A Surgeon in Arms

by R. J. Manion

These bearers wear a red cross on the arm, are non-combatant troops and carry no rifles. Each two of them carry a stretcher, and all of them carry a little haversack slung over the shoulder and filled with large and small surgical dressings, bandages, scissors, splints, and perhaps a bottle of iodine. Being non-combatant troops they are supposed to be allowed to carry out their work in comparative safety, but they really run the same risks as the combatants. This is to be expected in severe actions, for a machine-gunner or artilleryman cannot even try to avoid the stretcher bearers when they are mixed up, as they always are, with the fighting troops.

But, at any rate, the Germans get the reputation of caring as little for red crosses or white flags as they do for scraps of paper. One afternoon I stood in a trench one-quarter mile from Willerval which was held by our troops, and in the ruins of which there was an advanced dressing station of a field ambulance. For some reason two ambulances came over the crest of Vimy Ridge in broad daylight, in plain view of the Germans, and ran rapidly down into Willerval. They arrived without mishap, but one-half hour later I saw them start back over the ridge a few minutes apart. The first one had got one-half way up the steep side of the ridge when a heavy German shell lit thirty feet behind it. And then shell after shell dropped behind it all the way up the steep slope. Fortunately the gunner's aim was short, for the car disappeared from view over the crest. Then the second car made the trip, the German shells falling behind it just as they had with the first one. They both got out in safety, but no thanks were due to the Huns who had done their best to get them with heavy shells. That was one instance in which I saw the Germans shell two ambulances which could not have been mistaken for any other type of vehicle.

Suppose a soldier is hit by a piece of shell or sniper's bullet while he is in a trench which his battalion is holding. He is first attended by the stretcher bearer nearest to him at the time, who should use the man's own aseptic dressing which each soldier is compelled to carry in the lining of his coat or tunic. The injured man is then taken to the dugout of the M.O., if necessary on a stretcher, where the M.O. rearranges the dressing, gives a dose of morphine if pain is severe, and after seeing that all hemorrhage is stopped and the man is comfortable, he hands the case over to the field ambulance stretcher bearers who always serve him and live in an adjoining dugout. This squad carries the case back—through the trenches if there is no hurry, but overland if haste is important—to the advanced dressing station of the field ambulance. If this should be a particularly hard trip it may be done in relays. For there relay post dugouts are established with other bearer squads.

The A.D.S. is usually situated a mile or so in the rear of the trenches, preferably in a large cellar, but at any rate in a fairly well sheltered area where cots are ready to receive fifty or more patients. At the A.D.S. one or two of the medical officers of the field ambulance are stationed with a large staff of men. The patient is here made comfortable; given coffee or cocoa; name, number and battalion recorded; and finally he is inoculated with anti-tetanic serum. This has practically wiped out tetanus, or lock-jaw, which was very prevalent at the beginning of the war. He is kept here till a convenient time, which may be after dark, when he and any others who may have come in are put into ambulances and taken to the M.D.S.—main dressing station—of the field ambulance, another two or three miles behind. The M.D.S. may be in some old château, or in a group of huts, or, if the weather is mild, in tents. Here a light case, or slightly wounded man, may be kept for a few days and then sent back to the line or to a rest station to recover his stamina and quiet his nerves. But if the case should be a serious one, such as a shattered leg or arm or a large flesh wound that will take a considerable time to heal, he is again transferred by ambulance to the C.C.S.—Casualty Clearing Station—another two to four miles back.

The C.C.S., usually in huts or tents, is the first real hospital behind the firing zone. It may have accommodation for a couple of hundred patients; is supplied with X-Ray equipment, a well-arranged operating room with expert surgical assistance, and is the nearest place to the line that trained nurses are sent. Here for the first time since he left the line the patient gets all those little motherly attentions that only a woman can give. The injured man may be kept here days, weeks, or even months if he happens to be a case that would be endangered by moving. All immediately necessary operations are at once performed, and often a seriously wounded man from the firing line may be lying anesthetized on the operating table of a C.C.S., being operated upon by expert surgeons within two or three hours of receiving his injury—practically as good attention as this type of injury would receive in civil life.

This is particularly the case where a man has been wounded in the abdomen, from which wound he may quickly develop peritonitis and reach the valley of the shadow of death in a few hours if prompt attention is not given. It is also done in cases of head or lung injuries, or in any wound causing uncontrollable hemorrhage. In any of these emergencies, after the M.O. in the line has given all immediately necessary attention, the patient is ticketed SERIOUS by him, and he is rushed with all speed to the A.D.S., perhaps at great personal risk to the stretcher bearers. Here he is quickly transferred to an ambulance which may have to rush him over heavily shelled roads, missing the main dressing station altogether, and taking him direct to the C.C.S. for his life-saving operation.

After varying periods in the C.C.S. the patients are sent by ambulance trains, which run almost to their doors, to base hospitals at the rear. From here they are re-transferred to hospital centers in England and Scotland.

So much for the methods used in caring for the wounded in the lines during stationary periods. The same principles and methods are employed during big advances, but of course on a larger and more thorough scale. All the arrangements are made during the weeks preceding a push; extra stretcher bearers are trained; the field ambulances increase their staffs, particularly just behind the firing lines, in order that the field may be cleared of wounded at the first lull in the fighting. The whole intricate system is so complete and so well arranged that hundreds of cases may be rushed through in a few hours, some of them being comfortably in bed in English hospitals the evening of the day on which they received their "Blighty."

It must be remembered that in actions of a severe nature, such as great advances, the first object of the advancing troops is to obtain their objective and to hold it. Therefore care of the wounded may not be possible till the action is over. But during these hours the wounded are by no means without attention. It is here that the battalion stretcher bearers do their finest and most self-sacrificing work. They go over the top with the fighting troops, and as the men are hit it is their duty to give them first aid, while the fight still goes on, with machine-gun bullets whistling by their ears and shells bursting all about them. Their duty it is, and nobly they perform it, to dress the wounded, stop bleeding if possible, and temporarily set fractures. Then they place the wounded men in the most protected side of a shellhole, or in any other sheltered spot, and pass on to the next needy one, after placing any bit of available rag on a stick or old bayonet to attract the attention of the field clearing parties who come over that area. In the meantime the wounded who can walk—walking cases—make their way to the point at which the M.O. is caring for the injured. After getting the required attention, they walk on back to the A.D.S. of the field ambulance.

At the first lull in the fighting it is the duty of the medical officer to see to the clearing of the field of those wounded who cannot walk. Any men going to the rear for supplies, and any German prisoners, are commandeered by the M.O. as stretcher parties. In big actions his own trained stretcher bearers are employed only as dressers. In the battle of Vimy Ridge which began at 5:30 a.m., it was twelve hours later ere all the wounded on our front were evacuated to the field ambulances. That was quick work when one considers that some battalions, including my own, had 35 per cent. of their men hit. One hundred German prisoners were sent up under escort to act as stretcher bearers, and gradually the field was cleared.