Racine County, Wisconsin - Chapter 29: How Wounded Men Are Cared for in War Bv Dr. Carl O. Schaefer, 1920

HAVING been asked to explain the workings of the American army medical service and hospitals in war time, I find it necessary to state at the beginning that considerable variation existed in methods of evacuating battle victims. The methods depended upon the type of injury, the circumstances under which it occurred, available transportation, the number of casualties to be dealt with and the important question of whether the combat organizations were at that time engaged in offensive or defensive operations.

Obviously, an army in retreat cannot give the same sort of attention to wounded men that can be offered while an army is advancing and leaving its casualties behind it in a zone of comparative safety. American wounded men received better care, on the average, than the wounded of other armies because for the greater part of the time our units were advancing when they were fighting at all. This fact also prevented many of our wounded men from being captured, and also enabled the Graves Registration service to identify and bury decently our own dead.

Perhaps the easiest way to explain the working of the hospital system is to begin with a descripition of the organization itself, and then describe the "ideal" way of handling wounded; that is to say, the way they were handled when circumstances permitted.

As a part of the regular equipment of each soldier, there is a first aid pocket which contains a sterile dressing and bandage besides the small vial of tincture of iodine which each soldier is instructed to use, either on himself or a comrade. In a great majority of cases the actual care of the injury takes place very shortly after the same has been inflicted.

Attached to each battalion or company of combat troops, (infantry, artillery, etc.,) is a unit of medical aids, under the direction of a medical officer, and this unit follows right with the troops as they advance taking care of those who fall on the field of battle. This medical detachment is the first organized group to care for the wounded and each of these men carry a fuller equipment of bandages, a supply of tetanus antitoxin (to prevent lock-jaw), and a limited set of surgical instruments which are to be used to check extensive bleeding, if possible. In addition, each man is equipped with a tourniquet which is to be used when the bleeding is severe, the tourniquet being tightened around a limb to check the flow of blood.

The use of tetanus antitoxin became a most important factor and was resorted to very early in the war by both the Allies and the Germans. Where fields are so abundantly fertilized as in France, the danger from lockjaw is very great, and the use of the anti-toxin caused an almost unbelievable drop in the number of cases. Various figures show a decrease from 25% to less than 1/10 of l^'r, and in my own experience, of several thousand cases, I saw only two cases of tetanus.

Another important duty of the medical detachment men was to properly attach a diagnosis tag on every case that came to their attention. On this tag was noted the type of injury, time of injury, whether or not antitoxin had been given, whether or not the injured had had a dose of morphine, and if so at what time given, and lastly whether or not the case needed a litter. The latter was shown by a blue margin on the tag, and could be determined at a glance by the litter bearers.

For the purpose of clearness, I will attempt to trace through a litter case, for example a man shot through the thigh with a resulting fracture of the thigh bone. This man having received the attention alluded to above, was next taken in hand by litter bearers, also a part of the medical detachment, who transported the man to the nearest dressing station, called the battalion aid station, which was located in some reasonably secure place, preferably a shell-proof dug-out. Here a medical officer again was in charge of the work, and here the injuries again received such care as was necessary and possible. More time could be spent in checking hemorrhage, applying a splint or giving the patient morphine if needed. The man now being made reasonably comfortable, he is carried by litter further to the rear. Often it is possible to provide immediate transportation by ambulance to the casualty clearing station, or evacuation hospital or more frequently to a field hospital, which is the nearest hospital to the front lines.

At the field hospital the man has his emergency operation, adjustment of splints, stimulation (such as coflfee), additional blankets, etc., as the case may require. The more severe cases are held until the dangers of shock are less, the less severe being immediately prepared for evacuation further to the rear.

From the field hospital the injured man is transported to the evacuation hospital by ambulance where similar attention is provided and where a great number of the injured receive their first operative experience. As in the field hospital, the patient is again held until evacuation can be effected with a minimum of danger to the man. The evacuation hospital ordinarily was located out of danger at the rail head, from which point the hospital trains moved, and once aboard such a train, the care of the injured was splendid. These trains were equipped to the last detail, having even an operating room which compared favorably with one in a civil hospital at home. On the train every possible care was extended the injured.

Base hospitals were located all through Prance and for the purpose of illustration, I will confine my story to the American Red Cross Military Hospital No. 1 located at Paris, and at which hospital I had the pleasure of doing my work.

Arriving at Paris, the hospital train was met by a convoy of ambulances. Classification as to type of injury was done by a medical officer at the station, surgical cases going to a specified hospital, gas cases to another, mental cases to still another, etc.

Word came in advance of the arrival of a train and all was in readiness when the boys reached the hospital. Every-one was busy; for at a hospital the size of A. R. C. M. H. No. 1, where we had 2200 beds, our allotment varied from 100 to 500 at a time, and needless to say, it kept all of us moving to care for this size of convoy.

Immediately on arrival, the boys were carried into the receiving ward, where details of their cases were noted, a bed assigned, and the operating room through which the individual was to pass designated. One and sometimes two medical officers were assigned to make a preliminary examination of all the wounded to determine the more serious cases so that they might receive the first attention. In the receiving ward, each was given all the hot coffee and sandwiches he wished, he was provided with a Red Cross bag into which he could place his personal property and which he found at his bed when returning from the operating room.

The delay prior to operation varied v^rith the number of wounded received and the seriousness of the injury, though ordinarily much expedience was evident. At A. R. C. M. H. No. 1 there were 16 operating tables and in a rush, these were in use continuously night and day. In the operating room, every precaution possible was taken to give the injured man the best possible attention, every wound was X-rayed, and the location of the missile indicated by a pencil mark on the skin, to simplify its I'emoval.

In the wards, the attention given the men was splendid. To be sure, during a rush, there was much need for additional doctors and nurses and nurses' aids; frequently after serving eight or ten hours continuously at the operating table, the surgeon would go to his wards to dress the wounded or attend to other details as they might arise. The rush over, and the patients on the road to recovery, much was done for the pleasure and entertainment of the wounded, thanks to the efficient work of the nurses and nurses' aid. Many of the latter were from the best homes of the country and often not accustomed to work. Here they served the men in their charge, almost as a mother herself would have done.

The wounds being sufficiently advanced to make moving of the patient safe, the next procedure was to evacuate the man to some hospital further away from the scene of action, and often this was direct to some base port, where after a brief stay, the soldier would find himself aboard a transport, or hospital ship and on his way to the U. S. A. The real thrill of "We're going home," cannot be described in words and only by the experience can it be appreciated.

The work in the general hospital on this side was comprehensive and in the hands of skilled men. Here the work was that of reconstruction and re-education, and then a final classification and determination of percentage of disability.

Just prior to discharge, the boys passed through a discharge ward where special effort was taken to have each case justly passed on and to see that the condition of each warranted his return to home.

I wish to apologize to any who might feel that this is not entirely the way he was taken care of, bearing in mind, that but a few passed through the hospitals of Paris. They without question were equipped second to none overseas. In all the base hospitals in France, however, every effort was made to give wounded men the very best care possible and I think most of those who were patients appreciate this fact. There was never any serious shortage of drugs or equipment, and it was only immediately after severe battles that the base hospitals were crowded.

Every war has had its epidemic of cholera, or typhoid, or yellow fever, or any of a half dozen other plagues that flourish best where men are crowded together under more or less unsanitary conditions. Against such scourges as these modern armies had pretty well immuned and fortified themselves, the .4merican Army particularly; until influenza made its destructive onslaught.

Unlike former epidemics, it was least fatal to men in the field, most damaging to those in barracks and camp. And when the great tide of American O. D. was at the flood in the fall of 1918, the flu broke out with peculiar virulence on the packed transports which were bound for France.

Probably other ships could furnish as dramatic a story as that which follows. But the very hugeness of the ship and the immensity of the numbers carried aboard her make the picture more striking.

That the Leviathan in ten trips during the war bore 96,804 troops to France, that the total death list for nine of these trips was but eight, while on the one trip when the flu raged the disease claimed 96 fatalities, are facts that reveal its swiftness and malignity.

OflTicial reports are ordinarily the dryest and dullest reading, but Dr. H. A. May's report of that voyage in September, 1918, is so tense and interesting that it is worth quoting almost verbatim:

"I submit for your information the following report of an epidemic of influenza, with pneumonia as a complication, which occurred among the troops of the U. S. Army embarked on this vessel for the last eastbound voyage.

"During the hours of embarkation, Army medical officers removed from the ship approximately 100 men and 4 nurses as being infected with influenza.

"I have been told by an Army officer (Capt. Cheney), attached to the headquarters staff on board, that the 302nd Water Tank Train left 178 men behind at camp because of influenza. In this connection, the following copy of a telegram sent from Headquarters, Port of Embarkation, Hoboken, N. J., to the Commanding Officer, Camp Holabird, Md., September 23, 1918, is submitted:

" 'T 765. Send Water Tank Train 302 to Camp Union as scheduled, regardless prevalence influenza. Please acknowledge receipt. Signed, Judson. 11.59a.'

"By the same officer I was told that a large number of the 57th Pioneer Infantry were left behind at camp because of illness with influenza. This statement was confirmed by the Chief Army Surgeon on board.

"There were but 14 Army Medical Officers and 48 Army Hospital Corpsmen available for duty. Under normal conditions this personnel would not have been sufficient. In the face of such an epidemic as this the combined Navy and Army medical force has not been enough to properly care for the stricken."

Dr. May relates how the rapid spread of the epidemic made necessary the vacation of compartment after compartment to provide space for the sick, which necessarily led to overcrowding in other sections of the ship.

He tells how a great part of E deck became a hospital ward, and of the difficulties experienced because the top bunk in the standees could not be reached by nurses.

Doctors and nurses were stricken by the disease and thus became not only unable to aid but also an added burden to the overworked medical personnel. Every available medical officer, nurse and hospital orderly was utilized "to the limit of endurance."

"There are no means of knowing the actual number of sick at any one time, but it is estimated that fully 700 cases had developed by night of September 30. They were brought to the sick bay from all parts of the ship, in a continuous stream, only to be turned away because all beds were occupied. Most of them lay down on the decks, inside and out, and made no effort to reach the compartment where they belonged. In fact, practically no one had the slightest idea where he did belong, and he left his blankets, clothing, kit, and all his possessions to be salvaged at the end of the voyage.

"The conditions during this night cannot be visualized by anyone who has not actually seen them. Pools of blood, from the severe nasal hemorrhages of many patients, were scattered throughout the compartment, and the attendants were powerless to escape tracking through this mess because of the narrow passages between bunks. Everyone called for water and lemons or oranges. A plentiful supply enabled their desire to be gratified. But within a few minutes of the first distribution of fruit, the skins and pulp were added to the blood and vomitus upon the decks. The decks became wet and slippery; the filth clung to the clothing of the attendants; groans and cries of the terrified sick added to the confusion of the applicants clamoring for treatment, and altogether a true inferno reigned supreme.

"In the E deck ward, every possible appliance for the care of the sick was furnished to the Army surgeons on duty. The Commissary Off'icer placed at our disposal stewards, cooks and mess men, and furnished just the kind of food required, in the best possible fashion. The Medical Department of the ship owes a great debt of gratitude to the Commissary Department, and to Paymaster Farwell and Chief Commissary Steward Flowers especially, for the success with which they gave comfort and aid to the sick, and removed from our shoulders the always worrisome burden of feeding men unable to eat regular diet.

"Hospital Corps. - I cannot speak in terms of suff'icient commendation of the work of the hospital corps of this ship. Every man is called upon to exert himself to the limit of endurance during the entire round trip. No man complains, every man is on the job. During this last voyage many of them worked twentyfour hours at a stretch amid conditions that can never be understood by one ashore or on a

"Second, the type of men comprising the most heavily infected group. Large numbers of them were unable to read or write and some did not know their right hand from their left. Many of them had been in the service not more than three or four weeks and knew nothing of discipline; and the meaning of personal cleanliness and the methods of self protection from disease was as a closed book to them.

"Third, the absolute lassitude of those becoming ill caused them to lie in their bunks without complaint until their infection had become profound and pneumonia had begun. The severe epistaxis (nose bleed) which ushered in the disease in a very large proportion of the cases caused a lowering of resisting powers which was added to by fright, by the confined space, and the motion of the ship.

"As noted above, the sick bay was filled a few hours after leaving Hoboken. Until the fifth day of the voyage few patients could be sent to duty because of great weakness following the drop in temperature as they grew better. The E deck ward was more than full all the time, and there were many ill men in various spaces in other parts of the ship.

"Morning of the 2nd October, brought no relief. Things seemed to grow worse instead of better. Cleaning details were demanded of the Army, but few men responded. Those who came would stay awhile and wander away, never to be seen again. No N. C. O.'s were sent with them, and there was no organization for control. Then nurses made a valiant effort to clean up and the Navy hospital corpsmen did marvels of work, but always against tremendous odds. Only by constant parolling between the bunks could any impression be made upon the litter, and finally our own sailors were put on the job. They took hold like veterans and the place was kept respectably clean thereafter.

"Each succeeding day of the voyage was like those preceding, a nightmare of weariness and anxiety on the part of nurses, doctors and hospital corpsmen. No one thought of bed for himself, and all hands worked day and night. On the 5th there were ten deaths, on the 6th there were 24, and on the 7th, the day of arrival at our destination (Brest), the toll was 31. The Army ambulance boat was promptly alongside, and debarkation of the sick began about noon. The sick bay was cleared first, and we at once thereafter began to clean up in preparation for the wounded to be carried westbound. E deck was then evacuated, but all the sick could not be handled before night, about 300 remaining on board.

"On the 8th these were taken off by the Army, but not before 14 more deaths had occurred. The nurses remained until the last sick man was taken off.

"It is my opinion that there were fully 2,000 influenza cases on board during the voyage. Pneumonia cases must have numbered at least 100, but in the unavoidable confusion due to the rapid spread of the influenza it is impossible to be exact.

various parts of the ship, and many died in the E deck ward a few minutes after admission. Owing to the public character of that ward, men passing would see a vacant bunk and lie down in it without applying for a medical off^icer at all. Records were impossible, and even identification of patients was extremely difl'icult because hundreds of men had blank tags tied about their necks, many were either delirious or too ill to know their own names; 966 patients were removed by the Army hospital authorities in France.

"I have learned that the following named men of the Commissary department voluntarily remained on duty with the sick on E deck during the entire voyage: George Willis, H. L. Ringrose, A. Barbel, R. Steinman.

The men shown were brought from Chateau-Thierry July 20 after the counter attack, the turning point of the war. American Red Cross Military Hospital No. 1 received 3,000 such cases in that week. Dr. Carl O. Schaefer of Racine was on the operating staff at that institution. The illustration is a remarkable piece of photogrraphy. The faces of the men indicate somewhat their condition. The sufferers lie on the litters upon which they were brought in ambulances, taken to elevators and brought to the upper floor corridors by bearers.