- 'the American Ambulance Hospital'
- from the book
- 'Our Part in the Great War'
- by Arthur Gleason - 1917
American Volunteers 'Over There'
THE AMERICAN AMBULANCE HOSPITAL
THE recital of the young college boy crowding his ambulance between singing shells and bringing in his wounded down death's alley is familiar and stirring. And this, for most of us, has been the entire story. But that is only the first chapter. It is of no value to bring in a wounded man, unless there is a field hospital to give him swift and wise treatment, unless there is a well- equipped hospital-train to run him gently down to Paris, unless there are efficient stretcher bearers at the railroad station to unload him, and ambulances to transport him to new quarters. And finally, most important of all, the base hospital that at last receives him must be furnished with skilled doctors, surgeons, nurses and orderlies, or all the haste of transportation has gone for nothing. For it is in the base hospital that the final and greatest work with the wounded man is wrought out, which will let him go forth a whole man, with limbs his own and a face unmarred, or will discharge him a wrecked creature, crippled, monstrous, because of bungled treatment. It is a chain with no weak link that must be forged from the hour of the wounding at Verdun to the day of hospital discharge at Neuilly. And that final success of the restored soldier is built upon the loyalty of hundreds of obscure helpers, far back of the lines of glory. That which is fine about it is the very absence of the large scale romantic. It is humble service humbly given, with no war-medals in sight, no mention in official dispatches - only a steady fatiguing drive against bugs and dirt and germs and red tape.
So I begin my story with the work of the Scotch-American at the entrance of the American Ambulance Hospital at Neuilly-sur-Seine. He is the man that gives every entering wounded soldier a bath, and he does it thoroughly in four and a half minutes. He can bathe twelve inside the hour. He has perfected devices, so that a fractured leg won't be hurt while the man is being scrubbed. He has worked out foot-rests, and body-rests and neck-rests in the tub. This man has taken his lowly job and made it into one of the important departments of the hospital. And with him begins, too, the long tale of inventive appliances which are lessening suffering. The hospital is full of them in each branch of the service. Everywhere you go in relief work of this war, you see devices - little things that relieve pain, and save time and speed up recovery. That is one of the things differentiating this war from the old-time slaughters, where most of the seriously wounded died: the omnipresence of mechanical, electrical, devices. Inventive skill has wreaked itself on the sudden awful human need. The hideously clever bombs, and big guns, all the ingenious instruments of torture, will shoot themselves away and pass. But the innumerable appliances of restoration, the machinery of welfare, suddenly called into being out of the mechanic brain of our time, under pressure of the agonizing need, will go on with their ministry when Lorraine is again green.
The Ambulance is the cheeriest, the cleanest, the most efficient place which I have visited since the beginning of the war. There is no hospital odor anywhere. Fresh air and sunshine are in the wards. A vagrant from Mars or the moon, who wanted an answer to some of his questions about the lay-out of things, would find his quest sh9rtened by spending an afternoon at the American Ambulance.
What does America mean - What is it trying to do? How does it differ from other sections of the map?
The swift emergency handling of each situation has been American in its executive efficiency. Things have been done in a hurry, and done well. In eighteen days this building was taken over from a partially completed school, with the refuse of construction work heaped high, and made into an actively-running hospital ready for 175 patients. That, too, in those early days of war, when workmen had been called to the colors, when money was unobtainable, transportation tied up, and Germany pounding down on Paris.
The skillful surgical work, some of it pioneering in fields untouched by former experience, has been a demonstration of the best American practice.
The extraordinarily varied types of persons at work under one roof in a democracy of service presents just the aspect of our community which is most representative. Millionaires and an impersonator, Harvard, Dartmouth, Tech, Columbia, Fordham, Michigan, Princeton, Cornell and Yale men, ranchers, lawyers, and newspaper men-all are hard at work on terms of exact equality. A colored man came in one day. He said he wanted to help with the wounded. He was tried out, and proved himself one of the best helpers in the organization. He received the same treatment as all other helpers, eating with them, liked by them. Some weeks later, one of our wealthy "high-life" young Americans volunteered his services. After the first meal he came wrathfully to the surgeon.
"I've had to eat at the same table with a negro. That must be changed. What will you do about it?"
"Do about it," answered the surgeon. "You will do one of two things-go and apologize to a better man than you are, or walk out of this hospital."
Recently this black helper came to the director in distress of mind.
"Have to leave you," he said. He held out a letter from the motor car firm, near Paris, where he had worked before the war. It was a request for him to return at once. If he did not obey now in this time of need, it meant there would never be any position for him after the war as long as he lived.
A day or two later he came again.
"My old woman and I have been talking it over," he said, "and I just can't leave this work for the wounded. We'll get along some way."
A little more time passed, and then, one day, he stepped up to the director and said: "I want you to meet my boss."
The superintendent of the motor car factory had come. He said to the director: "I have received the most touching letter from this darkey, saying he couldn't come back to us because he must help here. Now I want to tell you that his position is open to him any time that he wants it, during the war, or after it."
Visitors, after walking through the wards, smelling no odors, hearing no groans, seeing the faces of the men smiling back at them, are constantly saying to the director: "Ah, I see you have no really serious cases here.”
It is the only kind of case sent to Neuilly-the gravely wounded man, the "grands blessés," requiring infinite skill to save the limb and life. So sweet and hopeful is the "feel" of the place that not even 575 beds of men in extremity can poison that atmosphere of successful practice. Alice's Queen had a certain casual promptness in saying, "Off with his head," whenever she sighted a subject. And there was some of the same spirit in the old-time war-surgeon when he was confronted with a case of multiple fracture. "Amputate. Off with his leg. Off with his arm." And that, in the majority of cases, was the same as guillotining the patient, for the man later died from infection. There was a surgical ward in one of the 1870 Paris hospitals with an unbroken record of death for every major operation. At the American Ambulance, out of the first 3,100 operations, there were 81 amputations. The death rate for the first year was 4.46 per cent.
These gunshot injuries, involving compound and multiple fractures, are treated by incision, and drainage of the infected wounds and the removal of foreign bodies. A large element in the success has been the ingenuity of the staff in creating appliances that give efficient drainage to the wound and comfort to the patient. The same inventive skill is at work in the wards that we saw on entering the hospital in the bathroom of the Scotch-American. These devices, swinging from a height over the bed, are slats of wood to which are jointed the splints for holding the leg or arm in a position where the wound will drain without causing pain to the recumbent man. The appearance of a ward full of these swinging appliances is a little like that of a gymnasium. Half the wounded men riding into Paris ask to be taken to the American Hospital. They know the high chance of recovery they will have there and the personal consideration they will receive. The Major-General enjoys the best which the Hospital can offer. So does the sailor boy from the Fusiliers Marins.
We had spent about an hour in the wards. We had seen the flying man who had been shot to pieces in the air, but had sailed back to his own lines, made his report and collapsed. We had talked with the man whose face had been obliterated, and who was now as he had once been, except for a little ridge of flesh on his lower left cheek. I had seen a hundred men brighten as the surgeon "jollied" them. The cases were beginning to merge for me into one general picture of a patient, contented peasant in a clean bed with a friend chatting with him, and the gift of fruit or a bottle of champagne on the little table by his head. I was beginning to lose the sense of the personal in the immense, well-conducted institution, with its routine and system. After all, these men represented the necessary wastage of war, and here was a business organization to deal with these by-products. I was forgetting that it was somebody's husband in front of me, and only thinking that he was a lucky fellow to be in such a well-ordered place.
Then the whole sharp individualizing work of the war came back in a stab, for we had reached the bed of the American boy who had fought with the Foreign Legion since September, 1914.
"Your name is Bonnell?" I asked.
"Yes."
"Do you spell it B-o-n-n-e double 1?"
"Yes."
"By any chance, do you know a friend of mine, Charles Bonnell?"
"He's my uncle."
And right there in the presence of the boy in blue-striped pajamas, my mind went back over the years. Twenty-seven years ago, I had come to New York, and grown to know the tall, quiet man, six feet two he was, and kind to small boys. He was head of a book-store then and now. For these twenty-seven years I have known him, one of my best friends, and here was his nephew.
"Do you think I'm taller than my uncle?" the boy asked, standing up. He stood erect: you would never have known there was any trouble down below. But as my eye went up and down the fine slim figure, I saw that his right leg was off at the knee.
"I can't play base-ball any more," he said.
"No, but you can go to the games," said the director; "that's all the most of us do.
"I wish I had come here sooner," he went on as he sat back on the bed: standing was a strain. He meant he might have saved his leg.
We came away.
"Now he wants to go into the flying corps," said the surgeon.
He still had his two arms, and the loss of a leg didn't so much matter when you fly instead of march.
"Flying is the only old-fashioned thing left," remarked the boy, in a later talk. "You might as well work in a factory as fight in a trench-only there's no whistle for time off."
I have almost omitted the nurses from this chapter, because we have grown so used to loyalty and devotion in women that these qualities in them do not constitute news. The trained nurses of the Ambulance Hospital, with half a dozen exceptions, are Americans, with a long hospital experience at home. During the early months they served with no remuneration. An allowance of 100 francs a month has now been established. They reluctantly accepted this, as each was anxious to continue on the purely voluntary basis. There are also volunteer auxiliary nurses, who serve as assistants to the trained women. The entire nursing staff has been efficient and self-sacrificing.
We entered the department where some of the most brilliant surgical work of the war has been done. It is devoted to those cases where the face has been damaged. The cabinet is filled with photographs, the wall is lined with masks, revealing the injury when the wounded man entered, and then the steps in the restoration of the face to its original structure and look. There in front of me were the reproductions of the injury: the chin shot away, the cheeks in shreds, the mouth a yawning aperture, holes where once was a nose-all the ghastly pranks of shell-fire tearing away the structure, wiping out the human look. Masks were there on the wall of man after man who would have gone back into life a monster, a thing for children to run from, but brought back inside the human race, restored to the semblance of peasant father, the face again the recorder of kindly expression. The surgeon and the dental expert work together on these cases. The success belongs equally to each of the two men. Between them they make a restoration of function and of appearance.
In peace days, a city hospital would have only three or four fractures of the jaw in a year, and they were single fractures. There are no accidents in ordinary life to produce the hideous results of shell-fire. So there was no experience to go on. There were no reference books recording the treatment of wounds to the face caused by the projectiles of modern warfare. Hideous and unprecedented were the cases dumped by the hundreds into the American Ambulance. Because of the pioneer success of this hospital, the number of these cases has steadily increased. They are classified as "gunshot wounds of the face, involving the maxilla, and requiring the intervention of dental surgery." These are compound fractures of the jaw, nearly always accompanied by loss of the soft parts of the mouth and chin, sometimes by the almost complete loss of the face.
I have seen this war at its worst. I have seen the largest hospital in France filled with the grievously-wounded. I have seen the wounded Out in the fields of Ypres, waiting to be carried in. I have seen the Maison Blanche thronged with the Army of the Mutilated. I have carried out the dead from hospital and ambulance, and I have watched them lie in strange ways where the great shell had struck. But death is a pleasant gift, and the loss of a limb is light. For death leaves a rich memory. And a crippled soldier is dearer than he ever was to the little group that knows him. But to be made into that which is terrifying to the children that were once glad of him, to bring shrinking to the woman that loved him-that is the foulest thing done by war to the soldier. So it was the most gallant of all relief work that I have seen-this restoration of disfigured soldiers to their own proper appearance.
And the work of these hundreds of Americans at Neuilly was summed for me in the person of one dental surgeon, who sat a few feet from those forty masks and those six hundred photographs, working at a plaster-cast of a shattered jaw. He was very much American-rangy and loose-jointed, with a twang and a drawl, wondering why the blazes a writing person was bothering a man at work. It was his time off, after six days of patient fitting of part to part, and that for a year. So he was taking his day off to transform one more soldier from a raw pulp to a human being. There were no motor car dashes, and no military medals, for him. Only hard work on suffering men. There he sat at his pioneer work in a realm unplumbed by the mind of man. It called on deeper centers of adventure than any jungle-exploration or battle-exploit. It was science at its proper business of salvation. Those Krupp howitzers were not to have their own way, after all. Here he was, wiping out all the foul indignities which German scientists had schemed in their laboratories.
Two days later, I saw the boys of the American Ambulance unload the wounded of Verdun from the famous American train. The announcement of the train's approach was simple enough-these words scribbled in pencil by the French authorities:
"12 Musulman
"241 Blesses
"8 Officiers
"1 Malade
"Train Américain de Revigny."
Those twelve "Musulman" are worth pausing with for a moment. They are Mohammedans of the French colonies, who must be specially fed because their religion does not permit them to eat of the unholy food of unbelievers. So a hospital provides a proper menu for them.
Add the figures, and you have 262 soldiers on stretchers to be handled by the squad of 38 men from the American Ambulance. They marched up the platform in excellent military formation. The train rolled in, and they jumped aboard, four to each of the eight large cars, holding 36 men each.
In twenty-seven minutes they had cleared the train, and deposited the stretchers on the platforms. There the wounded pass into the hands of French orderlies, who carry them to the French doctors in waiting in the station. As quickly the doctor passed the wounded, the boys took hold again and loaded the ambulances en route to Paris hospitals. It was all breathless, perspiring work, but without a slip. There is never a slip, and that is why they are doing this work. The American Ambulance has the job of unloading three-fourths of all the wounded that come into Paris. The boys are strong and sure-handed, and the War Ministry rests easy in letting them deal with this delicate, important work. They feel pride in a prompt clean-cut job. But, more than that, they have a deep inarticulate desire to make things easier for a man in pain. I saw the boys pick up stretcher after stretcher as it lay on the platform and hurry it to the doctor. That wasn't their job at all. Their job was only to unload the train, but they could not let a wounded man lie waiting for red tape. I watched one long-legged chap who ran from the job he had just completed to each new place of need, doing three times as much work as even his strenuous duty called for.
"Look here," I said to Budd, the young Texan, who is Lieutenant of the Station squad. I pointed to a man on a stretcher. My eye had only shown me that the sight was strange and pathetic. But his quicker eye caught that the man needed help. He ran over to him and struck a match as he went. The soldier had his face swathed in bandages. Arms and hands were thick with bandages, so that every gesture he made was bungling. He had a cigarette in his mouth, just clear of the white linen. But he couldn't bring a match and the box together in his muffled hands so as to get a light. He was making queer, unavailing motions, like a baby's. In another second he was contentedly smoking and telling his story. A hand grenade which he was throwing had exploded prematurely in his hands and face.
Work at the front is pretty good fun. There is a lot of camaraderie with the fighting men: the exchange of a smoke and a talk, and the sense of being at the center of things. The war zone, whatever its faults, is the focal point of interest for all the world. It is something to be in the storm center of history. But this gruelling unromantic work back in Paris is lacking in all those elements. No one claps you on the back, and say's:
"Big work, old top. We've been reading about you. Glad you got your medal. It must be hell under fire. But we always knew you had it in you. Come around to the Alumni Association banquet and give us a talk. Prexy will be there, and we'll put you down for the other speech of the evening."
What the people say is this:
"Ah, back in Paris, were you? Not much to do there, I guess. Must have been slow. Couldn't work it to get the front? Well, we can't all be heroes. Have you met Dick? He was at Verdun, you know. Big time. Had a splinter go through his hood. Better come round to our annual feed, and hear him tell about it. So long. See you again."
But the boys themselves know, and the hurt soldiers know, and the War Minister of France knows. These very much unadvertised young Americans, your sons and brothers, reader, often sit up all night waiting for a delayed train.
These boys of ours, shifting stretchers, wheeling legless men to a place in the sun, driving ambulances, are the most fortunate youth in fifty years. They are being infected by a finer air than any that has blown through our consciousness since John Brown's time. And the older Americans over here have that Civil War tradition in their blood. They are gray-haired and some of them white-haired. For, all over our country, individual Americans are breaking from the tame herd and taking the old trail, again, the trail of hardships and sacrifice. They have found something wrong with America, and want to make it right. I saw it in the man from Philadelphia, a well-to-do lawyer who crossed in the boat with me. He was gray-haired, the father of three children, one a boy of twenty-one. He was taking his first real vacation after a life-time of concentrated successful work. I saw him lifting stretchers out of the Verdun train.
Boys and old men with an equal faith. The generation that isn't much represented over here is that of the in-betweeners, men between thirty-five and fifty years of age. They grew up in a time when our national patriotism was sagging, when security and fat profits looked more inviting than sacrifice for the common good. Our country will not soon be so low again as in the period that bred these total abstainers from the public welfare. The men and boys who have worked here are going to return to our community-several hundred have already returned-with a profound dissatisfaction with our national life as it has been conducted in recent years.
I have left the American train standing at the platform all this time, but it rests there till the afternoon, for it takes three hours to clean it for its trip back to the front. Only three hours-one more swift job by our contingent. It is the best ambulance train in France. The huge luggage vans of the trans-continental expresses were requisitioned. Two American surgeons and one French Medecin Chef travel with the wounded men. It carries 240 stretchers and 24 sitting cases in its eight cars for "Les blessés." The five other cars are devoted to an operating room, a kitchen for bouillon, a dining car, a sleeping car for the surgeons, and the other details of administration. Safety, speed and comfort are its slogan. The stretchers rest on firm wooden supports riding on an iron spring. The entire train is clean, sweet smelling, and travels easily. J. E. Rochfort, who has charge of it, went around to the men on stretchers as they lay on the platform.
"You rode easily?" he asked. "Tres bien: tres confortable."
If an emergency case develops during the long ride, the train stops while the operation is performed. It is also held up at times by the necessities of war. For the wounded must be side- tracked for more important items of military demand-shells, food, fresh troops.
Village and town along its route turn out and throng the station to see the "Train Americain." The exterior of the cars carries a French flag at one end, and, at the other, the American flag. I like to think of our flag, painted on the brown panel of every car of the great train, and brightly scoured each day, riding through France from Verdun to Paris, from Biarritz to Revigny, and the thousands of simple people watching its progress, knowing its precious freight of wounded, saying, "Le train Americain," as they sight the painted emblem. It is where it belongs-side by side with the Tricolor. There isn't a great question loose on the planet to-day, where the best of us isn't in accord with the best of France.
That is the biggest thing we are doing over there, carrying a message of good-will from the Yser to Belfort, up and down and clear across France, and every town and every hamlet has heard" not our trumpet blast," but the whirr of our rescue motors and the sweetly running wheels of our express. It is one with the work of the Ambulance Hospital, where, after the bitter weeks of healing, the young soldier of France receives his discharge from hospital. Looking on the photograph and plaster cast of what shell-fire had made of him, and seeing himself restored to the old manner of man, he has a feeling of friendliness for the Americans who saved him from the horror that might have been. The man whose bed lay next walks out on his own two legs instead of hobbling crippled for the rest of his life, and he remembers those curious devices of swinging splints, which eased the pain and saved the leg. He, too, holds a kindly feeling for the nation that has made him not only a well man, but a whole man. And America has two more friends in France, in some little village of the province.
This work of the hospital, the train, the motor ambulance, is doing away with the shock and hurt of our aloofness. These young Americans, stretcher-bearers and orderlies, surgeons and nurses, drivers and doctors, are unconscious statesmen. They are building for us a better foreign policy. It is a long distance for friendly voices of America to carry across the Atlantic. But these helpers are on the spot, moving among the common people and creating an international relationship which not even the severe strain of a dreary aloofness can undo. Our true foreign policy is being worked out at Neuilly and through the war-cursed villages. This is our answer to indifference: the gliding of the immense train through France, carrying men in agony to a sure relief; the swift, tender handling of those wounded in their progress from the trench to the ward; the making over of these shattered soldiers into efficient citizens.
The quarrel none of ours?
The suffering is very much ours.
Too proud to fight?
Not too proud to carry bed-pans and wash mud-caked, blood-marked men. Not too proud to be shot at in going where they lie.
Neutrality of word and thought?
We are the friends of these champions of all the values we hold dear.
War profits out of their blood?
Many hundreds have given up their life-work, their career, their homes, to work in lowly ways, with no penny of profit, no hope of glory, "just because she's France."
- photographs of American Ambulance personnel at Neuilly
- from 'The War Illustrated', a British news magazine
