country if they are British, the Boche is after them,-in their ambulances on the roads in France, in the base hospitals, in the trains-and if they are British, in the hospital ships coming over to England. Air raids are trying to any oreature, but to a helpless wounded man, with nerves perhaps still on edge from the racket and tumult of the battle, they can be hell. The marvel is that so many scarcely heed them. Many of our men sleep through the noisiest and nearest of raids. I do not know when our drivers slept, for they were on the road night and day, what with bringing men in and taking them out, and doing extra runs to other hospitals from the distant H.O.E. On the 31st May began for us at the Abbaye the period of the greatest stress and strain our staff has ever known. During the first battle of the Somme we had had the consciousness of meeting a crisis fresh, with something in hand. There was never any danger organisation being strained to snapping point. This time we were tried up to and beyond our strength. And we started tired. The Villers Cotterets hospital was officially evacuated on to us, and carried on in amalgamation with us. Somehow or other we managed to provide 480 beds. . . . They even stood in a serried rank all round the four sides of the Abbaye cloisters. In this great surprise drive the Germans had swept away all the hospitals between Soissons and Villers Cotterets. Normally, the So the wounded from the forest would have been evacuated rearwards, towards Meaux. But there were German troops at Longpont, and Germans were shelling La Ferté Millon. And the French were not facing the Aisne, with their backs to Meaux. They were standing across the Villers Cotterets Forest, obliquely facing the Ourcq, with their backs to Senlis and the Oise Valley, their left swinging up Coeuvres and the Compiégne Forest, their right pushed down on to the Ourcq. wounded from that magnificent army that held the second Forest Gate to Paris were taken by road to Senlis, where an H.O.E. or Hôpital d'Evacuation had been hastily set up in tents, and thence distributed to the scattered hospitals of the district around, again by motor ambulance. Our own old Distributing Station had removed from its former quarters at C to a neighbourhood less frequented by Flying Fritz than an important railway junction, and to a line whence, under conditions subsequent to the German advance towards the Amiens-Paris communications, we at the Abbaye should only receive through it evacuations from the Beauvais distriot. We were thus a godsend to the sorely - pressed H.O.E. at Senlis, and they flooded us with badly wounded cases. In obedience to our Médecin-Chef's inspired telephone message received on the 29th, we had emptied our hospital of the March-April cases, all but about a dozen. In three days we were full to overflowing. In fifteen days we had brought in, X-rayed, and operated on, one thousand wounded men. On several days our six drivers brought in one hundred cases from Senlis (a fifteen kilometre run) and evacuated another hundred to our new H.O.E. for the northern front, eight kilometres distant in the opposite direction. I do not remember how many men were brought in during the twenty-four hours of that first day 31st May-but I know that I, personally, made eighty-five X-ray examinations, and that neither my assistant nor the developer in the Dark Room got to bed until the dawn. I went on until the assistant from the Villers Cotterets hospital relieved me at 9 A.M., and did not go on duty again until noon. We worked at this pressure in the X-ray Department until the 4th June, when the Villers Cotterets radiographer rigged up the salved outfit and started in to help us. The heaviest week for the Villers équipe was the one that followed, from 9th June till 15th, in which period they made 164 examinations. And in all the history of the camp hospital-that is, from August 1917 till the day they evacuated it-they had made less than a thousand X-ray examinations. Our own Abbaye équipe, from the 31st May until 13th July (the period of the Aisne fighting) made 1100 X-ray examinations, against some 9000 of its entire three and a half years' career, the total figures for both équipes bringing that total up to 1680 examinations for the six weeks. (In normal times the proportion of screen examinations to plates was about one to four, but when working at such high pressure many of the cases were only soreened and the position of the foreign body marked in two positions at righ. angles to each other, and the proportion then worked out at about 40 per cent.) If we were overwhelmed with work in the X-ray Department, the Operating Theatre staff was even harder pressed. Two extra emergency theatres were opened. With three theatres working all day and two of them all night, it can be imagined how the surgeons were pressed, and how near the anesthetists came to being anesthetised themselves. I do not think the Médecin-Chef or the "Second - in - Command " ever got more than three hours rest in the twenty-four during that first strenuous fortnight. The X-ray and theatre staffs, after the first two or three days, when they fared equally badly in the matter of sleep, roughly organised themselves into shifts working eighteen hours and resting six. Thus we were able to cope with it, but at the cost of such a severe physical and mental strain on those who were already tired with two or three years' work at the hospital, that some of them were worked out by August who might otherwise have carried on until the end of the war. However, they coped with it, and that was the main thing. To take up my old metaphor of the rope with his officers. Already we -this time it frayed-some had some of his troopers. He strands even broke. Yet in was brought to my table effect it held. We only lost to be examined, and he was forty out of the thousand wounded in several places, gravely wounded men brought with a badly smashed elbow to us in that first fifteen days. and upper arm. He was Some of those losses, even in courteous and brave, and seethat nightmare of suffering and ing that he was a heavy man unceasing work, seemed doubly and the stretcher-bearers too sad to touch us personally. busy to stay and help move Perhaps it was because we had the patients, he tried hard to been brought so near to the accommodate his poor sufferbattle. Some of us had been ing body to the number of in the forest. All of us were positions necessary for localisbehind it in the valley of the ing the different pieces of Oise in the path of the enemy shell, speaking all the while progress to Paris, if that forest politely in his laboured Enggateway did not hold. And the lish. The regiment had been men who were so gallantly, and rushed up as reinforcements, with such a full appreciation as usually happens in an emerof the situation, holding it, gency with France's splendid were brought to us when they cavalry (which for four weary fell, by road, within a few hours years has taken its turn in of the attack or counter-attack the trenches with the infanin which they had been try), and then dismounted. In wounded. We did not have an open corn-field it had faced to wait for our papers for news and held the enemy while of the fluctuations of that death other troops were thus being struggle. It came to us hourly, enabled to retire to stronger on the lips of men mortally positions. They had been wellhurt, yet full of the sense of nigh out to pieces. He did their personal responsibility, of not attempt to disguise the a fine determination that the gravity of the situation: he enemy should not pass. It was had never imagined that there the spirit of Verdun over again. could be so many Germans, he In the early part of the said wearily, smiling. Yes, struggle, when the fate of they were still falling back, Villers Cotterets was in the but slowly. Yet, somehow, balance, there came to us a those grave tidings, coming gallant old colonel of huz- from the commander of such zards, with his commandant, a regiment, with such a story, and two or three of his junior filled me with confidence, not officers. He had heard about dismay. With such troops to our hospital. He had faith in bar their way, the Germans the methods by which we com- might advance still fartherbated that dreaded enemy- but they would not pass! And gas gangrene; he had asked his arm? He was interested, that he should be sent to us not anxious. The smash was 2 U VOL. CCIV.-NO. MCCXXXVII. not too grave in itself: he would very likely keep his arm; but there was always the danger of infection. . Yes, he understood that. But he had heard that here, at our hospital, we acted quickly, drastically. Here, even if there were infection, with such prompt radical treatment, one had the best chance. . . . There seemed, indeed, full ground for hope. Yet some days later, after drastic treatment-his arm had been amputated, large ineisions made, serum given the old colonel was buried at our little village churchyard. I was examining one of his troopers at the hour the colonel died. The man was a Corsican, with a bullet in his body that had traversed vital abdominal organs, and he was in great pain. He asked after his colonel-a good man, he told me. Not only a just man whom his men would follow anywhere because he was just, and though kind, a strict disciplinarian, but a man with the fine brain of the accomplished soldier. Such a one he must not die: it would be a loss to the French Army: there were others who were good officers, and as just as he; but there were not many with his gifts, his intellect, his skill in warfare. If he died, it would be a loss to the campaign was already a serious loss in that he was severely wounded and thus out of it. I did think, did I not, that we could save him. I dared not tell him, as he himself was about to undergo a critical operation, that his colonel had just died. The trooper himself followed the colonel not many days later. How one learned to hate and dread the deadly gas infection. Usually it proclaimed itself unmistakably enough to one of the senses. Sometimes it was latent and localised; sometimes latent, and then, suddenly, would light up and destroy its victim almost before its presence could be discovered and the unfortunate man rushed, out of his turn, to the operating-table. That was always the problem to take the most urgent oases first, for by the time one convoy had been examined and and graded for priority of operation, another had come in, and the order had to be upset, for here were new cases worse than the "next on the list" of the preceding lot; and by the time these had been done, and the original list resumed, some poor fellow far down on it had run up a temperature, and the deadly infection had lighted up in some unsuspected way, and there followed an amputation; while others, now equally bad, waited. It so often happened that two men, let us say, graded A and G when examined at a certain hour, in two hours would have changed places, A's condition remaining stationary, while G's became progressively worse. Since the early days of the War the X-ray plate has had its share in detecting the lurk ing enemy. As a rule, with gas infection, the radiographie plate merely confirms the ex gangrenous, is to As wounded men amining surgeon's diagnosis. all the stages until the flesh Occasionally, in rush work becomes such as ours was, when the produce negatives in every eursory examination of the instance of such fine quality wounded man on his admis- that the slightest indication sion gives no hint of gas of the presence of gas in the infection, the plate reveals the soft tissues may be clearly fact that the anaerobe is at visible; and secondly, in order work in the soft tissues lying that his reading of the plate deeper than the wound; or may not be confused by the that gas, perhaps at some shadows of gauze or wool, or distance from the entrance uniform fabric in the wound wound, is beginning to track itself, or even by medicaments along the muscle sheaths. It in the dressings that photois when the radiographer gets graph in identically the same such an indication-say, in the manner as gas, to radiograph case of a wounded knee, with wounds wherever possible gas tracking up the thigh- without a sorap of dressing that the plate is of supreme on them. value; for in such a case it is on the radiologist's report, and not on the grading of the examining surgeon, that the man is sent straight into the operating theatre, that the knife and the Pasteur serum may between them arrest the misohief before it has gone too far. An indication to be of any real value is bound to be very slight, for if there is much radiographic evidence of gas, the infection is far advanced, and the loss of the limb almost certain. Further, when the infection is thus far advanced, it is not only clinically evident without any confirmation being necessary from bacteriologist or radiographer, but it has other patent means of proclaiming itself to any person not destitute of his olfactory responses. The aim of the radiographer then, in assisting to detect latent infection by anaerobes which may at any moment light up, and if unchecked run through are often placed on the X-ray |
