Frederick A. Pottle
History of the College de Juilly;
of Hospital Activities There before Our Arrival;
the Nature of War Surgery.
JUILLY, a little village in the smiling fields of Seine-et-Marne, seems to derive its name from Julius Caesar. Its Latin name, Juliacum, probably perpetuates the memory of a Roman camp established by the great Roman in the near vicinity. The history of Juilly begins with Saint Geneviève, the maiden who, by persuading the people of Paris not to flee before the Hun Attila, became the patron saint of the grateful city. This was in 451. Geneviève often traveled between Paris and Meaux, passing through the grounds on which the Collège now stands. The spring there is called by her name, and tradition says that she called it into being by a miracle. A wonderful spring it certainly is, for in 1918 we must have been drawing from it upward of fifteen thousand gallons of water a day. It soon became an object of pious veneration, and was visited by throngs of pilgrims during the Middle Ages. One can still descend the worn stone steps and see the bright jet spurting from the wall much as it did then; the old stone walls go back to the twelfth century, and the polychrome statue over the fountain to the thirteenth. It was in the twelfth century that the spot became of such importance that a monastery of monks took over its management and administered it for 450 years. The school, which in these latter days has eclipsed the spring, came into existence in the thirteenth century. Blanche de Castille, mother of France's sainted king, Louis IX, made here a foundation to care for the children of the knights who fell in her son's disastrous crusade. During the hundred years' war with England it suffered much from the English troops which had overrun all this part of the country. On her return from Orléans, Jeanne d'Arc passed through Juilly, winning a great victory at Lagny near by. The Abbaye was then almost in ruins; it was rebuilt in the middle of the sixteenth century, but in 1637 the monks finally left Juilly, turning their charge over to the order of the Oratory, whom Louis XIII had commissioned to found a seminary for the education of his young nobles. The school was called an "Académie Royale" and was allowed to quarter the lilies of France with the crown of thorns of the Oratory. Many of France's most famous sons have been pupils at the old Collège de Juilly. Montesquieu, La Fontaine, and Jerome Bonaparte were among the number, as were also two of the most famous of England's illegitimate royalties---the Duke of Monmouth and the Duke of Berwick. Bossuet, as Bishop of Meaux, was closely connected with the school, and La Fayette had an estate near by and always showed great fondness for it. In the Library is still preserved a facsimile of the American Declaration of Independence, given by Congress to La Fayette and by him presented to the College. During the Revolution it was nearly extinguished, most of the Oratorians going to the guillotine during the Terror, the direction of which was largely in the hands of certain radicals who had formerly been on its faculty.
The Collège was three times a hospital before the World War: First, during the war with England in 1790, then in 1814, when Napoleon, near the end of his career, was fighting on the Marne, and in 1870 when Juilly was occupied by the Prussians. In 1914 the Germans almost reached Juilly again. They occupied St. Soupplets, some five miles away, and for a time it looked as though they would advance as far as Juilly itself. The wounded from the first Battle of the Marne were brought to the Collège, many of them being picked up by the superintendent in a furniture van drawn by an old horse which had been rejected as unfit for military service. In January, 1915, the French Government put a part of the buildings at the disposal of Mrs. Harry Payne Whitney, who equipped and maintained there a hospital for the care of French wounded. It was known as American Ambulance No. 2, and was a sister institution to American Ambulance No. 1 (later Army Red Cross Hospital No. 1), at Neuilly, a suburb of Paris, the latter institution being also supported by American charity. The staff---doctors, nurses, and ambulance corps---was mainly composed of American volunteers.
When the Second and Third Divisions were sent in at Belleau Woods and the Marne, there was no American military hospital service back of them at all. It had been agreed that the French Sixth Army, in which they were serving, should provide all the necessary service of hospitalization and evacuation. It developed that they were quite unable to do anything of the sort. During the months previous to the great German advance of the spring of 1918, the stable condition of the line, and the obvious advantages to be gained by early treatment of wounds, lured the French to carry their advanced hospitals nearer and nearer to the front, and to make them constantly larger and less mobile. When the Germans broke through, the French lost at a blow thousands of beds and enormous quantities of hospital stores. Because of these losses they were barely able to care for their own wounded. Furthermore, the French command failed to inform the American Medical Staff of the destination of our divisions, so that they had to discover where they were after casualties had already begun. Had we been earlier advised of the true state of things, it would have been possible to handle the wounded from the June fighting much more effectively. But it is doubtful whether the French knew the true state of affairs any too well themselves. Everything was in confusion; the enemy were advancing rapidly, and were within striking distance of Paris. From the military standpoint only one thing was clear: the enemy must be stopped. In such an emergency the handling of wounded, though of the greatest importance, was a secondary consideration.
On June 2 the French Sixth Army notified our liaison officer (Lieut. Col. A. D. Tuttle) that the French would be largely unable to fulfil their promise of hospitalization, and begged the American command to do what it could to meet the situation. Our troops had already been in action twenty-four hours or more. A hasty survey showed that the Ambulance at Juilly was the only American institution available for an evacuation hospital. The capacity was then only 250 beds, and the personnel was inadequate to care for even that number. Plans were immediately formed to increase the capacity to 800. There were still some 250 boys (pupils) still left at the Collège, which had continued its work as an educational institution in spite of the partial conversion into a hospital. These were hurriedly sent away, and an appeal made to the Red Cross in Paris for the necessary material, which began to arrive by June 4. There remained the grave difficulty of personnel. The surgical consultant of the Second Division collected such teams as he could find, and frantic telegraphic appeals throughout the A.E.F. brought in several others. The marines have no medical corps, but are cared for by surgeons and corpsmen of the navy. Consequently one of the busiest teams we found when we arrived at Juilly was that of P.A. Surgeon John H. Long from Navy Base Hospital No. 1 at Brest. On the night of June 3 the patients began to arrive, and soon jammed the hospital. It must be remembered that the material for the proposed expansion was only just arriving, and that the surgical teams were coming in one by one. On the morning of June 4, the senior representative of the Medical Department with G-4, G.H.Q. (Col. S. H. Wadhams), visited Juilly in company with the chief surgeon of the A.E.F., General Ireland, now surgeon general. On his return to Paris the same day, General Ireland requested of G.H.Q. that Evacuation Eight, the only evacuation hospital available anywhere in France, be sent at once to Juilly. We had meanwhile been making our pleasant, but useless, trip across France, and had just arrived at Bazoilles. It was hoped that we would reach Juilly on June 5, but the French were unable to provide the necessary railroad transportation. On June 5 the Acting Chief of Staff, G-4, G.H.Q., made an urgent plea to the chief of the French mission to expedite the movement. The cars were made available at Bazoilles on the morning of June 6, but the railroads were so congested that we did not reach Juilly until the morning of the eighth.
Meanwhile the situation had been considerably alleviated by the arrival on June 6 of the forty army nurses of Replacement Hospital A. This group had been organized by the army in New York City, April, 1918, five nurses being selected from each of eight different cantonments scattered from Massachusetts to Texas. They sailed from New York on May 19, 1918, suffered a submarine attack, but without casualties, and landed at Liverpool on May 31. On June 2 they crossed the channel to Le Havre, remained there two days, and then were rushed to Juilly by way of Paris and Meaux. On June 9, Miss Goodine, the chief nurse, and ten others were detached and ordered to La Ferté-sous-Jouarre for duty with Field Hospital No. 23. Here they remained until July 19. The hospital was subjected to air raids, during which two of the nurses, Miss McNamara and Miss Zang, distinguished themselves by unusual bravery, and were later cited.
The heroic quality of those four days before our arrival at Juilly is best communicated, I think, by the terse and restrained words of the Surgeon General's Report. "On June 4 and 5 arrangements were made for evacuations by ambulance from the hospital at Juilly. . . . The personnel at that time was becoming physically exhausted. . . . On the morning of June 6 all available ambulances and numerous trucks were evacuating from the front of the 2d Division into Juilly. . . . Though the surgical teams there worked day and night, they were insufficient to care for all the wounded received. As a matter of fact, not more than a fourth of the personnel needed by this hospital could be furnished it. . . . The next day [June 7] the first hospital train arrived at Juilly. [Because Juilly was some distance from the railroad, the method of evacuating by train required handling the patients twice, and had to be abandoned because of the small number of men available for carrying litters, and their exhaustion.] On June 6 and 7, by ambulance and train, 1,183 patients, practically all of whom had come from the 2d Division, were sent from Juilly to Paris. . . . On the dates mentioned the small hospital at Juilly had received about 1,700 patients, and for a period of four days its personnel worked 20 hours a day. The litter bearers---most of whom were French soldiers unfit for front-line service---worked even longer hours. Their labors were supplemented by ambulance drivers. Finally all were too weary to lift a litter to the level of the upper tier of an ambulance. A detachment from the 2d Division then relieved them until the personnel of Evacuation Hospital No. 8 arrived on June 8."(10)
The number of admissions continued very large after our arrival. From June 4 to June 20 there were admitted in all 3,274 patients; that is, in the twelve days after we took over the hospital, we received about as many as had been admitted in the previous four days. As a matter of fact, immediately after our arrival the admissions were heavier than these figures indicate, for our admissions practically ceased from June 16 to July 15. The reason was that another evacuation hospital had been established at a place more accessible to the front and to the railhead. On June 12 Evacuation Seven reached Château Montanglaust, a mile or so from Coulommiers, and was joined there by Mobile Hospital No. 1. Within a few days these hospitals were ready for work, and the stream of wounded from the Second Division was diverted to them. In the six weeks subsequent to June 13, these two units received and evacuated twenty-seven thousand men.
Because we brought none of our army hospital equipment with us to Juilly, but were operating entirely with Red Cross supplies, the hospital was officially known at first as Army Red Cross Hospital No. 6, though, as an organization, Evacuation Eight never lost its own name. By the first of July or earlier, however, this designation was dropped, and our own substituted.
IT is the common belief of people not conversant with medical history that the greatest advance made in the surgical treatment of wounds in this war as compared with that of previous times---for example, the Civil War---has been through the employment of anesthesia. I myself used to believe that the surgery of the Civil War was all done without anesthetics. As a matter of fact, both ether and chloroform were then known, and were generally used (chloroform much more frequently than ether), though I find in official reports opinions of prominent military surgeons who clearly considered them newfangled and express doubt whether wounds do not heal more quickly when anesthesia is not employed. It is also incorrect to suppose that ether has done away with all pain in war surgery. Present-day operative technique of infected gunshot wounds requires very radical excision of tissue; that is, the wounds to be dressed after operation now present much greater areas than they used to, and must consequently be more painful. I never worked in the wards, but it is my belief that in our hospital anesthetics were seldom employed for the dressing of wounds. At any rate, I know that the period in the morning when the surgeon came in to dress wounds was a terrible one both for patients and orderlies.
One of the greatest advantages of ether does not concern the feelings of the patient at all. It renders him completely inert, and thus enables the surgeon to work more slowly and thoroughly, and with more thought for the final outcome. Before anesthetics were discovered, amputations had to be made with a few quick slashes with a knife and cuts with a saw; now a surgeon can take time for proper dissection, with his attention not merely on the present emergency of saving the patient's life, but definitely looking forward to the future usefulness of his body and limbs. But important as was the discovery of anesthesia, it was of infinitely less moment than the aseptic technique which came to us through the work of Lister and Pasteur. When we remember that the surgeons of the Civil War knew nothing about bacteria and the nature of infection, we should marvel that they did as well as they did. For the majority of men who die of wounds in war are not killed outright, nor do they die from the extent of their injuries. They die in hospitals of infection. Our percentage of death from gunshot wounds in the Civil War was 13.65, in the World War, 8.12.(11) This gain in efficiency (nothing less than the saving of five more men out of every hundred) was almost wholly due to the development of the aseptic and antiseptic technique.
And it was a greater gain than at first appears, for without it the percentage of deaths from infections in this war would have been higher than in the Civil War, because the wounds were generally more dangerously infected, and were of a type more favorable to the development of infection. The majority of the wounds in the Civil War were made by rifle bullets, bayonets, or solid cannon shot. A wound from a modern high-power rifle, if it does not kill a man outright by piercing a vital organ, is in general not dangerous nor difficult to treat. When a bullet has gone a few hundred yards, it is traveling in a perfectly even trajectory, without wabbling, and, when it strikes a solid object, it drills a tiny clean hole through it. It may even go through a large bone without completely fracturing it. It carries with it no dirt nor pieces of the soldier's clothing. If a bullet had drilled a clean wound through a fleshy part of the body (such as the calf of the leg), and no inflammation appeared, we ordinarily did nothing to it at all, but simply painted the orifices with iodine and put on a dry dressing. In a few days it would heal without any attention. I remember one remarkable case of a man who walked into the operating room without help. A bullet had gone clear through the front part of his head from one cheek bone to the other, below the eyes and above the teeth. There proved to be nothing for us to do at all. The wound was clean and healing of itself. He walked out again, and in a short time must have been able to report back to his company for duty at the front. So, too, a bayonet would be likely to make a clean wound, which, if it did not kill a man outright, would probably not make much trouble. It is hard to say, for we had almost no experience with the treatment of bayonet wounds. Of the hundreds of cases which I recorded myself, I remember but one bayonet wound, and that was accidentally inflicted. I suppose the man who was unlucky enough to be wounded with a bayonet was usually finished on the spot. But I suspect that, except for a brief period during the summer of 1918, the Germans were not near enough to our men for much hand-to-hand fighting with bayonets. For that matter, we had comparatively few bullet wounds to treat. Those we did receive were almost always made by machine guns, which shoot the same ammunition as the ordinary rifle. In the old days rifle fire must have furnished the great majority of the wounds treated in army hospitals; now the number of such wounds is almost negligible. Many men were wounded by machine gun fire, but such men seldom came back to us. The machine gun is a diabolical invention. It shoots so rapidly that a man is not often wounded with merely one bullet. If he is hit at all, he is likely to be riddled. The machine-gun operators aimed low; if they hit a man in the legs, he fell, and then they had a chance of hitting him again in the abdomen, chest, or head. I remember one of our wounded men telling of seeing the body of a comrade who had eight machine-gun bullet wounds in an absolutely straight line across his chest. But to return to the Civil War. As the majority of wounds then were made by rifle bullets, bayonets, and solid shot, they must have been, as compared with those we had to treat, fairly clean and easy to care for. Yet the wounded died in hospitals in appalling numbers. The sad truth was that the hospitals themselves were seminaries of contagion which spread virulent infections from infected wounds to clean ones. "Hospital gangrene," as it was called, sometimes swept off most of the patients in a hospital. Walt Whitman's The Dresser contains graphic pictures of extensive personal experience in the treatment of wounds in army hospitals during the Civil War, and should be read in comparison with the methods I shall describe.
The vast majority of wounds in this war were made by fragments of metal shell-casings containing a charge of high explosive. Solid cannon shot are now entirely disused. The modern "cannon ball" is a long, tapering, beautifully finished steel mechanism shaped something like a squatty cigar, and ranging from an inch in diameter up to great things a foot or more through at the base and three or four feet long. The favorite gun of the Allies, the famous "75," had a bore of seventy-five millimeters, almost exactly three inches. The missiles are fired from brass shells, shaped very much like rifle cartridges. The interior of the projectile is hollow, and filled with a quantity of an explosive sufficiently inert to bear the shock of propulsion from the gun, but which will explode with terrific force when detonated by a cap in the tip. The object of the artillery is not to score direct hits. They send the projectiles over in steep parabolas, striking the ground at an angle. As the shells plunge into the earth, the cap explodes and detonates the high explosive, which blows the casing into fragments ranging in size from bits as large as the head of a pin up to chunks that would weigh a pound. These are blown up in all directions from the ground, or from beneath its surface, carrying with them quantities of dirt. Their velocity is low as compared with that of rifle bullets. They are quite easily stopped by a steel helmet, or even by an aluminum identification tag. They do not bore a clean hole, for they are not whirling like bullets. But they have sufficient velocity to drive deep into the soft flesh of the human body, carrying with them dirt, and usually a large wad of the soldier's clothing. If they strike a bone they ordinarily shatter it, but they seldom have velocity enough to carry them all the way through a limb. Consequently, the typical wound with which we had to deal was a so-called "bottle-wound"; that is, a deep jagged lesion with pieces of metal, cloth, bone fragments, and dirt embedded in it. If it was in a fleshy part (such as the calf, thigh, buttock, or upper arm), the flesh tended to close behind the missile, shutting off the interior of the wound completely from the air.
Now this is precisely the type of wound in which two dreadful infections flourish best. The first is tetanus or lockjaw, with which civilians are sufficiently acquainted. But tetanus has ceased to be of much consequence in war since the discovery of the antitetanic serum. If a wounded man is given the serum immediately after he is wounded, he rarely has tetanus. At the first-aid station the invariable practice was to administer "A.T.S.," no matter how slight the injury. Among all the thousands of wounded who went through our hospital, we had only two or three authentic deaths from tetanus. In one of these cases, the patient, through an accident, was not given the serum at the first-aid station, and when the symptoms of the disease were recognized it was too late to save him. A greater and more successful enemy than tetanus was gas infection. Civilians, I find, and even men who were wounded, have highly erroneous ideas as to the nature of gas gangrene. They think it was a condition induced somehow by the German poison gas. Of course, it had nothing to do with gas warfare. It was caused, like tetanus, by a germ, or rather a group of germs, the best known of which is a bacterium, isolated some time before the War by Doctor Welch of Johns Hopkins, and for him called "Welch bacillus," or sometimes "bacillus aerogenes capsulatus" (the capsulated, gas-producing bacillus). Cases of it occur in civilian practice, but very rarely, for two reasons. The first is that civilian wounds are seldom of the type in which the gas infection can develop, even if it is present, and the second is that civilian wounds usually receive such prompt attention that gas infection is not allowed to get a start. The infection is not difficult to destroy if one can get at the wound in time.
The gas bacillus is an "anaerobic" organism. That is, it can multiply only in the absence of air. A favorite habitat of the bacillus is soil which has been heavily fertilized with animal manure. This was precisely the sort of soil in which the fighting in France was carried on. The trenches were dug in fertilized fields, and in such fields the shells burst, picking up the infection and carrying it with them. The jagged fragments of shrapnel made wounds highly favorable to its growth. The progress of the infection naturally varied a good deal, but it generally worked with frightful rapidity. By a process somewhat similar to that of fermentation it breaks down the sugar of the tissue, producing large volumes of carbon dioxide gas. This collects under the skin in bubbles, which in an advanced stage of the infection can be distinctly felt by passing the hand over the surface. As one applies pressure, the bubbles shift, and one can even hear them crackle. The pressure of the gas bubbles mechanically shuts off the circulation, and gangrene results. The tissue is at once attacked by various putrefactive organisms, which, rather than the gas infection, give off the horrible odor characteristic of its presence.
Once started, the infection may spread so rapidly up the muscle bundles that death from gas gangrene of an entire limb has been known to result in only sixteen hours from the time of injury. It will therefore be seen how important speed was in the treatment of our wounded men, for practically all the wounds made by shell fragments had the gas infection.
Under the most favorable war conditions, a considerable time must inevitably elapse between the time a man is wounded and the time that he can receive definitive surgical attention. The spot at which he falls wounded is probably under direct fire of the enemy; it is difficult and dangerous to get him back to the dressing station. The ambulances going back from the dressing station must move over roads constantly under shell fire. If the army is advancing or retreating, the prompt handling of wounded becomes doubly hard. The evacuation hospital is bound to be at some distance behind the lines---certainly beyond the ordinary range of enemy artillery. Such units must be elaborately and expensively equipped, and it is folly to establish them where there is a high possibility that they will be immediately destroyed. The Germans have been charged with bombing hospitals through deliberate intent of forcing them farther back from the lines, so that more of the wounded would die of their injuries. Such bombings, however, seem to have been too casual and sporadic to support the theory of a general campaign against the advanced hospitals, but there can be little doubt that the bombings did result in our placing our hospitals in more sheltered sites, even if they had to be somewhat farther back.
The surgical unit being, then, anywhere from five to twenty kilometers from the trenches, an elaborate system of handling and sorting the wounded has to be devised. When a man is wounded, he probably applies the first-aid pack which he himself carries, or a comrade applies it for him. If he is only slightly wounded, he walks back to the battalion-aid station; if severely wounded, he is carried by the regimental stretcher bearers. The battalion-aid station is from fifty to fifteen hundred yards behind the front line trenches, in a shell hole, cellar, culvert, dugout, or some such location.(12) It has no equipment for major surgery. The wound is simply painted with iodine and covered with a good-sized sterile dressing. Antitetanic serum is administered, and fractures immobilized by splints, but no attempt is made to "set" them. During the summer fighting there was more or less confusion in what happened from this point. But later on, as in the Argonne, when the system was working as it was meant to, the wounded went back, on foot, by litter, animal-drawn or motor ambulance, depending upon the severity of the injury and the difficulty of the terrain, to the dressing station, which might be three thousand yards behind the line. This, besides giving first-aid treatment to men who had been wounded in the zone between the aid station and the dressing station, and inspecting and supplementing the treatment given there, also provided shelter and served as a collecting and classification center for the motor ambulance service, which was regulated from this point. Hot food and drinks were usually available here. The wounded were then carried back by ambulance to the triage, or sorting station, which was usually manned by a field hospital. This was normally from two to four miles back. Here the wounded were carefully sorted out according to the seriousness and urgency of their injuries. Gassed men were sent to the gas hospital; seriously wounded to an evacuation or mobile unit, slightly wounded farther back to the railhead. The field hospitals operated on some of the most desperately wounded men---those with abdominal and chest wounds, for instance---but the first definitive surgical work was performed principally by the evacuation hospitals and mobile units. The latter differed from companies such as ours only in being smaller, doing practically all their work under canvas, and in having much of their equipment fitted in trucks, so that they could move on shorter notice and with greater ease. As has been pointed out, all the transportation of wounded from the dressing station to the triage, triage to evacuation, and often from evacuation to the railhead, was performed by motor ambulance. Upon the courage, skill, and devotion of the ambulance drivers much depended, for they, more than any other agency in the system, had an opportunity to cut down the distressing delay which cost the lives of so many of the men who died.
I have already described at length what the operative technique of an evacuation hospital looked like to a layman. But it remains to add a word as to the theory underlying that technique, and to describe the postoperative treatment. We used to sum up the operative procedure by the French term débridement, which meant nothing more nor less than the removal with knife and scissors of all the tissue affected by the missile or by infection. The surgeon simply started from outside the wound and cut until healthy muscle was exposed in every direction.(13) This often made very sad looking chasms, particularly when the wounds were in the thigh, as so many of them were. The dimensions I have given above on page 110 were by no means unusual for a wound of this sort. Carrel, in his book The Treatment of Infected Wounds (p. 189), casually mentions a buttock wound which, after "cleaning up" measured 18 cm. long, 9 cm. wide, and 8 cm. deep (about 7 1/8 by 3 1/2 by 3 1/4 inches). An evacuation hospital naturally had a larger percentage of such large wounds than a base. Toward the end of the War, I believe successful results were being obtained through radical excision alone, by making it so thorough and careful that the wound was "clean" after the operation, and could be at once closed. But with us, this radical excision seldom or never proved enough by itself. The opening of the wound stopped the growth of the gas infection so far as the air could reach, but in the interior there were pretty certain to be closed pockets where it could continue to thrive, especially if combined (as it always was) with aerobic organisms, particularly staphylococci and streptococci, which formed with it a sort of mutual protective league. These would use up the oxygen which inhibited the gas bacillus, and then the gas bacillus would begin to multiply. The streptococci themselves, though much less rapid in their action than the gas bacilli, were almost as fatal if not eradicated.
The second stage of the treatment consisted in the irrigation of the wound with a solution capable of destroying both the aerobic and the anaerobic organisms. Dr. Henry D. Dakin, an English scientist who for some time had made his home in America, working at the laboratories established at Compiègne by the Rockefeller Foundation, invented the antiseptic solution, and Dr. Alexis Carrel, the famous Franco-American surgeon, devised the operative technique. Hence the method, which was used by all the Allied armies, was properly called the Carrel-Dakin method. I have already described how rubber tubes were inserted into the wounds after operation, the ends being brought out through the bandage, and fastened with safety pins. After the patient had been carried to the ward, the Dakin solution was forced into the tubes every two hours, keeping the whole interior surface of the wound continuously drenched with fresh antiseptic. When the man was to remain in our hospital some time, the tube ends were joined by glass couplings to one large rubber tube, like that of a fountain syringe, which connected with a glass reservoir hung over the bed. When the clip on the large tube was opened, the solution flowed into all the small tubes. When the men were to be evacuated so soon as to make this elaborate equipment unfeasible, the nurse or attendant simply injected a small quantity into each tube separately with a bulb syringe.
The Dakin solution was very simple in composition. It was composed of nothing but chlorinated lime (bleaching powder, "chloride of lime"), sodium carbonate (washing soda), boric acid,(14) and water, with a dash of eosin dye to distinguish it from the other clear liquids (alcohol, sterile water, saline solution) which we used in large quantities. The effective ingredient was the free chlorine which it gave off when it came in contact with raw tissue. This so-called "hypochlorite solution" was by no means new. Under the name of "Javel water" and "Labarraque's liquor" it had long been used for bleaching cloth, disinfecting, embalming, and kindred processes. Dakin's great achievement was twofold. Hypochlorite solutions as ordinarily prepared are strongly alkaline, and corrode human tissue. Likewise, if the percentage of hypochlorite is too high, the solution is irritating; if too low, it has no effect on the bacteria. Dakin discovered a means of making a neutral hypochlorite solution, and determined the exact strength it must have for use as an antiseptic. The percentage must not fall below 0.45 per cent of hypochlorite, not rise above 0.5 per cent. Obviously the preparation of Dakin solution required expert chemical training. Moreover, the chlorinated lime, which was the chief ingredient, is a highly unstable substance with a constantly changing chlorine content. It was therefore necessary to make chemical analysis of it constantly in order to be able to prepare the solution properly. The technique demanded a first-class pharmacy as well as first-class surgery. And both surgeon and pharmacist would have been helpless without a competent bacteriologist and a well-equipped bacteriological laboratory.
The first effect of seeing these radical methods of excision was to fill the uninitiated with dismay. "How can such extensive wounds ever be closed?" they asked. "What good will such a mangled body ever be?" Could they have seen the whole process, they would have thought the final results little short of miraculous. The wounds after operation were never closed with sutures, but left wide open, protected by the dressings. Cultures were taken daily and sent to the laboratory. When the bacterial count showed that the antiseptic had swept out the infection, the wound was closed with sutures, and healed promptly, like a clean cut, leaving only the narrowest and firmest line of scar tissue. The removal of so much tissue was not so serious as one would have supposed. Muscle shows remarkable power of repair. If the whole middle part ("the belly," as surgeons say) of a muscle were removed, it would fill in with scar tissue, and the use of that particular muscle would be lost. But this seldom happened in practice. It was usually possible to leave one edge or the other of the muscle, so that even if a portion were replaced by scar tissue, the function would be largely retained. In the great majority of cases, the man recovered with a perfectly sound and useful limb.
The following are transcripts from the records of actual cases which passed through our hospital. The first and last are from duplicates of "Form 52," one of those quaint forms which the army required us to make for every patient; the others are from the operating record book which I myself kept for six tables at Petit Maujouy between September 13 and October 13, 1918.
It will be noted that the first record is incomplete. A glance at the date shows the reason; the man was admitted at Juilly and died there before we took over the hospital. When the form was made out, he was already lying in the morgue.
|(1) SURNAME||(2) CHRISTIAN NAME|
|(3) RANK||(4) COMPANY||(5) REGIMENT OR STAFF CORPS|
|(6) AGE, YRS.||(7) RACE||(8) NATIVITY||(9) SERVICE, YRS.|
|(10) REGISTER NO.||271625.|
|(11) DATE OF ADMISSION.||June 3, 1918.|
|(12) SOURCE OF ADMISSION.||Unknown.|
|(13) CAUSE OF ADMISSION.||G.S.W.(15) left thorax, severe, below last rib. Incurred in action.|
|(14) IN LINE OF DUTY?||Yes.|
|(15) COMPLICATION, SEQ., ETC.||June 4, 1918. Wide incision of shell wound of thorax. F.B.(15) removed. Ether.|
|(16) DISPOSITION.||Died. Cause of death: G.S.W. left thorax severe. Cause of death originated in the service and in line of duty.|
|(17) DATE OF DISPOSITION.||June 6, 1918.|
|(18) NAME OF HOSPITAL, ETC.||Evacuation Hospital No. 8, Juilly, Seine-et-Marne, A.E.F.|
|(19) SENT WITH REPORT OF S. & W.(16)||FOR MONTH OF June, 1918.|
|(20)||ARTHUR M. SHIPLEY, Major, M.R.C.|
Of the cases from the book, the first illustrates what I have said about rifle and machine-gun bullet wounds.
September 24, 1918..............................................Ward 22
M-----, J----- ,.........................................Serial No. 135681
Private, Headquarters Co., 102 F.A.
Time of Injury, Sept. 24, 8.30 A.M.
Time of this writing, Sept. 24, 4.15 P.M.
Diagnosis: G.S.W. right thigh, perforating, machine gun bullet. No fracture. No nerve injury. Leg not tense. Not operated.
Hold.( 16).......................................MAJ. SHIPLEY.
Why the following patient was sent to us, I do not know, but I have copied out his case because it furnishes something in the way of relief:
September 30, 1918..............................................Ward 5
H----------, A----------...........................Serial No. 3109797
Pvt., Co. K, 315 Infantry.
Time of Injury, Sept. 28, 3 P.M.
Time of operation, Sept- 30, 4 P.M.
Injury to ingrowing toenail. Operated.
The following cases are typical, though rather more severe than the average. I have avoided giving records for men who died in our hospital after operation. Note the frequency of multiple wounds.
October 12, 1918, 1.30 A.M. ..............................................Ward 29
R-------, A-------- G. .........................................Serial No. 12157005
Pvt., Machine Gun Co., 131 Infantry.
Duration of injury, 7 hours.
I. G.S.W. right thigh, perforating, involving knee joint. Complicated by gas infection. Débridement about half the extensor muscles of thigh. Wounds of entrance and exit in knee joint debrided, joint irrigated with ether, capsule closed with chromic gut. 8 C.D.(17) tubes.
II. G.S.W. lateral aspect right buttock, extensive area of skin and fascia lost. Débridement. 6 C.D. tubes.
III. G.S.W. right calf, outer side. Small éclat(17) removed. Dakin dressing.
IV. G.S.W. right leg, perforating. F.C.C.(17) tibia middle and lower third, extensive loss of bone substance. Anterior tibial vessels severed. Débridement. 5 C.D. tubes.
V. G.S.W. middle right leg. Small éclat removed. Slight notch in anterior edge of tibia. Débridement. I C.D. tube.
VI. G.S.W. hand. Iodine dressing.
October 12, 1918, 2.30 A.M. ..............................................Ward 5
K--------, C-------..............................................Serial No. 1388750
Pvt., Medical Department, 131 Infantry.
Duration of injury, 20 hours.
G.S.W. right leg, perforating, made by éclat. Massive gas gangrene. Amputation mid thigh.
Evacuate. ..............................................MAJ. SHIPLEY.
October 10, 9 P.M...............................................Ward 22
K--------, S--------..................................Serial No. 1388656
Pvt., CO- M, 131 Infantry.
Duration of injury, 12 hours.
I. G.S.W. left knee, penetrating. Large éclat in joint, F.C.C. head of tibia. F.B. removed. Atypical resection of joint. Cavity packed with ether gauze. Splint applied by Lt. Morris.
II. G.S.W., penetrating face, tongue, and lower jaw, anterior to angle. Trajet through left cheek, tongue, and into right cheek. Large éclat removed from right cheek. Counter drainage.
Hold ..............................................MAJ. SHIPLEY.
The most significant thing in the record of the poor fellow that follows is the date. He was sent over the top on the morning of November 11, after the high officers in command had been notified that the fighting would cease at eleven o'clock.
|(1) SURNAME||(2) CHRISTIAN NAME|
|(3) RANK||(4) COMPANY||(5) REGIMENT OR STAFF CORPS|
|(6) AGE, YRS.||(7) RACE||(8) NATIVITY||(9) SERVICE, YRS.|
|(10) REGISTER NO.||1893302|
|(11) DATE OF ADMISSION.||Nov. 11, 1918.|
|(12) SOURCE OF ADMISSION.||F.H. 321.|
|(13) CAUSE OF ADMISSION.||I. G.S.W. left shoulder, F.C. of acromion process of left scapula. 2. G.S.W. left arm, deltoid region. 3. G.S.W. left forearm, severe. 4. G.S.W. left wrist. 5. G.S.W. left hand. Gas gangrene. 6. G.S.W. right shoulder. 7. G.S.W. left thigh, perforating . 8. Shock, severe. Incurred in action.|
|(14) IN LINE OF DUTY?||Yes, 1, 2, 3, 4, 5, 6, 7, & 8.|
|(15) COMPLICATION, SEQ., ETC.||Nov. 14, 1918. Operated. All wounds débrided. Ether.|
|(16) DISPOSITION.||Died. Cause of death [as above].|
|(17) DATE OF DISPOSITION.||Nov. 18, 1918.|
|(18) NAME OF HOSPITAL, ETC.||Evacuation Hospital No. 8, Petit Maujouy, Meuse, A.E.F.|
|(19) SENT WITH REPORT OF S. & W. FOR||MONTH OF NOV., 1918.|
|(20)||ARTHUR M. SHIPLEY, Lt. Col., M.C., U.S. Army.|
Of the final stages in the treatment of wounds by the Carrel-Dakin method we saw very little. Our function was to perform definitive surgical treatment and then get the men as soon as possible back to the base hospitals for convalescence. Some men left us before they came out of the ether; some stayed with us a day or two; some a week; some few, still longer. At Evacuation Eight they were loaded aboard ambulances and carried back to Paris when we were at Juilly; to Souilly, the railhead, when we were at Petit Maujouy---and there put aboard hospital trains and rushed down to the base hospitals in the middle and south of France. For most of them, probably, the long weeks at the base obliterated all memory of their brief stay with us. Yet those few hours with us were terribly significant. "The evacuation hospital, plus the mobile hospital, and the mobile surgical unit, . . . constituted the hospital for early surgery; upon it, to a very great extent, the patient's life and limb depended."(19)
Juilly. The Champagne-Marne and the Aisne-Marne.
AN evacuation hospital never receives a steady inflow of wounded. Armies do not advance in tidy, evenly apportioned distances day by day, but by desperate sallies and spurts, between which they lie quietly but ominously at rest, gathering strength for another effort. The Argonne came near being a slow, steady, inexorable advance, with a fairly certain number of wounded to be counted upon each day, but even in the Argonne we had periods of inaction.
For nearly a month after the twentieth of June we received few patients. The assistants in the operating rooms continued for some time to report for duty, spending the days quietly rolling bandages, burnishing instruments or copper sterilizers, mopping up floors, and putting everything in readiness for the expected drive. Then, a few at a time, they were sent back to report for detail---such tasks as policing the grounds, carrying and storing equipment, working in the sisters' kitchen and our own, or digging graves. Only a skeleton force was left to manage the machinery of the receiving ward and the operating rooms. Time was thought to hang so heavy on our hands that occasional roll calls, inspections, and drills were again instituted. Pay day came on June 17, inspection on June 20. By June 24, at least, hikes and drills were on again, for I find in a diary a record of "hike, drill, and fatigue" on June 24, 27, and 28, with a remark about a big laugh on a lieutenant (name not mentioned) who had the whole company do "left-front-into-line over a high bank and tomato plants."(20)
For one group of men---the ward orderlies---the lull made little difference. Some of the emergency wards had been entirely evacuated, so that we were caring for considerably fewer patients than we had had earlier, but as we began to receive fewer wounded, we were naturally not in such a hurry to evacuate, and so, during the lull, our work assumed something the complexion of that of a base hospital. The patients we retained were generally desperately wounded: fracture cases, amputations; abdominal, chest, and head wounds. They required constant and tender attention. Many of them were quite helpless and had to be fed and bathed like infants. Soon after breakfast the surgeon appeared and the dreadful ordeal of dressing the wounds began. The nurse accompanied him from cot to cot, an orderly pushing along a white-enameled cart bearing fresh sterile dressings, Dakin solution and tubes, bandages, and the necessary instruments. The orderly would cut the bandages and lay bare the great wound. The surgeon, equipped with sterilized gown and gloves, would pull out all the old packing and tubes, often having to probe deep with the points of his instrument. Then he would swab it out with a gauze sponge soaked in Dakin solution, push new tubes and gauze back into it, and the orderly would replace the bandage. All this caused the patient excruciating agony. The wards in the morning, when wounds were being dressed, were dreadful places. It was in the first dressing that the wounded realized the extent of their injuries. Sometimes a poor lad found out then for the first time that he had lost a leg, the absence of which he had been unable to feel. They tried to be brave, but who could quietly endure that pain after such long sapping of his strength? One who had never worked in the operating room would suppose, to read of what was done there, that the daily witnessing of such work would have subjected the observer to greater nervous strain than that of any other department of the hospital. But I think it was not so. The patients in the operating room were unconscious, inert. One never felt as though the knife hurt them any, and the deft technique of the surgeon filled the observer with such admiration that he soon forgot the nature of the stuff this artist was working on. So, too, such experiences as burial details, after the first shock of horror at touching a corpse was forgotten, were grim but not painful. However much these poor chaps might have suffered, they felt nothing now. After one or two experiences of carrying amputated legs down to the incinerator, it was impossible to get a thrill of horror out of such commonplace events. Indeed, we developed a most unbecoming levity with regard to them. But in the wards one was in constant contact with dreadful agony, which expressed itself in irrepressible moans and shrieks. One had to deal with cringing fear, with unreason, with selfishness, in a spirit of charity that always saw these men as not masters of themselves, but drained of their strength and courage. One had to be ready to give endlessly those unpleasant attentions which bedridden men demand. I never worked for any length of time in the wards, but what hours I did spend there gave me a deep respect for the ward nurses and orderlies, who, it seems to me, had the hardest job of any of us. It was not sufficient for them to be deft, careful, untiring; they had also to be patient, encouraging, and tender.
I shall insert here as an interlude an account of one of the poor lads who was with us during this period. It was written in February, 1920, long before this book was ever planned, and repeats many things which I have already said or shall have to say. I print it, however, almost without revision, because its unity is all that makes it worth reading, and because the recollections it contains are so much more detailed and accurate than anything any of us could achieve now.
HERBIE---AN INCIDENT OF THE WAR
I FIRST saw Herbie a week after I started work in the operating room at the old Collège de Juilly, during the last of the Belleau Woods fighting. I was new enough to it then so that I saw him as a human being rather than a case: a big, well-built lad of nineteen,(21) but pale and thin, with very clear blue eyes and closely cropped blond hair.
He was wounded in the knee, a serious wound, but not so pressing as some of the other cases. He lay nearly all day on a shaky old French litter on the tiled floor outside the operating room, waiting his turn. Once I found him shivering and tucked the blankets in around him. It was about four in the afternoon when he was finally brought in.
I took down the record for the operation. The boy's last name was German; his first name, Herbert. He was, as I have said, only nineteen. A marine. He had been wounded sixteen hours previously. His voice was high pitched and rather unsteady; he was clearly frightened by the operating room. That was hardly to be wondered at. Operations were under way on the tables at either side, and the room ran with blood and reeked with ether. My white gown (at Juilly even surgical assistants had luxuries) was covered with blood stains. In that gown, with a piece of bandage tied around my forehead to keep the sweat out of my eyes, I must have been a terrifying spectacle. Yet he would have died rather than admit that he was afraid. I saw the dumb appeal in his eyes as I helped lift him on the table, and slid my hand into his. He looked up at me gratefully. The nurse started to put the ether mask down over his face. His voice shook a little.
"You'll hold my hand and see me through, won't you?" he asked.
That was how my friendship with Herbie began.
The operation proved to be long and difficult. The missile was a jagged piece of shell nearly a centimeter each way, which had penetrated the joint cavity. Once the major threw it out, but it slipped back again. But he found it again, and dressed the wound. I took the dictation. I do not know why I should remember that dictation, but I do, as well as though I had written it yesterday.
"June 16, 1918. Herbert H-----, 15th Company, 6th Machine Gun Battalion, U.S.M.C. Duration of injury, 16 hrs. G.S.W. right knee joint. Missile entered from popliteal space, traversing between outer hamstring tendon and the notch of the condyles, lodging in the joint cavity. External arthrotomy. Piece of shrapnel 1 x 1/2 x 3/4 cm. removed from the joint cavity. Débridement. Joint irrigated with Dakin solution and left open for drainage. 9 Carrel-Dakin tubes in posterior wound. Hold. Major Shipley."
I helped to carry the boy, limp and hardly breathing, to the ward, and put him in bed. Ward B was the best in the hospital. It was a long bare room with whitewashed plaster walls, and a floor of red tiles, with long windows, overlooking the old stone-flagged central courtyard of the Collège. I had to pass through it on my way to the operating room, and I always used to stop to speak to Herbie when I could.
He could not sit up, but had always to lie flat on his back with his leg in a long aluminum splint. When our work slackened toward the end of June, I used to sit by his bed and talk with him. Sometimes I wrote letters to his dictation: letters to his mother, his aunt, his sweetheart---"The little lady," he called her. In those letters he repeated over and over that he was getting along well, was feeling better, and would soon be out of bed.
It was not true, for his case went badly from the first. The joint was badly infected, and kept getting worse: a slow, obstinate infection which sapped his strength. He had apparently been on the verge of a physical breakdown at the time he was wounded, and could seem to rally no strength to throw off the infection.
In our talks I learned a great deal about his history. His father was a successful business man in a mid-western city. There was only one other child, a brother. His people were of German descent; his grandmother spoke no English. His parents had not tried to dissuade him from joining the marines. He had been personal orderly to an officer, a major, and at the front had served as a runner, carrying messages for him. He had gone through two weeks of the horror of Belleau Woods, seldom getting anything to eat, and keyed up to a dreadful nervous pitch, for he must have been by nature timid. He had had none of his clothes off for the sixteen days before he was hit. On that morning, he, his major, and three other men were crouching in a shell hole. A shell landed on top. of them. The major and two of the men were killed outright, and the other man died very shortly afterward. Herbie said that he had not been killed because he had been praying just before the shell struck.
The days went by, and Herbie got no better. Twice he had to undergo reoperation because of the infection. I was off duty both times, but because it seemed to steady him, I came back to help. He feared an amputation both times; dreaded it literally worse than death.
After the third operation his cot was moved to the windowside so that he could see the men hurrying around in the courtyard below carrying the wounded on litters, or loading the convalescent into ambulances for evacuation. On one of the old towers opposite was an ancient clock. He used to watch the slow progress of its hands all day long. I remember that one day an elm branch swung in between, and I found him almost in tears because nobody would heed his request to move his cot a few inches. A boy of nineteen, thousands of miles away from home, terribly alone, and facing the probability of death, what did he think, as he lay there for weary hours and days, watching the lacy boughs of the elms spatter the flags of the courtyard with arabesques of light, which shifted and faded as the hands of the clock crawled around?
In Juilly was one little fruiterie, where, for exorbitant prices, one could occasionally buy fresh fruit. One day I got a pound of big cherries for him. When I poured the beautiful red things out on his blanket, he looked up startled, struggled manfully for a moment to keep down his emotion, and then his eyes ran over with tears. He said nothing to me, but I felt sick with shame as I realized how casual the gift had really been.
On the fifteenth of July the Germans attacked furiously, and three days later we launched the counterattack which kept them retreating to the end of the War. Several surgical teams were detached from our hospital, and I was sent along. I was gone three days. I came back half dead, and found our hospital crowded with wounded. It was three days more before I could go to Herbie.
I stumbled down the ward, and brought up with a start of surprise. Herbie's bed was empty. At first I was disappointed, and then glad, for it came to me that he must have improved sufficiently to be sent back to the base. On the way out I stopped to speak with the ward nurse, Miss O'Toole, a tall, thin, gray-haired Bostonian, who had gone from a holiday at Nice to four years' voluntary service with the American Red Cross. I knew that she was fond of Herbie.
"So they evacuated Herbie?" I asked.
She looked up, startled. Then her eyes filled---and it takes a great deal to make a woman cry after she has been seeing men die almost every day of her life for four years
"Herbie died yesterday morning," she said.
From the ward orderly I learned afterward the story of his death. On the night of the twenty-first the infection started a hemorrhage. It was almost immediately detected and controlled, but in his weakened condition the loss of blood proved fatal. Every attempt was made to raise his blood pressure sufficiently to make an operation possible, but he never rallied from the condition of shock. He died just before dawn that morning. At that hour I was sound asleep in my billet. At the last, when he had so many things to think of, did he remember me, his friend?
So far as I know, he left just two things. One was a letter he wrote to his mother the night before he was wounded, when he expected to be killed at any moment.
He had kept it with him, and it was in the pocket of his pajamas when he died. It was the most truly pathetic thing I ever saw. You must remember that it was written by a quite normal boy under the expectation of sudden death at any moment. It had the awkwardness which any American boy of nineteen would show in trying to tell his mother of his love, but it told it so even more effectively. At the end he made a little will, giving all his few belongings to different members of his family. The chaplain took that and sent it to his mother. The other thing was one of the small buttons of his uniform which he gave me as a souvenir in the first days of our acquaintance.
A few days after Herbie's death, I walked out to the American cemetery. It was just outside the grim, gray wall of the old French burying ground, beside the cobbled highway, in a wheat field. The wheat had grown up to the very foot of the wall; it was now golden and -almost ready for the harvest, starred here and there with flaming red poppies. From the foot of the wall a lane had been cut in the wheat, and two rows of raw mounds with brown crosses faced each other across a narrow path; all exactly alike except for the name plates. I had to stoop and read several before I found his---number 100. I laid a bunch of already wilting poppies on the mound, and stood a moment trying to grasp the situation, to feel to its depths what Herbie's death meant.
The sun was just dropping below the horizon, sending out dazzling streamers on a level with the eye. A skylark was soaring and singing overhead. A cart trundled by on the cobbled road, and sweet and clear from the church spire came the peaceful notes of the Angelus. The air smelled of the harvest. I could not feel sad. My tired brain would not fix itself on the grave; it wandered off into a blissful apathy. I forgot for a moment the sight of mangled bodies and the smell of blood and ether and gas gangrene. The healing beauty streamed in upon me: the glory of the sunset, the smell of the wheat, the sound of the bell, the song of the lark. I could not grieve for Herbie at all. He was gone, forever; but for me no more gone than the other wounded men who had passed through our hospital for another.
I must have stood there a long time, for presently the dew came down and made me shiver. As I turned away, I saw far on the horizon to the northward a flash like heat lightning, and then, dull and muffled, I heard the thudding tremor of the guns.
Drill and fatigue could not consume all the time. We continued to be divided into day and night shifts, and when a quiet night allowed us to snatch some hours of sleep, the whole of the next day was left gloriously free for adventures of exploration. Juilly itself abounded in pleasant places. There was the great green park, with its solemn trees overgrown with ivy, and the various small grocery and baker shops with their fascinatingly new wares and methods. Round about Juilly the country smiled with great fields of wheat and barley, turning golden for the harvest. Fine broad white roads, shaded with evenly spaced rows of symmetrically trimmed trees, led off in all directions through the grain-covered country. Near at hand, and reached after an entrancing walk through a green park and beside the green little stream that fed the lake of the Collège, was the old Château of Nantouillet, with its moat and crumbling wall and towers of early medieval days, surrounding an elegant Renaissance castle, built piecemeal of the older structure, and itself now falling into picturesque decay. The old gateway still stands, guarding in its niches the battered statues, and one reads over it the partly effaced Latin inscription of the ancient count who flourished centuries before America was discovered. In the old church of St. Denis in the tiny hamlet of Nantouillet (whose floor boasts a slab dated---I hope not mendaciously---A.D. 676) the gentle old curé delighted to display his pathetic sacristy with its massive barred oak door, which could be locked and counterlocked by a great key shaped like a crank. The room had suffered little change but had been despoiled of most of its treasures, though he could still display a fine twelfth-century copper box enameled in blue and green, and eleventh-century tapestries and vestments.
The largest town within easy walking distance (some five kilometers) was Dammartin, whither we often made pilgrimages. The road thither led through the most beautiful scenery---grain fields, meadows, little streams, wooded slopes, and many solitary trees festooned with mistletoe. In feudal days the Count of Dammartin had ruled all the district about Juilly. The castle was destroyed in the seventeenth century by order of Richelieu, but the tremendous mass of its ruin rises up like a fort, a great flat-topped mound with a circle of trees on the summit. Within, the ruinous passageways and corridors served as a bombproof shelter for the citizenry of the town. There were scores of other delightful walks-St. Soupplets, for instance, where the "Coq d'Or" lured us with its occasional chance to purchase a supper of something different from army fare, to reach which we passed through the hastily built trenches and fortifications of the first Battle of the Marne, with the many solitary graves of the nameless heroes still dotting the woods and fields where they fell. Montgé and St. Mard were near at hand; farther off were Meaux, Claye, Paris itself. We were within twenty-five kilometers of the French capital, but strange as it may seem, very many of us never set foot in it. During all the time we were at Juilly, I believe not one enlisted man was given a pass to go to Paris except on some official errand, real or fictitious. There were, however, as might be expected, many surreptitious leaves.
No memories of the past can be more charming or gracious than those of these sunny quiet walks which we took alone, or in the company of some especially intimate comrade, chatting as we strolled along, or lying silently for long moments on the grass under the trees as we fared forth on these adventures of finding somewhere a spot so far overlooked by the American Army, where one could buy eggs, French fried potatoes, coarse, sweet rye bread and butter, and experiment with new and wonderful beverages. Occasionally one could rent a bicycle, and then the quest went further afield. One of these bicycle adventures was so amusing that it deserves recording. Two members of the company hired bicycles from a somewhat furtive blacksmith in Juilly, and departed in high spirits for a tour. As they passed through a small village near Juilly, a young man spied them, gazed a moment in amazement, and then, with agonized shrieks, raised the townspeople, who surrounded the amazed tourists and prevented their further progress. An important looking person in uniform, who appeared to be the police force, arrived, listened to the young man's shrieks, and put certain questions to the Americans, which they were unable to understand as they spoke no French. Then the mayor arrived and things got even more exciting. The Americans were indignant at this unreasonable detention; the French firmly insistent that the Americans should not depart until they had arranged matters with the young man. At last a native who spoke a few words of English was obtained, who, with the help of the few words of French at the command of the Americans, made it clear that one of the bicycles they were riding was the property of the young Frenchman, and that he had taken it to the blacksmith at Juilly for repairs. Seeing it in the possession of an American he not unnaturally concluded that it had been stolen. The real culprit was the blacksmith, who had been earning a dishonest penny by letting it out unrepaired.
The French people, civilians and soldiers alike, were extraordinarily easy to get acquainted with in those early days of our active participation in the War, before suspicion and disappointment had spoiled the beautiful idealism which possessed us both then, or destroyed the affection that really existed between us. The civilians were kindly, frank, and generous; the soldiers touchingly humble and friendly. There was nothing of the supercilious superiority which we should certainly have displayed toward a foreign army in our own country. The barrier of language prevented the development of many intimacies that otherwise might have flourished, but some of us cherish warmly the memory of brief friendships made with French soldier lads during their stay in Juilly. "I have a Croix de Guerre," says a letter, "won at the Battle of the Somme by a French artilleryman whom I came to know here---a splendid young chap about my own age. Of eighty men who started the war in his company, only five are left. I walked with him every evening for a week, and talked with him as well as I could. One night he told me that he had been ordered back to the front. I felt as though my best friend were going. Then, with some embarrassment, he said he would like to give me something, 'as a souvenir.' He unpinned his Croix de Guerre and gave it to me. Of course it didn't cost much, but it must have been pretty nearly priceless to him. I saw that he really wished me to take it, and I did. At the moment, I would have given my right arm cheerfully for the right to wear it. Then I have a piece of cloth from a German plane, with the names of several other French soldiers written on it, a souvenir from a detachment from an automobile division I used to visit evenings at their billet. And they're gone too. I think the French soldiers are wonderful."
As I read this over, it seems to me that I have exaggerated the difficulties put in our way by difference of language. Most of our Americans got along perfectly well without a word of French. Soon after our arrival at Juilly the whole company was thought to be so alarmingly familiar with certain members of the French community that we were ordered to be confined strictly to quarters for a week. The experiment in enforced virtue was not, I believe, a success.
Our chief excitement during this period was furnished by air raids. As a matter of fact, no attempt was actually made to bomb the hospital during our stay there. But the German planes on their way to bombard Paris passed almost every night directly over Juilly, and the antiaircraft guns always took a shot for luck. What goes up must come down, and one can be killed quite as neatly by a fragment of his own shrapnel as by the enemy's. About midnight we would be roused by the firing. Then, high overhead, we would hear the unmistakable drone of the heavily-laden German bombing planes, so different in their sound from ours or the French----Br-r-r-r-R-R-R! Br-r-r-R-R-R! Br-r-r-R-R-R! Then the searchlights would crisscross the sky like mad, and the guns would roar wildly. At such times, stay indoors! I suppose sometime during the War the antiaircraft guns must at least once have scored a direct hit. But I have seen and heard tons, literally, of shells fired at German planes without the slightest damage to them. I am told, however, that the antiaircraft guns were highly useful, for though they did not bring the planes down, they forced them to fly much higher, and thus spoiled the accuracy of placing bombs.
As air raids were the nearest we ever came to being under fire, we naturally made as much of the experience as it would stand. Indeed, rather more. Some truly remarkable yarns were sent home, including one which I believe is here for the first time recorded in its complete unvarnished truth. One night, during heavy firing from the antiaircraft guns, Mr. St. Clare, our Y.M.C.A. chaplain, looking out the window at the officers' billet, saw, in the window directly below him, a certain base-hospital major, then on detached service with us. The major combined a loud voice and great excitability with considerable honesty and amiability. At that moment, he was craning his neck wildly, trying to see the German planes. Mr. St. Clare stealthily retreated, took from his stores two or three large round lemon candy drops, and leaning carefully out threw them past the major's head. Bang! In popped the head, down slammed the window, and great excitement prevailed. The next morning at breakfast, the major entertained the company with a thrilling story of his narrow escape. More than that, he wrote home an extended account of it, which was published in a San Francisco newspaper. I suppose he is still talking about it. At any rate, he thinks he is telling something like the truth, which cannot be said for some of the lurid yarns we sent home.
On July 4, the French residents at the Collège arranged a most gracious celebration of our national holiday. The pretty little hectographed program, of which I have a copy before me, is headed by a sketch of some of the buildings of the Collège, and at the bottom a rather inadequate American soldier stands against a background of ocean and a rising sun, lifting his helmet
in greeting. The program is as follows:
The "Cérémonie Religieuse" is thus described in a letter: "We formed in line at 10.30 and marched to the service in the college chapel, a most beautiful place. A French regiment had lent their band for the occasion, and the sanctuary was decorated with French and American flags. After we had all taken our seats, the procession of ecclesiastical dignitaries came down the center aisle, from the rear. I had not learned who was to officiate, but I had supposed it would be the local curé. He came, however, near the head of the procession, with a whole company behind him, getting more and more splendid all the time, until finally we saw, bringing up the rear, the Bishop of [Meaux], unspeakably impressive and reverend with his long beautiful cope, his mitre and crozier, a splendid old man with a voice like an opera singer. He presided at the solemn high mass which followed, and made an address to us in French. They tell wonderful stories about him---how he refused to leave his city when it was evacuated before the Germans in 1914, but stayed and protected the few of his people who remained.
"After the service, we formed again and marched to the cemetery. At the head of the procession went the band, then the colors of the Allies: American, French, British, Italian, and Belgian, all of which except the Belgian were carried by members of our company born in the country whose flag he was bearing. At the cemetery the Bishop made another short address, and our chaplain also spoke. The graves had previously been decorated with American flags and bunches of flowers. That part of the service over, we returned to the square before the village church, where the band played 'The Star Spangled Banner' and 'The Marseillaise.' Something happened then which all of us who noticed it regarded as beautifully symbolic. Our flag was carried by the tallest man in the company, and it soared way above the others. As we stood at attention during the playing of the anthems, the wind caught it and swirled it around the French flag, completely enveloping it. When the music stopped they dropped apart."
Grand as the service was, it is probable that many of us missed the full extent of its significance. The average American soldier was an aesthetic barbarian, and in no respect more frankly barbarous than in his attitude toward Catholic ritual and symbolism. I remember the remark of one of our wounded men on the day of the celebration. Catholic bishops, even Bossuet's successor, meant nothing to him, but he was intimately familiar with the great bottles of rosy-tinted Dakin solution which went by his bed several times a day. As the good old bishop in his purple cassock went through the ward, speaking kindly to the boys and distributing little crucifixes, this irreverent person called out in a loud voice, "Who is the old boy in the Dakin-colored robe?"
The "jeux sportifs" of the afternoon are best recorded in the exact words of a diary before me: "Fine dinner: mutton, peas, potatoes, pie. Ran relay in P.M. and French won. Sat with Miss ----- during ball game. Duty at 7.30. 8.00 P.M. boys gave musical entertainment until 10-30 P.M. Went with Miss ----[a different lady from that of the afternoon]. Ward A had movies."
On July 14 (a Sunday) we returned the favor of Independence Day by celebrating the French national holiday. I was sick at the time, and have not the slightest recollection of what took place. A diary says, "big celebration and ball game for the French Bastille Day"; another, "dinner: steak, gravy, cakes, jam, ice cream---made me think lots of home. [I certainly don't remember the ice cream. Is it possible that by being sick I missed the one occasion on which it was served in our company?] Saw French service in afternoon. It was very impressive. Taps blown for both French and American soldiers. Rested most of afternoon, and at night went to church. Text Romans 9.8. Talked of social progress and dance for us on Monday evening."
Does it sound shocking to read of the personnel of a war hospital planning a dance while the wards are full of wounded men? It certainly shows one thing: that the hospital had become very quiet. As a matter of fact, there had already been a dance. A diary records it under date of July 13 (the previous evening): "Cloudy, but stood inspection, then played tennis, Miss ----- and Miss ------. Had good dinner, beef stew, mashed potatoes, peas, jam. Sat around during P.M. reading and writing. Officers gave nurses a dance. I was a silent watcher, but couldn't join. [Enlisted men cannot mingle with officers on terms of social equality.] Better times coming, said I."
The fifteenth was declared a holiday, as far as possible, so that everyone could get ready for the dance---the first that any of us had attended in months. We scrubbed ourselves and brushed our clothes, and a festive air prevailed. But the dance never was held, for the Germans upset our plans. Early on the morning of the fifteenth they launched their last and most determined offensive, the "Peace Battle" which was to end the War with a German victory. It involved a concerted attack along the Allied line from Château-Thierry eastward and southward, the object being to cross the Marne, cut off Reims, and drive the point of the salient as far south as Châlons, about one hundred kilometers to the east of us. In some of the most brilliant and heroic fighting of the War, the French and American troops foiled the assault, which succeeded in getting a foothold across the river in only one short portion of the line. But to repulse so overwhelming an assault meant dreadful casualties. On July 18 the French and Americans made a vicious counterattack, not opposite the point of the German advance, but on our side of the salient, from Château-Thierry northward and westward, the main thrust being in the direction of Soissons. If this attack succeeded, the Germans would be forced to evacuate the entire salient between Reims and Soissons. It did succeed, and from July 18 to the end of the War the Germans were in retreat. So, by eight o'clock, when we had expected to be starting the grand march, we were carrying in the wounded, who were arriving in unprecedented numbers.
I shall take the liberty to describe the care of the wounded in the great Marne battles of the summer of 1918, by means of a letter written by a member of the company who was not at Juilly, but on detached service at Coulommiers. I do this because this letter, which he wrote on his return, is fuller and more graphic than anything which I have describing the work at Evacuation Eight. Much of it is intensely personal, and in no way a history of the experience of the whole company, but in tone and atmosphere it is representative. And it seems to me that this elusive inner core of experience is more important in our record than the bare outward details of chronology.
Since we had set up at Juilly, the American front line had not changed to any extent, but other hospital units had established themselves in localities more directly south of that part of the line which bore the brunt of the offensive. When the German attack was launched, the first great wave of wounded reached these hospitals and threatened to swamp them. Evacuation Seven and Mobile Unit One were at Coulommiers. In response to their appeals for assistance, two surgical teams were detached from Evacuation Eight to help them out.
". . . I was sent on detached service with a surgical team to a hospital nearer the front. There were two teams of us---four surgeons, four nurses, another enlisted man, and myself. I was ill with a severe attack of tonsillitis at the time, but, as I thought I might get nearer the front, I said nothing about it, but rolled my pack and reported to go. We traveled about thirty kilometers in a Ford ambulance, leaving about supper time. I wish you could see these French roads. They are broad, hard, and straight, generally provided with a curb, white, always clean, and always lined with evenly spaced rows of symmetrical pollarded trees---sycamores, horse chestnuts, or lindens. We had hardly started when we ran into what seemed like an endless line of trucks filled with soldiers headed for the front, an unbroken procession of huge Army camions stretching back for miles, each one about thirty feet behind the one in front.(22) The sun was going down in one of the most gorgeous sunsets I ever saw. Our road ran through broad fields of wheat, now yellow and ripe, dotted here and there by solitary crosses, which mark the graves of poor French lads who were buried where they fell in 1914. And moving past us endlessly that stream of great brown trucks filled with brown clad men, like the endless belt of some great machine, feeding them into a gigantic hopper. As the glow of the sunset faded and the dusk came on, the dusty brown uniforms blended with the brown of the trucks, and one might not have realized that they were filled with men if he had not seen occasionally the flash of white teeth as they spoke to one another.
"We had better than thirty kilometers to go, and our driver wasn't sure of the road. It was ten o'clock and quite dark by the time we reached our destination. We drove through the unlighted and quiet streets of a town ---whether large or small it was impossible to say---climbed a steep ascent, and stopped before a building on the hill top which, from its mass and the dark shadow of a grove of trees behind it, seemed to be a mansion of considerable importance.(23) We walked up a graveled driveway with trampled hedges and flower beds on either side, up two or three broad stone steps, and into a dark hallway. There was not a ray of light, and we stumbled over something that moaned with pain. The floor was covered, except for the narrowest of passageways, with litters on which were wounded men. We turned to the left, toward a door around which could be seen a narrow chink of bright light, pushed it open, and, shutting it quickly, paused a moment to gaze at one of the strangest sights man ever beheld. Two units were at work here on this hill top, an evacuation hospital, and a mobile unit or 'auto-chir.' This was the operating room of the evacuation. It was evidently the most splendid parlor of the château; a fairly large room, elaborately decorated with a hand-painted landscape frieze, and had, at the side opposite the entrance, a fireplace with an immense rococo mantel and mirror. Now it was jammed full of operating tables, and several teams were hard at work. Bloody gauze and towels were everywhere---on the floor, in the fireplace, simply trodden underfoot. The rush was so terrific that the orderlies had had only time to mop off the top of the table as one man was carried out and another brought in. There was no electricity, the light being furnished by portable acetylene generators, bubbling smelly tanks which stood on the floor beside each table, with a bare jet of flame at the height of about five feet. The shutters (which must have been made of solid plank) were all tightly closed for fear of air raids, and the air was terribly close, reeking with ether and acetylene, and shimmering with the heat. To one slightly light-headed with fever like myself, the room was an impossible nightmare of unearthly shapes: silent and prostrate forms cumbering the tables, tense and busy groups of surgeons and nurses with their ghostly white gowns and ghoulish gloved hands, like black claws, wielding the glittering little instruments in a silence broken only by the oppressed breathing of the men under the ether, the click of the instruments, and occasional curt commands.
"I had to assist for two tables. We started with a patient. I held his arms as he went under the ether, and, as I did so, gazed uncomprehendingly at what was going on at the next table. The surgeon there (a man with an unpleasantly loud and cheerful voice) had amputated one of his patient's legs and was starting to amputate the other. For some reason, he had had the patient laid on the table with his feet where the others' heads were ' . It looked to me as though he were amputating the man s head, which at the time did not seem in the least surprising. It came over me that I was about to faint. But there was no one to pay any attention to an assistant with a silly case of tonsillitis while all these desperately wounded men waited. Besides, the anesthetist just then had her hands full, and all the others were scrubbed up. And if I let go the patient, he might struggle and throw himself off the table. So I stood, holding his arms, hoping that if I fell I should go across his chest. Everything went black. I could see nothing, though I could hear the talking and the vicious gritting of the haemostats. Suddenly the lights came back with a blaze, and I was out of it. The major, seeing me sag, had flopped me down on a stool and pushed my head between my knees. He had just got himself ready to begin the operation, and in touching me broke his asepsis, which quite properly annoyed him. He told me to go out doors and stay there until I was steady enough to be of some use. I stumbled out through the hall (tripping over the wounded men again), and collapsed on the grass in front of the château. Then I got up, crawled into the hallway, found my pack and belt, and drank some aromatic spirits of ammonia. It tasted vilely of the rubber stopper of the flask, but seemed to have no effect at all. I thought that if I walked about a bit it might steady me. I skirted the side of the château, and had just got well around into the trees behind, when BANG!! a terrific explosion almost lifted me from the ground. A German plane had dropped a bomb within a hundred yards.(24) In the interval between that bomb and the next, I heard the motor of the plane right overhead. Then a battery of antiaircraft guns opened fire. They were so near that for a moment I thought it was more bombs. I was standing beside a good sized oak tree, and I remember that I embraced it firmly. What good I thought it would do me, I don't know. The German dropped two more bombs, neither so near as the first, and departed. The shock had cleared my head completely. I went back to the operating room and worked without stopping until noon the next day. Just before we went off, a patient died on the table. I helped carry him to the morgue, a small white tent on the lawn. It stood quite in the open, under the direct rays of the scorching sun. Before we got to it, I could hear quite clearly the heavy buzzing, like that of many swarms of bees, made by the hordes of flies that filled it. We went off until seven that evening. I hunted up a stretcher and pulled it into an empty ward tent on the lawn. The tent was one of those fussy English contraptions with three great poles, and peaks like a circus tent. It was made of glaring white canvas, and lined with flaming yellow. It seemed to me that every ray of the blistering sun came through to torture me. Officers and men coming off duty or going on again were continually passing by and talking. I lay in a heavy stupor, unable to sleep, and yet got some rest.
"When we went on duty again it was with the mobile unit. All their equipment was in tents, or on wheels. Their kitchen was on wheels, their sterilizer was a truck, and a portable generator furnished electric light. The operating room was a long tent with twelve tables in a row. A person who had not seen it would be unable to believe that so commodious and efficient an operating room could be set up in a tent.
"We worked twelve hours this time---until seven the next morning. My knees soon gave out completely, so that to bend them hurt me as though I had rheumatism. I walked stiff-legged. I was the only orderly for two teams of surgeons, but I managed to get through somehow. I remember only one thing that happened. I tried to remove the wet and matted hair from the head of a poor chap with a scalp wound, first using a pair of dull scissors, and then a pair of duller clippers. The clippers (which I hadn't the slightest idea how to use) stuck in the hair so that I had to unscrew the blades to get them out again. I must have almost scalped the patient, but he made no protest, though he looked rather reproachful.
"This time we had twelve hours off, but again I had no luck in getting to sleep. The heat was as bad as ever, and as soon as I stretched out my legs, my knees would cramp and force me to sit up. We went on again at seven, but about midnight the supply of wounded ran out. I got a bloody stretcher, covered it with a blanket, and lay down on the operating room floor. I was just dropping sweetly off to sleep when an orderly waked me and made me get up so that he could scrub the floor. But I got to sleep again and rested a lot. We went on again the next noon, and worked until six, when we received orders to report back to Evacuation Eight. So back we came, to find our own hospital as jammed with wounded as those with which we had been working.(25) The ground space of the great cobble-paved courtyard was literally completely covered with wounded men, some lying on stretchers, and some sitting. You found them everywhere---lying in corridors, sitting on stairs, filling the wards, patiently waiting for attention. We had four awful days, but we seem now to be pretty well cleared up.
"I have run some of the impressions of that first night at the château together into a few lines of verse. Would you like to see them?"
THE MAN ON THE TABLE
Château Montanglaust, Coulommiers, July 15, 1918
THERE were four of us there by ourselves, the tired-faced nurse and I,
And the man on the table who lay with his teeth tight shut on a cry,
And the surgeon who turned to his task with a weary nod and a sigh.
For the man on the table was young, with a pain-twisted boyish face,
And rounded and smooth were the lines of his long naked body's grace,
Like the slender forms of the youths round the curve of a Grecian vase.
As I held his hands till he breathed through the ether mask deep and slow,
I saw as a dream the walls of the room in that old château,
With the elegant woodland frieze, and the fireplace carved and low.
But now, how the room was filled! White tables, white figures between,
And the thick air shook with the heat of bare flames of acetylene,
And reeked with spent ether fumes, and the stench of the gas gangrene.
My heavy head throbbed and burned; there was not a breath of air,
And great black circles wheeled, and met my eyes everywhere,
And I felt myself slipping and falling, but something held me there.
For I saw how the nurse's eyes, in spite of herself, would close,
And the surgeon's face set like a mask, though his busy hands fell and rose,
And I knew they were tired as I, who was weary to death, God knows.
Then I heard my voice, far away: "His pulse is bad, sir," it said,
And the surgeon lifted his eyes, then "Pulse! Great God, man, he's dead!"
And gathered up in a heap his instruments, sticky and red.
Then he stripped off his gloves and his gown, and said, "Get him out in the hall";
And the nurse said, "Cover his face up," and I said, "Look out, men, he'll fall";
But the man on the table lay still, and smiled, and said nothing at all.
We received greater numbers of wounded during this drive than at any time previous. But our service was now better organized, and the routine operated more smoothly. An extract from a diary will serve to indicate the mixed spirit of idealistic altruism and matter-of-factness which characterized the greater part of our war work. Caring for wounded men becomes a job like everything else, and to carry on this job efficiently for a long period demands a reasonable attention to one's own physical and mental health. This diary was, of course, never intended for public inspection. But the naiveté of its entries is therefore all the more illuminating.(26)
(Diary A.) "Monday, July 15. Played tennis until 11 .00 A.M. [This man was on night duty.] Beaten once, but did not play to finish. Holiday for all the boys. Slept some. Took shower and got ready for dance. Alas! 7.00 P.M. Evac. 8 luck. Dance called off account of big drive. From 8.00 P.M. carried our boys from Battle of Marne to operating room and then to ward.
"Tuesday, July 16. 4.45 A.M. carried the last poor mate to operating room. News said Huns had crossed Marne, but were pushed back. Slept 5.00 to 7.00 A.M., then [I suppose after eating breakfast] slept all day, as I was very tired. Got up for dinner and supper. Reported at 7.30 P.M. Carried a few patients, then slept after supper [at midnight] of pork, bread and butter, lettuce, and cocoa. [This midnight mess was-prepared by the sisters, and served in the refectory of the Collège itself.]
"Wednesday, July 17. Up at 7.00 A.M. Sat around and talked. Germans at Marne had advanced ten miles, but losses were great, and victory conceded to U.S. To bed after dinner and slept until 6.00 P.M. Reported for duty. Nothing to do. Slept until 12.00, then supper. 1.30 A.M. called and helped with man in A Ward. He died, then I slept until 7.00 A.M.
"Thursday, July 18. Played tennis with B. and lost 6-3, 6-2, 6-4. Slept well until 4.00 P.M. Company had dance, but did not go, account of big rush of our boys. Some had legs amputated, and litter bearing in an operating room is surely some job. Took delight in helping to make the boys comfortable. Had supper at midnight, beef, lettuce, and bread. Then back to work.
"Friday, July 19. Reported off at 7.30 A.M. and was surely tired, sick at stomach, etc., and went right to bed. Good news says we drove the Huns back six or eight miles. Up at 6.00 P.M. Worked hard all night carrying. Saw some mean wounds. Had no time for supper at midnight. Court filled with wounded.
"Saturday, July 20. Did not report off duty until 1.00 P.M. after strenuous time all night. [At least eighteen hours of lifting and carrying wounded.] Slept three hours after reading letters from home. Worked hard evacuating until midnight and was about all in. Finished work after a big night. News says our boys are still going ahead. Received six more letters.
"Sunday, July 21. Breakfast, oatmeal and bacon. To bed very tired and weak at 8.00 A.M. after short prayer. Up at 6.00 P.M. Went to church in Ward F. Grover [Walters] read text, Mark [John] 14: In my father's house, etc. No patients came in, so talked with nurses until midnight, then had supper, and to bed on litter, very tired."
This strenuous-week completed our busy work for the summer. From then until we left Juilly, our days moved on in the sleepy routine into which they had settled before the Marne battles. The wards were still well filled, but the receiving office and operating rooms might almost as well have been closed, and in fact one of them finally was. Diaries speak of bicycle excursions, attempts at making ice cream without ice, movies, entertainments by infantry bands passing through, and inspections, besides such work as cleaning instruments, rolling bandages, and burying the dead. Whether we admitted wounded or not, we had a few deaths nearly every day. Our living conditions were by no means as comfortable as they had been during the sunny days of June. From July 23 to August 6 it rained almost continuously. The French farmers were then just ready to harvest the glorious fields of grain which had been ripening so auspiciously. With cruel persistence the rain continued to pour, soaking down again and again the soggy and blackening harvest which the peasants---more than half women because most of the men were at the front---strove doggedly to save. Our kitchens were still out of doors, so that we often had to stand in our slickers in the downpour for mess. The flies and wasps were innumerable. The wasps had been rather amusing at first when we shooed them away and marveled at their persistence. By this time they had become an intolerable nuisance. They settled down in swarms over our food, and had actually to be brushed off with our hands or fished out with our spoons. There were wasps in everything we ate. One could leave nothing uncovered a moment without finding it filled with wasps. Our open latrines probably furnished most of the flies, and the flies furnished various unpleasant infections. We all suffered from painful stomach and intestinal disorders. Inaction began to get on our nerves, and rumors began to circulate to the effect that we were soon to leave.
The death and funeral of a French aviator created a diversion for at least the fatigue gang. "How do you suppose I celebrated my coming of age?" asks a letter from one of those unfortunates. "In blue denim overalls pushing a cart around and collecting rubbish! Operating Room B is closed until another drive, and the surgical assistants are now in the chain gang. Being on fatigue has brought me one rather memorable experience. A French aviator fell last week a few kilometres from here. A wing of his plane broke off, I believe, and dropped him more than a mile. He was terribly smashed up, they say. He was given a fine military funeral in the village church. The officers of his escadrille were here, and a guard of ten infantrymen, with their rifles. As a mark of respect, we Americans were asked to furnish eight bearers. That was the fatigue gang. We carried the coffin---a plain plank box covered with the tricolor on which rested one great bunch of flowers from his family ---into the church, and up to the altar. His father and mother were there; the father a short rotund gentleman with a fierce moustache, the mother a handsome woman of middle age. She was in deep mourning and wept bitterly, but the father seemed almost unmoved. The service, a high mass of requiem, was naturally all in Latin, except for a brief but very powerful address in French by the curé. We then bore the coffin to the French cemetery. I wish I could give you some idea of the procession. First, side by side, went the little crucifer and an acolyte carrying the holy water. One wore an American trench cap with an infantry button, the other an horizon-blue French cap with infantry numeral. Each wore a white cotta trimmed with lace. Then came the curé and his deacon in their vestments, chanting a Latin hymn, with pauses between the verses. (I strongly suspect that the curé timed the verses by the regularly spaced trees alongside the road.) Then we followed, carrying the coffin on a bier, with five French infantrymen marching on each side; then the father and mother, and the rest of the funeral cortège.
"After a short burial service we lowered the coffin into the grave. The dead man's captain read a panegyric of his military achievements. Then, for the first time, the father showed signs of emotion. One big tear rolled down his cheek and was shaken fiercely off the point of his moustache. The mother gently thanked us for our services. "
Sections from a diary (Diary B):
"August 9. Went to a nearby town and had a three-egg omelet with vin blanc and citron . . .
"August 10. Very little out of the ordinary happened, and in fact things were so quiet that the air was oppressive with its stillness . . .
"August 11. Sunday, and a very peaceful day. It seems anything but the war zone here. I had a very fine bath, and after the evening repast of goldfish, went to the next town. . . . We started for Dammartin, but missed the train, so went to the regular booze joint [a rather cruel name for the café in St. Mard] and played some time on the piano.
"August 10. P.S. From now on each day I will put in the various rumors and their sources, so far as possible. Reported by a nurse that we were moving to Toul very soon. It was also rumored that we were about to leave for Oulchy le Château.
" August 11, 12, 13, 14. Nothing special doing, except on the IA. I washed clothes [in the town lavoir]. Didn't seem to suit the French woman next to me. She took some of my clothes and did them for me. Pay came about 8.00 P.M., but on account of lack of change we were not paid. Probably will be on Wednesday. The latest rumors say either Italy or Toul. Probably neither. "
Our last days at Juilly are well described by the entries in another diary (Diary A):
"Thursday, August 15. Up at 6.00 A.M. Worked little all day, which was warm and bright. Took short walk at night. Bought box of chocolates [from the quartermaster at St. Mard] and to bed at 10.30 P.M.
"Friday, August 16. Beautiful day. Sat around, had letter from home. Played tennis after supper of eggs and good bread and butter. To bed at 10.00 P.M. after short walk.
"Saturday, August 17. Beautiful day. Little to do and no excitement. Rested in P.M. and to bed early, tired of doing nothing.
"Sunday, August 18. Beautiful day. Orders to move, and spend day loading an army of French trucks [with all our surgical equipment and company stores]. Took walk after shower . . . until 9.00 P.M., then to bed. . . .
"Monday, August 19. [The writing of this entry is extremely uneven, having been written on board a jostling freight car.] Roll call at 6.15. Oatmeal. Packs rolled. Carried patients until I 1.00 A.M. Sat around all P.M. Pie from sisters at 5.00 P.M., at 6.00 P.M. lined up and marched to St. Mard. Hun prisoners along the way. Piled aboard singing, and by 7.30 nurses and men were leaving Juilly behind forever."
I have before me as I write a condensed daily summary of our work at Juilly. The totals are perhaps more impressive than one would suspect from a casual reading of this narrative. During our ten weeks in the Collège we admitted 3,736 American sick, gassed, and wounded. This does not include the 1,700 admitted between June 4 and June 8, about 500 of whom were in the hospital when we arrived. Up to about June 15, all the transportable seriously wounded from the engagement at Belleau Woods passed through Juilly. Our busiest day, in number of admissions, was July 19, when we took in 608 patients. Our total deaths, June 8 to August 19, were only 71. The percentage of death for the period that we were in charge was only 1.9, which is extremely low; in fact, too low to represent adequately our more characteristic work later in the Argonne. At Petit Maujouy, where we received no gassed (unless also wounded), and only men suffering from serious wounds, our mortality was between 7 and 8 per cent. The smaller figure at Juilly is probably to be accounted for by the large number (about 800) of gas patients we received there, and the fact that many of our admissions in the July offensive were of slightly wounded.
"The best of our war time experience," says a letter I received not long ago from a member of the company, "was at Juilly." Life at Oglethorpe was occasionally more fun. Life at Petit Maujouy was constantly more strenuous, often more exciting, but always sterner and bleaker. But when a member of Evacuation Eight pauses in reverie upon the sweetest moments of his months in France, he will linger, I am sure, upon recollections of the grand old white buildings of the Collège, the broad courtyard drowsing sleepily in the heat, the quiet green of its park, the idyllic beauty of its lake and quiet swans. And mingled inseparably with these memories will come back others, touched with pain and regret but still more to be treasured: thoughts of high idealism as yet unspoiled by cynicism, of ungrudging devotion to the labor of alleviating suffering, of friendships made among the many wounded boys whom we sent away from Juilly, or among that other company who rested in the cemetery in the wheat field.
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