Frederick A. Pottle graduated from Colby College in 1917 and enlisted in the army that December, only to be told that his poor eyesight would restrict his service to the medical corps. In May 1918 his evacuation hospital unit landed in France, and on June 8 he arrived in Juilly, northeast of Paris, where he worked as a surgical assistant treating casualties from Château-Thierry and Belleau Wood. Pottle describes the military medicine of the day—far advanced from that of the American Civil War, when sepsis control was unknown, but woefully lacking the antibiotics and blood plasma of future conflicts.
NO QUARTERS have as yet been prepared for us, and it is imperative that we waste no time hunting for any. We drop our packs on the beautiful green lawn, where a line of our great brown ward tents is later to stand, and sit down on the grass to snatch a hasty dinner. Within thirty minutes of our arrival we are all at work. Our officers, indeed, who preceded us to town, have been in the operating rooms some time, having taken only time enough to scrub up. We are told off into details, pretty much at random, and assigned for duty in the receiving ward, the operating rooms, the surgical wards, to dig graves and bury the dead; in short, to perform all the multifarious tasks of a large evacuation hospital jammed with wounded.
Let us follow some of these men as they get their first impressions of war surgery. The separate glimpses will be confused, but the very confusion will make the picture more adequate. Our first man is assigned to Ward D. Ward D, he finds, is a detached building in the corner of the lawn, facing the great building with the statue of the Virgin at its peak. He goes up the steps, crosses a narrow entry, and looks in. What a strange room—large and bare, with the further end elevated like a stage. It is a stage. The place was evidently the theater of the school. Now it is filled with cots; not only the floor, but even the stage, from which all the scenery has been stripped. The cots are lined up as thick as they will go, with only the narrowest alleys for walking between, and every cot has a wounded man on it. After all, the place looks a little more like a civilian hospital than he had expected. The beds are made up with sheets, covered, to be sure, with the inevitable army blankets, but the men have been completely undressed and clothed in various styles of Red Cross hospital shirts—short white gowns with loose sleeves, tying with strings at the back. It is in the only too obvious evidence of terrible wounds that one realizes that this is a war hospital. Here lies a fair-haired boy of eighteen or so, his eyes closed, his neck and shoulder exposed to show a great bulky wad of bandage over the stump of an arm amputated near the shoulder. Here is an older man, haggard, unshaven, and ugly, his knees drawn up over his distended stomach, a look of peculiar and characteristic agony on his face. He has a severe wound of the abdomen, and has not much longer to suffer. He struggles to repress the frequent coughing fits which tear him with pain. He is continually calling out something in a language that is not English. There are some French wounded here, but the card tied to the head of his cot shows that he is an American, an immigrant who enlisted before he had mastered the language of his adopted country. There is a black-haired youngster who has lost his leg above the knee. The majority of the others have suffered less severely, but there is not a man here who has not escaped death scores of times in the last week by the narrowest of margins. Some of them are babbling in delirium, some shouting and cursing as they fight their way out of the ether dream in which they are reënacting the horror of the trenches, some in their right minds, gaily talking and joking, but the most lie in a half-waking stupor, the inevitable reaction to days of hunger, fatigue, the nervous strain of incessant deadly peril, and, finally, the shock of severe wounds, ether, and surgical operations. They have been for days without food; they have lain for hours in shallow holes with shells bursting every moment within inches of them and inflicting sudden and awful death among their comrades; their ears have been deafened with noise which in itself would produce prostration; they have walked unprotected straight into the murderous hail of machine-gun bullets; they have fought hand-to-hand with bayonets, in duels where the only possible outcome was either victory or death. These are the wounded marines from Belleau Woods. One’s first shock of surprise comes from finding them so young. Most of these wounded men are boys of the age of college freshmen or a little older, boys of magnificent physique, but preserving still in contour of limb and downy cheek the grace of boyhood. The beauty of their faces is only enhanced by suffering. They have not yet wasted away with weeks of torture. Their faces are smooth and round, though drained of all color, and their pallor makes their eyes stand out with extraordinary clearness. They are now touchingly brave, self-sacrificing, grateful. Weeks in hospital will sap their courage. They will become emaciated and fretful, calling out querulously, cringing at a touch. The hot room is pervaded with that indescribable but unforgettable atmosphere of an army hospital: fumes of ether, the heavy stench of gas gangrene and putrid infections, like the odor of decaying cabbage, and, strongest of all, the reek of chlorine from dressings wet with Dakin solution.
Some of this the new man has taken in as he stands in the door. He is not overcome with horror. He does not feel faint, even. Things are happening too fast for him to think of himself at all. He is moving in an existence apart from his own, like that of a dream. An army nurse, who was stooping over one of the patients, rises and comes to him. She is the first woman in uniform with whom he has ever had anything to do, and in the past months he has seen so little of women that her near proximity moves him strangely. He sees that she is ready to drop with fatigue. Her hair is escaping from under her cap, her face is gray and suffused with perspiration. She is so glad to see him that she nearly cries. During the last four days, this hospital has given surgical attention to nearly two thousand desperately wounded men. On June 2, it had only the personnel of a Red Cross base hospital of about 250 beds: two surgeons, twenty Red Cross nurses, a few civilian employees from the village, and, for transporting patients, half a dozen Annamite boys and a handful of French soldiers unfit for service at the front. The surgical force has been augmented by several hastily gathered teams, and day before yesterday these army nurses arrived. But the men available to lift and carry the wounded men (neither operating room is on the ground floor) were exhausted long ago, and there have been no proper replacements. Surgeons and nurses have been carrying litters in addition to their proper duties. For the last four days hardly anyone at Juilly has worked less than twenty hours a day.
There is no time now for chat. “Oh,” says the nurse to our enlisted man, “will you please help me take care of a man who has just died?” He follows her to a cot well up the aisle on the right. The man who has just died bears no mark on his peaceful face. He looks as though he might be asleep. Under the direction of the nurse the new assistant takes off the shirt, which can be used again. The dead man has to be turned on his side to unfasten it; the flesh of his bare back is as warm as the hand which touches it. They wrap the long comely figure in the sheet, securing it with a strip or two of bandage. This man is so tall that the sheet will not cover him, and they pull a pillowcase on over his feet. Another enlisted man has meanwhile come in, and the two get the body on a stretcher and carry it to the morgue. From the driveway they pass into a wide cobbled court with buildings on all four sides, under a quaint old clock tower on the opposite side, into a corridor, and at last into a small bare whitewashed room. There has been no time to bury the dead, and a dozen long rigid white bundles lie here on stretchers, placed side by side on the floor. It will take many applications of chloride of lime and whitewash to remove the traces of the odor of mortal decay which assails one’s nostrils long before he reaches the door of this room.
Or perhaps our man was sent instead to Ward E, the great room beneath the chapel, which is on the second floor under the statue of the Virgin and Child. This was of old the “Salle des Bustes,” as we should say a memorial hall—a long, beautiful room with waxed floor, around the walls of which are ranged upon pedestals the busts of famous men. There are fine stained-glass windows and memorial tablets, including, in the most conspicuous position at the end of the room, a great marble slab to the memory of the graduates of the Collège who fell in the Franco-Prussian War. In the little alcove on the right lies a solitary patient, a French aviator who was burned in the crash of his plane. His body is not much marked, but his face is so charred that none of the features are distinguishable, and his hands are burned to mere stumps. Thin strips of gauze wet with some antiseptic solution cover his face, but not so completely that one cannot see the horror of his condition. His sense of hearing is acute, and as anyone comes up to his bed he begins to murmur in a faint, hoarse whisper, the hole where his lips should be puffing up the edges of the gauze. He is asking in French for something. It sounds like “morphine.” Is it morphine? “Non! non!” says the whisper passionately, “pas morphine!” We cannot make him out, and try to tell him that we will call one of the French nuns.
Ward G is at the farthest distance from the operating rooms, above a fine cloister, up a steep and narrow flight of stairs. It was the children’s dormitory and their little iron cots are still there. In the center of the room is a sort of trough, with running water, where they washed their faces of a morning. None of the beds are long enough for a six-foot marine; you must push their heads through the high open head of the cot until their feet clear, and then stick their feet out through the foot. It would be a laughable sight, were it not so pathetic, those rows of blanket-wrapped feet sticking out into the aisle, some motionless, some vigorously wiggling and getting uncovered.
Other men have gone to work in the operating rooms. To get there they enter the first great building by the gate, climb a broad stone stair, turn at a landing, and come out at the entrance of Ward B. Ward A is on the floor above. Beyond, on the corridor, are the X-ray rooms. Men in litters, undressed and wrapped in blankets, are lying on the floor waiting for their turns in the dark room. Ward B, which I suppose was formerly a recitation hall, is a long narrow room, divided down the center by a partition filled with arches. There is a double row of beds on each side of the partition, lined up with heads to the wall. Ward A is much the same kind of place. These are the best-equipped wards of all, and were probably the only ones in regular use from the time the Collège was overrun with French wounded in 1914 until Belleau Woods. Many of the beds are fitted with elaborate frameworks of wood (“Balkan frames”) for the proper treatment of fractures. Men with broken thighs lie here for weeks—even months—flat on their backs, the broken limbs kept under constant tension by heavy weights. At the end of the ward is a little anteroom to the operating room. Evacuation Eight has not yet organized its receiving service so efficiently as it will later, when the men will come up to the operating room already undressed and with their wounds prepared for operation. The floor here is covered with litters on which lie the men just as they came from the ambulances, fully clothed with boots, puttees, breeches, shirt, and blouse, often with their steel helmets on their breasts and their gas masks beside them. Into one of the buttonholes of the blouse or shirt is tied a linen tag giving the man’s name, his serial number and company, the treatment which he has thus far received, and from what medical unit. On their foreheads, standing out with startling distinctness on the white skin, are letters in iodine; always “T,” and sometimes “M.” These indicate the administration of morphine and antitetanic serum.
The first thing to do is to get their clothes off. Puttees come off first, then muddy shoes, tattered and bloody breeches, blouse, shirt, underwear. Much of it must be cut off to avoid bending wounded arms and legs. In spite of their pain the men make no outcry and do their best to help us. We put hospital shirts or pajamas on them, wrap them in blankets, and they are ready for the operating room. The stretcher bearers come out with a stretcher on which lies a wounded man just off the table, still deep under the ether, his face wet with perspiration, eyes closed, his breathing deep and heavy. Next! We pick up the stretcher nearest the door and carry it into the operating room.
There are three tables. Around two, busy and silent groups of white-gowned figures are bending over their work. The third is empty, and an attendant with a wet cloth is wiping off the blood which covers the lower portion in a shallow pool. We transfer our patient to the damp table, and at the same time get a mental picture of the room. It is not large, perhaps fifteen feet square, and very white and dazzling. The door is in one corner, and there are two high windows in the wall opposite. Against the wall on the left as you enter is a small oil cookstove, on which steams a highly polished copper tank for sterilizing the instruments. Against the wall facing you, between the windows, is a stout wooden table covered with a sheet, on which the sterilized instruments are laid out in shining rows, like silver in the drawers of a sideboard. Against the wall to the right are the lavatories where the surgeons scrub up. The three operating tables, white enamelled and covered with thin, oilcloth-covered mats, are lined up in the middle of the room, their heads toward the entrance, the feet toward the table with the sterilized instruments.
But we must get to work on our wounded man. The surgeons who have just finished with one man have stripped off their blood-stained gowns and gloves and are scrubbing their hands. Under their direction we fold back the blanket which covers the wounded man so as to expose the wound, let us say on the thigh. We fold another blanket to cover his feet and legs to the knee, and slip two stout straps around him, one just above the knees and one around the chest. The wound is still covered with the pack and bandages applied at the first-aid station or field hospital. We cut the bandage and expose it—a jagged aperture made by shrapnel, perhaps two inches long. With an ordinary razor we shave a considerable area around the wound. The surgeon has now finished scrubbing his hands. The nurse at the supply table opens for him a square parcel which contains a sterilized gown wrapped in a piece of muslin. He shakes it out gingerly by the neckband, careful not to touch the front. The attendant as gingerly ties the strings behind. The surgeon now rinses his hands with alcohol, and, when they have dried, pulls on a pair of rubber gloves, picking them up by their long, turned-back wrists, which, when the fingers are worked on, he turns up over the sleeves of his gown. His hands and the whole front of his body now present a perfectly sterilized surface, which nothing unsterilized has touched, and which must touch nothing unsterilized except the wound itself.
Meanwhile the anesthetist has been busy. She sits on a stool at the head of the table, at such a height that her elbows rest easily upon it on either side of the patient’s head. Beside her is a little stand with her cans of ether, gauze, vaseline, a shallow basin shaped like a kidney, and clips for pulling forward the man’s tongue if he should choke. The man has not cried out or in any way expressed his fear, but his eyes show that he is terrified by the array of glistening instruments, the solemn, white figures—worst of all, by the rapid play of scalpel and scissors which he can see by turning his head toward the tables on either side. His eyes in mute appeal seek those of the one familiar figure in the room, that of the enlisted man at his side. “Don’t be frightened,” I say, “the ether won’t bother you at all, and it will all be over in a minute.” (God forgive me, I have never taken ether in my life.) “Will you just take my hand, buddy,” says the wounded man a trifle huskily, “I don’t know much about this, and I’m afraid I may fight when the ether gets bad.” “Sure!” I reply, “that’s what I’m here for.” The nurse smears a little vaseline around his eyes, and, holding the mask a few inches above his face, begins to pour the ether on it. “Breathe deep,” she says, “and don’t fight it.” The mask comes lower, finally rests on his face, and a piece of gauze is wrapped around the edges to keep in the fumes. She pours on the ether faster. The man groans and struggles; he throws both his arms wide and tries to sit up. We have to tighten the straps and hold down his arms. Now he is limp, the moaning faint and dying away. The surgeon takes a long-handled clip which holds a swab, dips it in iodine, and paints a large area around the wound. One nurse stands all the time by the supply table, serving the surgeons at all three operating tables. She hands him four sterilized towels, which he lays around the wound, leaving exposed only a small rectangular patch of darkly stained skin with the wound in the center. How will he fasten his towels on? A little stand has been pushed up beside the foot of the table. The nurse covers it with a towel, and begins to lay out instruments on it. The surgeon picks up one that looks a little like a pair of manicure scissors, but, instead of cutting blades, it has two little sharp curved points that meet like a pair of pincers. With these he picks up the towels at the point where two of them overlap, and clips them together, pushing the points of the instrument down so that they meet in the skin underneath. The instrument has a catch which will hold it tightly shut until it is released. He puts on three more, one at each corner of the exposed patch. The uninitiated assistant gasps and flinches at this apparently cold-blooded process, and then derides his tenderness as he thinks how trivial these pinpricks are in comparison with what is to come. The team is now ready: the chief, or operating, surgeon, his assistant (always a surgeon also, and an officer), and a nurse, who stands beside the little stand of instruments, ready to hand what is wanted. (This is in addition to the nurse at the large supply table of sterilized instruments.) These are all “scrubbed up,” that is, provided with an elaborate surgical asepsis of sterilized gowns and gloves. The anesthetist and two enlisted men, who are not “scrubbed up,” must look out for manipulating the patient, getting him on and off the table, bandaging, and bringing unsterilized equipment.
The surgeon takes a scalpel (a little knife with a rigid blade, no larger than a penknife), which he holds like a pen, and with firm, even pressure draws an incision on each side of the wound and considerably longer. The skin springs apart, showing the yellowish fatty layer beneath, and exposing the red of the muscle. This wound was made by a fragment of high explosive shell, which is still deeply embedded in the flesh. It has been located by the X-ray surgeon, who has made two marks with silver nitrate on the thigh, one on the top and one on the side. The foreign body lies at the point where perpendicular bisectors from those marks would intersect. The surgeon goes after it with scalpel and scissors, excising all the damaged tissue with what looks like reckless abandon. As he cuts into the muscle the blood spurts up like juice in a berry pie. The assistant mops it up with a gauze sponge, discovers the point where the blood vessel is severed, and the surgeon clips it with a haemostat, another variety of pincers with handles like manicure scissors. This is for small blood vessels; larger ones must be tied off at once. By the end of the operation the wound is full of these dangling haemostats. The surgeon probes with his finger between the muscle bundles for the shrapnel, and finally dislodges it, a jagged chunk of metal an inch square each way, with a great wad of cloth from the man’s breeches clinging to it. He goes on, painstakingly removing every particle of clotted blood and tissue that has been damaged by the missile or resulting infection. Now, with the help of his assistant, he ties off the blood vessels still held by haemostats. During all this, the enlisted assistants at his direction have been turning the patient on the table, elevating or flexing the leg, or with a flashlight throwing light into some peculiarly inaccessible part of the wound. The operation is finished. What was a small jagged wound is now a gaping hole six inches long, two or three wide at the top, and perhaps four deep, perhaps extending through the entire thigh. The nurse places on the stand a bundle of little red rubber tubes, open at one end, the closed end punched full of holes. The surgeon pushes these into the wound, leaving the open ends out, inserting the closed ends into every crevice. He fills the cavity with gauze plentifully soaked with a solution smelling of chlorine, lays gauze strips soaked with yellow vaseline along the edges of the wound, and places a large absorbent pad over the orifice. His work is done. We bind on the pad with yards of bandage, roll the inert body onto a stretcher, and hurry it away to a ward. As he scrubs for the next case, the surgeon dictates to one of us a description of the case and the surgical treatment he has given it. All this may have taken half an hour; possibly an hour or more. We go on with the work, in twelve-hour shifts, night and day, as long as the supply of wounded holds out.
Remember that few of these enlisted men have ever been in an operating room before in their lives, and that as few of these surgeons have had actual previous experience in the technique of war surgery. Yet in that first afternoon they are called upon to perform the most dreadful as well as the most delicate operations. One could not plead inexperience as an excuse for delay. Amputations high in the thigh or upper arm, operations of the chest where the ribs must be sprung apart with retractors, and looking in with incredulous amazement we see the heart throbbing bare; wounds of the head and brain, wounds of the abdomen—in one day we performed more major operations than some civilian operating rooms see in six months. We work on without pause, undressing men, carrying them in, carrying them out, carrying them to the X-ray, carrying them to the wards. It is amazing how we form friendships in those few moments before the man goes onto the table. Late this evening, when we have gone off duty after twelve hours of such work, we shall stumble around to the wards to see how some of these boys are now, to wash their hands and faces, to sit quietly and talk with them. But we cannot sit long, for there is so much to be done in a ward, and wounded men naturally do not understand that you are not the regular ward orderly.
There are many, many other departments in this great organization. There is the division of trucking, all day on the road between Paris and Juilly bringing in surgical supplies, food, quartermaster’s stores. An orderly is always bumping back and forth in a motorcycle with dispatches. In the great square flagged court (the “Cours d’Honneur”) a tent has been erected to serve as receiving ward and personnel offices. The ambulances drive in unceasingly through the archway and unload their wounded before the tent. There are four litters in each ambulance, two above and two below, suspended from hooks. The ambulances are muddy, and frequently splashed with holes from the fragments of shells that have burst just beside them. The drivers are weary, but they hurry to unload their freight and hurry off again—a long, brown, almost unbroken line of ambulances filling the road from Château-Thierry to Juilly. The attendants in the receiving ward inspect the tag which comes tied to each wounded man, make other necessary records, check his few pathetic valuables and put them in a cotton-wool bag, and then send him to the operating room. Later, when things are better organized, the greater part of the work of preparing the patient for the table will be done here.
Every night we evacuate. Another long, brown, unbroken line of ambulances pulls out of the hospital, not empty, but filled with our wounded men who have undergone operation, bound for Paris. After operation, the wounded are sorted out according to the severity of their injuries, and the ward to which they are assigned indicates whether they may be immediately evacuated or not. For a large evacuation every man in the hospital not actually on night duty is expected to turn out and lend a hand, often extending the twelve hours of work he has already done by five or six more of carrying and lifting litters. Some wards are practically depleted at each evacuation. The ambulances pull up before the wards, the nurse indicates which men are to go, the orderlies and litter men transfer them gently to litters, lift and stow them away in the ambulances, call out a word of farewell, and they are off from Evacuation Eight forever.
One large detail has been at work all day on the grimmest task of all, that of digging graves and burying the dead. I shall describe the cemetery later, as it appeared after we had been at Juilly nearly two weeks. But today the grave detail finds the cemetery already well established. They dig the graves laboriously out of the stiff soil of a glorious field of wheat full of scarlet poppies, under a blazing sun; regulation graves, three feet wide, six feet and a half long, and six feet deep, and hastily lay in them the bodies of the dead. Later we had a burial party every afternoon about five. There would be five or six bodies, for which we then provided the luxury of unpainted wooden boxes. We piled them into a high two-wheeled French cart, drawn by a great patient work horse, and spread out an American flag over the ends of the boxes. The little procession started from the Cours d’Honneur, at the head the little crucifer from the parish church, then our Y.M.C.A. chaplain in plain khaki uniform, walking side by side with the village curé in his biretta, cassock, surplice, and stole. Behind trudged a French urchin, bearing the pail of holy water, a cotta over his breeches, but with an American trench cap on his head. Then came the lumbering cart driven by its stolid French owner, and, walking beside it, the men of the burial detail. At the cemetery we unloaded the coffins and lowered them down into the graves, jumping impatiently on the tops of the boxes if they happened to stick in the narrow space, and then stood uncovered, leaning on our spades, as the curé in his clear sonorous voice read the grand Latin of the Roman burial service over Catholic and Protestant, Jew and Gentile, and our chaplain followed with the familiar English words. One sprinkled with holy water, the other cast in a handful of earth. The bugler, facing the west and the golden lightning of the sunken sun, blew the long tender notes of taps, while far overhead an unseen lark poured forth its shrill delight.
From Stretchers (1929)