No small part of the cruel anxiety felt by the people at home for their friends and relatives at the front has been caused by the many ignorant and unfounded criticisms of a noble branch of the Army Service which is prevented by professional etiquette from speaking in its own defense. Since returning from a winter spent working in France at a large base hospital intrusted by the Royal Army Medical Corps to the Harvard Surgical Unit, I have been asked seriously and repeatedly why the government leaves the care of the wounded soldiers to a voluntary society called the ‘Red Cross.’ I have found, indeed, that the public knows as little about the way the wounded are dealt with as we ourselves knew when we first landed in France. The confusion has been augmented by people forgetting that the red Geneva Cross, with its white background, used by the medical corps of all nations as their emblem, is identical in appearance with the badge of the Red Cross Society; and, in many minds, it has come to be considered as the exclusive property, the distinguishing mark, of the great voluntary organization. The fact is that those who wear the badge on the field of battle are practically never employees of the Red Cross Society, but are members of the regular army.
This popular ignorance, if not exactly pardonable, is easily explained. A search carried even into the British Museum has revealed the fact that as yet no history has been written of a service which it is supremely important that the public should appreciate and trust. It has seemed somehow in keeping with the spirit and calling of the fighting man that he should be careless of the fate that awaits him if he is wounded, and that he should despise such mean things as sanitary precautions. That is why literature preserves no account of how the armed Crusaders cared for their stricken comrades. Possibly they were justified in comparing unfavorably the ‘leech’ and his pillboxes with the bearer of more ostensibly destructive weapons; at any rate, in civil life the social recognition accorded to the versatile ‘barber-surgeon ’ was never perilously exaggerated. It has always seemed strange, however, that the duty of the State to care for the bodily welfare of its protectors should have been taken so lightly, until the time of the ‘Lady with the Lamp’; and that even then the burden should fall on a voluntary society. However romantic amateur ‘flying ambulances’ may be, they are necessarily inefficient; and however unselfish and courageous ladies may be, the fact that even at the beginning of this war they were permitted to rush about here and there, picking up stray wounded, is as serious a comment on the public interest in making proper preparation for army medical service as was the Kaiser’s estimate of the small army we originally sent to fight him.
Very reluctantly, indeed, has the recognition of equal rank been bestowed on the fighters of germs and of Germans, though so many of the former have died at their posts, like the brave men they are. Numbers of them have given their lives, in China or in Servia, in the endeavor to save tens of thousands of their fellows from the ravages of typhus and plague. The valor and glory of such sacrifices never seem to stir the popular imagination like that of the hero who, to save the lives of his friends, flung himself on a bomb which he had himself inadvertently dropped. The appreciation of proper perspective is an acquired art.
Now, the immense moral value of recognizing success is unquestioned. Even the sacrifices at Verdun would be justified to Germany if they secured for her the stimulus of a great victory. By the same token, the scant praise and liberal criticism which have been accorded to the Royal Army Medical Corps spell a real loss to the nation. The successes of these men, won in the face of stupendous difficulties, already form a romance of which England has as much right to be proud as she has of the achievements of her splendid fighting men on sea and on land.
The first necessity of an army is unquestionably munitions; the second, equally unquestionably, is food; medical care comes a close third. In the first of these we can at least feel that we are doing as well as any other unprepared nation. As for the second, Tommy Atkins, from the Somme to the Yser, will admit that the Army Service Corps has simply done marvels. And as regards the third, I say, in the face of all the grumblers, that any Englishman who has seen the R.A.M.C. at work and is not filled with pride in his countrymen, can surely have no soul.
It is scarcely out of place to say here that those elements in the make-up of a man which are least visible and tangible, but which alone account for the noblest, the most that is worth while in him, are to-day being more considered as worthy of serious provision. It is really being acknowledged, at last, that high souls, and not alcohol-dulled sensibilities, are factors of highest importance in making the best fighters. In this connection, the unpretentious services rendered by the Y.M.C.A. huts are admittedly more real influences for victory than the fighting man was once willing to admit; and the attitude of the R.A.M.C. toward intoxicants is of the greatest importance. A large obituary notice of the ‘Rum Ration,’ with a heavy black edging, hangs prominently in the General Headquarters Office.
The question, What provision is made for the average wounded Tommy before he reaches England? is so frequently asked these days that a brief sketch of the various progressions of the medical service may be considered timely.
First of all, the Army itself provides, from the R.A.M.C., a doctor for each battalion, who always remains with the regiment. The men know him by sight, and know where to find him. He has three orderlies of his own, a Maltese cart for supplies, and four stretcher-bearers to each company — twenty-four in all. These men have received special training in the work of stretcher-bearing and the giving of first aid; in other respects they are ordinary soldiers, and do not wear the Red Cross. If fighting is very heavy and these men are killed, — as very often happens, — the medical officer may ask his battalion commander for additional assistance. At a pinch, the field-ambulance men (of whom more will be said later) will help to carry the wounded along the trenches. These men also supply the line with sterilized water, look after the latrines, and wheel round the medical supplies.
A few yards behind the line the medical officer has one or more heavily protected dugouts, called regimental dépôts. To these the wounded walk or are carried, and receive first aid. An extra doctor, or even two, from the R.A.M.C. field ambulance help here in ‘unhealthy’ times. Roads do not lead to every part of a line; often they could not be used if they did. To be near is not always to be accessible; so, farther back from the trenches, in as safe a spot as can be found where it is possible to carry a man by hand or on wheeled stretchers, the ‘advanced dressing station’ of the R.A.M.C. is placed. This is probably in a cottage, or barn, or in another, and larger, protected dugout. This dressing station must be at a road-head if possible, so that the motor ambulances may come and carry away the wounded who have been collected there from two or three dépôts. On account of the firing, these ambulances may not be able to come in till dark.
In spite of all precautions, the shadow of danger hovers dark over the men who work in these stations. In the midst of a heap of bricks and rubbish, in a ruined village of France, some blue crystals of copper sulphate one day attracted my attention. I wondered how they had come there. ‘Oh, that’s all that is left of a dressing station,’ came the reply. ‘A “coal-box” 1 went square into it; but the wounded were in the dugout behind it, and were not touched.’
It is hard going for the motor ambulances over the shell-torn roads; but squads of Tommies are eternally repairing and filling up holes. The wagons have good springs, and are as merciful as anything could be. In places where the motors cannot go, horsedrawn ambulances assist.
The next stop is the field ambulance, which collects the wounded from three or four dressing stations. It usually has room for about one hundred and fifty patients at a time. It must be ready to move at once if the line moves, and yet be able to keep patients for two or three days if necessary. It provides for operations on men wounded in the abdomen, or chest, for in these cases every moment gained is priceless. If possible, it is located beyond reach of the enemy’s guns. Each bed is, in reality, a stretcher, raised on rough wooden legs, so that it can be quickly carried off, patient and all, if need arises. Each field ambulance has ten medical officers and two hundred and thirty or two hundred and forty men for stretcher-bearing and for tent work. Its motor ambulances leave for the dressing stations about sunset; to avoid accidents, as far as possible their work must be done at night. The doctors go right on the field with the stretcher-bearers, and many have been killed at this work. They must stumble along in the dark — not even wearing the Red Cross badge, because the white on it serves as a mark for the enemy’s snipers. Three of these doctors are civil surgeons, specially brought out for their known skill and experience. Yet no man in the R.A.M.C., of whatever eminence, receives more than the regimental pay of his rank, however much he loses by accepting the commission.
Of course, all the desirable conditions can seldom prevail. More than once, these field ambulances have shared the fate of the advanced dressing stations; they have been shelled, and lost men thereby. More than one brave man has had to operate hour after hour in these unfavorable situations, at the peril of his life, just as the shells may also destroy the roads, upset the ambulance cars, and kill the stretcher-bearers. Yet one field ambulance at least has saved many lives by being a ‘special abdominal hospital.’ One poor fellow was operated on an hour after being wounded, and was saved as a result. The roof was one day knocked off by a shell, but no one was hurt, and the ‘special hospital’ only moved a few hundred yards to one side, nearer a friendly mound. It is all in the day’s work.
That is the spirit in which my friend Colonel-accepted his vicissitudes. Earlier in the war he had made his field ambulance in a church, where he had three hundred wounded. The Germans overran the place before he could move the poor fellows. He chose to stay by his wounded. From the enemy he could get neither food nor dressings; indeed, he was forced to help them, while foraging as best he could for his own men, between times. One morning the Germans raised hurried barricades across the streets. An excited battery, drawn up in the road, began firing, and was shortly answered by another from a distance. Then a French battery suddenly came into sight on the sky-line. The Germans hastily packed up and disappeared, but not before they had rushed to the church, seized on any wounded who were able to stand or hobble, and carried them off. The colonel, rushing out to welcome the incoming French, found himself brought up short at the point of several bayonets. He had been mistaken for a disguised German. But when once he was recognized, the hearty Frenchmen overwhelmed him with more kisses on both cheeks than fall to the lot of the average British officer.
From the field ambulance, the stream flows on to the next stage in the long journey — the hospital at the nearest rail-head, called a Casualty Clearing Station. Now that the roads are better, traveling is safer, and shells seldom reach so far back. In France, where firm trust in the line prevails, there has been a wonderful development of these stations. A large proportion of their two hundred beds are real hospital beds. The presence of nurses and sisters adds a psychic and spiritual factor of untold value to the man on the road to recovery. Patients likely to get well in a fortnight need go no farther than these stations. Every ingenuity has been exercised to adapt the school, brewery, or whatever the buildings occupied, to the purposes of preventing wastage, and at the same time so thoroughly renewing ‘Tommy’ that he may soon be back in the fighting line again. Some casualty clearing stations have become really marvelous hives of work. Out of the eight officers at each station, four are probably civil surgeons with varied, special lines of work; while the eighty-five men allotted include carpenters, tinsmiths, washmen, store clerks, dispensers, armorers, wardmen, and that useful variety of man called ‘batman.’ This place is really like a large sieve. Cases that will need long treatment, and, in rush times, less serious cases, are placed on hospital trains, each with three medical officers and two nurses, or on large canal barges if the jolting of the train is liable to hurt such injuries as bad fractures — five hundred men in a train, or thirty on a barge. A motor convoy, with a doctor in charge, always does the transference work.
Some casualty clearing stations are almost entirely rest-camps, sending the less serious cases back in a week or two, but with everything renewed, washed, repaired, and ready for the line. Splendid new surgical methods have been devised, and fractures can now be set here so that frequently they will need no rearrangement at the base hospital. Many operations entailing the removal of larger and more obvious foreign bodies can be performed; much other major surgery is also accomplished. Hundreds of our soldiers are now healed at these developed casualty clearing stations, and are saved the time and expense involved in sending them to the base.
And now, the serious cases, arrived at one of the bases, which are purposely multiplied so that the stream can never be entirely blocked by any accident, are carried in motor ambulances (in France now the property of the Red Cross Society) to the stationary general, or special, hospitals provided. In these are found every comfort and convenience of the most modern hospital. To-day over fifty thousand beds are ready if required. These hospitals at first had to be installed in hired hotels, or in canvas marquees; but gradually they are being transferred to veritable cities of asbestos, iron, or wooden huts, on the beautiful French seacoast. There are infectious hospitals, special fracture hospitals, hospitals for slight dressings, massage, and finishing-up purposes, fine convalescent camps, and, beyond all this, provisions for games, for recreation at night, and for religious exercises.
Those men who cannot return to the line are periodically shipped to England on fine hospital steamers, still in charge of doctors and nurses, and go to hospitals in England if necessary. That only one hospital ship has been torpedoed, or mined, in this ‘everyday’ service is a marvelous testimony to the efficiency of the naval guard. In order that empty beds may always be ready ‘across the water,’ and no wounded men be left untended, there must always be some units more or less idle to meet the varying requirements of this unprecedented war. One man blames Lemnos and Malta for having too many doctors while another blames Mesopotamia for having too few. In France at least, where the main part of our armies is located, the balance has been most wonderfully preserved.
The good men of the R.A.M.C. see the magnitude and difficulty of the problems, and if they feel they ‘might do more elsewhere,’ instead of squealing they find temporarily other outlets for their energies — and these are endless. The fact that a small percentage in every profession is faulty is only a confession that this is a human world. The one great comfort which the public can take to heart is that the heads of the service are not the inflexible, conservative officials, who care only for old methods, and conventions, and statistics — as critics both in and out of Parliament might lead us to infer. In France, where I saw the work of the R.A.M.C. from the base to the trenches, the one great, impressive feature was the flexibility displayed, and that willingness to receive suggestions which alone can lead to perfection. Such suggestions are tested thoroughly, and the old methods discarded if found wanting.
A fine detective service is always a comfort to peace-abiding people, because it suggests efficiency. A better knowledge of the R.A.M.C. in France reveals it as a thoroughly up-to-date secret service. Each division of sixty thousand men has a chief executive officer, called the A.D.M.S.,— assistant director of medical services, — as has each base, and also each advanced base. These report to their army head offices, over which presides a D.M.S., — director of medical services, — and these again to the surgeon-general at General Headquarters, ‘somewhere in France.’ The town where he works is not named. Even if one finds the town, only the elect know where the G.H.Q. is; and only those who gain admittance to it would credit the truly marvelous system which enables it to keep in touch with every last medical officer, with every individual patient, and, of course, with the War Office in England.
Endless graphic charts in bright colors are kept, illustrating every valuable line of knowledge connected with the administration of the forces. During our visit a discussion on the value of helmets arose. Instantly a chart was produced showing at a glance every head wound for every day since the office started work, and the proportion of head wounds to those of any other part of the body. Thus, for one month, let us suppose that the total wounds were three thousand two hundred. Seven hundred and sixteen were of the head. Of these four hundred were slight, two hundred severe. The majority were on the side and back of the head, as against the crown, and were in the order of shrapnel, bullet, shell. The leg injuries came next — four hundred and twenty; the chest, two hundred; and the abdomen, one hundred. By comparing the months, and taking into consideration the movements of the line, invaluable suggestions had been made.
Again, the discussion turned to the losses from typhoid fever. Charts were instantly produced, showing that in the Boer War the wastage from typhoid was one hundred men out of every thousand; in Dongola, seventy; in the Nile expedition, eighty-five; in China, twenty; in Mashonaland, sixty; in France to-day, one; and even with the addition of doubtful cases and para-typhoids, it is only three and eight tenths. If one case of typhoid is diagnosed in the whole British Expeditionary Force, from Switzerland to the sea, it is known by telegraph the same night at G.H.Q., and next morning the cause of its origin must be hunted for by the medical officer nearest the case. Yet in the trenches west of Ypres our Allies had 6000 cases of typhoid when we took them over. Typhoid was endemic in all the villages, and 26,000 Belgians had to be persuaded to be vaccinated.
The ‘trench-feet’ chart was the next one produced. It showed a tracing somewhat like that of the fever of acute pneumonia,—large numbers at first, and then a rapid return to next to none, — a fall like the subsidence of the fever crisis. Once and again occurred a little rise, a small relapse, but each one was accounted for. The week before, we had seen a batch of Highlanders straight out of the trenches, with disabled feet, sitting and lying around a large dressing station. The chart instantly revealed, not only the fact, but the cause: continuous fighting, wet, snow-flooded trenches, no time to change socks for two days, and so no reprimand for the medical officers in charge. ’Trench feet’ have almost become a misdemeanor, so successful are the precautions for preventing the trouble.
To us, the most interesting chart of all was that showing the total sick and wounded for every day of the war. The lines of rise and fall looked much like relapsing fever, and with the brief appended comments, it gave one a history of the fighting. This big red rise meant Loos, and that one Festubert; this one meant the Battle of Ypres, that one the advance of Hooge. The level blue line denoted fine weather in Flanders and less sickness. The strange thing seemed that sickness showed always nearly twice as much wastage as wounds (except in cases of big attacks) in spite of all the advances of hygiene. We also noticed that, when fighting was most severe, sickness grew less. ‘No time to take notice of it’ was the explanation.
The public must realize that examinations for physical fitness to enter the army are fallible and are often hurried. A certain economic loss is entailed by drilling and sending out men who have later to be sent home as useless. Seeing that old men give false ages to get passed through, and that young men are no more veracious; that appearances are deceptive; that past illnesses may be denied, and many disabilities and hereditary taints concealed temporarily, this wastage will always occur. But where it occurs is accurately known; it is brought home as soon as possible to the responsible examiner, and, if his mistakes are serious, he soon finds himself weeded out, like other ‘undesirables.’
The consideration of just one apparently simple problem — the personal cleanliness of the armies — is worth a moment’s attention. It is unnecessary to say that it is a matter of supreme importance. The very first step had to be to take over the whole sanitary arrangements of every village and town anywhere near the fighting lines, the water-supply, sewerage, and drainage: an Augean task for the modern Hercules! But it has been accomplished, as the splendid health statistics of the enormous semi-stationary armies that flooded into these villages demonstrate. Ambulatory chemical laboratories repeatedly test the source of every watersupply; not a pump or tap but has a certificate of some kind attached to it. Ambulatory pathological laboratories everywhere pry into the secrets of ‘ bug diseases.’ Breweries and factories are commandeered and converted into public baths. Two thousand Tommies a day are washed in one of these, in batches of one hundred and fifty — at times to the music of ‘Jack Johnsons’ dropping into the water-supply. ‘Tin sheds’ have been erected for ‘itch’ treatment — a skin disease that has laid up as many as four thousand men at a time. No happier men exist in France anywhere than these victims just freed from their tortures. The jolly naked crowds of splendidly developed fellows, singing and shouting in the great baths within hearing of the thunder of the guns, make the murder of war seem plain devilish.
The plagues of vermin are an additional horror. A shirt preserved in a glass at—Baths is said to have come there unattended. So while Tommy is tubbing, his clothes are superheated and hot-ironed; clean underclothing is provided, and he goes out a self-respecting being again.
Meanwhile, in improvised laundries, truly built of ‘consecrated’ iron, one sees through Newfoundland fogs of steam heroic squadrons of women attacking what appear, in that flat country, to be mountains of the dirty clothes of armies. They also work to the accompaniment of shrapnel and shell. Never were there truer ‘companions of the Bath’ than these women.
Sewage and garbage are dealt with by clever economic incinerators built of old tins and clay, in which the fires burn as eternal as in the Valley of Hinnom.
In these and a thousand other ways, the R.A.M.C. is holding down waterborne diseases, preventing tropical sicknesses, avoiding dietetic troubles, and nipping ‘filth’ diseases in the bud, until the total sick ratio per thousand for the army in the field is a little more than one half that of ordinary civil life. The scrupulous worship of Hygeia is more dramatic in its results than even the cult of Æsculapius.
In a well-known magazine, a British officer a short while ago wrote, ‘For every Englishman killed in the war, two will be created.’ Every oarsman knows that a crew is more likely to win, the less dead weight it has to carry; and although this war has killed off a large number of our physically best men, it has as certainly made many new ones, both body and soul, out of those who were anæmic, neurotic, bottleshouldered, flat-chested, with cramped lungs, embarrassed hearts, liable to every malady that came along — turning these by the magic of the openair life and the sanitary care of the R.A.M.C. into veritable tan-faced giants. Hundreds have had handicapping physical deformities operated on and cured; thousands have had infected, rheumatism-causing teeth and throats cleaned up and repaired by the R.A.M.C. — men who never would have had treatment in peace times. Thousands have learned to appreciate simple and more natural living; tens of thousands are interested as they never were in the things that make for true manhood. At length the man of arms has accepted the man of science as a real factor in fighting; has given to him the same rank and insignia and the chance to share the same honors. The world has realized that his claim to recognition depends not merely on successful operations on the wounded, and that even the battle with dirt and drains is an honorable calling.
It is often said now that if the government service was what it ought to be there would be no need for a Red Cross Society at all; and its very existence does at first seem a stricture on the R.A.M.C. The world at last has agreed that the soldier wounded has as much right to be cared for by government as the soldier unwounded — not merely because that is good economy but because it is inherently right. There are always, however, many things needful, which, in England, we prefer to leave to voluntary work, and we hate naturally every form of conscription. The Red Cross is essential when sudden strains arise, as at the beginning of this war, or in suddenly developed new fields, as in Serbia, when we or our Allies have still no adequate government organization to meet the needs of the moment. The Red Cross is an invaluable outlet for these services of love that honor a nation, and a blessing of untold value to those who find in it the peculiar opportunity they want for exercising their capacities for unselfishness. To the worried doctor it brings help immediately, when organization on more rigid rules spells delay. To the wounded soldier it spells luxuries which no public service yet considers that it is justified in charging to the taxpayer.
On the other hand, like every other presentation of the ideal of the great Master, its ideal is to work for its own elimination. One service under one control is the ideal; voluntary hospitals dotted here and there are far from desirable, however useful they may be temporarily. It is the duty and privilege of government — I say this advisedly—to provide all that is needed for the heroic men who give their lives for their country. That there should be inadequate medical provisions, something lacking because of a shortage of voluntary funds, is almost worse than the failure to insist on universal service when the fate of the nation is hanging in the balance. The system cannot afford to risk being haphazard; the R.A.M.C. must be every bit as scientific as the fighting branch of the service. This it can be only under one government control; and division simply means overlapping and waste. It is the one great fault of the presentday service of man’s higher self — the division that seeks to bolster particular methods, and thus befog or lose sight of the main issue.
We forget that the human body is the most wonderful material machine between earth and heaven. The fact of death still forces us to admit that the knowledge of how to keep it in perfect running order still lies within a sealed book, which prayers, no less than pills and potions, have failed completely to open. The diverse schools of medicine, the various arts of healing, the large fortunes of the venders of patent medicines, the patronage accorded to the shrines that work miracles, show that even in the more stable times of peace the public is inclined to question the value of the discoveries of science.
The R.A.M.C. has demonstrated to the most skeptical by its sanitation results, as well as by its vaccines and sera, and at a time when the long casualty lists come in and our loved ones are in danger, the rationality of experimental research. The confidence inspired in man’s capacity to adapt himself to a hard environment is fostering the spirit of Empire among men whom circumstance and vocation had hitherto tied to the office or the counter. No chronicle as yet records the deeds of the R.A.M.C., its splendid devotion, its scientific triumphs, its unselfish economies. It never blows its own trumpet. Truly ‘it seeketh not its own.’ Only generations to come will fully appreciate the nation’s debt to that noble body, which for the first time in history has really begun to come to its own — in this, the greatest war of all times.
- Soldier’s slang for a shell of large calibre. — THE EDITORS.↩