"CLEARING HOSPITALS"

Dominion, Volume 8, Issue 2388, 18 February 1915, Page 6

"CLEARING HOSPITALS"

BRITISH WOUNDED

FORTITUDE OF THE MEN (By Colonel Sir Anthony Bowlby, C.M.G. in the "British Mcdical Journal.") It is nearly three months since I joined our army in Franco. 1 spent most of the first fortnight in Rouen, where were two excellent general hospitals, and where 1 had a very interesting experience. Two-months the British Army moved from the Aisno to tho North of Trance, and I was-then invited to go up with the general headquarters, and found myself acting as consulting surgeon to the "clearing" hospitals behind the firing line. It is already well knowin that wo occupy the line from near Ypres to La Basse©, a distance of some 30 to 40 miles, and tho northern part of this is hilly and undulating, while south of Bailleul tho country is very flat and marshy along the river and canal of the Lys. This town is some miles from each end of. our lino, and. wo havo .had "clearing" hospitals at tho towns at each end, and in three other centres between.

The Functions of a Clearing Hospital.

For the sako of thoso who are not yot familiar with army nomenclature, I will premise that a "clearing" hospital is placed conveniently near to the field ambulances of the different corps, and that the wounded are sent into, it as soon as possible after being injured, and after their first field dressing, lu actual practice this generally means that the men wounded during the night-fight-ing are brought in in the morning, and thoso wounded in the day may either bo got in during tho afternoon, or else it may be necessary to wait till darkness permits of their, being brought' in safely.

A "clearing hospital" is essentially a "mobile unit," and must bo able to move with tho army at the shortest notice. Consequently, it is not equipped like a "general" hospital, for it has no touts or huts, and it has stretchers instead of bed 6, and no such luxuries as X-rays and a pathological outfit. It consists really ouly of a staff with a sufficient amount of surgical and medical equipment for emergencies, and is in future to bo called a "casualty clearing station." But, although these are tho normal conditions, :we were very fortunate in that we found some excellent buildings in this town and in tho neighbouring ones, and we ■ occupied school houses, hospitals, lycees, and colleges, many of which had a few excellent beds and bedding, and two' of which had sisters of charity as nurses and operating theatres. What is very striking is that these small towns have far more commodious buildings than would be found in any similar places in Great Britain.

We arrived at this town one afternoon, and were informed that fighting had taken place that day 14 miles away and that there were 450 casualties to bo sent for. There were 50 motor ambulances ready; suitable buildings were found for a clearing hospital staff to occupy, and preparations were at once made to house, feed, and attend surgically 011 tho wounded.

. It must be realised tbat a clearing hospital is supposed to be staffed and equipped for 200 patients, but warfare and necessity know no laws, and sufficient accommodation was at once found in a derelict college, and in a- jute factory, and all night the staff laboured hard and got through their work splendidly. But this was only tho beginning of a month of unprecedented difficulties, all of which have been surmounted in the same spirit of prompt decision and energetic action which characterised this first incident.

As tho divisions caino up and moved into line other hospitals were started, and very soon tho fight known as the "Battle of tho Lys" or the "Battle of Ypres," developed. along the whole frcnt. But the pressure of the fighting .would bo at one part of the line one day, and at another point another time, and it was therefore my duty to go to the place which was the most busy, and either to stay there or else to go on to some other hospital as might do required.

It is quite impossible really to describe the scene at a clearing hospital when the fighting was at its height, but I . will try to give some idea of it. Picture a large open space surrounded by buildings. Into this there drives a motor-ambulance. The tail are opened and reveal four '"lying-down cases" 011 stretchers. These latter are swiftly and carefully slid out, and carried into a largo receiving room 30 or 40 feet long. Another ambulance draws up with six or eight men who are- "sit-ting-up" cases, and these are helped out and walk into the receiving room. The clothes of the patients are all thick with mud. Ambulance follows ambulance, for the field ambulances at tho front have been filled up during the night, and there has been heavy fighting again at daybreak—a common hour for attacks—and thus it has happened that on many, days from 500 to 1000 or more wounded have arrived at a single clearing hospital in a single 24 hours. And now look inside the receiving room. Here are half-a-dozen or more surgeons, often some dressers who aro medical students, and a score or two of well-trained and very efficient orderlies. Men with simplo flesh wounds are sitting on tho benches round the room while tho look at their wounds' and.perhaps decide that a simple ing is all that is required; the skin is painted with iodine, tho wound is washed with an. &niiiseptic, a, dressing is put on by the orderly,.and the patient goes off to another room for rest and food.

In another patient the arm bones are fractured, aid splints have to be applied before tho wound is dressed. In another case there is a bad smash of the thigh or tho leg bones, and anaesthetic is required and given, while the clothes are cut off, the wound washed out with an antiseptic, and splints and dressings applied.

.Hero is a man in whom it is only too evident that the limb is bopeieesly sniashed, so the patient is put into the ambulance and sent round to a neighbouring building where a surgeon is°in waiting ready to amputate, so tho work of dressing the wounded is not interrupted by an amputation. But, in addition to -the dressing of wounds, you will see that one surgeon is detailed to inject every man with antitetan'io serum, and you will notieo that all the men are given hot soup or milk, or perhaps stimulants, while they wuit thoir turns to see tho surgeon.

And so on 6ome days for hour after hour, and for most of both day and wight, the same sceno is enacted with constant, variations of detail. But consider for a moment what forethought has been necessary for such a condition to be successfully dealt with. Picture what etores of dressings and bandages aro required to dross many hundred wounded men day after day at well of soveral hospitals, and remember that it has all to come from England, and has all to he got to the railhead in quantities greater than have over been required in any previous war. Think of all the stretchers and blankets and a score of other requisites, without which the whole thing would be a failure; then realise that we have never oneo run out of chloroform, dressings, or any single thing, with the sole exception that for some days, after using 30,000 doses, we had not quite enough tetanus antitoxin. But you must next appreciate that the hospital is o«ly il. "oleni'injj has. Lgital" ox. static: '* and in its turn it

must be promptly cleared of ail cases that can be moved, so as to be ready for next day's wor.nded. Thorefore, ambulance trains must bo ready daily to remove their hundreds to Boulogne or Rouen, or to hospital ships waiting to go to England. You might, at first thought, consider that there should bo no difficulty about these trains, but there is a great olio. The first duty of every general is to defeat the enemy, and trains for troops, and guns, and horses, and stores are tho very first consideration, and lied Cross trains must wait their turn.

Remember that we are in the country of our ally, and tho trains on the railways aro all French, and under French management. AVo must have what they can afford to give us, said it is not in our power to provide facilities or engines, or engine-drivers, etc. So it conies about that the train question is a most difficult one; yet it is another of thoso difficulties that has been completely overcome by tho energy and foresight of those in charge.

The Wounded. I cannot closj these notes of the clearing stations without a word as to the demeanour of the patients. Nothing could bo more admirablo than tho sang-froid and chooriness of men and officers alike. Many of them were cold, wet, and hungry. All of them had more or less pain. Some of thorn had suffered exceedingly during their transit from tho front, some of them were faint from loss of blood. A few were obviously dyir.g. Yet no one really grumbled or made querulous complaints. At the most they asked for something to drink, or for somo one to'move them to a more comfortable position'. Many of them wore so tired that, inspite of pain, they went to sleep on their stretchers, but, unless they were too tired, they were cheerful and grateful to those who helped them. Their spirit was not broken by their misfortune, and they were still as steady and self-re-liant. as when they. endured tho shell lire in the trench or advanced >to a counter-attack. "Tho men aro splondid," said Sir Redvers, Buller 15 years ago, and this is still true to-day.