Keeping Fighting Men Alive
By Louis Livingston Seaman
(Special Correspondent of The Independent)
[The Independent; December 7, 1915]
The harvest moon has waned, and never was nature more lavish in the abundance of her bounty to this beautiful land than in the season just closing. The vineyards have yielded luxuriantly, the orchards are bending with fruit, and the well filled stacks mark the landscape everywhere except in the pathway of the grim monster of war. But the harvest festival, which in the early summer days was anticipated with more than usually festive thoughts, has been turned to one of sorrow. Thruout half of Europe death has been the harvester.
During the past two months I have made almost daily visits to some of the eight hundred or more military and Red Cross hospitals of Antwerp, Ghent, Dunkirk and Paris; or, from the firing line, field and base hospitals, between Soissons and Arras, Nieuport and Ostend, to the newest and most up-to-date institute at Neuilly—the Lycée Pasteur, now known as the American Hospital, where representative American surgeons are winning well deserved honors. In spite of the utter collapse of the department responsible for clearing the battlefields and transporting the wounded to base hospitals, the work of the surgeons and Red Cross nurses is highly commendable.
Many of the wounded, on admission to the base hospitals, suffer from advanced septicemia and gangrene, which makes operative procedures extremely dangerous. Roughly estimated, I should say sixty per cent of the casualties are uncomplicated, and would have healed by first intention without treatment had they received prompt first aid dressing, and a well applied bandage such as every Japanese soldier is taught to apply for himself or his comrade, on the field.
The most serious cases have resulted from neglect of this dressing, and from the long delay in transmission from the battlefield to the base, often requiring five and in many instances eight days, during which time sepsis developed. Tetanus, too, has proved a serious factor, the majority of the cases ending-fatally. In a battle like that on the Aisne, it was claimed by the military commanders that every energy, at whatever cost, must be expended on the firing line, or to replace fresh troops .for those who had fallen. The horrors following such a battle could be avoided only by carefully evolved organization and preparation, such as does not exist in American or European armies, but which was found in the armies of the Mikado.
But the generosity of two continents is here being given in surgical and Red Cross service to the wounded of both friend and foe. Paris has become a center where the Red Cross flag, denoting places for the reception of the wounded, is seen as often as the tri-color of France. In the little villages between Paris and the long firing line, which reaches from the borders of Switzerland to the Straits of Dover, hotels, convents, schools, public buildings and many private residences have been utilized for similar purposes.
At the single station of Obervilliers, a few miles beyond the fortifications of Paris, as many as 15,000 patients have been received in a single day and sent either to the city or to hospitals in southern France. The fear of a possible siege of Paris made the concentration of wounded there a source of danger, notwithstanding the fact that over 60,000 beds awaited their arrival. The military authorities allowed the admission of the dangerously wounded only, while the remainder were sent to distant localities. I visited Obervilliers many times. It was no unusual thing for from three to five thousand wounded to arrive daily, the majority coming between 9 p. m. and 5 a. m. Several railroads intersect there, and a large temporary reception depot, with many tents serving as annexes, has been established for the reception of the terrible stream of victims which pours in from the trains. They are met by the military surgeons and Red Cross attendants, and after examination the severely wounded are sent in convoys of motor ambulances to the military and Red Cross hospitals in the city. The remainder who form a large majority, are placed in cots for temporary rest, or are given warm clothing, blankets and nourishment, and entrained for other destinations. Here it is that the women of l'Union des Femmes de France,' and other members of La Croix-Rouge, find their endurance severely tested. They assist in transporting the poor, limping sufferers to their cots an in dressing their wounds, and distribute hot coffee and chocolate, rich broth or bouillon, raw eggs, rice or wine where most needed. It is often the first food and drink many a poor fellow has received for two or three days. The work of these self-sacrificing women is worthy of highest commendation. They report for duty at ten in the morning and are on continuous service for twenty-four hours, twice during the week.
The military authorities claim that the necessity for removing large bodies of troops to and from the different parts of the long firing line compelled the use of air transports for that purpose, and neglect of the wounded could not be avoided. This condition has been largely relieved thru better railroad facilities, and long auxiliary trains of motor ambulances render additional assistance.
The most seriously wounded who reach Paris are taken to the American Hospital at the Lycée Pasteur. This splendid institution is named after the immortal discoverer of the microbic origin of disease. One could imagine the delight of this great savant on seeing the humane use to which the institution is being devoted. It is admirably adapted for hospital purposes, altho built for a public-school, and within its walls skill nearly five hundred patients are now receiving every attention surgical skill and nursing can suggest. It was established as a temporary annex to the American Hospital of Paris and is under the patronage of the American colony there. Its active agents are on the board of that hospital, and the Rev. W. S. Watson is chairman of its executive committee. Its staff includes such names as Dr. de Bouchet, surgeon-in-chief, Doctors Blake, White, Wooster, Maguin, Derby, Gross and others, all of whom give their services voluntarily. It is fully equipped with an operating room, apparatus for the sterilization of water by the ultra-violet ray, a department for dentistry, rooms for chemical analysis, radiography, and all other features of an up-to-date institution. Only surgical cases are admitted to its wards, and the records of the work performed during the war should form a valuable contribution to surgical literature. It also has its own complete ambulance corps and a dozen motor ambulances, donated by the manufacturers, for transporting the wounded either from the battlefields or from the reception depots as Obervilliers and Pantin.
Val de Grace is hospital of Paris of great importance. It was here that Larray made himself the most beloved man in the French army during the Napoleonic war a hundred years ago. It now contains about one thousand patients, among whom are some three hundred German wounded prisoners. In the large hollow court which forms the garden of the hospital can be seen picturesque groups of French Zouaves and Turcos, Sikhs, Senegalese and Moroccans, convalescing in the sunshine, and longing for the hour when they can return to the colors.
In the military hospital adjoining the Musée at Versailles I saw another thousand French wounded or invalided. This institution occupies the extensive quarters which were formerly the ancient kitchens of the chateau of Louis XIV. The Hôtel Trianon nearby has been reserved for British wounded. This beautiful establishment has been converted into an ideal hospital and equipped regardless of expense with operating rooms and other necessary fittings. It is under the supervision of the Royal Army Medical Corps, and Queen Alexandra's nurses are in attendance. Here I found my old friend Colonel Smith, D.S.O., in command. Two hundred and seventy-six of the five hundred wounded now there were received on the opening day, most of whom were the victims of Prussian shrapnel. This war is an artillery duel and the majority of casualties result from shell and shrapnel. The modern high velocity steel jacketed rifle bullet is comparatively harmless, when passing thru soft tissues. It is aseptic, and I have seen many cases, both in this war and in the Japan, where two and sometimes three bullets have past completely thru the lungs without serious result. It is when the bullet strikes a bone that its effects are most dangerous. But the killing in the armies has been mainly the result of shrapnel and shell. The bullets of the one and irregular fragments of the other produce frightful contusions and lacerations and compound fractures. They carry into the wound septic material, dirt, shreds of clothing, etc., that produce infections with too often fatal results.
AN ESSENTIAL SAFEGUARD
In the American Hospital is installed the best device ever invented for the preservation of the health of an army. It is an apparatus for the sterilization of water b the use of the ultra-violet ray, which kills all bacilli and pathogenic germs as instantly as an electric shock of full voltage kills a human being. It is simple, potable and thoroly practical, and costs less than a single howitzer shell. In two of the hospitals I visited at the front, one near Soissons and the other near Arras, there were twenty-nine soldiers among whom there was not a wounded man. The majority suffered from intestinal infections, typhoid and maladies resulting from the use of polluted water. The danger from this menace will inevitably increase as the season advances unless it is promptly checked, for the territory where the fighting is now in progress has been occupied by the enemy in his advance toward Paris and on his retreat over the same ground. In places it resembles a cemetery. Many of the dead—men as well as animals—have been buried in its trenches or flung into its ditches and other waterways. Many have been drowned and never buried, and its water sources are all more or less infected. The only escape from such disastrous conditions is the sterilization of water used for drinking purposes. Thoro boiling for twenty minutes, as was done by the Japanese in their campaign in Manchuria, will kill all bacilli, but this method is not possible here. The Taubes, which are constantly on the lookout on the firing line, would promptly report the smoke of a fire to their artillery corps, and trouble would follow. It is, therefore, imperative, if disease is not to claim a large percentage of the invalidism and mortality in the campaign, that a practical method of sterilization of water should be adopted, and the ultraviolet ray offers the solution of the problem.
It has been my privilege to recommend its general adoption to General Favrier, and the French military authorities in Paris, as well as to other high officials in the armies of the Allies. Its general use will save thousands of men for the firing line who otherwise are doomed to end their days as our American boys did camp Alger and Chattanooga, from causes that science has demonstrated are preventable. I have seen over a thousand soldiers killed by the bacilli of cholera who, ninety-six hours before their death, were healthy fighting men, and who might have remained so had they taken the simple precaution of sterilizing their drinking water.
If a fire was discovered in a valuable building in plain view of its inmates, and buckets of water stood conveniently near by which it might be extinguished, some one with sufficient initiative to throw on the water, might put out the blaze. The question here is, "Will the military authorities of the Allied armies use the bucket?"
THE EXAMPLE OF JAPAN
Thus far the armies of all the belligerents have been comparatively fortunate in escaping preventable disease, and for many reasons. In the early days of the war the majority of troops sent to the front were hardened soldiers who had been immunized against typhoid fever (or enteric, as it is called here) and smallpox. The weather, even in August, was cool, and those active carriers of disease, the mosquito and fly, were not much in evidence. But the cold is rapidly approaching, and the most dangerous bacilli are not killed by frost. When it is remembered that the mortality of armies in nearly all the wars of history has been five times greater from preventable diseases than from bullets, the necessity for using preventive measures must be self-evident. By adopting such a course, and giving to its medical officers the necessary power to enforce its execution, the Japanese completely reversed the mortality statistics in their war with Russia. In that campaign, lasting nearly two years, the total mortality was 81,000, of whom more than 60,000 died of battle casualties. In other words, instead of losing eighty per cent from disease and twenty per cent from battle casualties, they lost about thirty per cent from disease and seventy per cent on the firing line. This is the most remarkable record ever made in the annals of war. The Japanese were the first to recognize and anticipate the danger from disease. In order to prevent the invasion of that deadly foe they saw that the military surgeon must prove himself a keen sanitary engineer in the selection of camp sites, of camp drainage, of the location of latrines, in the inspection of all water supplies, the quality of the food and its cooking, of the soldiers' clothing and his personal cleanliness. He must be an epidemiologist and a bacteriologist, as well as a student of dietetics and metabolism. Terrible epidemics of typhoid fever and diarrhea have resulted from flies, which carry disease germs from unsavory places to the mess hall; or from the drinking of polluted water. The ironclad ration of the soldier has at times led to starvation or scurvy, or has proved an excitement to intestinal disease. With all these problems the military surgeon must be prepared to wrestle, especially when he is with newly recruited troops, unaccustomed to the discipline of army life, or when stationed in foreign climes.
The normal condition of the soldier is health. Disease and premature death are to a large extent unnecessary. They are to be overcome, however, not by the abrogation of the intellectual faculty, but by its exercize. With a thoro knowledge of the microbe of any disease, its prevention is comparatively easy. But it is only by the exercize of the greatest vigilance and judgment that these most pathetic tragedies of war can be averted, and that a high standard of health in an army be maintained, so that in the emergency of battle it may respond effectively.
In order to accomplish this most desirable result the Japanese have in their army 44,000 sanitary soldiers who are at the command of its medical officers, and whose duty is to save life, instead of taking it. This enormous factor in their service is practically unknown in the armies of Europe and America, but it has proved its value thru results. It illustrates the fact that the only safety for a nation lies in its thoro preparation to meet all emergencies.
© J. Fred MacDonald, 2013
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THE HEADLONG FURY
A Novel of World War One
By J. Fred MacDonald