A surgeon in khaki

Bethune held a position of great importance behind our lines, for our wounded were evacuated thither from the front, and those fit to take the journey were then sent on by hospital trains to Boulogne and Rouen and then to England. This old city will be visited by many English after the war, for many English officers and men are sleeping their long sleep in the old cemetery and in various parts of the surrounding country. One day, I am sure, a monument to the memory of the brave dead will be raised in Bethune, and the mural inscription will commemorate the names of the fallen, and place on record for all time the kindness, the sympathy, and the generous hearts of the people of Bethune who helped us all so much during the hard days of the war.

Owing to its many recent bombardments from guns and aeroplanes, and its proximity to the famous canal and La Bassée, Bethune has become a city of world-wide interest. Its population was at this time a cosmopolitan one. The warriors of the East were in friendly touch with the warriors of the West. The slanting, almond-eye Gurkha, the stately bearded Sikh, the swarthy fighting men from the frontiers and central plains of India, the Turcos with their flowing robes, the dapper Spahi, the black-eyed Senegalese, the French Alpine Chasseur, and the splendid Cuirassier, were all to be seen in its streets; and there also was Mr. Thomas Atkins, making himself, as usual, quite at home with them all, and also with the pleasant-faced smiling young women in the tobacconists and fruit shops.

Bethune, with its 14,000 inhabitants, is said to be the home of many millionaires—those manufacturing and industrial magnates who control the big industries of this thriving and populous part of France. The situation of the city is not very attractive. It is surrounded by muddy, swampy country, in some places nothing better than marshes or bogs in winter, but it is supposed to be attractive in spring and summer, when it is “a green prairie land.”

The old square in the centre of the city has a very Flemish complexion, but is undoubtedly, owing to the irregularities in design and architecture of the surrounding houses and shops, a very attractive and fascinating spot. On one side are two fine old fourteenth-century Spanish houses built for some Spanish grandees in the days when Spain was supreme in the Netherlands. In the centre of the square is an old church and a mass of hoary buildings forming an island, and out of this island group of buildings the wonderful old Belfry of Bethune erects itself proudly skyward. The belfry was built in 1346, and behind it is the venerable church of St. Vaast, a product of the sixteenth century, with a very ornate Gothic tower.

Naturally the belfry and the tower of St. Vaast proved to be irresistibly attractive to the German gunners, and the batteries beyond La Bassée were constantly having long bowls practice at them. From the top of the belfry one could obtain a splendid view of the surrounding countryside and see the shrapnel and big shells burst miles away. Taubes were constantly flying over Bethune at this time, but later on they became very chary about visiting it.

The life of the old city during the past eight months has been rather unhappy, and it has gone through some stormy periods in the past. In 1188 a devastating plague swept the countryside, causing thousands of deaths and plunging the population into an abyss of fear and misery.

When the plague was at its height Saint Eloi appeared to two blacksmiths and recommended them to form an association of “charitables,” charged to perform the last offices for the dead gratuitously and to help those in distress. This curious association exists to-day in Bethune under the name of Confrères des Charitables. During our stay in Bethune the charitables lived up to their old tradition and took the deepest interest in the welfare of our soldiers, made coffins for a very large number of our dead, and in their curious three-cornered “Napoleonic” hats and quaint badge and bands, solemnly followed the many dead to their last resting-place.

Bethune has passed through many sieges in its day. In 1487 it was in possession of the Germans under Philippe of Cleves, and was captured by the French under Marshal d’Erquerdes at the victory called “Journée des Fromages,” and at a later period of its history it was fortified by the great French engineer, Vauban.

The people of Bethune opened wide their arms and welcomed our wounded. From the Mayor of the city to the humblest little shop girl these good people did all they could for our men, dead, wounded, or active. The women of the town made delicacies, soups, and special dishes, provided wines and more solid comforts, such as beds, mattresses, blankets, and sheets. Had I but lifted my little finger and asked for volunteer nurses, I could, I am sure, have obtained them in hundreds. Every day while I was there I received letters from all sorts of people offering me help and all manner of things for our men. On an afternoon at Bethune at this time it was “the thing” for ladies to visit L’Hôpital Civil et Militaire and see the British soldiers. Our lightly wounded men would generally be sitting about on seats outside in the courtyard of the hospital surrounded by convalescent Frenchmen and crowds of admiring ladies, who had brought cigarettes, chocolate, and cakes for the soldiers of both nations.

Although Tommy did not know a word of French and they knew no English, they seemed to thoroughly understand each other, judging by the amused faces of the elder French ladies and the screams of laughter of the younger ones. We could never quite understand how Tommy has won such an enduring place in French hearts. The French people certainly like Tommy. I was glad to see this everywhere in France, for I, too, like Tommy, although he is full of tricks.

A section of the Field Ambulance consisting of two medical officers, Royal Army Medical Corps orderlies, waggons, cooks, and equipment had already taken possession of the school called L’École Jules Ferry, and was getting it into some order so as to act as a Clearing Hospital, or temporary Dressing Station or temporary Clearing Hospital.

We were to hold the fort till a properly equipped Clearing Hospital with its increased personnel and supplies should arrive. This did not appear for some days, and our Field Ambulance section had the herculean task of handling all the wounded from the fighting front, where a bloody struggle was in progress round the swamps and marshy country towards La Bassée. L’École Jules Ferry was situated down a side street of the old city, and near the railway station. It was a very large school, with several big lofty rooms, many small side-rooms, porches and alcoves of many sorts. There was a large courtyard with latrines, and the buildings formed a hollow square with part of the courtyard in the centre. The face of the buildings looking on to the courtyard had a long sweep of verandahs. The orderlies soon got to work, cleaned and swept the rooms, and covered the floor thickly with clean straw. No beds were then available. In a small side-room off a passage-way an operating table was fixed, and the surgical instruments and dressings were laid ready. Boiling water had to be carried to the operating room in buckets from the kitchen at the end of the building. The hospital was all very crude, but it was the best that could be done under the circumstances.

We did not have to await events; the events were there at once in the guise of crowds of recently wounded men. Motor ambulance after motor ambulance dashed up with its load of wounded. These were rapidly lifted out and carried into the building; then away went the ambulance to bring in more wounded. Many and large as were the schoolrooms they were quickly filled to overflowing. The corridors and porches were then covered with straw, and this straw was soon covered with rows of wounded men. The paved courtyard under the verandahs was covered with thick straw, and again covered with wounded. Every foot, every inch of floor space in the buildings and under the verandahs was utilised. In one room we had closely packed rows four deep, with a narrow footway of straw down the centre of the room for the doctors and orderlies to pass along. So narrow was this track, that it required the agility of a mountain goat to negotiate it without bumping some poor devil’s feet, and we walked along it just as a man walks across a ploughed field, stepping high and watching each step. Those densely packed rooms during that long night were a lurid and impressive picture of the devastation of war. As more and more wounded continued to arrive we had to pack our men closer and closer together—gently push one this way, lift another one there, edge a third one closer still. So it went on. We had in our rooms a number of French wounded picked up and brought in by our ambulances, and also a fair number of German wounded. There is no nationality amongst the men in a hospital, and English, French, and German all had a little bit of floor space and a bit of straw in our schoolhouse that night. All were glad to get in out of the pouring rain, and be placed on the warm dry straw, and covered with a blanket.

All these men arrived with the first field-dressings on. Some had been put on by the surgeon with the regiment, some by bearers and orderlies, some by Field Ambulance officers, and some by the man’s comrades on the field.

At first we were so busy “packing” our wounded that we could not investigate the nature of the wounds, but we were very soon under way with the professional side of our work. Every wound was examined; the slight ones were left alone, but the serious ones were re-dressed and a rough differentiation of serious and slight cases was made. Those requiring immediate surgery were brought into our operation room and anæsthetics were administered. All men in pain were given hypodermics of morphia, and our orderlies made hot drinks and soups for all those able to take nourishment. There were, of course, many men lying unconscious with severe brain wounds, and most of these men died next day. The brain injuries were amongst our most hopeless cases, but fortunately these poor fellows suffered no pain whatever, and slept stertorously till death. There was one particularly fine, strapping, young giant lieutenant of a Scotch regiment who was comfortably placed on straw and covered with a blanket, and who lay quietly sleeping, with gentle and easy respirations, all the night till the next forenoon, when he suddenly became quite still. The top of his head had been blown completely away.

The crowds of wounded behaved like brave men and took their gruelling like good sportsmen. Next day the pressure was relieved by the opportune arrival of a hospital train, and we were enabled to evacuate 250 of the cases fit for transport. More doctors and Red Cross dressers were sent to help, and the vacant places of the 250 sent away were occupied by the arrival of another 300.

As the pressure for beds showed no signs of easing off, and as the reports from the front were that the fighting was still violent and obstinate, a search was made for another building to hold more wounded. This was found at L’Hôpital Civil et Militaire, a permanent hospital of the city of Bethune. It was a hospital of three stories, built of brick round three sides of a big hollow square. The fourth side was occupied by the porter’s lodge, the two gateways, and the residential quarters of the Reverend Mother and Sisters of the Order of St. Francis, who formed the nursing staff. The basement wards of one wing were for French military patients, and the other wings were for civilian patients; but as a matter of fact military wounded were put in all the wards except the midwifery ward, which was full of young babies and mothers. One of these young mothers, by the way, had just become the proud possessor of triplets. I had a look at them, and they seemed very fit. Their father had been away for the past three months in the trenches of the Argonne, but permission had been asked to enable him to come down and see how well his wife had done.

The top story of the hospital had two large empty wards, each capable of holding seventy patients placed fairly closely together. I asked permission of the Reverend Mother and the hospital secretary to use these wards for the reception of our wounded.

“But yes,” I was eagerly told; “you are welcome, and we shall do all we can for your English wounded.” I was also offered the use of three side-rooms and part of another small ward for any wounded officers, and—greatest boon of all—the use of the two operating theatres of the hospital. These operating theatres were modern and splendidly equipped with good surgical iron operating tables, suitable for adjusting in any position, sterilisers for instruments, dressings, aprons, and operating towels, glass cases full of the latest type of instruments, and hot and cold water taps controlled by foot-pedals on the floor.

The lighting was all that one could desire. My joy knew no bounds now, for I felt that at last I would be able to do good surgery and clean surgery. Up till now the surgery I had done on the field was crude and not very clean. It was absolutely impossible to be otherwise, for we were the victims of stern military circumstances. But now things would be different, and our wounded men and officers would get the benefit of surgical cleanliness.

I asked the Reverend Mother if she would prepare one hundred straw mattresses for me, and get in some blankets. “But yes” I would get them; and also Monsieur le Docteur would have tables put in the centre of the wards for the dressings, and would have basins and towels. An electrician would fix up electric lights, and a kitchen stove would be put in a side-room for cooking soup, boiling water, etc. I reported all this to Surgeon-General P——, and that able officer quickly grasped the possibilities of this hospital, installed me there as operating surgeon, and directed that all serious cases requiring surgical operation should be sent to me. A real Clearing Hospital arrived in the town next morning, and next day took in patients. It established itself in the “College for Young Ladies,” and very soon the spacious quarters of this big building were filled with wounded and sick men. For besides our wounded at this time we had also a large number of sick. This hospital also sent me any case requiring surgical operation.

Work at my wards proceeded apace. The women of the city rushed eagerly to assist, and in a clin d’œil had made 180 straw mattresses, provided blankets, hot-water bottles, and other sick-room adjuncts. The position in Bethune was now as follows. One Clearing Hospital at the College for Young Ladies, one at the school “Jules Ferry,” and my surgical wards, only for serious cases, at L’Hôpital Civil et Militaire. All three buildings were soon full, and over seven thousand wounded men passed through these buildings in less than three weeks.

Sir Anthony Bowlby, consulting surgeon to the Army, constantly visited this hospital, and was always a welcome visitor; and his surgical opinion was as welcome as his encouragement and cheeriness of manner.

The operating theatre was presided over by Sister Ferdinande, a trained and capable nurse, with rigid antiseptic and aseptic principles. All I had to do was to tell her that I was going to amputate a limb or do a trephining operation, and ask her when she would be ready. At the agreed time everything was certain to be prepared, and I just had to scrub up, put on my sterilised apron, cap, and rubber gloves, and be ready for my part of the séance. The Reverend Mother Superior was a trained anæsthetist and administered chloroform to many of my cases during the three weeks I was there. Some days I have had her administering anæsthetics for seven hours. Seven hours’ continuous administration, broken only by the taking out of one patient and the bringing in of another, is a big test of endurance for a young man; yet this old lady did it smilingly and well, and said it was “indeed nothing.”

There were two Irish nuns at this hospital; one spoke French well, one was just learning, but both spoke “Irish,” which is good English. These two nuns were put on nursing duty in my wards, and they were hugely delighted to get amongst the British wounded and to hear their countrymen talk. Tommy Atkins was delighted with the two Irish nuns, and told them some wonderful stories about the fighting and about the Germans. One of them asked me if I really thought that Private S—— of the Warwicks had shot two hundred Germans one afternoon. I told the sister that I did not know, but hoped he had. These two sisters were at work in the wards night and day. They told me one day that they had never heard a soldier swear. I was very glad to hear this, for it showed that Tommy was behaving himself, and I did not tell the sister that Tommy on occasion was a very past master in strange oaths. The sisters were very concerned about the lice on our soldiers’ shirts and flannels; and really this was a terrible source of anxiety to all medical officers at this time, for these cursed parasites would make the lot of our wounded men unbearable at times. One man with a fractured leg put up firmly in splints begged me to take the splints off so that he could “scratch the leg.” I had really in the end to take off the splint, bathe the skin in petrol, and dust sulphur on the cotton wool, for lice had worked their way down into the warm wool next the skin, and by their “promenading” about had set up the irritation which the soldier begged to scratch. The sister once said to me that she used to think that the British soldiers were the most cleanly of men, but she found really that they were all covered with lice. I told the wondering-eyed sister that it was a regrettable fact, but nevertheless true, that the whole British Army at the front was lousy.

When our wounded arrived at the hospital they were speedily placed on the straw mattresses, quickly undressed by the sisters and other helping nuns, and covered with warm sheets and blankets and surrounded with hot bottles. Basins of hot water and soap were brought round and then the men were washed and cleaned. Their lice-infected shirts and underclothing were sterilised by dry heat.

It was the finest example of l’entente cordiale to see the French nuns taking off the muddy boots and puttees, cutting off blood-stained clothing, washing and cleaning the wounded, slipping on warm dry shirts, and tucking the blankets and pillows comfortably. Others appeared with hot soup, hot coffee, red wine, and hot gruel. These nuns were magnificent.

I wrote to Lord Grey, late Governor-General of Canada, asking him to bring to the notice of Her Majesty Queen Alexandra the splendid work performed by these ladies. Lord Grey very kindly did so, and also sent a copy of my letter to His Majesty the King, who replied through Lord Stamfordham that he had read it with much interest. Queen Alexandra sent the following letter to the Reverend Mother Superior of the Franciscan Sisters at Bethune:

“I have learned from Dr. Martin of your noble and heroic devotion for our brave and unfortunate wounded soldiers, and it is with a heart full of gratitude that I ask you to accept my most ardent and warmest thanks.

“I pray God that He will reward you for the angelic care that you have bestowed on our unfortunate soldiers, and I will never forget that it is to you, madame, and your sisters, that they assuredly owe their life and their recovered health.

“Alexandra.”

This letter was published in all the leading French and British papers, including the London Times, Tablet, Daily Mail, Figaro, Le Journal, Le Temps, in February 1915, and excited very considerable interest and attention in France. The Abbé Bouchon d’Homme, the Aumonier to the hospital, wrote me later to say that the Reverend Mother and the Sisters were delighted beyond measure at Queen Alexandra’s gracious message.

It may not be out of place now to describe briefly the nature of some of the wounds met with during the fighting at La Bassée. The non-medical mind is as interested in the wounds and sufferings of our men as are the doctors, and it is to the intelligent interest of the layman we owe so much of what has been done for our wounded and sick men. Compound fractures and splintered bone, septic wounds, tetanus, brain injuries, inoculations, etc., are words freely bandied about and understood by any group of ladies met together round an afternoon tea-table. Mrs. Smith-Jones will tell Mrs. Jones-Smith that her son is in hospital with a septic compound fracture and that the wound is being fully drained, and Mrs. J.-S. will reply that her sister’s husband, Captain X—— of the R.F.A., is recovering from a penetrating wound of the lung, but has still some pleural effusion. So no apology is further necessary when referring to such a thing as gas gangrene.

Gas gangrene was one of the terrors of the doctors at this time. It was a new and totally unexpected complication of the wounds, and at first we did not know what to do in the face of this pressing danger. A man would get, say, a flesh wound of the arm or leg, or perhaps a fractured bone, and very soon the whole limb would become gangrenous and die. Gangrene means death of the part. It may be death of a small part or of a large part, and the worst feature of the form of gangrene met with at Bethune was its tendency to rapid spread, resulting in the speedy death of the limb and of the patient. We had many deaths from this terrible gas gangrene, and performed many amputations to save lives. A good surgeon hates to amputate a limb, and will gladly exert all his skill and knowledge to save even a toe. It was heartrending to have to perform so many amputations at Bethune, and yet these serious mutilating operations had to be performed in order to save lives.

The gangrene was caused by a group of bacilli called anærobes, amongst which may be many organisms. About ten different organisms have been obtained from cases of gas gangrene, and these all belong to the same family of anærobic bacilli. They are all spore-bearing, and grow in the absence of air. These bacilli are found in the soil in France and Belgium, and are always to be found in the soil of those countries which have been closely cultivated for centuries past.

If a guinea-pig is inoculated with a sample of this earth shaken up in a little water it will develop this gas gangrene and die. Imagine, then, this picture. The soil of the trenches is full of these organisms, which, if introduced into an open wound, grow and spread and cause the limb to become gangrenous. As the organism spreads up the limb it produces a gas of its own, and by pressing on the skin one can feel this gas cracking, like tissue paper, under the fingers. The treatment is to inject the parts with oxygen or peroxide of hydrogen, to make free incisions round the wound, thoroughly cleanse the wound and keep it clean. The general condition of the patients required great care, for they were all very, very ill. When a man got wounded in the trenches some dirt was bound to get into the wound, for the men’s hands and clothes were usually caked with mud.

It is a natural movement to clap a hand on the wounded spot. If a man is struck on the face or limbs, he will lay down his rifle or perhaps drop it, and at once put his hand on the injured part to ascertain the extent. It is a movement which is almost involuntary. I have seen hit men do this often, and when they withdraw their hand they always look at it to see if there is any blood, and the bravest man does not like to see his own blood. The hands of the men in the trenches were infected with the bacilli of this gas gangrene and of tetanus, and when these infected fingers touched a recent wound, the wound itself became infected with these highly dangerous organisms.

Pieces of khaki cloth, caked in mud, were often driven into the wounds with the bullets and shrapnel, and on this cloth there were of course millions of the deadly little beasts.

If the case reached us soon after the onset of gangrene a cure could almost certainly be promised. If the case arrived late, when the limbs were dead, amputation was the only “conservative treatment” that one could adopt. Many of the cases sent to me were beyond any hope of recovery and soon died. On one day I saw in one Clearing Hospital in the town four cases dying from gas gangrene; in the other Clearing Hospital, two cases in articulo mortis from the same trouble; and in my own, one other case. Seven cases dying on one day from gas gangrene! None of these had been operated upon. This will give some idea of the formidable character of this complication.

None but the very serious cases were sent to me. Many cases of gas gangrene were evacuated early and sent to the Base Hospitals. Most of my cases came from one or other of the Clearing Hospitals in this town. Some arrived direct from the Field Ambulances. In every amputation for gas gangrene performed at this hospital the limb was absolutely dead and beyond the possibility of any treatment short of amputation. All the patients were in an extremely grave state, and their general condition was in every case very bad. I cannot picture any worse surgical subject than these men with gas gangrene. Numbers of them were in too low a state to admit of a general anæsthetic, and here the necessary operations were performed under conduction anæsthesia.

Dr. F——, an eminent French surgeon in charge of the French wounded in this town, saw many of my cases before, during, and after operation. I had the privilege also of seeing his gangrene cases at this time. He had amongst the French wounded the same experience as mine. Both of us had German wounded to treat, and here also we met dead limbs from gas gangrene. We were both of the opinion that the Germans at this place were also up against a very virulent “culture” here, that of the anærobe. Some wounded French refugees were brought into this hospital at this period, and some of these had gas gangrene. The serious character of gas gangrene at this time could only be recognised at the front. The serious cases were retained here for operation. I am of the opinion that all cases of gangrene should be treated at the front at the nearest Clearing Hospital, and that no case should be sent to the Base till the gangrene had disappeared, subject, of course, as always, to the military situation. All the wounded admitted to this town—French, British, and German—came from the same area of the battle front.

In many of the cases of gas gangrene bones were badly shattered and pulverised, splinters of bone were lying in surrounding muscles, or had been driven out through the skin. Important nerves were injured, torn, or compressed in many of them. Important blood-vessels were frequently, but not invariably, injured. In some, big vessels had been torn through; in others, arteries and nerves were compressed by displaced fragments of bone. The wounds were dirty in most cases. The skin was black and lacerated, and muscles were extruded and covered with coagulated blood clots.—Wound full of blood clots, and containing at times pieces of khaki cloth, shrapnel fragments, nickel casing of bullets, gravel, and, in two cases, bits of rock.—So runs the record in my notes. There were, however, cases in which the bullet had drilled an apparently clean hole through a joint, like the wrist or ankle, without much apparent destruction to bone. In such cases one would not expect gas gangrene; yet it sometimes occurred.

Gas gangrene is encouraged by tight bandaging, and many of the cases had a bandage applied all too firmly. When a man is wounded in a trench his mate frequently applies the first-aid dressing, and fixes it like a tourniquet. This could perhaps be obviated by making the bandage of the first field-dressing a little wider than at present. A narrow bandage tends to become cord-like.

All the cases of gas gangrene had a very penetrating putrefactive smell, which is quite characteristic. The area of advancing gangrene is preceded by an œdematous zone, which fades in one direction to the area of healthy skin and in the direction towards the wound to a dullish injected area which crackles on palpation. Nearer the wound the skin is purplish and dark. Around the edges of the usually jagged wound the tissues were black or greenish-black. Extravasated blood undermined the skin all round the wound. The wound itself was full of blood clots. The limb distal to the wound was swollen, greenish-black, covered with green blebs, cold, insensitive, and pulseless in the “dead” limbs. Frequently toes and fingers were quite black. In other serious cases there might be a little warmth or a slight pulse. If any case showed either of these two favourable signs, an attempt was made to save the limb, and was in many cases successful. The gangrene did not spread up a limb in an even circle. For example, it might reach anteriorly to the lower third of the thigh, and posteriorly be at or well above the fold of the buttock. This was due to the extravasated blood lying more towards the dependent parts and to gravity. In the upper arm the gangrene travelled rapidly up the inner side along the course of the big blood-vessels. The invasion spread upwards; very little crackling was felt below the site of the wound. The circulation below seemed to be rapidly cut off, and that portion of the limb underwent the changes associated with a complete circulatory block. Wounds of the thigh with shattering of the femur, wounds of the elbow-joint and of the metatarsus were very prone to develop this gangrene. Some of the cases were admitted within thirty-six hours after receipt of the wound, with well-marked gangrene.

In every case of amputation performed there was nothing else to be done in order to save life. The limbs were dead. In many of these cases important blood-vessels were torn, crushed, or compressed, and when the vessels were injured the gangrene developed more quickly and spread more rapidly. It is regrettable that one had to perform so many amputations at this time, but it is a matter for congratulation that so many lives were saved. One of the cases died suddenly twelve hours after a disarticulation at the shoulder-joint. Another one died three days after amputation at the hip-joint, from gangrene which progressed steadily on to the lower abdomen. There were, in addition, five deaths from gangrene following wounds of the extremities. These five were admitted in a dying condition, and passed away two to four hours after admission. One could do nothing for them surgically. Other cases died at the other Clearing Hospitals in the town. It was a sad and mournful experience seeing these fine young men die.

These cases of gas gangrene were all bad surgical subjects, for in addition to the gangrene, loss of blood, privation, and exposure subsequent to being wounded, their wounds were dangerous and mutilating, and the transportation to the hospital was, sometimes, necessarily an agonising ordeal. This will show that our Clearing Hospitals at the front should be well and thoroughly equipped with all modern appliances for the treatment of shock, and a staff fully alive to this clamant necessity. A Clearing Hospital cannot to-day remain as an administrative unit only.

Another complication of our wounds at this time was tetanus (or the so-called lock-jaw). When it was recognised that the bacillus of tetanus was also found in the soil of France and Flanders, efficient measures were at once adopted to combat its terrible effects. Accordingly anti-tetanic serum was provided at all the Base Hospitals, Clearing Hospitals, and Ambulances, and every man wounded in France or Flanders to-day gets an injection of this serum within twenty-four hours of the receipt of the wound. No deaths from tetanus have occurred since these measures have been adopted.

Tetanus caused many deaths at the beginning of the war, not only amongst our own soldiers, but also amongst the Belgians, French, and Germans. When tetanus manifests itself, when the convulsions and muscular spasms come on, it is a terrible malady to treat, and most of the cases die. At this time the injection of anti-tetanic serum does not ensure a recovery, but if this serum is given to every wounded man, then none will develop tetanus, and that is why none of the wounded men are asked if they will have the “lock-jaw injection.” At the front there is no time for conscientious objectors.

Shrapnel wounds were always bad; the round bullets of lead always ripped and tore the tissues about so terribly. The Mauser bullet did not cause nearly so much damage, but it sometimes produced very lacerating wounds. The Mauser bullet “turns over” when travelling through a limb, and this turning means tearing of tissues on the path of the bullet, and often a huge jagged wound like that produced by an explosive bullet.

It has been said that we are treating wounds of an eighteenth-century character with twentieth-century technique. The eighteenth-century battle wounds were inflicted at close range, and so are many of the wounds inflicted to-day.

At Crecy and Agincourt both sides used arrows. The aviators of the Allies and the enemy carry steel darts which they spin down on the foe below. Bows have been used in the trenches to send inflammable arrows into the opposing lines. The Roman soldier advanced to close combat behind a shield held on his left arm, and shields have been used at certain observation spots by the Germans and in the Russian trenches; our Allies have at times used spades for a similar purpose.

Bombards were employed at Crecy, and bombards have come to their own again in the trenches from Switzerland to the sea. Hand grenades were employed in the Peninsular War, and are employed to-day in this War of the Nations. Our men attack the enemy and the enemy attack us with bayonets as in the days of the Crimea and the Peninsula, and our riflemen pick off the enemy by long-distance fire, and also fire at close range into solid masses of them. Even the armour of old days is represented on modern fields of battle, for the French Cuirassier goes into action with a brass cuirass and helmet; and a French infantry officer of my acquaintance has worn a light shirt of chain-mail extending from his neck to beyond his hips, all through this campaign, and he said that it had saved his life on more than one occasion. In one magasin in Rouen shirts of beautifully made chain-mail can be purchased, and the shopkeeper told me that he had sold hundreds to French soldiers.

The hardships of the Crimean trenches—cold, rheumatism, and frostbite—have been repeated on the Yser. Gangrene was rampant amongst the wounded of Wagram, Austerlitz, and Borodino, and amongst the French and British wounded at Vittoria, Salamanca, Badajos, and other great battles of the Peninsula, and it has startlingly reappeared on the Aisne and in Flanders.

Historians of that day refer to it as hospital gangrene, or the gangrene so common after any surgical operation or wound of that time. It may, on the other hand, have been the same gas gangrene that has ominously complicated so many of our wounds in France and Flanders. The bacillus which produces this gangrene may belong, for all we know to the contrary, to a very old family of bacilli, who would look upon pedigrees dating to William the Conqueror with an aristocratic contempt when his own stretched back to the beginning of time.

There is one feature of war as carried on to-day which is quite new, and that is by poison gases and by poisoning wells and water supplies. In West Africa the Germans have been proved indisputably and by their own admissions to have poisoned wells and water supplies, and the whole world stands amazed and aghast at the devilish and inhuman Germans who set free poison gases to overwhelm and suffocate British, French, and Belgian soldiers in the trenches. This diabolical and ghastly method of murder is without parallel in history, and the bloodily-minded men who conceived and carried out this sinister, ferocious thing will live accursed all their days and be a name of scorn and loathing for ever.

Although the civil hospital at Bethune was such a grim place of crowded wounded, it was yet the scene of much humour. We had wounded men belonging to many different countries, and the nuns were very interested in all the odd types. Off one of the large French wards there was a small room holding eight beds, and a nun brought me in one day to see the curious occupants ranged in beds alongside each other. There were a Senegalese, an Algerian, a Zouave, an Alpine Chasseur, a Turco, a native of Madagascar, a man of the Foreign legion, and a Frenchman. I think that the nuns always kept this ward “International.” It was their little joke, and visitors were always shown this ward. The patients themselves enjoyed the mélange. The courtyard of the hospital was a great meeting-place for our convalescent soldiers with the French convalescents, and they used to sit about on benches surrounded by an admiring lot of French women from the town. We also had a fair number of German wounded on our hands, and one of them at this time was terribly ill, suffering from the after-effects of gas gangrene of the foot following on a bullet wound of the ankle joint. His foot was amputated, and he had a struggle for some days to keep going, but eventually pulled through. The wounded German soldiers were very tractable and easy to manage. They were obedient, gave no trouble, and seemed grateful. I cannot say the same of the two wounded German officers I had. Both were slight wounds, and ought not really to have been sent to this hospital at all. They were truculent and overbearing to the nuns and orderlies, and behaved like cads. The German has no sense of humour. He takes himself very seriously, and that amuses us. He thinks and says that we are fools, and that also amuses us. A German once said that the English would always be fools, and that the Germans would never be gentlemen. This is most obviously correct. We asked a German sergeant-major who had been captured if the Hymn of Hate was really popular in Germany. The sergeant-major in civil life was a school teacher. He wore big spectacles and had a rough beard, and was altogether a very serious-minded man. He assured us that the German hate was a very real one, and he took the hymn very seriously. Lissauer, its author, is said to be a serious man also, and has he not been awarded the Cross of the Red Eagle by the All Highest himself? We laugh at the hymn, and this makes the German mad. Certainly we must be fools to laugh at the Hymn of Hate. The words inspire and enthral the Teuton, and the music uplifts his sentimental soul to the Empyrean.

The German considers this to be a purely German hymn, breathing the spirit of the Fatherland—unending hate. It is his song, and to sing it does him good. You can then understand the expression of blank amazement on the face of our captured schoolmaster—the sergeant-major with the spectacles and beard—when he was told that the Hymn of Hate was sung with gusto in the music halls of London and Paris, and was received by the audience with shrieking sounds of applause.

The Hymn of Hate sung by an Englishman in an English music hall! Donnerwetter! He could not understand. He had no sense of humour.

A Prussian officer was captured in November with about fifteen men, and I saw him marched in shortly after the capture. He looked arrogant, and one instinctively took a dislike to him, he was so obviously stamped “bounder.”

His revolver was in its pouch on his belt. We had forgotten to take it, and he had forgotten that it was there. Our prisoner spoke English very well, and said that “he wished he had been shot. He was for ever and ever disgraced at being made a prisoner. His regiment would not have him again as an officer.” The impression we formed, who were standing round listening, was that this whining bounder seemed to feel it a particular disgrace to be a prisoner of the hated English. An English officer in charge at this particular place here went up to our snarling Prussian who wished “that he had been killed” and said: “I see we have omitted to take over your revolver. It is still in your pouch and probably loaded—sure to be. You say you are sorry you were not killed. Well, go off five paces over there and blow your damned head off with your own gun. I won’t interfere with you, and none of us will mourn for you.” The Prussian shut up like an oyster. We all laughed, and the soldiers round enjoyed it hugely. The eyes of the man blazed with fury, but he made no movement towards that five paces off, and handed over his revolver to our English officer, who refused to touch it, and called on a soldier to take it.

The Prussian did not see the humour of the situation, and “there’s the humour on’t” old Falstaff would have said.

A few days after the sinking of the Emden the news reached the British and French in the trenches. The French were as delighted as we were. In the Argonne an advanced French trench was separated by only the width of a road from an advanced German trench. The officer in command of the French trench wrote out the news of the Emden fight on a piece of paper and tied this paper round a stone, which he flung into the German trench. It was received with guttural cries of annoyance. Shortly after this time from the German trench came another stone with a piece of paper inscribed, “Monsieur, go to Hell.” The French officer, ever polite and determined to have the last word, sent back this note:

“Dear Bosches,—I have been to many places. I have been invited to visit many places in my time, but this is the first time that I have been invited to visit the German headquarters.”

There is a society in London called the “Society for Lonely Soldiers.” Its object is to be of some assistance to soldiers who have no relations or friends and are quite alone in the world. A young lady of this society sent a parcel of comforts to the British prison camp in Germany, and addressed the parcel to “The loneliest British soldier in Germany.”

Some weeks afterwards a reply was received from the German officer in command of the camp. “Madam, your gifts have been impartially distributed amongst all the prisoners. We were unable to decide which was the loveliest British soldier in camp.” Imagine a spectacled old German officer methodically scrutinising all the British prisoners to ascertain which was the “loveliest” one!

Apropos of humour, read this incident reported by “Eye-witness” from the front. “One wounded Prussian officer of a particularly offensive and truculent type, which is not uncommon, expressed the greatest contempt for our methods: ‘You do not fight. You murder!’ he said. ‘If it had been straightforward, honest fighting we should have beaten you, but my regiment never had a chance from the first. There was a shell every ten yards. Nothing could live in such a fire.’”

This from one of the apostles of frightfulness!

Now read this concluding sentence in a letter from a German lady of high social position to a Russian lady:

“We wish to carry in our hearts an undying hatred, and we utterly reject all useless verbiage on ‘humanity.’

“To mothers and to German women this hate gives a sort of satisfaction without which our hearts would not be able to support,” etc. etc.

Read this order of the day, dated 26th August 1914, from General Stenger, Brigadier of the 88th Brigade, 14th Baden Army Corps. (This document is quite authentic, and is at present in the hands of the French War Office.) This is the translation: “The Brigade on setting out to-day will make no prisoners; all prisoners will be killed. The wounded, with or without arms, will be put to death. Prisoners, even in large organised units, will be put to death. No living man must remain in our rear.”

More will be heard of this document at the end of the war. It is a prized possession of the French just now.

Yet our wounded Prussian officer, as related above, objected to our murderous artillery fire, and said that “we do not fight, we murder.” In spite of the tragic side the incident has some humour.

Dr. Ludwig Ganghofer, a Bavarian Court journalist, recently described a visit which he had paid to a German hospital in Lille. He there saw some wounded British prisoners. Two caught his eye, and thus he writes:

“As I regarded these two sulky pups of the British lion, I had a feeling as if every hair on my head stood on end. This unpleasant irritation only ceased when I had turned my German back on the sons of civilised Albion, and looked again at suffering human beings.”

“Suffering human beings” is good; our two unfortunate countrymen were not human beings. They were pups of the British lion—young lions, in fact. The German appellation for us is improving. Some weeks ago we were “Swine dogs,” now we are “Young lions.” Ganghofer is the Bavarian Court journalist. One wonders if that feudal power keeps a court jester.