the method of caring for the wounded at the front depends a great deal upon whether a battalion is holding a set of trenches on a standing front, or advancing, either in a big push, or in a raid. the medical officer to a fighting battalion is the member of the army medical corps who is closer to the firing line than any of the other officers of that corps in the whole theater of war. he is served by the nearest field ambulance, whose stretcher bearers not only evacuate the wounded from his r.a.p.—regimental aid post—but also keep him supplied with medicines, dressings, splints, and other medical and surgical necessities. his food is sent up with that of the remainder of his battalion from his own battalion transport.
the field ambulance evacuates the severe cases to the nearest c.c.s.—casualty clearing station—which is the closest hospital to the lines. it is at the c.c.s. that the necessary operations are performed. here the real surgical work of the medical corps begins, for up to that station it is much a matter of first aid. from the casualty clearing station cases that look as if they will require protracted attention are transferred to ambulance trains, which convey the cases fifty, sixty, or more miles to the base hospitals at the rear, perhaps about boulogne, havre and other towns reasonably well out of danger. and from these hospitals the wounded or sick may be transferred again, this time to hospital ships which cross the channel to one of our channel ports. at these points they are once more put aboard ambulance trains and distributed to hospitals in london, manchester, canterbury, edinburgh or any of the other large hospital centers.
suppose that a battalion is holding a part of the entrenched front, roughly one thousand yards square. the medical officer always travels with his battalion. in an area such as this his r.a.p. would be in a dugout somewhere in the vicinity of the one which is used as headquarters for the battalion. a medical officer's position is toward the rear of his battalion whether the men are on the march, in an advance, or holding the lines, for the reason that the wounded and sick are naturally sent toward the rear. very commonly the r.a.p. is about half way from the rear support trench to the firing line.
the dugout of the m.o. is generally of the superficial variety. it has a roof made up of two or three layers of bags of sand piled on top of a layer of boards, just sufficient to give one a feeling of security in a most insecure position. a straight hit from a shell on the roof of this type of dugout means that a new medical officer will be required for that battalion at once. i have a vivid recollection of my first experience in such a dugout, long before i had become accustomed to living in them by the week. it was on a fairly active front near bully grenay. i had been sent from a field ambulance to relieve the regular m.o. while he took a well earned leave. his palatial residence was only about two hundred yards from the front line, its ceiling was less than six feet from the floor, for my head hit it whenever i stood up, and the rain which poured for days trickled down our necks as it filtered through the roof in many places. the shells kept dropping most annoyingly that first day, hitting everywhere except exactly on the center of the roof, and i knew it was only a matter of minutes till one landed there. then to add to my uneasiness the sergeant lit a fire with wet wood which made a black smoke that poured from the bit of tin which was used for a pipe in the roof. this was the finishing touch, for i felt certain that every gunner on that front was using that smoke for a target. turning to the sergeant, i asked with as cool a manner as i could command:
"how close do those shells have to come before you would consider it advisable to move out?"
"to move out? oh, coming through the roof, i guess," he answered, with a blank stare. i did not dare to ask any more questions, but i thought to myself,—"what a nice, healthy time to move!" it took some time for me to become accustomed to that billet, but out there one learns to become accustomed to anything.
in front of the medical officer are the men who hold the line. there are four platoons to a company, four companies to a battalion; and with each platoon is one stretcher bearer, making sixteen bearers to each battalion. these stretcher bearers are trained in first aid, dressings, setting fractures and so forth by the m.o. of their regiment when they are out at rest billets behind the lines. in the lines they accompany their platoons and companies, and when the men go over the top in raids and advances the stretcher bearers go with them, stopping to dress and care for the wounded as they cross the battle area.
no finer set of men serve out there than the stretcher bearers, whether they serve with a battalion, an ambulance, or any other unit. their work is without the stimulation or excitement the fighting men get, but has the same dangers and hardships. they go over the top as do the others, and it is their duty to carry wounded with all haste through heavily bombarded areas. the fact that, out of thirty-two stretcher bearers used by me in three days, thirteen were hit, well illustrates the dangers that these boys cheerfully go through. a good story is told of one of them, a chap who in civil life had been a "tough" in the slums of one of our large cities, and who had seen the inside of a jail more than once, but who as a stretcher bearer faced coolly, even gayly, any extraordinary danger to get his wounded to the rear.
he was in charge of a squad for number —— canadian field ambulance one day. he and his men were taking a stretcher case over a ridge which was under constant and heavy shell fire. tiring, he commanded his squad to stop and rest. they obeyed, but demurred, saying that it was too dangerous a place to rest.
"naw," he said, lighting a cigarette after handing one to the wounded man, "there ain't no danger. sit down an' take it easy."
"but, look here now, tom," the others argued, "you may be the first to have one of those bally shells blow you into kingdom come."
"not—by—one—damsite," he slowly replied, "i've got a hunch dat i'm goin' to slip me arm round lizzie once agen before dey get me;" and he lay on the ground and thoughtfully puffed at his cigarette. so the others joined him, for their bravery was unquestioned; and with the philosophy so common out there, one said,—"well, i guess we can stand it if you can." tom had puffed at his fag a few moments with the shells dropping dangerously near, when, without changing his position, he asked:
"did you mugs ever hear de story of de two specials wot met in lon'on de oder day? naw? well, i'll tell yez. two special constables met, an' one o' dem had no hat, coat all torn to rags, bot' eyes black, an' some hair gone. 'hello, brown,' says de oder, 'wot-a-hell's wrong wid yez?' an' de first answers: 'ye know dat purty little missus smit wot lives behind de lion an' dragon whose husban's gone to de front? well, he ain't gone!'"
even the wounded man joined the laugh. they all finished their smoke without even glancing in the direction of the shells bursting nearby, when the stretcher was picked up and carried safely to the rear. his officers all say that they would as quickly trust tom in a ticklish job as any other man in the world. but he is just an example of the thousands of loyal, life-risking stretcher bearers—some, like tom, rough, uneducated, uncouth; many others with the culture acquired in college halls and drawing rooms—who are daily and nightly giving of their blood and their service to the men in the lines.
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 chateau, 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.
the only difference between the handling of the wounded during actions and during stationary warfare is the fact that in the former more unavoidable congestion takes place, though this is prevented as far as possible in the forward areas by rushing the cases to the rear or to england. in big actions, where many wounded are expected, this is always done.
after hospital treatment in england or scotland the men are sent to convalescent homes in ramsgate, herne bay, whitstable, sturry, brighton, or any of the hundred and one other points that are suitable in the british isles. later these men are sent before medical boards which decide as to their disposal thereafter. they may be sent directly back to duty; to prolonged rest; to have some weeks, p.t.—physical training—which is not popular with the men, but is often needed; or, they may be marked p.b.—permanent base duty—which means that they are not fit for general service, but are able to perform some duties at the base or at home. lastly, they may be discharged as permanently unfit for further service, the amount of their pensions being decided by the pension board.
until the wounded man reaches the c.c.s. his wounds are dressed in very rough surroundings, not the aseptic dressing rooms of peace times. dugouts, cellars or open trenches are employed for dressing stations. after the battle of vimy ridge my boys and i dressed our men for four days in an open, muddy trench, with the shells dropping about all the time. dugouts are simply holes in the ground, and may be most primitive dressing rooms. everyone knows how aseptic the ordinary cellar could be made, even with the greatest care on the part of an m.o.'s assistants. but our dressings are folded and wrapped in such a manner that they can be applied, even though the dresser's hands are covered with mud, without the aseptic part of the dressing, which is applied to the wound, being in any way soiled. i have given one hundred and fifty inoculations hypodermically for the prevention of typhoid in a tent in which the men and myself stood ankle deep in mud. not one case of infection of the point at which the needle was inserted occurred. this illustrates the efficiency one reaches from being accustomed to working in filthy surroundings. your stretcher bearers and dressers become as skilled in this art as yourself, so that the men really get good attention in spite of the many difficulties in the way. of course, at the c.c.s., which is five to ten miles from the trenches, the surroundings are as good as they are in the average city hospital. and the base hospitals are often elaborate in their equipment, though they may be situated in large tents or newly constructed wooden huts with stoves to lessen the raw cold of the french winter weather. the base hospitals in england are the highly scientific city hospitals, simply put under military control.
