C.C.S. 17. August 25th
FOR THE FOURTH time I am in Flanders, having returned from Rouen where I was planning for certain changes in the model of transfusion tubes which General Bowlby asked me to make for the Army. I have finished my reports on Air Concussion, and Exhaustion and Restoration.
The return to the Front is always pleasant. My driver lost his way; I realized that he was going through Bailleul, but the day was fine and the hour early, so I let him wander on over Mont des Cats, over Mont Noir---the Tommy didn't mind, he just moved on.
The view from Mont Noir was beautiful. Here a scion of German royalty, Prince Max, nephew of Emperor Wilhelm, imposed himself on the owner of a château three years ago, demanded everything and paid no bills. When at last the Allies pushed the Germans back, the insolent guest was wounded, died, and was secretly buried in the grounds of the château. Soon the various Royal Highnesses of Germany began to request through neutrals, then demand the body. Madame will deliver it when all bills and damages are paid in cash. Meanwhile the lady has the cold-storage lord.
C.C.S. 17, August 26th-September 5th
Ever since arriving at No. 17 I have worked steadily with my team and with Gwathmey, running patients through at the rate of four an hour. Restoration by infusion and transfusion and conservation by nitrous oxide have cut down the mortality here enormously; we have convinced every person in this clearing station and the neighboring ones that these are great lifesaving procedures. Gwathmey's apparatus, Hewett's and our own---the Ohio Chemical---were all interchanged to ascertain which method would be recommended for our Army. The Ohio Chemical was recommended.
Ed Lower has been transferred from No. 10 to us at 17. He with Miss Roche, his anesthetist, and Miss Grundies, his surgical assistant, have been the star team. I could never overestimate my appreciation of Ed's companionship and his co-operation. We have had numerous walks and discussions, dreaming about everything on the horizon. Some day we plan to have our own advance hospital here on the battlefields of France, in which we will give Tom Shupe bones; Sloan, heads; Ed, chest; and me, abdomen.
I have met so many people here who interest me. A stalwart group of Britons serve in these C.C.S.'s. I shall be forever grateful that our lot was cast with them. Pupils of my old friends, Moynihan, Stiles, Alexis Thompson, Makins, Morrison of New Castle have made themselves known.
Osler is frequently spoken of here as in every part of the world. I remember him for so many years; when he was at the University of Pennsylvania, when he met and married the widow of Gross, and when he went to Baltimore. He was always joking. When his only child, Revere, was born, he said to me, "What a joke on old Gross"who had no child.
It seemed impossible to think that twenty years had passed since that day until I looked at the field card of Lieutenant Revere Osler, R.A.F., and saw him cold and pulseless at C.C.S. 47, with shrapnel wounds through his lungs, abdomen and thigh. Brewer, Cushing and I were in consultation, the splendid Darrach in charge. The long marquee tent was quiet and dim; the end was fast approaching. The boy's features were serene and a faint smile illuminated his face when he was told that his father's American friends were there.
Hemorrhage, shock, asphyxia! I had taken Eisenbrey with me, sensing that Revere might be in need of a transfusion. We gave him one which brought up his pulse so that he could be operated upon. Darrach and Brewer operated, Harvey held his pulse, a skillful nurse-anesthetist gave ether and I continued the transfusion while the operation was proceeding. Large rents were found in the colon, much blood in the chest and a large wound in the thigh. Obviously all was lost; cure was anatomically impossible although, owing to the transfusion, his pulse was better at the close than at the beginning of the operation. Before the operation Harvey had sent the following message to Sir William: "Revere severely wounded. Not hopeless. Conscious, comfortable." In the morning the boy died. The day after---a drab, dull, rainy day---he was buried with many others in the mud of Flanders. As I was journeying home at 3 A.M., I thought about the two times that Sir William's son had claimed my attention---tonight and twenty years ago, the first and the last.
On the Road from Poperinghe
One night while we were creeping along the great Ypres highway without lights, we met miles of lorries that had been in concealment during the day and now were prowling---whole villages of houses spun out in single file, each house a camouflaged gun, skulking along without lights, without a sound. Then came the tanks crawling cautiously in this divine night. The sky flashed just ahead. Pops came nearer---the purr of the tanks grew louder. As we turned the corner, a deafening crash shook us. We sped home. When I entered our quarters I found no one; the prairie dogs had all taken to their holes. The Taubes were dropping their bombs to our left---to our right. All the guns of our quadrangle were going full blast.
On account of the red crosses and the wide area, the hospital is a landmark. Our hospitals are prominent on German air maps as we saw in papers on a captured pilot. What called on all my philosophy, was that on several occasions we saw one flying low, apparently bent on our destruction. In the morning a number of dead were found in the road just past us.
Paris, September 5th
This morning bright and early, Gwathmey and I started for Rouen via Boulogne. At Boulogne we were to have another ambulance but there was none available so we went to Paris by train. Only standing space was left. I sat on the floor at the end of the aisle, picking up dinner from venders on the platform.
On the train one sees many interesting scenes; here a soldier and an adoring mademoiselle; there an officer with bandages, attended by his wife; a white, soft-handed profiteer; soldiers, Australians, New Zealanders, East Indians, Portuguese, Canadians, Americans, English, French---all showing each other courtesies. Speaking of the Portuguese, a recent Army order is typical of the best British form. It ran thus: "It has recently come to the knowledge of the Commandant that Portuguese soldiers have been referred to as 'those damned Portugooses.' Hereafter they will be designated only as 'our gallant Allies.'"
At the Army and Red Cross Headquarters in Paris I found that it was reported I was dead. This I denied. I met William Allen White, the famous editor, who wishes to come to Rouen with Lambert to see our work. He spoke of my book, The Mechanistic View of War and Peace.
C.C.S. 17, September 14th
The long busy days---the incessant, wet, cold days and shivery, damp nights---if only we could have just one perfect night with a harvest moon, soft and mellow, but above all a luminous moon. Such a perfect moon and perfect night came, at last.
It was September third---the air was cool, the stars languid, the moon ardent. We sat in the open and watched it creep up over the dark hills.
Suddenly enemy planes were over us. Supplies of bombs---accumulated during those halcyon days of darkness, fog, and drizzle were falling all about us. Every side of this splendid portal to the famous Ypres salient was showered with bombs and Archie shrapnel just as it had been showered before by the blessed, chill rain.
It was as if giant bees laden with bitter honey were over us in a continuous swarm. This is the gateway between the main highway and the main railway. The sides of the highway and railway are one continuous warehouse---concentrated at the crossroads but packed like a mercantile building from Ypres to Hazebrouck, Cassel and St. Omer. Both sides and part of the middle are militarily bombardable. Our planes fill this aerial highway during the day, and the enemy planes fill it at night. The heavy German bombing machines come groaning along with a rhythmic whirr, like a flat tire. On each side of us there is an upper and lower anti-aircraft battery and at each end of this rectangle, a machine gun battery. Stationed about are eight powerful electric searchlights.
These batteries, sturdy and aggressive defenders, are holding under their protection four of the best casualty clearing stations on this great highway through which more than one half the wounded of the Battles of Flanders pass. The sense of security that these batteries give us is beyond description. It seemed to one of us that it would be courteous to call on the commanding officer and express our appreciation of this day and night protection of the hospital area.
"Oh, sir," replied the commandant, "we have no orders about you, we are protecting the munitions dump next to the hospital."
But my colleague was insistent.
"How do you manage to prevent shrapnel and shell from falling on the hospital when the enemy is flying so high and we are directly under."
"We have orders about that too, sir. We are not to take any notice when shells fall---we are thinking only of getting the craft."
My hut wears a cotton dress and a straw hat so, when the fragments begin to spray, I put on my steel helmet and lie on my side. I have rarely seen falling fragments penetrate the bone of the arm, the ribs or the heart. The orderlies have dug trenches. The Sisters have an utterly inadequate dugout. The medical personnel have divers ways; some have small burrows at the brink of a deep, banked brook; others have burrows surrounded by high mounds of earth; a few have private dugouts in their tent, just their length, at the further side of their cots, into which they roil. Some place their beds on the floor and some merely put on their helmets, lie on their sides and trust to luck.
Hesdin, September 15th
I went alone up to Flanders today in an ambulance. On the way I stopped at Hesdin G.H.Q. to consult with Colonel Watson concerning a special mission to the United States which I am about to undertake. His chemical laboratory and headquarters were in a fine old residence with a stately hail, and each room was adorned with rows of huge enemy poison shells of various sizes.
This laboratory has as its duty the examination of every piece of metal, every weapon of explosive character, every poison. At the moment the chief interest is two new gases that came over last week.
I was invited to lunch with H.Q. staff officers representing the various branches of the service. As I was a total stranger, the luncheon presented novel features. There was no servant, everyone helped himself. The following morning at daybreak one of the great battles of the war was to open. Everyone was absorbed in the preparation. A stranger was in their midst---they must ask nothing and comment on nothing; they must make no inquiries about American troops or America's plans; they must have no conversation in which I could not participate; the weather of that morning was excluded because of the coming battle; nothing remained but the weather of the future which was gone over several times with minute attention. The conversation was then suspended altogether during the remainder of this discreet luncheon.
Paris, September 16th
Military surgery has its shadows and its highlights. The highlights are romantic, for in a brief season whole areas of the body are conquered; great principles are worked out; foundation stones laid.
Patients come in volleys. The surgeon is barraged with fractures; shelled with broken heads: bombed with bellies; gassed with wounds.
If he wants post-mortem material he chooses from the daily pile. If he desires transfusions he keeps a stream of blood flowing from donor to recipient, day and night. More progress has been made in the treatment of the chest and the abdomen, of wounds, infections, hemorrhage and exhaustion; more knowledge has been accumulated regarding splints, apparatus, and of every applicable mechanism in the brief three years of war than in the past generation. Daily new things evolve: the best talent of the world is concentrating on the battle line for this is not a war of men. This is a war of ideas. If one wants to render a service equal to putting a hundred thousand well-trained soldiers in the field, then let him discover a method of delousing the armies; abolishing scabies; preventing trench fever and trench nephritis. Any one of these would be of incalculable value. About half of the invalidism of the Army is in this preventable group, and indirectly, a vast mortality. What greater scientific romance could there be than to play the game of preventive medicine?
September 16th to 20th
Armed with credentials from H.Q., B.E.F., I reported at a great university to attend the Interallied Gas Conference, an ultrascientific meeting at which the discussions centered on poison gases, the most important offensive and defensive problem of the war. The secrecy had been so great that world-famed scientists of the same nation, lifelong friends, listened with open-eyed surprise to the discussions of the other. Towering intellects that sedulously avoid agreement with each other were present, not only belligerents of the same branches of science but also of opposing sciences---chemistry, physics, physiology, pharmacology, medicine---each normally with a chip on his shoulder. Cats on a ridgepole would be a pacific comparison, but here all was dovelike peace. The discussions were listened to with absorbing attention. Everyone helped the other to viewpoints, and helpful suggestions were reciprocally offered to individuals of the same and of other branches and of different nationalities. But it was a Scientific Peace. If at any moment during this conference the surrender of Germany had been announced, at that moment normal human discord would have returned.
C.C.S. 17, September 24th
Gordon-Watson called this morning and he and I made plans with Colonel Davis, C.O. of the Second Canadian C.C.S., to establish in connection with his plant the research group that Bowlby wants me to bring back with me. A hut will be built on the ground adjacent to the operating theater, and Bowlby gave his permission for us to take over one ward as an experimental ward in order to study metabolism and wound infection.
In the afternoon Bowlby took me with him to G.H.Q. to testify before the commission from England which was appointed to investigate the dilution of British medical men in France in order to return some of them to England to relieve the civil population who are not receiving adequate care.
I suggested women anesthetists and regular Army officers as commanders of the hospitals. This would release about two hundred medical men and would not impair the service. Beyond this I do not see how the service can be cut at all, as the British are operating on a basis of three medical men per thousand; we on a basis of seven per thousand. I advised four medical men to one regular Army officer for a C.C.S. and suggested establishing pools at the Base Hospitals from which to draw.
The long pull of war service at the Front with its single train of thought has told seriously on this band, remarkable for intelligence---a picked group of differentiated young Britons. It has made them war weary, dimmed their intellectual vision, stilled their ambition, handicapped their initiative, made them wonder what will become of them after the war. Can they make a place? Will there be an opportunity? Where? Will there be money enough left to pay a living wage? They are looking forward, yet not looking forward; they are almost disinterestedly discussing their own uncertain future.
If this is the effect of the war on the medical men who hold the envied position of team captains at active clearing stations, what of the men who have been on duty between the clearing stations and the front line. They have been holed like rabbits all these months and years, and the theory and practice of medicine has scarcely entered their minds. They are not, like the C.C.S. surgeons, asking themselves in what hospital, to what teaching post, they will go, or where they will locate to practice medicine after the war. They are wondering what else they can do to earn a living. Long ago the War Department took these young medical men up into Flanders, put them into a hole in the ground and forgot them. They realize that the war has taken away their medical training.
The next day I breakfasted with Bowlby, then called at D.G.A.M.S. offices, where I met the men who execute the show---General MacPherson, Colonel Black, Colonel Martin, all 2,300-volt men. On the table in the office of the D.G.A.M.S. I found my manuscript on "Exhaustion and Resuscitation" with numerous endorsements and a request to permit its being circulated in the five armies. We then went over to the C.O.'s poison laboratory and found packed up for me two neat packages.
In the evening I gave a dinner in order to discuss plans and policies ---General Sloggett, Colonel Herringham, Bowlby and I. They asked if we could supply nitrous oxide and anesthetic apparatus for the British and I agreed to take this up with the Red Cross. Sloggett said that although the War Office had opposed women anesthetists---he would adopt the plan and asked me to arrange for twenty women anesthetists trained to administer nitrous oxide-oxygen anesthesia.
C.C.S. 17, September 30th
Ed Lower and I are convinced from our experience with war wounds that there exists no basic distinction between the war patient and the civilian patient; between the man exhausted by days and weeks of intensive fighting waiting, dirty, wet, hungry, and thirsty, and the starved patient exhausted by the ravages of disease. For instance, in surgery of the abdomen, in the war zone as well as in the home clinic, the prize problems are shock, hemorrhage and infection.
During our service at No. 17, amputations have accumulated so rapidly that one could realize the experience of a civilian lifetime in the course of a single battle and draw definite conclusions.
Hugh Cabot and my nephew, Dennis Crile, who served at the C.C.S. while we were there, were employing spinal anesthesia in thigh amputations. At that time some teams were using full nitrous oxide anesthesia, others, ether or chloroform. The contrasts in mortality were clear and striking.
The advantage of nerve-blocking was made apparent by Colonel Cabot's series of 180 amputations of the thigh, one half under ether, one half under spinal anesthesia, with a reduction of mortality by the use of spinal anesthesia of 50 per cent. Captain Douglas C. Taylor, a brilliant British surgeon, is using nitrous oxide-oxygen and local anesthesia and has reduced his mortality rate for thigh amputations more than two hundred per cent. This is a long way from the beginning that Ed and 1 made so many years ago.
New York, October 9th, 1917
WHEN Miss ROWLAND and her secretary, Miss Dorothea Barney, and I debarked from a darkened ship we thought the city must be afire, so stupendously excessive was the glow of light. In the taxi, by the light of the advertising signs, I read a newspaper appeal to the American nation to conserve her coal and light for her Allies. It seemed as if there was as much light wasted in advertisement alone as is used in all France for maintaining life.
Washington, October 10th
After reporting to the Surgeon General I spent the afternoon and evening with Franklin Martin, Edward Martin and Frank Simpson learning from them that there was chaos in the Surgeon General's office, that contracts for hospitals of several hundred thousand beds for which there was no plan of organization were about to be let, that eight specialists and five surgeons were to be on each staff, that orthopedists had been allocated twenty thousand beds in France, that there were head hospitals, nose hospitals, eye hospitals, in fact every specialty except obstetrics. Everyone was in distress of mind, especially when I said that in France and Flanders there were no specialists except dentists. Instead, an able C.O. in each field, attached as a consultant, covers the entire area. When I presented my plans for the medical organization of the Army, these three men grasped them eagerly.
I met Colonel Williamson, chief of the gas services. This the most intricate, difficult, scientific and technical service of the Army was in the hands of an Army officer who told me he had learned more about chemistry in the last six months than he had ever known before and that he learned it by reading the reports of the Gas Defense. It was his committee that invented and manufactured thousands of gas masks whose outstanding feature, as proved by Colonel Watson of the British Gas Service, was the facility with which they would suffocate a soldier. To Colonel Williamson I presented the two heavy wooden boxes with rope handles that I had carried from the General Headquarters in Hesdin to Rouen, from Rouen to Paris, from Paris to St. Nazaire, from St. Nazaire to the boat, from my room on the boat to my room at the Belmont in New York, to the train for Washington and at last to my room at the New Willard Hotel. No one carried these boxes, no one touched them but me, and they never left my room. They contained one shell of every kind of poison gas used on the Allied Front, enough to kill everyone in New York. Colonel Watson had asked me to deliver these boxes with their chemical analyses to the head of the United States Gas Service. Colonel Williamson was not eager to take them and said he would send for them in the morning but I insisted that I be relieved of the responsibility.
At the request of the British I reported to the Chief Engineer of the U.S. Army, General Black, on the effect of the high explosives, leaving him a copy of my report. General Black was so much interested that he cabled General Pershing to detail Colonel Taylor, Chief Engineer of the American Expeditionary Forces, to consult immediately with Major Stewart and my collaborators in the research. General Black at once caught the significance of the principle that we had established.
To Secretary Baker I gave a confidential report from the British of the seriousness of the gas attacks. I pointed out to him the shortage of gas at the moment in the British lines, the great need of gas from us, and that because of that need I had just delivered to the Chief of the United States Gas Service shells of poison gas with their analyses. I told Mr. Baker also about the incapacity of the representative sent from the United States to the Interallied Gas Conference in Paris to which, on account of my researches, I had been sent as a delegate from Great Britain. I also called to his attention the results of the biologic test of the dugouts and the need of our Army to become acquainted with those results. The limitations of our uniforms I also discussed with him---the need of more and larger pockets, the discomfort of the high collar, the impracticability of the puttees, the poor quality of the material used, and the great practicability of the English uniform.
The animal specimens showing the results of the experiments in the shell concussion research and in the poison gas research, the human autopsy material from phosgene poisoning, as well as the lungs of the German prisoners killed at Rémy Siding in the air raid, I took to the Army Medical Museum and turned over to the Curator, questioning him as to what the Museum would be prepared to do in the way of collaborating with the American College of Surgeons to collect material for a military museum. There is great need for planning during war for medical and biological literature of war, examples of missiles used in war, examples of war wounds, splints, apparatus, analyses of poison gas, and specimens of pathologic anatomy.
Washington, October 11th
The train on which Grace was arriving was late and as an important appointment kept me from meeting her, I left on her bureau a British shell that I had picked up on the battlefield of Messines, with three red roses in it, a message that I knew she would understand.
Washington, October 12th
I found that the seven reports and the manuscript entitled "A Suggested Plan of Clinical Organization of the Medical Service of the U.S. Army," that I had written on the way to America have been read with interest on all sides, so 1 left with a feeling of gratification. We hurried to Philadelphia to see Margaret at Bryn Mawr, taking with me the shell that I had picked up for her at Messines and had had polished and engraved. I left Margaret in May, thinking of her as a little girl. I found waiting for me at the station, a beautiful grown daughter, with her hair up, and matured in so many ways that I scarcely recognized her.
Cleveland, Sunday, October 14th
With bursting enthusiasm, I was devoured by Elisabeth, Barney and Bob. Elisabeth has grown surprisingly tall and graceful but has retained all her childish winsomeness. Barney has had a hothouse growth and seems exceptionally mature. Bob has changed less in the six months than the others.
When I went to my room I found an illuminated verse of greeting from Elisabeth on the bureau, which had been decorated by Barney and Bob with autumn leaves, moss and pretty pebbles---treasures of their present stage of evolution.
October 14th
Franklin Martin, realizing the crisis impending in the Medical Department of the Army and that the plan of organization that I presented might be the only means of straightening out the difficulties, telegraphed Will Mayo to come to Cleveland and go over my proposed plan. Will, the same resourceful, farseeing, masterful Will, immediately grasped the force and logic of the proposed organization and said he would endorse it.
Cleveland, October 16th and 17th
Our entire house is transformed into a series of offices; the library is used for consultations, two stenographers and Miss Rowland are working in the upstairs sitting room, a draftsman works on maps and charts in the billiard room, and people wait for conferences in the living and drawing rooms.
Chicago, October 19th, meeting of the American College of Surgeons
Upon arrival at the Blackstone, Grace and I found ourselves guests of the American College of Surgeons and were shown to a beautiful suite overlooking the boulevard, the training grounds and the lake. I arrived at the Hospital Standardization meeting late but in time to pick up the threads, sum up the meeting and give what I believed to be the keynote for the campaign ahead of us. I pointed out that standardization means a correlation of interests, a getting together, a cohesion of spirit, and I told of the benefit of the daily meetings of all departments of our Base at Rouen, a meeting at which everyone's problem could be aired and none could be cubbyholed. During the week in Chicago many secret conferences were held in our rooms at the Blackstone on the walls of which were hung my charts, showing the suggested plans of clinical organization of the Medical Service. Within these walls was laid the foundation stone of the reconstruction of the Medical Department of the United States Army.
Chicago, October 21st
The Executive Committee of the General Board of the Council of National Defense with Sir Berkeley Moynihan, of Leeds, England, Colonel Thomas H. Goodwin of the Royal Army Medical Corps, who for six months had represented the British Medical Service in the office of Surgeon General Gorgas; Colonel Charles U. Derkle, representative of the Medical Department of the French Army; Surgeon General Gorgas, Admiral Braisted of the U.S. Navy; Surgeon General Blue of the Public Health Service; and the heads of the various specialties met to give everyone an opportunity to discuss the proposed revision of the medical organization which I presented to them. The Surgeon General opened the discussion and commented favorably. A round robin of discussion followed, the result being that the fight for reorganization was won easily. The battle for Surgery, that is, the separation of the clinical surgeon from the duties of administration, was more difficult. My proposal was the establishment, under the direction of the Surgeon General through our first-class university medical schools, of a complete professional organization as an adjunct to the Army Medical Service. The Army Medical Corps I believe is better qualified to administer; the civilian Medical Corps, to take care of the sick and wounded.
This point was won by the clinical surgeons. To my great satisfaction, before the meeting closed it was the consensus of opinion that the organization of the Medical Section of the Army had been achieved. General Gorgas said that he would approve the plan and officially asked me to present it to General Bradley in France.
Washington, November 5th
Franklin Martin, Moynihan and I met at the office of Surgeon General Braisted where there were a number of spick-and-span naval officers, including Admiral Grayson, waiting to take us on a tour of inspection of the Navy Building. Later we were to be received by the President. Afterward I was interested to hear Sir Berkeley say he thought Wilson's face far stronger when one saw him than when judging from photographs, but that his intellect, like an iceberg, seemed to be seven-eighths submerged.
Washington, November 6th
Today l had an appointment with Colonel Noble, the one man in the Surgeon General's Office that everyone fears. He is a forceful and able executive and is called "the bulldog of the Mills Building." I approached him gingerly, armed with diagrams and maps. After I showed him the plans including the university sectors, the consultation areas, the consultants or staffs of the chief surgeons, he agreed to it all. He agreed also to the plan of the hospitals, namely, the large operating area in the front, the mobile teams, the limitation of specialists and the "communion of saints."
In the course of the conversation he referred to the Gas Service of the U.S., intimated that it was in the hands of a pleasant but incompetent executive and asked if I would consider accepting the post of Chief of the Gas Service of the Expeditionary Forces. I discussed freely with him the menace of gas to the armies of the Allies and impressed upon him the immediate need of placing the service in the hands of the strongest committee of physiologists, chemists, etc., that he could gather. I told him that within twelve hours after the first chlorine gas attack on the British forces, Haldane, Britain's greatest physicist, was in Europe. Within a short time a mask had been devised and one hundred thousand had been made.
Personally, I should like the problem of organizing the Gas Service but I would have to educate myself anew in chemistry and physics and it might take me far afield from my clinical work and research in hand. Colonel Noble understood and before I left, assured me absolute support in anything I wanted for my researches in gas, electric conductivity and metabolism.
He promised me also that the increased rank that I had suggested for members of the Lakeside Unit would have to be referred to the liaison officer in London, but would be carried out according to the suggestions and that the names of the twenty anesthetists for service with the British Army would be passed, as well as the names of the delegates to the Interallied Surgical Congress to be held in Paris in November.
Meanwhile, I had received a message to go to the Sanitary Department which proved to be one of the most sane and able ones that I had visited in Washington. Here I found a group of four, Zinsser among them. They asked many questions and took voluminous notes on the location, duties and scope of laboratories in the field, a subject on which they had only academic knowledge. My intimate experience with Stokes, C.O. of Rats, gave them just what they wanted to know. I gave them also the report of the C.O. on rats, and of the C.O. on lice both of which contained much information that was new to them.
Washington, November 18th
Grace and I are in Washington to attend the monthly meeting of the National Council of Defense where I reported at length on the leading war problems, lice, fleas and scabies, trench nephritis, trench heart, trench fever, war neurasthenia, phosgene and mustard gas poisoning, shell concussion, wound infection, exhaustion and the treatment of compound fractures; and offered our plan of organization to meet them. At the end of the report there was great applause in which all but a few joined. After a dead silence that grew more apparent every minute, Martin asked Charlie Mayo what he thought they ought to do about the report and whether or not he felt it should be discussed.
"This report comes from the Front," said Charlie, "and there is no one here who can add anything to it; a discussion might put a fog over it." Martin then called upon one of the full-time academic professors who resented my allusion to the limitations of the academic man to meet problems. I asked permission to explain what I meant, which was that when a cloistered professor is sent out to the trenches to kill rats he becomes so interested in the age of the rats, their heredity and the number of their whiskers, that he often neglects to kill the rats. Whereupon loud applause came from the sidelines and shouts of "Kill the rats!"
In the midst of this welcome diversion, Franklin Martin rose and said with the utmost sincerity, "As I understand Dr. Crile's message, it is this: Dr. Crile returns from the actual battle line and finds that we are immersed in a lot of useless routine, most of which is piffle, and that the thing for us to do is to go abroad and meet the problem and feel it at first hand." We adjourned amid mild confusion.
Washington, November 20th
As I finally take leave of Washington I feel that I have probably opposed everyone's interest in the Surgeon General's Office, in the Medical Department of National Defense, and even in the Cabinet. Wherever I have gone I have exploded a mine and upset people's plans and way of thinking. I told Grace that I doubted if I had a friend left in the world, that I had differed with everyone on every problem and that I felt like a Tommy I found at Messines sitting up in a dark pavilion filled with wounded, all the rest of whom were groggy with sleep.
"Well," I said, seeing the Tommy smiling and smoking a cigarette, "what is it?"
"Oh, I had a bully fight last night," he replied. "I bayonetted five Boches."
As I read the words on my order: "You will proceed to Hoboken, New Jersey, and report to the commanding general, Port of Embarkation, equipped for prolonged field service," I feel that Washington is taking no chances on another visit from me. But I would not trade one atom of the satisfaction I have had in the enemies I have made.
In France again, December 1917
HERE IN CHAUMONT there is the most military atmosphere I have seen in the American lines, but how patently less prepared we are than our Allies. We are amateurs in a game with professionals. Major Tuttle is in a large room working out plans for a hospital. In spite of the fact that America declared war seven months ago, as yet, not a single bed has been prepared for our men. The regular Army is trying its best to perform work alone, but the clinicians from civil life and the reserve corps on duty on the American Front are so efficient that this little army will not be allowed to fail.
Recently all of the six American medical units in France that were loaned to the British government were suddenly deprived of their regular Army commanders, leaving in each case the ranking officer, that is, the Surgical Director, to succeed as the C.O. of that unit. Apparently General Bradley sees no disadvantage to our Army Medical Service in taking from its professional and clinical staff such men as Brewer, Cushing, Hart, Fred Murphy, Finney, Beasley and me and appointing them as C.O.'s of American units serving in British hospitals. Rather than take such a post I have asked to be detached from my Unit and assigned as Director of my research group to be stationed with the Unit. This has been done.
General Bowlby sent orders to have me passed up to H.Q.B.E.F. for a conference. At dinner he told me of a Tommy who lived in a shell hole with a fractured thigh for seven weeks. The date was confirmed by the time his battalion left that territory, by the date when this Tommy was put down as missing, by the man's own description, by the fact that he had long hair and nails and, finally, by the fact that his fracture had become united. His food was obtained for him by a wounded comrade who crawled about gathering iron rations from the dead. When his friend did not return, Tommy, presuming that he was dead, dragged himself back to his own line. This case now stands as a record.
General Hospital No. 9, Monday, December 24th
Christmas in Rouen has brought to me many vicissitudes, many solitudes, but many memories of the happy Christmases of childhood when Mother baked delicious little cakes in the shapes of animals---memories of the first Christmas when Margaret was old enough to be attracted by a glittering tree---kaleideoscopic memories of each succeeding year revealing the increasing pleasures of Christmas as my family has grown.
But the most picturesque Christmas Eve that I have ever experienced was on my journey yesterday to and from General Haig's Headquarters, through beautiful Normandy, in a comfortable limousine accompanied by a pleasant young British officer, Captain Williamson. Our route lay along the familiar highway, which I have traversed in all the seasons, from blossomtime in May until the bleak December of yesterday.
There had been a heavy fall of snow. The sun was shining, the wind bitter cold. The beautiful French forests sparkling like tinsel, the haze, the mystery of the cathedral-like aisles of Normandy poplars, stretching out until lost in rich pastels-all this-the entire earth and the unfathomable sky was my Christmas tree of 1917.
At Rouen all was bustle on Christmas Eve. The great forest of Rouen had been brought into the hospital. The naked boards, pillars and braces, even the huge fracture frames were decorated and Tommy was enjoying the show.
In the dim light of the evening, a troup of white-capped nurses and medical officers, including the padres, wandered from ward to ward with an old melodeon and a fiddle, singing Christmas carols.
Ed Lower and I talked late. Each day some new team comes blowing in from the front. Only today Captain Graham and his team arrived from Cambrai. Each officer, nurse and enlisted man declared it to be the experience of a lifetime. Something is taken from their faces, their manner, their viewpoint, and something else is put into its place ---a better something.
Paris, January 16, 1918
I have had a feeling of apprehension that the research at the Front would have to be dropped because our plans had been laid with the Second British Army and it is now in Italy; the line at Ypres is thin; the enemy, heavily reinforced from the collapsed Russian Front, is threatening us, and, limited as our own ocean traffic is, it is so packed with soldiers and freight that it has almost ceased to move.
The Allies have their wind up frightfully and everyone is apprehensive, so at the research meeting which is being held in Paris I asked colonel T. R. Elliot, Chairman of the British Commission, if my group of Miss Rowland, Obear, Milner and a secretary had not actually sailed, would he advise revocation of the orders?
"By all means," he replied. "Under present conditions such work at the Front would be unsafe. Everyone is jumpy. No one knows what will happen. When things clear we can resume our plans but if your group comes now, all we can do is to store them at the Base."
On this authoritative information I cabled General Gorgas and wired General Bradley and General Bowlby. This wound up once and for all the greatest dream of research I have ever had.
General Hospital, No. 9, February 26th
Americans are arriving. There are said to be about five hundred thousand here. England has diverted two-million tonnage and we shall have a million soldiers here by October. Americans are building docks, warehouses and railways. They expect to build a two-track military road straight to Dijon from Bordeaux. When will the great offensive begin?
I must never ask myself if I am enjoying the work here. Heaven knows I am not. I must not ask myself if I would want to be at home or I would be useless here.
One of the greatest causes of getting into complications with one's fellows is to be too effectively useful. The priceless reward of being useful is so much coveted by a host of good men who wish to achieve the same goal, that there arises a resentment against anyone who has earned that reward and, by so doing, has stood in the way of their having the same recognition.
These are porcupine days. In order to preserve myself, I must reply to nothing, interpret values in accordance with what the situation warrants, in other words, achieve a negative phase, and remember the Chinese maxim that "Great things can be reduced to small things, and small things can be reduced to nothing."
General Hospital No. 9, February 28th
Although the chapter of the prevention and treatment of surgical shock is closed, I have not as yet identified what happens within the cells themselves in shock and exhaustion. Theoretically it seems that the difference in electric potential, i.e., the maintenance of the acid-alkali balance between the nucleus and the cytoplasm of the cells, is lost; but how this fact causes depression and death, and why the cells of the liver always show destructive changes and recovery changes exactly parallel to similar changes in the brain cells, remains a teasing mystery. The thousands of shell-shocked cases that I have viewed gave me my first light. Now as there is little or no fighting, I have sent to London for the Cambridge Series of books on physics, physical chemistry and electricity and am cramming them as if for examination, in order to crystallize in my own mind my belief that I may be able to make a physical interpretation of the energy transformation of cells and organs and of the reciprocal rate of the brain and the liver.
Under this forced draft I have glimpsed a possible relationship between these two organs, the brain as a complex nucleus, the liver as a complex cytoplasm---the positive and negative organs respectively of the body. This takes into account the extraordinary fact, as reported to me by the research group at home, that in electric conductivity experiments under every kind of stimulation these two organs, the brain and the liver, moved in opposite directions. When conductivity of the brain was increased, the conductivity of the liver was decreased, and when the conductivity of the brain was decreased, the conductivity of the liver was increased.
Yet the physical changes in the cells as revealed by the microscope, showed exactly parallel destruction and parallel construction. These two organs alike were broken down by death and by want of sleep and were reconstructed by sleep.
I have finally formulated definitely the bipolar or electric theory of living processes. In view of Mathew's discussion of oxidation, I have accepted the viewpoint that all life is essentially electrical in nature and that oxidation is one of the phases of electric phenomena in life. That is to say, I believe that by means of electric energy the nervous system drives the muscles and glands to perform the various physical and chemical activities by means of which the organism meets the vicissitudes of life.
Having thus glimpsed an electrochemical theory, I am seeking further evidence in its support. In these investigations l am taking as my criteria our histologic findings which seemed to suggest that the concentration of electrolytes is altered as a result of excessive activation or lack of normal rhythmic restoration.
The Oxford Press has agreed to publish "A Physical Interpretation of Shock, Exhaustion and Restoration," upon which I have been working all winter. This intensive study and the practical application of my researches have thrust me into biophysics.
General Hospital No. 9, March 1st
The first of March and still no offensive. The French and the British feel bucked up but anxious. All talk is of a German drive through Switzerland.
We have been over here for ten months and as yet there is no organization. I am to take the directorship of Research for the American Army. As a member of the Committee on Transfusion I recommended the citrate method and the blood grouping of Moss.
I have three homes and in each I keep some of my belongings. Number one is Neufchâteau, the Medical Headquarters of the A.E.F.; the second is General Hospital , at Rouen; the third is the Continental Hotel, Paris, where I go every week to Red Cross meetings and Interallied Conferences. All of the meetings of the Interallied Conference are secret and arose out of necessity. No one trusts anyone, the English do not even trust the French, their allies.
Châlons-sur-Marne, March 17th
Colonel Herbert Bruce and I have been asked to go on a mission of observation from Park to Verdun, with the idea of detecting flaws and making suggestions in the medical organization in the French line. As Bruce has a Daimler, we received permission to go together. In high spirits we set out from Paris this morning and arrived in the afternoon at Châlons-sur-Marne, Headquarters of the Fourth French Army.
Here we visited three hospitals, the best one being Hôpital Corbineau, a barracks hospital of which Gosset is surgeon. After examining the hospital carefully, we went to the Headquarters of the Second French Army where we were expected and received with the greatest courtesy. We were told we were to lunch in the Verdun citadel with the commandant and were sent there in a French car, through a military area filled with barracks, airdromes, abris, munition trains, old roads, newly built roads and a literal spiderweb of telephone and telegraph wires, but not a human being in sight!
As we approached scarred Verdun, dotted over the entire landscape as far as the eye could see were the military works among the Vosges foothills. At last we turned the grim corner and saw the sign, "Verdun." The effect of the entire scene was that of the Arizona desert or of the copper mines and smelters of arid Colorado.
We drew up in front of the ancient and all but impregnable citadel and entered the shattered building of which the walls were standing. This was the outer part of the defense. An officer showed us the mess hall, and we passed through the long corridor just wide enough for a table and seats, into the private dining room of the commander of the post. They had waited luncheon for us, and as we ate I noticed a shield on which was inscribed "On Ne Passe Pas." At the end of the table was a burnished 75 suspended upside down and used as a bell to call the servants. On it also was inscribed "On Ne Passe Pas." At one side of the room there was a cluster of all the Allied flags and it was thrilling to see Old Glory snuggled among them.
General Gouraud with whom we lunched, is a tall, erect, fine-featured man with a strong face. He has lost an arm and suffered fracture of a leg with shortening. His tunic was covered with medals.
After lunch we went with an officer to an advance evacuation hospital that occupied an old building at the outskirts of Verdun. It was badly ventilated, had many gassed cases and only a fair staff. This entire area is shelled daily, but the French believe that if there are no military objectives in the neighborhood, the gunners do not shell the hospitals. The commander of this fort identified my name with shock and transfusion, and was most cordial. At the next hospital of evacuation that we visited in Verdun they were treating a badly shocked case and asked me many questions. In the basement hospital at Reims and also in the underground hospital at Souain I had the same experience; everywhere our work seems to have become known in France.
Returning to Souilly, the General Headquarters of the Second Army, we picked up our own car and were off for Toul, a double-moated ancient fortress, the outgrowth of centuries of contact with the Hun. Verdun, Toul, Nancy, Belfort are calluses on hard-used frontiers.
Chaumont, Wednesday, March 20th
From Toul, Bruce and I ran out north to Sebastapol where we found that a good start had been made by a lot of the Americans at Evacuation Hospital No. 1---John Gibbon, Eugene Pool, Heuer, McWilliams, Goldthwaite and Keyes. They were proud of their organization and, like good Americans, said so.
After this view we drove off to see Bruce's friend, Jack de Lesseps, son of "Suez" de Lesseps and commander of a bombing group in a little village on top of a Vosges hill with a fringe of woods all about At first we saw nothing, then we counted eighteen airdromes, side by side, hidden in the edge of the forest. In each airdrome were two machines. De Lesseps, a tall, splendid-looking fellow, showed us his own great Caproni machine, a three-engined monster which carried twelve bombs of 104 pounds each. He has been bombing for two years and is keen to bomb Cologne.
Next to Nancy, her beautiful châteaux glistening in the sunshine, then to Chaumont where we stopped to see splendid Charles Peck and, of course, a splendid unit.
Paris, March 21st
Bright and early on this beautiful first day of spring, the enemy launched his great offensive. Bruce and I left for Paris. The guns which a few days before had been hidden were now roaring and the hospitals that had been empty were today overflowing with the dying. The peace, quiet and beauty that we had seen was but a veneer. Underneath it, man was crouching ....
Bruce and I were standing in the doorway of the Hotel Bristol in Paris waiting for a taxi when a shell hit Paris. It surprised and mystified the populace. We looked upon it as an accidental explosion but were puzzled when it recurred at regular intervals. While we were busy I sent Sanger, the private who drives my Ford, to see the Madeleine. As he stood in front of it, gazing at the relief of "The Last Judgment" in the great pediment, something hit him on the nose and knocked him down. It was the nose from one of the figures on the pediment. Had the Madeleine been bombed? In spite of all the excitement Paris seems tame, abnormal, useless, superfluous---a hothouse plant in the midst of famine. Reports of the battle led us to press on home.
I arrived in Rouen at No. 9 in the early afternoon and found everything exceedingly active; the operating rooms busy, the wards full. The backwash of the battle indicated it to be the greatest that has yet been fought. Ed and I took over the operating teams at 8:00 P.M. and operated until midnight, doing in all twenty-seven operations. We had supper then and went to bed.
General Hospital No. 9, March 22nd
During the past twenty-four hours we have taken in 740 patients and have performed 104 operations. Here I find letters from Washington in regard to matters that were settled last November. Ever since last autumn we have needed and wanted anesthetists, and ever since last November the American anesthetists have been waiting to come; only now is the correspondence coming through! I am attached to our Unit again and serving in the capacity of Clinical Director.
General Hospital No. 9, March 23rd
To my utter surprise this morning I learned that the explosions that Bruce and I heard in Paris two days ago were shots from a big gun---said to be seventy-five miles away. Bruce and I were under bombardment and did not know it!
The German offensive is now three clays under way and there is as yet no let up. Our wounded tell us the gunfire is terrific---the battle terrible beyond all others. This seems to be the decisive battle of the war and it does not appear to be going especially well for the British. Ed and I have just been reflecting on the fact that most of the wounded are lightly wounded or at least are walking wounded. This is in strong contrast to the many seriously wounded from the battles of Messines, Vimy, Ypres and Passchendaele. Then we were winning, now we are losing, hence there are few fractures or wounds of legs or feet. Those that cannot walk are finished off by the enemy. Some Scottish wounded among the new arrivals give a pessimistic account of the battle. They say that some of them had no ammunition, no guns, and that they used their fists. Whiskey is not a good ration in any army.
General Hospital, No. 9, March 24th
This is the fourth day of the advance on Amiens. Today we took in 760 patients. The wounded are pouring in by the hundreds a day. Our hospital is full, stretchers are strewn about the lawn in the moonlight, and the operating room with four tables is running continuously day and night. Ed and E were on from 4 P.M. until midnight last night and from 4 until 10 tonight.
General Hospital No. 9, March 27th
Barney and Brock, two of my old Lakeside boys, were at C.C.S. No. 36 for three days and then were shelled out. They conducted the evacuation, remaining until the last moment, and brought away over nine hundred patients on a horse and cattle train. The nurses were sent ahead. Miss Schultz came away so hurriedly that she arrived in her operating clothes, dirty and exhausted, her shoes slung over her back.
General Hospital No. .9, March 31st
Easter Sunday-record day of the hospital---over a thousand! Twenty dead were taken from one train. It was as if bees were throwing out the dead from their hives. There are troops of hobbling, walking wounded everywhere. Stretchers fill the aisles, the lawn, the recreation huts. Nothing is so profuse in Rouen as rain and wounded soldiers. 140 more beds have been ordered.
Everyone asks can we hold the line? The Americans are always coming, never arriving. It is like a bad dream.
We are having many freak wounds. Ed told me of two cases of his in which the bullets went through the thighs, landing in the patients' pockets. One patient had two gold coins removed from his buttocks. When they were given to him, he said they were the lucky pieces of his pal, who had been wounded by shrapnel, next to him.
General Hospital No. 9, April 9th
I forgot to note that the field hospital and laboratory at the Front that we had planned for research was entirely washed out in the last push---all equipment would have been lost. To escape with a whole skin and no kit would have been lucky.
Although I have recently been assigned to the position of Director of the Division of Research for the A.E.F., my station is still with the Lakeside Unit at Rouen which gives me a liaison with the British. Nothing could give me a broader field or be more to my liking; indeed, it is the only position I would have cared to undertake beyond the clinical direction of the work in our Unit, and I am still free to serve there in times of crisis.
Innumerable research problems with immediate clinical application present themselves. The field is wide and we are having wonderful co-operation from the British, the French and our own Red Cross.
During the last big push we started a research in infection, analyzing the cases as they came in. No. 9 has been nothing short of a casualty clearing station in the type of wounded to be cared for.