On the Fringe of the Great Fight Part 10

At the head of each army medical service is a Surgeon-General (D.M.S., or Director of Medical Services), and at the head of each corps a full colonel (D.D.M.S. or Deputy Director of Medical Service). The chief medical man of each division is also a full colonel (the A.D.M.S. or a.s.sistant Director of Medical Services), and he is responsible for the operation of the field ambulances and the evacuation of the wounded to the casualty clearing station while his division is in the firing line. The medical officers of battalions and the sanitary squad are also under him.

The casualty clearing stations and the mobile laboratories, are under the D.M.S. of the army, who is responsible for the clearing of the hospitals by motor ambulance convoys and by hospital train.

There are normally three field ambulances to each division and one casualty clearing station. The number of base hospitals to each division is normally two, but as many of these are utilized as are needed. They are scores of miles from the fighting zone, and do not particularly concern us here.

When a battalion medical officer or sanitary officer wishes to make a report or suggestion he does so through the A.D.M.S. of the division.

In the same way the A.D.M.S. of the division communicates with the D.D.M.S. of the corps; the D.D.M.S. of the corps with the D.M.S. of the army, and the D.M.S. of the army with the D.G.M.S. at G.H.Q. A battalion medical officer cannot go over the head of his A.D.M.S., nor could the latter pa.s.s his D.D.M.S. to make a report or suggestion.

Everything must go up or down the system through the various heads, and no side stepping is permitted.

The front line trenches were about seven miles from our laboratory which was located in a town with three casualty clearing stations, a railroad and ca.n.a.l. This made it possible to evacuate the wounded rapidly to the base by means of hospital trains and barges during an engagement.

The system which enables a sick or wounded man to be removed from the front is simple enough. Each day the medical officer of a battalion, who himself may be located in a dug-out in the trenches themselves or in a cellar of a house not far behind the trenches, holds a "sick parade" at his "regimental aid post." During a battle the wounded are collected by the regimental stretcher bearers and brought to the aid post.

Any soldier who is feeling unwell reports to the M.O. of the battalion who, if the trouble is a minor one, may give him some suitable medicine. It is one of the difficulties of the M.O. to distinguish between a case of genuine illness and a fakir or "scrimshanker," and a good supply of common sense and a knowledge of human nature is a great a.s.set in making correct diagnoses. It is almost impossible, for example, to distinguish between a genuine case of rheumatism and a clever imitation of it, because the only symptoms are pains, the effects of which can easily be simulated by a soldier. If the man shows serious symptoms he is sent back to the "advanced dressing station" which will probably be a mile or so behind the front line trenches, if possible in a house and on a road accessible to motor ambulances.

If the man can walk he goes through the nearest communication trench; if wounded he is given first aid, and if unable to walk he is helped or carried back by stretcher bearers from the ambulance--to the dressing station.

Some of these dressing stations taking in wounded under sh.e.l.l fire were located in sh.e.l.l-proof dugouts. At many points light narrow gauge railroads had been built which ran from the dressing stations right up to the trenches. On these railways little cars pushed by hand were used both for bringing out the wounded during a battle and for taking in food, water and other supplies. It is, of course, impossible to lay such railways in many parts of the lines where they would be exposed to direct observation by the enemy, but they are becoming more and more numerous as their value in saving time and labour in the "man handling" of food and trench supplies has been proved. At one of these dressing stations where the railway came right up to the sh.e.l.l proof dugouts fresh sh.e.l.l holes in the neighborhood testified to the fact that the work of the field ambulances is at times not unmixed with excitement.

The cases which acc.u.mulate at the advanced dressing station are given further treatment if required, and are evacuated by motor ambulance, usually at night, as the road to the station is frequently under the enemy's observation, to the field ambulance proper where they are given further treatment or dressings as the necessity may be.

From the field ambulance the sick and wounded are cleared by motor ambulance convoy to the casualty clearing station, or possibly in cases of tired or slightly sh.e.l.l-shocked officers and men, to the rest stations or convalescent hospitals, of which there are a number well behind the firing line.

At the casualty clearing station the men are checked over, their wounds redressed, operations performed, and all the work done necessary to enable the men to be pa.s.sed on to the base hospital by hospital train or barge. These clearing stations, of which there are usually three in a town, may keep certain serious cases for days until it is deemed advisable to send them on.

While one clearing station is filling up and treating the patients, the other will be sending all possible treated cases down the line.

From the base hospitals, which are near the sea, the men are forwarded as soon as advisable by hospital ships for distribution among the hospitals of England.

While a battle is in progress the men pa.s.s through this system so rapidly that they may be wounded one morning and be in a hospital in England the next.

The medical officer, of course, is attached to the battalion, and goes everywhere with it, and under him are a number of stretcher bearers who gather up the wounded. The advanced dressing station is merely an advanced party from the field ambulance which itself is divided into three sections, each of which may operate independently according to the nature of the country. Each ambulance is self-contained, having its own transport, and by using tents can work in an area which has no houses or other shelter.

The casualty clearing station, on the other hand, having an established capacity of nearly 600 beds, has much heavier equipment and is not supposed to be a mobile unit, though it is capable of moving with the aid of its two lorries by making repeated trips. Many of the casualty clearing stations are located in huts which can be torn down and moved forward and rebuilt by the engineers and construction units.

There is also in each division a sanitary section composed of one officer and 25 men, whose function it is to keep an eye on the sanitation of the divisional area, report failure on the part of units to observe the established sanitary regulations, see that the incinerators are operated, have new sources of drinking water tested, look after the bath houses on occasion, search for cases of typhoid fever, etc., among the civilian population, and, in general, make itself as useful as possible.

The British army regulations are such that each officer and man must be a sanitarian and must not only observe the regulations but see that others do the same; the principle underlying this system being that "if each before his doorstep swept the village would be clean."

Consequently it is not left to the sanitary section to clean up a divisional area, but rather to report those responsible for not keeping it clean. In this way every man is made a responsible party, and if the officers of any unit see that the regulations are enforced by each man, the unit will be a sanitary one.

Naturally as the battalion M.O. is directly connected with the field ambulance to which he sends his cases, he is most interested in the efficiency of that unit. Since the field ambulances are under the direct supervision of the A.D.M.S. of the division, you will find the latter during a battle visiting these to see that they are operating smoothly and whether more motor ambulances, stretchers, supplies or other necessities are being provided.

At the same time you will find the D.M.S. of the army visiting his special pets, the casualty clearing stations, and seeing that the evacuation of the wounded by train is working smoothly.

The hospital trains are specially fitted up with beds, kitchens and dispensaries, and with nurses and a medical officer in charge.

The hospital barges make the finest little hospitals that you could desire. They are the ordinary flat-bottomed square-ended Dutch barges, roofed in, and when the interior has been cleared out they form elongated covered floating boxes. Skylights in the roof give a splendid light, and the barges are wide enough to allow of two rows of beds with an aisle down the middle. The medical officer's surgery and bedroom are at one end of the barge, while the nurses' quarters are at the other.

The barge is entered through the roof by a stairway, and the first impression one gets on descending these is one of cosiness and restfulness that is never forgotten. Whether the barge is moving or at rest cannot be determined while one is inside, because the motion is so easy through these sleepy placid ca.n.a.ls. Usually only serious cases that cannot stand the vibration and jar of a train journey are taken by the water route.

In the British Army there are specialists of renown in medicine and surgery who are supposed to supervise the medical and surgical work of a certain given area. They travel about, find anything new that occurs of interest, act as advisers, and hand on to other units the special information or "stunts" that have been worked out or discovered at home or in the field. The consulting surgeons are usually to be found during a battle operating where there is the greatest need of skilled surgery.

Besides the sanitary officer of each division there is a sanitary officer for each army, and a chief sanitary officer for the whole expeditionary force. These are all in touch with the sanitary adviser at the base and the authorities in England. Since, under war conditions, new developments are always taking place in this work, the knowledge gained of practical value filters through to the army by these channels as well as through the scientific journals.

Each army is provided in the field with one or more "advanced depots of medical stores" which keep on hand and give out the drugs and medical materials demanded by the various hospitals and medical units.

If, for example, a field ambulance wants a lot of iodine, absorbent cotton, etc., the officer commanding sends an ambulance with an indent signed by himself, and the officer in charge of the depot hands over the material required.

There are other branches of the service, like the gas schools and inland water service, which, though strictly not medical, are closely akin to it.

It would be of little avail to speak of all the minute detail, of which there is a tremendous amount in each and every one of these offices and sections of the medical service. The methods of filing correspondence and records alone is wonderful when one thinks of the conditions and number of men involved, and comparatively few mistakes are made. This appears the more remarkable when one has had numerous experiences with the mistakes made in the offices in England where one would think the systems would have been systematized long ago.

The medical service of the British Army in France is a marvel of efficiency and one that the nation can well afford to be proud of.

CHAPTER X.

KEEPING THE BRITISH SOLDIER FIT.

The history of war has always been a history of epidemics. The fact that in an army men are crowded together makes it easy for all communicable diseases, once introduced, to spread with great rapidity.

And because soldiers are always a.s.sociated with the civilian population, it means that such diseases are readily communicated from the army to the civilians, and from the civilians to the army. It is therefore apparent that during a war, disease, unless quickly checked, may run like wild fire through a country, and be disseminated far and wide by soldiers returning to and from their own homes, or other distant places while on leave.

Advances made in our knowledge of how diseases are spread and controlled, particularly through recent studies in bacteriology and immunity, have made it possible to keep communicable diseases in absolute subjection. The marvel of the age is the lack of epidemic disease in the army to-day. This is particularly striking in view of our experiences in other recent wars. In the Franco-Prussian war of 1870, for instance, smallpox was fanned into a great flame, and there resulted the largest smallpox epidemic in 80 years. It is interesting to note that the medical authorities in Paris, in the first year and a half of the present war, vaccinated over 25,000 strangers pa.s.sing through Paris; they are taking no chances with another outbreak of smallpox.

In the Boer War the British losses through typhoid fever alone were 8,000 against 7,700 killed by bullets, sh.e.l.ls and other agencies.

The British army of nearly five million men in France and England to-day, has so little typhoid that it is practically a negligible quant.i.ty, and this holds with other communicable diseases. There must be some basic reason for this freedom from contagious diseases, for we know that such freedom does not come by accident.

No attempt will be made to deal with those auxiliary forces employed to keep the men physically and mentally fit. Such things as the provision of an adequate and wholesome food supply; proper clothing; amus.e.m.e.nts, such as games, compet.i.tions, horse shows, cinemas, variety shows; and Y.M.C.A.'s are all an integral part of the machinery necessary to keep an army in the field well and happy.

Only an attempt will be made to discuss the principles underlying the prevention of disease in use in the British army in France,--principles with which the average layman is comparatively unacquainted.

In the first place, it is well to realize that in the temperate climate of Europe, the vast majority of communicable diseases of importance from the military standpoint are contracted largely from three sources:

Group 1. From throat and nose secretions; e.g., diphtheria, measles, etc.

Group 2. From biting insects; e.g., malaria, typhus fever, plague, etc.

Group 3. Through intestinal secretions; e.g., typhoid fever, cholera, dysentery, etc.

The first group, which includes practically all the ordinary diseases like measles, mumps, whooping cough, influenza, colds, pneumonia, scarlet fever, diphtheria, etc., is conveyed in most cases by one infected person transmitting directly to another person,--through coughing, spitting or sneezing,--germs present in the nose and mouth secretions.

The second group is conveyed by insects biting people or animals infected with the disease, and subsequently biting people who are healthy. In this way the disease-producing organism is introduced into the body of the healthy person, and beginning to multiply, brings about the symptoms of the disease. Malaria is transmitted in this way by the anopheles mosquito; typhus fever by lice, and plague by the rat flea. These are all diseases greatly to be dreaded in the army.

The third group, including typhoid and paratyphoid fevers, cholera, and dysentery, all of which are intestinal diseases, is largely conveyed from the sick to the well indirectly through contaminated water and food. To develop one of these diseases means that the excreta of somebody who has the disease or who has had it, has been taken into the mouth and swallowed, and the germs finding a favorable medium in the intestines have multiplied and produced the typical symptoms. One of the chief ways in which this type of infection occurs is through drinking sewage-contaminated water or milk; another is through contamination of food by the hands of the person excreting the germs; and the third is through the contamination of the food or eating utensils by flies and other insects which carry filth germs from place to place on their feet and bodies.

With these facts in mind and with some knowledge of sanitation and medicine it is easy to see how most epidemic diseases can be held in check. Put briefly, it means that the sanitary organization must be such that the germs from one infected soldier are prevented from reaching another, or as is sometimes said, some link in the chain of circ.u.mstances whereby disease germs can pa.s.s from one to another, must be broken.