-mile till he could get help. When he was brought into the hospital, he was so exhausted from pain and loss of blood that no one thought that he could live for more than a few hours, but by sheer pluck he had pulled through. Even now he was desperately ill with as horrible a wound as a man could have, but nothing was going to depress him. I am glad to say that what is known in surgery as a short circuit was an immediate success, and when we left him three weeks later in Ghent he was to all intents perfectly well.

There were plenty of other serious cases, some of them with ghastly injuries, and many of them must have suffered agonizing pain; but they were all doing their best to make light of their troubles, whilst their gratitude for what was done for them was extraordinary. The Belgians are by nature a cheerful race, but these were brave men, and we felt glad that we had come out to do what we could for them.

But if we give them credit for their courage and cheerfulness, we must not forget how largely they owed it to the devoted attention—yes, and to the courage and cheerfulness—of the nurses. I wonder how many of us realize what Britain owes to her nurses. We take them as a matter of course, we regard nursing as a very suitable profession for a woman to take up—if she can find nothing better to do; perhaps we may have been ill, and we were grateful for a nurse's kindness. But how many of us realize all the long years of drudgery that have given the skill we appreciated, the devotion to her work that has made the British nurse what she is? And how many of us realize that we English-speaking nations alone in the world have such nurses? Except in small groups, they are unknown in France, Belgium, Germany, Russia, or any other country in the world. In no other land will women leave homes of ease and often of luxury to do work that no servant would touch, for wages that no servant would take—work for which there will be very little reward but the unmeasured gratitude of the very few. They stand to-day as an unanswerable proof that as nations we have risen higher in the level of civilization than any of our neighbours. To their influence on medicine and surgery I shall refer again. Here I only wish to acknowledge our debt. As a mere patient I would rather have a good nurse than a good physician, if I were so unfortunate as to have to make the choice. A surgeon is a dangerous fellow, and must be treated with respect. But as a rule the physician gives his blessing, the surgeon does his operation, but it is the nurse who does the work.

III The Day's Work

In any hospital at home or abroad there is a large amount of routine work, which must be carried on in an orderly and systematic manner, and upon the thoroughness with which this is done will largely depend the effectiveness of the hospital. Patients must be fed and washed, beds must be made and the wards swept and tidied, wounds must be dressed and splints adjusted. In an English hospital everything is arranged to facilitate this routine work. Close to every ward is a sink- room with an adequate supply of hot and cold water, dinner arrives in hot tins from the kitchens as if by magic, whilst each ward has its own arrangements for preparing the smaller meals. The beds are of a convenient height, and there is an ample supply of sheets and pillow- cases, and of dressing materials of all kinds arranged on tables which run noiselessly up and down the wards. At home all these things are a matter of course; abroad they simply did not exist. Four or five gas- rings represented our hot-water supply and our ward-kitchens for our 150 patients, and the dinners had to be carried up from the large kitchens in the basement. The beds were so low as to break one's back, and had iron sides which were always in the way; and when we came to the end of our sheets—well, we came to the end of them, and that was all. In every way the work was heavier and more difficult than at home, for all our patients were heavy men, and every wound was septic, and had, in many cases, to be dressed several times a day. Everyone had to work hard, sometimes very hard; but as a rule we got through the drudgery in the morning, and in the afternoon everything was in order, and we should, I think, have compared very favourably in appearance with most hospitals at home.

But we had to meet one set of conditions which would, I think, baffle many hospitals at home. Every now and then, without any warning, from 50 to 100, even in one case 150, wounded would be brought to our door. There was no use in putting up a notice "House Full"; the men were wounded and they must be attended to. In such a case our arrangement was a simple one: all who could walk went straight upstairs, the gravest cases went straight to the theatre or waited their turn in the great hall, the others were accommodated on the ground floor. We had a number of folding beds for emergency, and we had no rules as to overcrowding. In the morning the authorities would clear out as many patients as we wished. Sometimes we were hard put to it to find room for them all, but we always managed somehow, and we never refused admission to a single patient on the score of want of room. The authorities soon discovered the capacity of the hospital for dealing with really serious cases, and as a result our beds were crowded with injuries of the gravest kind. What appealed to us far more was the appreciation of the men themselves. We felt that we had not worked in vain when we heard that the soldiers in the trenches begged to be taken "a l'Hopital Anglais."

The condition of the men when they reached us was often pitiable in the extreme. Most of them had been living in the trenches for weeks exposed to all kinds of weather, their clothes were often sodden and caked with dirt, and the men themselves showed clear traces of exposure and insecure sleep. In most cases they had lain in the trenches for hours after being wounded, for as a rule it is impossible to remove the wounded at once with any degree of safety. Indeed, when the fighting is at all severe they must lie till dark before it is safe for the stretcher-bearers to go for them. This was so at Furnes, but at Antwerp we were usually able to get them in within a few hours. Even a few hours' delay with a bad wound may be a serious matter, and in every serious case our attention was first directed to the condition of the patient himself and not to his wound. Probably he had lost blood, his injury had produced more or less shock, he had certainly been lying for hours in pain. He had to be got warm, his circulation had to be restored, he had to be saved from pain and protected from further shock. Hot bottles, blankets, brandy, and morphia worked wonders in a very short time, and one could then proceed to deal with wounds. Our patients were young and vigorous, and their rate of recovery was extraordinary.

When a rush came we all had to work our hardest, and the scenes in any part of the hospital required steady nerves; but perhaps the centre of interest was the theatre. Here all the worst cases were brought—men with ghastly injuries from which the most hardened might well turn away in horror; men almost dead from loss of blood, or, worst of all, with a tiny puncture in the wall of the abdomen which looks so innocent, but which, in this war at least, means, apart from a difficult and dangerous operation, a terrible death. With all these we had to deal as rapidly and completely as possible, reducing each case to a form which it would be practicable to nurse, where the patient would be free from unnecessary pain, and where he would have the greatest possible chance of ultimate recovery. Of course, all this was done under anaesthesia. What a field hospital must have been before the days of anaesthesia is too horrible to contemplate. Even in civil hospitals the surgeons must have reached a degree of "Kultur" beside which its present exponents are mere children. It is not so many years since a famous surgeon, who was fond of walking back from his work at the London Hospital along the Whitechapel Road, used to be pointed to with horror by the Aldgate butchers, whose opinion on such a subject was probably worth consideration. But now all that is changed. The surgeon can be a human being again, and indeed, except when he goes round his wards, his patients may never know, of his existence. They go to sleep in a quiet anteroom, and they waken up in the ward. Of the operation and all its difficulties they know no more than their friends at home. Perhaps even more wonderful is the newer method of spinal anaesthesia, which we used largely for the difficult abdominal cases. With the injection of a minute quantity of fluid into the spine all sensation disappears up to the level of the arms, and, provided he cannot see what is going on, any operation below that level can be carried out without the patient knowing anything about it at all. It is rather uncanny at first to see a patient lying smoking a cigarette and reading the paper whilst on the other side of a screen a big operation is in progress. But for many cases this method is unsuitable, and without chloroform we should indeed have been at a loss. The Belgians are an abstemious race, and they took it beautifully. I am afraid they were a striking contrast to their brothers on this side of the water. Chloroform does not mix well with alcohol in the human body, and the British working man is rather fond of demonstrating the fact.

With surgery on rather bold lines it was extraordinary how much could be done, especially in the way of saving limbs. During the whole of our stay in Antwerp we never once had to resort to an amputation. We were dealing with healthy and vigorous men, and once they had got over the shock of injury they had wonderful powers of recovery. We very soon found that we were dealing with cases to which the ordinary rules of surgery did not apply. The fundamental principles of the art must always be the same, but here the conditions of their application were essentially different from those of civil practice. Two of these conditions were of general interest: the great destruction of the tissues in most wounds, and the infection of the wounds, which was almost universal.