C.C.S.

The ——th C.C.S. claims to be the hospital farthest advanced on the Somme. The claim is justified. Its grounds are lit at night by the gun-flashes. The discharge of our own heavies rattles the bottles in its dispensary and makes its canvas tremble. Sleep is sometimes driven from the eyes of its patients, not by pain, but by the thunder of bombardment. Convoys from the dressing stations have but a short run. The wounded arrive with the trench-mud wet upon them. Clearing them up is quick, if filthy, work, and in clearing them up is engaged a small battalion of orderlies.

The whole hospital is under canvas, except the operating-theatre, which is a hut, hermetically sealed, as it were, and heated to a working temperature—and, incidentally, an even temperature—by some ingenious device. Surgery cannot get done with numbed hands. Yes—and the officers' ward is a hut, to deepen the great gulf fixed between Tommy and his officer, even when they both are in mortal pain. The difference in the degrees of comfort between a marquee and a hut, in the Somme winter, is incredible. Unhappily, too, in these winter months there is a horrible shortage of coal and paraffin. This tells again in favour of the hut. The officers' hut is as warm as your civilian sitting-room, and wellnigh as comfortably furnished. No ingenuity could make it possible to say this of a marquee.

But it is only the wounded officers who are comfortable. The Medical Officers freeze and soak in bell-tents. You'll see the batmen drying their blankets nightly at the mess-fire before their "bosses" go to rest. No artificial heating is possible in these tents, because there is no fuel available for those who are well. M.O.'s retire after an all-night bout in the theatre to their clammy beds, and sleep from exhaustion; and for no other reason. They wake, and shiver into dewy clothes. They shiver through their meals in the biting mess-tent, and they plod through the sea of slush that surrounds the wards incessantly, now that the winter has set in. For the ground is never dry. When it's not raining (which is seldom) it's snowing—and snowing good and hard, as a rule, in fat flakes as big as carnations.

But they're a cheerful mess, with work enough to save them from dwelling overmuch on the discomforts of the Somme winter. There are twenty of them. The Colonel is a Regular, with long years of Indian service behind him, whose favourite table topics are big-game and economic problems—particularly those hypothetical economic difficulties which are likely to confront us after this war. His customary opponent is PadrÉ Thomas, the Roman Catholic Chaplain, who took a double-first at Oxford and was one time an Eton master. He receives weekly from a favourite nephew, reading for matriculation, Latin prose exercises, the merits of which he discusses with those members of the mess whose classical scholarship war has not quite obliterated.

There is Wallace, the X-ray expert, whose chief topic is the shortage of paraffin, lacking which his apparatus cannot carry-on. He's a Scotchman who once graduated in Arts. He is chief consulting specialist with the Chaplain on the merits of his nephew's prose composition.

The Anglican padrÉ is a raw-boned Scot (six-feet four) who has lived mostly in Russia and Germany. He talks a great deal of vodka and the hoggishness of German manners. "What a treat it would be," he says, "to march into Berlin with the pipes playing, go through to meet the Russians on the other side, and have a foregathering! That night I should cast away all my ecclesiastical badges!"

He preaches to the camp of German prisoners close by with a grace that is not altogether good. He cannot abide Germans. One envisages him as delivering them fire-and-brimstone discourses and calling them weekly to repentance.

The quietest members of the mess are the surgical specialists, P—— and R——. They are also the hardest worked and the most irregular at meals. It is rarely that they are taking their soup before the others have finished. This is perhaps a good thing, in the light of their frank physiological discussion at table of cases just disposed of in the theatre. On taking-in day they frequently do not come to table at all. I doubt whether they eat; if they do, it is a snack between cases in the abattoir. The hospital takes in and evacuates on alternate days. Theatre cases must be done at once, for it may be necessary to evacuate them to the base on the following day; it is, in fact, necessary, unless they are unable to bear transportation, and many are too critical for that—head cases, spinal cases, and the like. Cases that suffer greatly are visited with the merciful hypodermic before they start on their jolting journey in the ambulance-train. Not that A.T.'s are rough: they're amazingly smooth. But however smooth, they are agonising to the man whose nerves are lacerated and exposed, or into whose tissue the scalpel has cut deep.

The A.T. draws into an improvised siding adjacent to the wards. There is no question of mechanical transport to the train. It is the practice to establish C.C.S.'s beside a railway, where evacuation during a push can be facile and expeditious.

P—— and R——, the men of few words, but of great and bloody deeds, have operated in some degree or other on wellnigh every case that boards the ambulance-train.

Added to the shortages in fuel which hit the wounded so hard is that other present hardship: the congestion on railways. As soon as an A.T. is wired as having left the Army garage at ——, such preparations must be made as will ensure that the wounded will be ready to board her immediately on her arrival. They must be waiting in the evacuation tents by the siding before the minimum time of her arrival. But notwithstanding regulations which provide that A.T.'s shall take precedence over all other railway-traffic whatsoever, that requisitioned is frequently four or five hours late—such is the present state of the roads. That means four hours of frozen agony in the evacuation tents. Fuel cannot be spared for warming them, when it is more than the wards can do to get warmed. A shivering padrÉ moves round amongst them administering comfort which makes no pretence at being spiritual, except in a punning sense. That's one thing very few padrÉs in the war-zone have been obtuse enough not to learn: that attempts at spiritual consolation may sometimes be inopportune. Every padrÉ knows the full war-value of creature-comforts—even for his spiritual ends. So he moves about the evacuation tent ministering to the body rather than to the soul.

The surgical specialists have long since ceased to have connection with this stage of their patients' movements basewards. They are in the theatre making ready more for the journey down.

The mess harbours the O.C. of a mobile laboratory. He moves between the hospitals within the Army testing serums. He wears the peering aspect of a man accustomed to microscopic examination. All his table conversation is of an inquiring nature—better, an investigatory nature—into matters that are quite impersonal. During a whole meal he will talk of nothing but the Northern Territory of Australia or the structure of the Great Barrier Reef on the Queensland coast. If he's talking of the Reef he deals in a series of questions and in an examination of your answers thereto, until he has built up for himself—with the aid of diagrams contrived with table implements and slabs of bread—an accurate notion of the surface structure. He's as much interested in modern history as in science. One evening he edified the mess, by arrangement, with an hour's discourse on the causes leading up to the American Civil War. For this he prepared with academic care. It was curious to see how he could, for an hour, sustain the interest of the mess in so remote and comparatively insignificant a struggle, when that mess was stationed in the heart of the Somme at the height of the push.... His laboratory walls were decorated with pictures by no means scientific, and yet physiological. They are extracted from La Vie Parisienne, a French weekly illustrated journal of extraordinary frankness. But in this man there is nothing lewd. But he has an unusual appreciation of French cleverness; and that is a faculty alarmingly wanting in the normal English officer. French drawings, which the English call lewd are by no means lewd: merely intensely clever. They convey no notion of lewdness to the French mind. But the English, except in the case of isolated representatives of that race, will never understand the French—in other matters than that of art. So great is the gulf of miscomprehension fixed between the French and English that it becomes a daily deepening mystery how they could ever have found themselves Allies. Still more mysterious is it that they should continue so....

These are the men who impress you most in the mess. There's Wallace, the Scotchman who never says more than he's obliged, but has the tender heart with his patients. He always trembles when giving the anÆsthetic in critical cases. He calls himself weak-kneed for it, and reviles himself unmercifully for a womanish fellow (he's intensely masculine); but he can't help it.

There's Thompson, another Scotchman (the mess is fairly infested with Scots) who is dental surgeon. His gift is disconcerting repartee, with which he occasionally routs the C.O.

These are the officers. But what of the Sisters? There are eight of them. When you have said they are entirely unselfish, you have included most attributes. That includes an irrepressible spirit that no continuity of labour can break. It includes gentleness which familiarity with pain in others does not quench. And it includes a contempt of personal comfort that must sometimes amaze even themselves if they ever find time to grow either introspective or retrospective. They sleep in tents; they lack fuel; they shiver by the hour in damp beds unless exhaustion drives them to sleep; and they rise in the murky morning to don sodden garments. They work hard and without intermission for twelve to sixteen hours—and indefinitely when a "stunt" has brought the convoys from the line. But none of these things beats them down.

The theatre Sisters deserve immortalisation. All the qualities of patience and gentleness, endurance and cheerfulness, seem intensified in them. They have not the smallest objection to your watching them work in the theatre; nor have the surgeons. Rather, they encourage you, and get you to help in a minor way when the place is busy.

It is rarely on receiving-day that four "tables" are not in use simultaneously. This makes it inevitable that the victims, as they are brought in and laid out for the anÆsthetic, see within six feet sights not calculated to fortify them. Some smile in hardy fashion; some smile in a fashion that is not hardy. The abject terror of those wretches out of whom pain has long since beaten all the fortitude is horrible to see. What must be the state of that man, made helpless by unassuaged suffering, who sees the scalpel at work upon a fellow beside him—the gaping incision; the merciless pruning of the shattered limb; the hideous bloodiness of the steaming stump at amputation—and hears the stertorous breathing of the subject and his agonised subconscious moaning, which has all the infection of terror that actual suffering would convey?

Yes; this is inevitable. There can be no privacy. Despatch is everything. Nowhere is rapidity so urgent as in the theatre of a C.C.S. It means lives. The hideous gas-gangrene forms and suppurates in a single hour. This is the worst enemy of the field hospital surgeon. Half an hour's postponement of operation—even less—may mean death. And in other cases, if the preliminary operation is not performed in time for the case to move by A.T. for finishing at the base, it may cost a life equally. The surgeon has not time to fortify his victim by explanation or exhortation. He is lifted from stretcher to table; the anÆsthetist takes his seat at the head, sprinkles the mask and applies it; the surgeon moves up (he has already seen the case in ward); the stertorous breathing begins; the Sister attends and places ready to his hands what the surgeon requires in swabs and implements; and with the impressive directness of long and varied experience the incision is made and the table is in a moment stained. But let there be no confounding of rapidity with haste, despatch with carelessness. As much time as is necessary, so much will be given; but not more. Most striking feature of all is the curiously impersonal and scientific thoroughness of the surgeon here; this, and the providential faculty of humour in both surgeons and Sisters in the throes of it all, without which the tragedy of the place would be overwhelming. The case is treated with the impersonality (and the persistence) due to a scientific problem, and as such is wrestled with. Three hours will be given, if necessary; and sometimes they are. It is a grim and continuous fight with death, without intermission. But, like any successful warrior, the surgeon jokes in the midst of it. A smile—even a gentle guffaw—comes with a strange effect in this place of blood, but it "saves the situation." This, with the marked impersonality of the surgeon, can be nothing but reassuring to the potential victim, waiting his turn on the adjacent table.

One does not realise until he sees it what hard physical labour an amputation involves, with scalpel and saw; nor how bloodless it can be; nor how revolting is the warm stink of steaming human flesh suddenly exposed; nor how interest swamps repulsion as you watch a skull trephined; nor how utterly strange, for the first time, is the sight of a man lying there with his intestines drawn forth reposing upon his navel.

A man can suffer many wounds and still live—one man with multiple bomb and shell wounds; not a limb untouched; an arm and a leg gone; a skull trephined; fragments extracted from thigh and chest and shoulder; the other hand shattered; to say nothing of wounds and bruises and putrefying sores innumerable. Human endurance and survival can become incredible.

There are sessions in the theatre at which an orderly is kept almost busy passing between the M.O.'s, registering, for purposes of record, the nature of the operation.

"What shall I enter, sir?"

"Appendicitis, acute—abdomen closed," says P——.

"If you had not added abdomen closed," says R——, "would one be at liberty to infer it had been left open?"

"Get your head read!" says P——.... The orderly passes on.

"What's this, sir?"

"Damn you! Can't you see I'm busy?" K—— is boring, with all the strength of his massive shoulders, into the skull of his case. Trephining is, literally, hard work; but not that alone. L—— is cutting, cutting, cutting, at the buttock of the wretch, paring the hideous gas gangrene as one would pare the rottenness from an apple. A third surgeon is probing for bomb splinters in rear of the thigh; and getting them. The man is splintered all over. For one horrible moment you conceive him as suddenly and treacherously deprived of unconsciousness, with —— boring here to the brain membrane, —— slicing generously at his buttock, and —— probing relentlessly to the bone in the gaping incision.

"Well, it certainly looks as though we are doing what we like," says ----. "It is rather bloody; yet the C.O. says the most revolting operation to watch is that of the removal of a finger-nail."

"If we go much further, he'll drop his subconscious ire upon us," says ----.

"Yes, I suppose his subconsciousness is protesting in blasphemous silence: 'Pourquoi'?"

"Stitches, Sister," says ——, at the head. The blood-clot has flowed; and in a twinkling the triangular exposure of skull is covered by the stitched scalp.

"He'll be easier," says ——.

And then begins the tabulation of his multiple wounds. They cover half a page. It's a miracle of symbolism which can suggest all that man has suffered (and has yet to suffer) in the handwriting of half a page....

"Clear, thank God!" says ——, as Multiple Wounds is borne out insensible half an hour later. "It's eleven, and I've been here since the middle of the morning; and I could almost sleep. Good-night, Sister! I'm off."

So they go to the freezing dampness of their camp stretchers. The orderlies set about "cleaning up."

But at one they're all called. The railhead, three kilometres off, has been shelled. A convoy has brought forty casualties. Half of them must pass through the theatre without delay. So the nerve-jangling work recommences, and goes on past the murky dawn, beyond the breakfast hour. It is snowing hard. They are hard-pressed to keep the theatre warm enough for delicate surgery. To equalise the temperature has become impossible. But things are as they are, and cannot be bettered; and there will come an end to this spurt, though how long will be the respite, who can say? It would be longer if the surgeons were not so dangerously understaffed. There's —— on a long-deferred and necessary leave; there are —— and —— who have fallen ill: one through the overstrain of incessant surgery; the other a victim to his sopping, inclement tent. The watchword is Carry on. There may be assistance by importation to the staff; on the other hand, there may not. There will be, if possible; but the pressure is severe all over the Somme Hospitals during the offensive, and the bases are drained.

The hospital railhead was shelled one afternoon. One may have the charity to surmise the Hun was shooting at the aerodrome; which stands seven hundred yards from the hospital; for the shell fell about the aerodrome rather than in the C.C.S. However that may be, shell did burst in the hospital, either by accident or design.

The order was to evacuate immediately. The Colonel ordered the Sisters to enter a car and be transported beyond range. They declined. The Colonel, a bachelor, not skilled in negotiation with the long-haired sex, commanded the matron to command them. Matron ordered them to their tents to prepare to flit. She went to them in ten minutes' time. "Are you ready?"—"No, Matron; there's a small mutiny brewing here. If the patients are to go, we're going with them."—"I'm not going; I was just in the middle of my dressings; I'm going to finish the others."—"They shan't go without us, Matron!" ... So with a splendid indignation they disobeyed. The Matron is accustomed to obedience, but she didn't get it. She went to the Colonel and explained. "Well, damn 'em! the witches! Let 'em have their way!" The Matron broke into a run. "Take your flasks and your hypodermics; you can go!"

So they superintended all the removings, attending here and there with the merciful preliminary syringe; and, when the preliminaries to the journey were over, jumped up with the car-drivers, and the evacuation began into a field on the —— road. Those that could walk, walked; and some that couldn't well walk had to do so....

They laid them out in rows, by wards. Some were dying. Some died on the way. Some died in the grass, cut by the bitter wind as they lay there gazing into the unkindly heaven. The rain came in frozen gusts. Those still hovering on the border-line were blown and soaked into death. The groaning of the wounded was hideous. Shattered limbs are hard to bear in the complete comfort of a civilian hospital. What is a wounded man to do but die, exposed to the pelting rain of the Somme winter? Brandy and hot tea and cigarettes brought a transient consolation: most men were insensible to aid from such fragmentary comfort. It began to be plain that the risk from shell-fire was not more dangerous than this from exposure; a return was ordered. Sisters, doctors, patients, concurred with equal fervour. And so they were taken back.

The shelling had ceased.

Next morning came the ambulance-train.