May 24, 1917.

This afternoon, at three o’clock, the French began to prepare for storming the crest of Mont Blond. In an hour the Germans made up their mind that an assault was intended. The artillery fire, which had been continuous before, now swelled to a torrent. Each side placed a barrage. The German barrage covered our slope and the little valley between us and the top of the next hill. Between four o’clock and midnight, more than 10,000 heavy shells fell within a radius of a thousand feet from our cave. I took the count from time to time with my watch.

We were driven at once into our deeper refuge. The little stuffy hole was packed with men, knee to knee: stretcher-bearers, surgeons, my orderly, and myself. The three surgeons played baccarat. I sat on the edge of a plank and watched the game. We had an acetylene light. The shells fell all around, shaking the place and repeatedly putting out the light. The noise was remarkable. The air was filled with screams, hisses, and loud reports, followed by the slide of masses of earth. Many shells were so close that a strong push of hot gas was felt. At six o’clock the Moroccans took the ridge by storm. At midnight the bombardment slackened but did not cease.

With the dawn the wounded came in a stream, and were laid in the upper room. The wounds were of all sorts. The worst was a completely crushed jaw, in a man with a dozen slighter wounds. One man had a hole through the temple into the brain—a hole two inches long and half an inch wide. Another had a smashed leg, a bad head, and in the thigh a wound the size of a small orange.

I watched the blood-pressure carefully. Imagine a cellar with a plank floor covered with clay an eighth of an inch deep. A horrible tub full of bloody dressings. Two stretchers on the floor. Ten men in a space 10 by 12 feet, shoulder to shoulder. Two candles. Sandbag walls. The roof so low that I am always hitting my helmet against the beams. The air thick with the smell of blood, sweat, alcohol, iodine, vomit. Everywhere a smear of clay—the chalky clay of Champagne. The continuous scream, roar, crash of shells. A rain of small stones, dirty, pieces of steel. Every few seconds a profound trembling, as a shell strikes closer. Four men passing bandages and iodine in the half-light, over backs, under arms. The cries of the wounded. The litter of bloody garments. The fresh cases, obliged to lie outside, under the fire, until the room is cleared. The brancardiers, bent under the load of the stretcher, slouching off with the dressed wounded. The dawn, the falling moon, the thick vapors and acrid stench of the barrage. The blasted hillsides smoking under the continual rain of death. Countless fresh shell-holes all around us. The graves reopened.

They are bringing down the dead. They lie sprawling on the slope just below us, half sewed up in burlap, like pieces of spoiled meat.

Such was the battle for the crest—a ‘minor operation’ in this great war, but an excellent example of the most violent artillery fire. The blood-pressure remained normal, not only in the unwounded men, but also in the wounded. As it happened, there were among them no fractured thighs and no case of multiple wounds through the subcutaneous fat.

* * *

May 25.

To-day two or three rather elderly soldiers came in, with the plea that they were sic. The doctor, who has a soft full beard, large brown eyes, and a very gentle manner, said, ‘You are not sick. You are only tired. But all the world is tired here.’

During the evening, one of our own shells fell short. It struck squarely in our own trenches near the crest of Mont Haut. Immediately up went two rockets, each with three green flares, meaning ‘Great Jerusalem! Life your nose.’ Thus admonished, the humiliated seventy-five raised its muzzle and the next shell fell over the ridge.

* * *

May 26.

Just before daybreak there was drum-fire—continuous roars from all the batteries. This lasted two hours. I got up and crawled into the upper cave, but was at once driven down again. After the fire slackened, I went out—about two feet out—and Gérard prepared my toilet—a shave and face-wash. I have not had any of my clothes off during the last three days and nights. After shaving, I went out to brush my teeth. The air was clear and brisk, the sun not fully risen. To stand on the open slope of the hill, in the keen wind of dawn, under fire, and use a tooth-brush, was really exhilarating. It was the first time I have ever enjoyed brushing my teeth.

At nine o’clock we put a barrage on Fritz. At this he quite lost his temper. The noise was awful. Naturally, we went ‘down’ again. But his rage lasted only a short time. Then Gérard came to tell me there would be a Mass in the lower cave. ‘Is there a priest among you?’ I asked. ‘Yes,’ replied Gérard, ‘we have two ones; the both very brave.’

The Mass was a touching ceremony. The early Christians worshiped thus in the catacombs of Rome. A very small portable altar had been placed at the end of the tiny passage. Two candles burned upon the altar. The men stood elbow to elbow or kneeled in the bunks—martyrs not yet dead. The priest was a private in the infantry. Over his dirty uniform of horizon blue—the faded symbol of worldly hope—he had drawn the vestments of the Church that teaches Hope eternal and unsoiled. His grave strong face was lighted with sincerity and faith. The clear word of promise and of consolation mingled with the roar of German shells, beasts seeking whom they might devour.

About ten o’clock, the major turned up to fetch me to dinner, or déjeuner, at Headquarters. It was to be my farewell to Mont Blond. He had a great stereoscopic camera, with which he took my picture standing at the mouth of the cave. Then we went off, with Gérard and another orderly to carry my things. The major has a quick and almost jaunty walk. In ten minutes we arrived at the poste.

A officer went with me up to the observatory, a pit in the chalk on the top of the hill. The breeze was fresh, the sunshine delicious, and the view very extensive. Behind us, the slopes of Mont Blond and Mont Haut, smoking with shells, white with craters, trenches, and dust. In front, the plain of Châlons, green and smiling, with the spire of a church, and the villages of Mourmelon-le-Petit and le Grand. To the right, the Montagne de Rheims, with Épernay and its vineyards. After that diabolical cave all this was very sweet to me. I dozed in the sun, when suddenly a soldier, who was digging near us, threw down his tool, and with a warning cry rushed under cover. We jumped for our lives. An aeroplane sailed over us, half a mile up.

A hawk is hovering in the sky—
To stay at home is best.

After a delightful hour we returned to the gallery for lunch. It was quite a feast. There was one white plate, produced in my honor. The rest ate the whole meal out of one aluminum porringer apiece. It is useful to eat each course clean, to sour the porringer with bread, and then to eat the scourings.

After an excellent meal, I set out for Mourmelon-le-Petit. Two officers went a little way with me. It was hard to part with such kind friends. For success with these people there are three points to be observed: to be perfectly brave, to be always smiling and gay, and to be enchanted with your bed, your food, the dirty—in short, with everything. Fortunately, I do not mind shelling; few men do.

The walk across the plan to the Farm of Constantine, where the motor-ambulances wait, was not unpleasant, though a battery of seventy-fives directly en face made a deafening racket. The ambulance driver, an Englishman, worn, prematurely gray-haired, covered with dust, had lived for years at Stockbridge, Massachusetts, and knew my friends there well. He was very cross about the gas-shells; he could not see to drive with his mask on. After a dazzling, dirty ride, we reached the ambulance de triage at Mourmelon-le-Petit. Here are brought all the wounded from the postes de secours at our immediate front. It will be a good place to try the respiration method for the treatment of shock.

* * *

May 27.

Mourmelon is a small village, justly called ‘le Petit.’ Its glaring streets are white with lime-dust, which indeed lies everywhere. The dirt is quite inconceivable. The ambulance consists of a number of old barracks in a walled compound. On my arrival, the médecin chef gave me a very kind welcome. He is a bacteriologist by profession, and before the war was Assistant Director of the Pasteur Institute in China, where he had met my colleague, Dr. Strong, during the pneumonic plague.

I sleep alone in a small ward. My ward has five beds, a wooden floor thick with dirt of all descriptions, and painted canvas walls. Naturally the furniture is crude. But what a delight to strip once more and to bathe in clear cold water—about one quart! Last night I slept hard, but to-day I feel the strain of the terrible scenes that I have been through. Our popote, or mess, is excellent.

After supper, the médecin chef and I took a long walk over the Field of Châlons. It is a green almost level expanse, traversed here and there b roads lined with trees. The sun had set, the air was cool and luminous. The cannonade seemed for the first time without sinister meaning. The plain was covered with small shell-holes. In the distance, on rising ground, against the horizon, galloped a train of limbers bearing ammunition for the insatiable cannon.

* * *

May 28.

I am very tired. The glare, the dust, the endless stream of broken men, — ten thousand passed here in the last six weeks; one hundred and sixty-five last night between midnight and 6 a.m., — the necessarily great inadequacy of treatment—all this, added to my reaction from the sickening scenes on Mont Blond, is depressing enough. I have had to think to-day. That was a bore.

The respiratory machine has undergone a transformation. It is now, in fact, a tomato-can with a tube ending in a rubber mouthpiece. It has been cut in two and each half shoves over a collar of tin, so that it may be drawn out like an accordion. The patient is to breathe in and out of this can, filling it with the carbon dioxide he exhales. As the gas increases, so will his respiration. To wash the can with fresh air, the two halves are pulled apart. Nothing could be simpler.

This hospital is a triage. It sorts the wounded. Those who can be moved are sent in suitable lots to Châlons and elsewhere. One hospital specializes in abdominal wounds, another in fractures, and so on. Only the most mangled are treated here. The cases of shock are among them.

To-day I was presented to General X——, one of the high command hereabouts. He is a man about five feet seven, slim, fit, handsome uniform, great star on his breast, intelligent, courteous. He was pleased at my having been in the barrage; he said it had been a very severe action—acharné.

Our médecin chef is very kind—much interested in my physiology and helps me with everything himself—says he is at my disposition day and night. But it is an awful load; there are such numbers of these battered fragments, and I know so little. It wrings the soul. A fine young officer came in to-day—shell in the abdomen.

I wish I were at home with you. I shall never be able to get these sights and sounds out of my mind or the smell of rotting flesh out of my nose.

* * *

May 29.

To-day, the chief and I tried an experiment on a blessé with multiple shell wounds and very low blood-pressure. It was a failure. The respiration was not increased, and the blood-pressure was not raised. Neither was the chief’s opinion of the method, though he was much too wise to be skeptical. My spirits were not elevated by the occurrence. Last night I was very tired. Indeed, I am tired to-day also. My bed is next a great ward filled with wounded, only a canvas wall between. Promptly at daybreak one of these sufferers begin to call, ‘Garçon! Garçon!’ The monotonous, feeble, penetrating wail rises with clock-like regularity every few moments until broad daylight. There are no nurses here, only ignorant poilus.

This afternoon I got a soldier as subject and tried the machine in the presence of several deeply attentive officers. Nothing doing. The breathing remained almost calm. Immense shrugs from all beholders. I do not see why it should work on animals and not on men. They brought me another man, a finely built youth, and intelligent. Another failure. This time the shrugs were so exaltés that I thought the spectators would put out their tongues at me. Then the soldier said, ‘But, monsieur le major, my nose is still open.’

O clever youth! Inspired young man! The officer whose duty it was to stand guard at the nose had put the clip too high up. Ten hands reach the recalcitrant organ. I look to see the nose pulled off. But no. It successfully resists. This time it is stopped for sure. The youth announces thickly that he can breathe only through his mouth. The instrument is now applied to the mouth. Listening to the artery, I get for a base measurement a clear bruit just above the minimum normal blood-pressure. ‘Commencez!’ I cry. Off we go. In fifty seconds, he is pumping merrily. The heart bounds. The blood-pressure goes up. Three cheers for les États-Unis. Bring back the first rebel. His nose is closed this time. It is all but squashed flat. Again a success. Voila! C’est fini. Profuse thanks to the experimentés. Conclusion: another triumphal demonstration that men are like dogs.

* * *

May 30.

It remains now only to get a couple of smashed thighs with low blood-pressure. It is practically certain that we shall have a rise also with them. They may come in any minute. It is very calm to-day. No cannonade to speak of. This morning the Boches dropped three shells on the railway station about two minutes from here. But their aim was good; they did not hit us. Just above me is a hole in the roof through which a shell fell a few weeks ago. A fragment sailed out the front door, narrowly missing the médecin chef.

The waiting is slow work. I am writing in the big pavillon de reception. It was a soldiers’ theatre. It is here that the sorting takes place. On the dirt floor, near my feet, lies a soldier on a stretcher. He has had a heavy thump on the chest and breathes with difficulty. Between us is a great brazier, half-full of red-hot coke. The air is keen to-day. Tea is to be served for me at four o’clock. As I speak English, they fear I should die without my tea. I wave my hands, but it is no use. After our dinner, we drink a hot decoction of the blossoms of the lime tree. They firmly believe that it helps the digestion. Who can refute it! The connection between faith and peristalsis is too strong to be denied.

The chief regrets that there are no women here. He thinks the would help the service. They would no doubt teach these poilus how to wash. Such dirt! The chief has lent me a clothes-brush. ‘It is for the house,’ he explains, ‘but I believe the brush for the horse is better for man than the brush of the shops.’ Mon avis: I shall need a curry-comb soon.

* * *

May 31.

To-day there were several cases of shock. I tried the respiratory machine. It did not work. All the muscles of these poor creatures were relaxed. Their lips would not close on the rubber mouthpiece. I am off for Paris to-morrow, to have made a frame enclosed in a kind of bag. The patient’s head will go inside and carbon-dioxide gas will pass into the chamber from a pressure cylinder. The bag will be tied round the neck. The new device will have two advantages. First, the patient will have nothing to do but to breathe; he need not close his lips on a respiration tube. Second, the treatment need not be interrupted to wash out the apparatus with fresh air. There will be plenty of carbon dioxide and a hole can be left in the chamber, thorough which the patient will be able to get all the oxygen he needs. But probably, by the time that this apparatus has been made and tested, the fighting in this region will have quieted down, and it will then be necessary for me to go elsewhere.

My sty at the Massif de Moronvillers has been very profitable. I have demonstrated that the blood-pressure is not altered by a barrage fire said to be as violent as the worst in the great drive at Verdun. Further, I have myself examined more than a thousand wounded. Save a few wounds of the abdomen, in which the blood-vessels or their nerves in that great vascular region were probably directly injured, there has been no case of shock except after shell-fractures of the thigh and after multiple wounds through the subcutaneous fat. In these, closure of the capillaries by fat-globules is known to take place. This is strong support for my discovery that shock may be produced in animals by injecting fat into the veins.

* * *

As might have been expected, the making of the new apparatus in Paris war-time was a slow business. When it as finished, I tested it at the Collége de France in the laboratory of my kind friend, Professor Gley. It worked very well. A wire frame covered with a thin caoutchouc bag enclosed the head. Carbon-dioxide gas passed into this bag from a pressure cylinder controlled by a regulating valve. On its way, the gas bubbled through a flask half filled with water. The rate of passage could be told by counting the bubbles. When the inspired air contained about three per cent of carbon dioxide, the subject’s respiration was doubled and the blood-pressure was plainly greater. Sufficient fresh air was obtained through an opening in the bag.

By this time the fighting at the Massif de Moronvillers had sunk to the habitual offensive; there were no longer enough wounded at Mourmelon-le-Petit. As only one in a hundred casualties has shock, I needed at least one hundred wounded a day. Since the point at which attacks might be made could not be foretold, it was necessary to obtain carte blanche to go anywhere on the French front. For this I went to Grand General Headquarters at Compiègne.

I felt at home at Compiègne. Months before, the French government had made me consulting physiologist to the Carrel Hospital there. I walked again in the wonderful beechen forest. I stood upon the terrace of the Château, where Napoleon’s Austrian bride had looked amazed along the entrancing vista, cut in one night through miles of billowing green by her all-powerful spouse. Compiègne fell to the Huns when the wave of invasion rolled over northern France. But they did not harm the place. It was the Kaiser’s plan, it is believed, to receive upon the celebrated terrace the submission of the dignitaries of France. Instead, one fateful day, during the battle of the Marne, there came over the wire words pregnant with the fate of civilization; ‘Foch has pierced our centre. Fall back at once.’

In my former days at Compiègne, the great Château had been a sleepy place, almost deserted. It was now the seat of Grand General Headquarters. No doubt it would be profoundly altered. There would be many guards, a stream of officers coming and going, a crowd of automobiles, a rush of aides bearing messages. To my astonishment, it was scarcely changed. This centre of perhaps the greatest intellectual activity in the world was as quiet almost as the grave. A lonely sentinel guarded the iron gates. A single limousine stood within the court; the chauffeur drowsed in the warm June sun.

Madame C——and I were admitted to a tiny room, economically boarded off from one of the salons. Presently a soldier led us up the ancient stairway to the third floor, where we traversed interminable corridors paved with brick. We passed door after door, each of which bore a white paper stating the name and business of the inhabitant. We met not a soul.

Finally, we arrived at the door we sought. We found within a pleasant officer at a large desk. He might have been writing his memoirs, so easy and good-natured was he. I stated my case, while my benevolent companion made signs behind my back that I was some kind of rare bird. Even the good are full of guile. The officer did not penetrate this aura. Next day I received a magic square of blue paper, giving me full powers and requiring every French officer to further my researchers.

Returning to the Ministry of War, at Paris, on the Boulevard St. Germain, I obtained an order of transport, providing free passage and all civilities on the railways. A message was telephoned to the front, ordering a limousine and an officer to meet me at a certain station. The next day I departed, in the company of an enormous cylinder of carbon-dioxide gas. I reached a station near Soissons, where I was most politely conveyed to Division Headquarters. Here the general brought out a map on which were marked the postes de secours, the sorting hospitals, and other administrative details. Soon I found myself just behind the Chemin des Dames, welcomed by a friendly médecin chef, in private life Professor of Surgery at the University of Marseilles.

* * *

June 24.

This is a hill country. The road to the Ambulance crosses a fold in one of these hills. On the left is a cliff, separated from the road by a narrow strip of ground holding a single line of low stone houses. On the right, a few others cling to the slope. It is Vauxtin. Below the village is a little valley containing barracks and stables. Beyond it the road rises to a rounded summit on which are the great tents of the hospital. It is almost a motor-ambulance. There are electric-light generators mounted upon an auto truck. There is an automobile dove-cote, with homing pigeons. The tents, with the exception of those used for operating-rooms, have dirt floors. There is good air, much sunshine, a wide view, a large and competent staff. The surgical results are excellent.

The staff sleep in the village—in caves dug in the cliff. I live in a house. It has a small courtyard, shut from the road by a wall. There is a wide gateway, closed by iron doors. Upon this yard open sheds in which are cows, swine, poultry, pigs, and rabbits. In the centre is a dunghill, a pool of liquid manure, and several indolent open drains. My room has a dirty brick floor, dirty walls with great cobwebs, and a dirty duvet, of a color once red. The sheets are coarse but clean. There is no soap-dish, no towel, no anything but a small, battered tin basin and a rusty tin water-can. The door will not lock, or even latch. Two dogs, three cats, and all the chickens, wander at intervals through the manure and into the chamber of the interesting stranger. The cats find the duvet comforting.

I am writing on our mess-table in the adjoining courtyard. We eat in the open, protected from rain by some flimsy tarred paper. Near my bench is a rabbit-hutch. Two large and fluffy hens, each with many chicks, are trying to teach me how to manage a family. I should be more interested if they would show me how it is that my family manages me. The proprietors of this court are a wrinkled, leathery couple who are evidently moved by the example of the prudent Noah; they seem to have at least one pair of each species of animal indigenous to these parts. Their owners think that, pending the arrival of the flood, it would be a waste of energy to clean the court. Our supper consisted of onion soup, omelette soufflé, hash in slabs, green peas, lettuce salad, confiture, toasted war-bread, and coffee.

At ten o’clock, the apparatus was tried on the médecin chef. If he does not complain, the soldiers will not. The experiment goes smoothly and the chief is entirely comfortable.

* * *

June 25.

It is nine o’clock, and I am sitting at the door of my shock tent, writing on my knee. I was called at 5:45 a.m. and worked without food till 1 p.m. Then an hour for dinner, and after this more work till 8 p.m. Then supper and a pipe, and here I am.

We have had five cases of shock. Three recovered; one was hopeless from the start; and the fifth could not be treated—constant vomiting and hemorrhage. A day full of dreadful sights. The battles here are fiercely fought; there are more than ten German divisions on our immediate front. The carbon-dioxide treatment is undoubtedly an advantage. Probably it is of considerable advantage. Just how much, can be determined only after many observations. But at least a forward step has been taken.

Yesterday I went for a walk to the end of our plateau, separated by a few miles from the Chemin des Dames. It was dusk. The flashes of the guns, the flares, and the smoke-clouds were all visible. Many years ago, the ladies of the French court had villas there and used to drive along the Chemin des Dames to get the view from the long, high ridge.

We had a grand lunch to-day. Tuffier and his aide were guests. The smoke from the green wood of the cook’s fire mercifully deadened our capacity to smell his stove five feet away and the manure-pool ten feet away. After all, the rich agricultural aroma of rabbit and of cow is not so bad. The wrinkled peasants, proprietors of this demesne, enjoy these ancestral odors.

Pomona loved the straw-built shed,
Warm with the breath of kine.

The old dame has stolen out to catch a glimpse of the great surgeon. She stands with bared head before a plastered wall, on which a vine has drawn a pattern of classic beauty.

The lunch is interesting. An officer tells us his experience at Verdun. He might be describing the barrage on Mont Blond. I am comforted. He at least will know that I have spoken truth. Our feast had reached the cheese, eaten in the hope that its sharp savor may correct our earlier excesses, when the air fills with a series of loud bangs mixed with the barking of pompoms. A Boche is trying to hit the barracks and stables down the slope of the hill. Last week sixteen horses were killed by a single bomb. This time the aviator is missing his mark. His bombs are falling at the edge of the low cliff above our heads. Our party leaves more or less hastily for the shelters under the cliff. The sensible ones run. Tuffier and I walk. After a minute or two we conclude that our German friend has done, and we sit down again. Our waiter fetches a jagged piece of steel which had struck about four feet from the plank on which rest my poor old bones at meal-time. I have saved the piece for daughter. But don’t be alarmed. This is a quiet enough place. All the hills are bearing haycocks. The fields are poorly cared for, naturally, but there seems, nevertheless, much precious fodder.

Last night it rained, but to-day has been fine and cool. I hated to spend the long, sunny hours in an intolerably hot little room over the remains of what was once a whole man. The wounded are so patient, poor dears.

* * *

June 27.

After writing you yesterday, I went almost at once to bed. It was still light. The cows and the chickens were at rest, but the peasants were cackling and soldiers and ambulances were constantly passing my open window. This window is three feet above an open drain at the side of the road. Nevertheless, I was soon asleep—fortunately, because at two o’clock a rattle at the shutter and a hoarse voice called me to a shock case. I dressed hurriedly and stumbled up the dark hill to the ambulance. I found the surgeons just bandaging the stump of an amputated thigh. The man was pulseless. The head surgeon turned him over to me—they always do: the more desperate the case, the more pleased they are to bestow him to my tent and all the surgeons stood by to see what would happen. He was placed head down on a sloping table. Six large electric lights were arranged between him and his blanket. The mask was put over his head and the carbon dioxide turned on. In three minutes his pulse reappeared. Every one was much pleased.

I am anxious to get back to Paris to try out a new idea, an electrical method for raising the blood-pressure.

* * *

It is not my purpose to give an account of the busy weeks that followed and the long series of experiments in the laboratories of the Collége de France. The harvest was, as usual, a pennyworth of new truth in an intolerable deal of disappointment.

In August, I sailed for my own country, bearing with me the certainty that the carbon-dioxide respiration treatment of shock was at least of some advantage.

The voyage home was exciting. It was given chiefly to playing chess with a submarine officer. He maintained the high traditions of the United States Navy. I was usually beaten.

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