A Surgeon in Belgium.

by Henry Sessions Souttar.

Preface

To write the true story of three months' work in a hospital is a task before which the boldest man might quail. Let my very dear friends of the Belgian Field Hospital breathe again, for I have attempted nothing of the sort. I would sooner throw aside my last claim to self-respect, and write my autobiography. It would at least be safer. But there were events which happened around us, there was an atmosphere in which we lived, so different from those of our lives at home that one felt compelled to try to picture them before they merged into the shadowy memories of the past. And this is all that I have attempted. To all who worked with me through those months I owe a deep debt of grat.i.tude.

That they would do everything in their power to make the hospital a success went without saying, but it was quite another matter that they should all have conspired to make the time for me one of the happiest upon which I shall ever look back. Where all have been so kind, it is almost invidious to mention names, and yet there are two which must stand by themselves. To the genius and the invincible resource of Madame Sindici the hospital owes an incalculable debt. Her friendship is one of my most delightful memories. The sterling powers of Dr. Beavis brought us safely many a time through deep water, and but for his enterprise the hospital would have come to an abrupt conclusion with Antwerp. There could have been no more delightful colleague, and without his aid much of this book would never have been written.

For the Belgian Field Hospital I can wish nothing better than that its star may continue to shine in the future as it has always done in the past, and that a sensible British public may generously support the most enterprising hospital in the war.

H. S. S.

A SURGEON IN BELGIUM

I. To Antwerp

When, one Sat.u.r.day afternoon in September, we stepped on board the boat for Ostend, it was with a thrill of expectation. For weeks we had read and spoken of one thing only--the War--and now we were to see it for ourselves, we were even in some way to be a part of it. The curtain was rising for us upon the greatest drama in all the lurid history of strife. We should see the armies as they went out to fight, and we should care for the wounded when their work was done.

We might hear the roar of the guns and the scream of the sh.e.l.ls. To us, that was War.

And, indeed, we have seen more of war in these few weeks than has fallen to the lot of many an old campaigner. We have been through the siege of Antwerp, we have lived and worked always close to the firing-line, and I have seen a great cruiser roll over and sink, the victim of a submarine. But these are not the things which will live in our minds. These things are the mere framing of the grim picture. The cruiser has been blotted out by the weary faces of an endless stream of fugitives, and the scream of the sh.e.l.ls has been drowned by the cry of a child. For, though the soldiers may fight, it is the people who suffer, and the toll of war is not the life which it takes, but the life which it destroys.

I suppose, and I hope, that there is not a man amongst us who has not in his heart wished to go to the front, and to do what he could.

The thought may have been only transitory, and may soon have been blotted out by self-interest; and there is many a strong man who has thrust it from him because he knew that his duty lay at home. But to everyone the wish must have come, though only to a few can come the opportunity. We all want to do our share, but it is only human that we should at the same time long to be there in the great business of the hour, to see war as it really is, to feel the thrill of its supreme moments, perhaps in our heart of hearts to make quite certain that we are not cowards. And when we return, what do we bring with us? We all bring a few bits of sh.e.l.l, pictures of ruined churches, perhaps a German helmet--and our friends are full of envy. And some of us return with scenes burnt into our brain of horror and of pathos such as no human pen can describe. Yet it is only when we sit down in the quiet of our homes that we realize the deeper meaning of all that we have seen, that we grasp the secret of the strange aspects of humanity which have pa.s.sed before us. What we have seen is a world in which the social conventions under which we live, and which form a great part or the whole of most of our lives, have been torn down. Men and women are no longer limited by the close barriers of convention. They must think and act for themselves, and for once it is the men and women that we see, and not the mere symbols which pa.s.s as coin in a world at peace. To the student of men and women, the field of war is the greatest opportunity in the world. It is a veritable dissecting-room, where all the queer machinery that goes to the making of us lies open to our view. On the whole, I am very glad that I am a mere surgeon, and that I can limit my dissections to men's bodies. Human Anatomy is bad enough, but after the last three months the mere thought of an a.n.a.lysis of Human Motives fills me with terror.

Our boat was one of the older paddle steamers. We were so fortunate as to have a friend at Court, and the best cabins on the ship were placed at our disposal. I was very grateful to that friend, for it was very rough, and our paddle-boxes were often under water. We consoled ourselves by the thought that at least in a rough sea we were safe from submarines, but the consolation became somewhat threadbare as time went on. Gradually the tall white cliffs of Dover sank behind us, splendid symbols of the quiet power which guards them. But for those great white cliffs, and the waves which wash their base, how different the history of England would have been! They broke the power of Spain in her proudest days, Napoleon gazed at them in vain as at the walls of a fortress beyond his grasp, and against them Germany will fling herself to her own destruction.

Germany has yet to learn the strength which lies concealed behind those cliffs, the energy and resource which have earned for England the command of the sea. It was a bad day for Germany when she ventured to question that command. She will receive a convincing answer to her question.

We reached Ostend, and put up for the night at the Hotel Terminus.

Ostend was empty, and many of the hotels were closed. A few bombs had been dropped upon the town some days before, and caused considerable excitement--about all that most bombs ever succeed in doing, as we afterwards discovered. But it had been enough to cause an exodus. No one dreamt that in less than three weeks' time the town would be packed with refugees, and that to get either a bed or a meal would be for many of them almost impossible. Everywhere we found an absolute confidence as to the course of the war, and the general opinion was that the Germans would be driven out of Belgium in less than six weeks.

Two of our friends in Antwerp had come down to meet us by motor, and we decided to go back with them by road, as trains, though still running, were slow and uncertain. It was a terrible day, pouring in torrents and blowing a hurricane. Our route lay through Bruges and Ghent, but the direct road to Bruges was in a bad condition, and we chose the indirect road through Blankenberghe. We left Ostend by the magnificent bridge, with its four tall columns, which opens the way towards the north-east, and as we crossed it I met the first symbol of war. A soldier stepped forward, and held his rifle across our path. My companion leaned forward and murmured, "Namur," the soldier saluted, and we pa.s.sed on. It was all very simple, and, but for the one word, silent; but it was the first time I had heard a pa.s.sword, and it made an immense impression on my mind. We had crossed the threshold of War. I very soon had other things to think about. The road from Ostend to Blankenberghe is about the one good motor road in Belgium, and my companion evidently intended to demonstrate the fact to me beyond all possibility of doubt. We were driving into the teeth of a squall, but there seemed to be no limits to the power of his engine. I watched the hand of his speedometer rise till it touched sixty miles per hour. On the splendid asphalt surface of the road there was no vibration, but a north-east wind across the sand-dunes is no trifle, and I was grateful when we turned south-eastwards at Blankenberghe, and I could breathe again.

As I said, that road by the dunes is unique. The roads of Belgium, for the most part, conform to one regular pattern. In the centre is a paved causeway, set with small stone blocks, whilst on each side is a couple of yards of loose sand, or in wet weather of deep mud. The causeway is usually only just wide enough for the pa.s.sing of two motors, and on the smaller roads it is not sufficient even for this. As there is no speed limit, and everyone drives at the top power of his engine, the skill required to drive without mishap is considerable. After a little rain the stone is covered with a layer of greasy mud, and to keep a car upon it at a high speed is positively a gymnastic feat. In spite of every precaution, an occasional descent into the mud at the roadside is inevitable, and from that only a very powerful car can extricate itself with any ease. A small car will often have to slowly push its way out backwards. In dry weather the conditions are almost as bad, for often the roadside is merely loose sand, which gives no hold for a wheel.

For a country so damp and low-lying as Belgium, there is probably nothing to equal a paved road, but it is a pity that the paving was not made a little wider. Every now and then we met one of the huge, unwieldy carts which seem to be relics of a prehistoric age--rough plank affairs of enormous strength and a design so primitive as to be a constant source of wonder. They could only be pulled along at a slow walk and with vast effort by a couple of huge horses, and the load the cart was carrying never seemed to bear any proportion to the mechanism of its transport. The roads are bad, but they will not account for those carts. The little front wheels are a stroke of mechanical inept.i.tude positively amounting to genius, and when they are replaced by a single wheel, and the whole affair resembles a huge tricycle, one instinctively looks round for a Dinosaur. Time after time we met them stuck in the mud or partially overturned, but the drivers seemed in no way disconcerted; it was evidently all part of the regular business of the day. When one thinks of the Brussels coachwork which adorns our most expensive motors, and of the great engineering works of Liege, those carts are a really wonderful example of persistence of type.

We pa.s.sed through Bruges at a pace positively disrespectful to that fine old town. There is no town in Belgium so uniform in the magnificence of its antiquity, and it is good to think that--so far, at any rate--it has escaped destruction. As we crossed the square, the clock in the belfry struck the hour, and began to play its chimes. It is a wonderful old clock, and every quarter of an hour it plays a tune--a very attractive performance, unless you happen to live opposite. I remember once thinking very hard things about the maker of that clock, but perhaps it was not his fault that one of the bells was a quarter of a tone flat. At the gates our pa.s.sports were examined, and we travelled on to Ghent by the Ecloo Road, one of the main thoroughfares of Belgium. Beyond an occasional sentry, there was nothing to indicate that we were pa.s.sing through a country at war, except that we rarely saw a man of military age. All were women, old men, or children. Certainly the men of Belgium had risen to the occasion. The women were doing everything--working in the fields, tending the cattle, driving the market-carts and the milk-carts with their polished bra.s.s cans. After leaving Ghent, the men came into view, for at Lokeren and St. Nicholas were important military stations, whilst nearer to Antwerp very extensive entrenchments and wire entanglements were being constructed. The trenches were most elaborate, carefully constructed and covered in; and I believe that all the main approaches to the city were defended in the same way.

Antwerp could never have been taken by a.s.sault, but with modern artillery it would have been quite easy to destroy it over the heads of its defenders. The Germans have probably by now rendered it impregnable, for though in modern war it is impossible to defend one's own cities, the same does not apply to the enemy. In future, forts will presumably be placed at points of strategic importance only, and as far as possible from towns.

Pa.s.sing through the western fortifications, we came upon the long bridge of boats which had been thrown across the Scheldt. The river is here more than a quarter of a mile wide, and the long row of sailing barges was most picturesque. The roadway was of wooden planks, and only just wide enough to allow one vehicle to pa.s.s at a time, the tall spars of the barges rising on each side. It is strange that a city of such wealth as Antwerp should not have bridged a river which, after all, is not wider than the Thames. We were told that a tunnel was in contemplation. The bridge of boats was only a tribute to the necessities of war. We did not dream that a fortnight later it would be our one hope of escape.

II. The Hospital

Antwerp is one of the richest cities in Europe, and our hospital was placed in its wealthiest quarter. The Boulevard Leopold is a magnificent avenue, with a wide roadway in the centre flanked by broad paths planted with trees. Beyond these, again, on each side is a paved road with a tram-line, whilst a wide pavement runs along the houses. There are many such boulevards in Antwerp, and they give to the city an air of s.p.a.ciousness and opulence in striking contrast to the more utilitarian plan of London or of most of our large towns. We talk a great deal about fresh air, but we are not always ready to pay for it.

Our hospital occupied one of the largest houses on the south-east side. A huge doorway led into an outer hall through which the garden was directly reached behind the house. On the right-hand side of this outer hall a wide flight of steps led to inner gla.s.s doors and the great central hall of the building. As a private house it must have been magnificent; as a hospital it was as s.p.a.cious and airy as one could desire. The hall was paved with marble, and on either side opened lofty reception rooms, whilst in front wide marble staircases led to the first floor. This first floor and another above it were occupied entirely by wards, each containing from six to twelve beds. On the ground floor on the right-hand side were two large wards, really magnificent rooms, and one smaller, all these overlooking the Boulevard. On the left were the office, the common room, and the operating theatre.

Behind the house was a large paved courtyard, flanked on the right by a garden border and on the left by a wide gla.s.s-roofed corridor.

The house had previously been used as a school, and on the opposite side of the courtyard was the gymnasium, with dormitories above. The gymnasium furnished our dining-hall, whilst several of the staff slept in the rooms above.

It will be seen that the building was in many ways well adapted to the needs of a hospital and to the accommodation of the large staff required. We had in all 150 beds, and a staff of about 50. The latter included 8 doctors, 20 nurses, 5 dressers, lay a.s.sistants, and motor drivers. In addition to these there was a kitchen staff of Belgians, so that the management of the whole was quite a large undertaking, especially in a town where ordinary provisions were becoming more and more difficult to obtain. In the later days of the siege, when milk was not to be had and the only available water was salt, the lot of our housekeeper was anything but happy. Providing meals for over 200 people in a besieged town is no small matter. But it was managed somehow, and our cuisine was positively astonishing, to which I think we largely owe the fact that none of the staff was ever ill. Soldiers are not the only people who fight on their stomachs.

The management of the hospital centred in the office, and it was so typical of Belgium as to be really worth a few words of description. It was quite a small room, and it was always crowded. Four of us had seats round a table in the centre, and at another table in the window sat our Belgian secretary, Monsieur Herman, and his two clerks. But that was only the beginning of it. All day long there was a constant stream of men, women, and children pouring into that room, bringing letters, asking questions, always talking volubly to us and amongst themselves. At first we thought that this extraordinary turmoil was due to our want of s.p.a.ce, but we soon found that it was one of the inst.i.tutions of the country. In England an official's room is the very home of silence, and is by no means easy of access. If he is a high official, a series of ante-rooms is interposed between his sacred person and an inquisitive world. But in Belgium everyone walks straight in without removing his cigar. The great man sits at his desk surrounded by a perfect Babel, but he is always polite, always ready to hear what you have to say and to do what he can to help. He appears to be able to deal with half a dozen different problems at the same time without ever being ruffled or confused. There is an immense amount of talking and shaking of hands, and at first the brain of a mere Englishman is apt to whirl; but the business is done rapidly and completely. Belgium is above all things democratic, and our office was a good introduction to it.

The common room was large and airy, overlooking the courtyard, and a few rugs and armchairs made it a very comfortable place when the work of the day was done. Anyone who has worked in a hospital will know what a difference such a room makes to the work--work that must be carried on at all hours of the day or night; nor will he need to be told of the constant supply of tea and coffee that will be found there. We go about telling our patients of the evils of excessive tea- drinking, and we set them an example they would find it hard to follow. We do not mention how often tea and a hot bath have been our subst.i.tute for a night's sleep.' A good common room and an unlimited supply of tea will do much to oil the wheels of hospital life.

But to myself the all-important room was the operating theatre, for upon its resources depended entirely our opportunities for surgical work. It was in every way admirable, and I know plenty of hospitals in London whose theatres would not bear comparison with ours. Three long windows faced the courtyard; there was a great bunch of electric lights in the ceiling, and there was a constant supply of boiling water.

What more could the heart of surgeon desire? There were two operating tables and an equipment of instruments to vie with any in a London hospital. Somebody must have been very extravagant over those instruments, I thought as I looked at them; but he was right and I was wrong, for there were very few of those instruments for which I was not grateful before long. The surgery of war is a very different thing from the surgery of home.

The wards were full when we arrived, and I had a wonderful opportunity of studying the effects of rifle and sh.e.l.l fire. Most of the wounds were fortunately slight, but some of them were terrible, and, indeed, in some cases it seemed little short of miraculous that the men had survived. But on every side one saw nothing but cheerful faces, and one would never have dreamt what some of those men had gone through. They were all smoking cigarettes, laughing, and chatting, as cheery a set of fellows as one could meet. You would never have suspected that a few days before those same men had been carried into the hospital in most cases at their last gasp from loss of blood and exposure, for none but serious cases were admitted. The cheeriest man in the place was called Rasquinet, a wounded officer who had been christened "Ragtime" for short, and for affection. A week before he had been struck by a sh.e.l.l in the left side, and a large piece of the sh.e.l.l had gone clean through, wounding the kidney behind and the bowel in front. That man crawled across several fields, a distance of nearly a mile, on his hands and knees, dragging with him to a place of safety a wounded companion. When from loss of blood he could drag him along no longer, he left him under a hedge, and dragged himself another half-mile till he could get help. When he was brought into the hospital, he was so exhausted from pain and loss of blood that no one thought that he could live for more than a few hours, but by sheer pluck he had pulled through.

Even now he was desperately ill with as horrible a wound as a man could have, but nothing was going to depress him. I am glad to say that what is known in surgery as a short circuit was an immediate success, and when we left him three weeks later in Ghent he was to all intents perfectly well.

There were plenty of other serious cases, some of them with ghastly injuries, and many of them must have suffered agonizing pain; but they were all doing their best to make light of their troubles, whilst their grat.i.tude for what was done for them was extraordinary. The Belgians are by nature a cheerful race, but these were brave men, and we felt glad that we had come out to do what we could for them.

But if we give them credit for their courage and cheerfulness, we must not forget how largely they owed it to the devoted attention--yes, and to the courage and cheerfulness--of the nurses. I wonder how many of us realize what Britain owes to her nurses. We take them as a matter of course, we regard nursing as a very suitable profession for a woman to take up--if she can find nothing better to do; perhaps we may have been ill, and we were grateful for a nurse's kindness.

But how many of us realize all the long years of drudgery that have given the skill we appreciated, the devotion to her work that has made the British nurse what she is? And how many of us realize that we English-speaking nations alone in the world have such nurses?

Except in small groups, they are unknown in France, Belgium, Germany, Russia, or any other country in the world. In no other land will women leave homes of ease and often of luxury to do work that no servant would touch, for wages that no servant would take--work for which there will be very little reward but the unmeasured grat.i.tude of the very few. They stand to-day as an unanswerable proof that as nations we have risen higher in the level of civilization than any of our neighbours. To their influence on medicine and surgery I shall refer again. Here I only wish to acknowledge our debt. As a mere patient I would rather have a good nurse than a good physician, if I were so unfortunate as to have to make the choice. A surgeon is a dangerous fellow, and must be treated with respect. But as a rule the physician gives his blessing, the surgeon does his operation, but it is the nurse who does the work.

III. The Day's Work

In any hospital at home or abroad there is a large amount of routine work, which must be carried on in an orderly and systematic manner, and upon the thoroughness with which this is done will largely depend the effectiveness of the hospital. Patients must be fed and washed, beds must be made and the wards swept and tidied, wounds must be dressed and splints adjusted. In an English hospital everything is arranged to facilitate this routine work. Close to every ward is a sink- room with an adequate supply of hot and cold water, dinner arrives in hot tins from the kitchens as if by magic, whilst each ward has its own arrangements for preparing the smaller meals. The beds are of a convenient height, and there is an ample supply of sheets and pillow- cases, and of dressing materials of all kinds arranged on tables which run noiselessly up and down the wards. At home all these things are a matter of course; abroad they simply did not exist. Four or five gas- rings represented our hot-water supply and our ward-kitchens for our 150 patients, and the dinners had to be carried up from the large kitchens in the bas.e.m.e.nt. The beds were so low as to break one's back, and had iron sides which were always in the way; and when we came to the end of our sheets--well, we came to the end of them, and that was all. In every way the work was heavier and more difficult than at home, for all our patients were heavy men, and every wound was septic, and had, in many cases, to be dressed several times a day. Everyone had to work hard, sometimes very hard; but as a rule we got through the drudgery in the morning, and in the afternoon everything was in order, and we should, I think, have compared very favourably in appearance with most hospitals at home.

But we had to meet one set of conditions which would, I think, baffle many hospitals at home. Every now and then, without any warning, from 50 to 100, even in one case 150, wounded would be brought to our door. There was no use in putting up a notice "House Full"; the men were wounded and they must be attended to. In such a case our arrangement was a simple one: all who could walk went straight upstairs, the gravest cases went straight to the theatre or waited their turn in the great hall, the others were accommodated on the ground floor. We had a number of folding beds for emergency, and we had no rules as to overcrowding. In the morning the authorities would clear out as many patients as we wished. Sometimes we were hard put to it to find room for them all, but we always managed somehow, and we never refused admission to a single patient on the score of want of room. The authorities soon discovered the capacity of the hospital for dealing with really serious cases, and as a result our beds were crowded with injuries of the gravest kind. What appealed to us far more was the appreciation of the men themselves. We felt that we had not worked in vain when we heard that the soldiers in the trenches begged to be taken "a l'Hopital Anglais."

The condition of the men when they reached us was often pitiable in the extreme. Most of them had been living in the trenches for weeks exposed to all kinds of weather, their clothes were often sodden and caked with dirt, and the men themselves showed clear traces of exposure and insecure sleep. In most cases they had lain in the trenches for hours after being wounded, for as a rule it is impossible to remove the wounded at once with any degree of safety. Indeed, when the fighting is at all severe they must lie till dark before it is safe for the stretcher-bearers to go for them. This was so at Furnes, but at Antwerp we were usually able to get them in within a few hours.

Even a few hours' delay with a bad wound may be a serious matter, and in every serious case our attention was first directed to the condition of the patient himself and not to his wound. Probably he had lost blood, his injury had produced more or less shock, he had certainly been lying for hours in pain. He had to be got warm, his circulation had to be restored, he had to be saved from pain and protected from further shock. Hot bottles, blankets, brandy, and morphia worked wonders in a very short time, and one could then proceed to deal with wounds. Our patients were young and vigorous, and their rate of recovery was extraordinary.

When a rush came we all had to work our hardest, and the scenes in any part of the hospital required steady nerves; but perhaps the centre of interest was the theatre. Here all the worst cases were brought--men with ghastly injuries from which the most hardened might well turn away in horror; men almost dead from loss of blood, or, worst of all, with a tiny puncture in the wall of the abdomen which looks so innocent, but which, in this war at least, means, apart from a difficult and dangerous operation, a terrible death. With all these we had to deal as rapidly and completely as possible, reducing each case to a form which it would be practicable to nurse, where the patient would be free from unnecessary pain, and where he would have the greatest possible chance of ultimate recovery. Of course, all this was done under anaesthesia. What a field hospital must have been before the days of anaesthesia is too horrible to contemplate.

Even in civil hospitals the surgeons must have reached a degree of "Kultur" beside which its present exponents are mere children. It is not so many years since a famous surgeon, who was fond of walking back from his work at the London Hospital along the Whitechapel Road, used to be pointed to with horror by the Aldgate butchers, whose opinion on such a subject was probably worth consideration.

But now all that is changed. The surgeon can be a human being again, and indeed, except when he goes round his wards, his patients may never know, of his existence. They go to sleep in a quiet anteroom, and they waken up in the ward. Of the operation and all its difficulties they know no more than their friends at home. Perhaps even more wonderful is the newer method of spinal anaesthesia, which we used largely for the difficult abdominal cases. With the injection of a minute quant.i.ty of fluid into the spine all sensation disappears up to the level of the arms, and, provided he cannot see what is going on, any operation below that level can be carried out without the patient knowing anything about it at all. It is rather uncanny at first to see a patient lying smoking a cigarette and reading the paper whilst on the other side of a screen a big operation is in progress. But for many cases this method is unsuitable, and without chloroform we should indeed have been at a loss. The Belgians are an abstemious race, and they took it beautifully. I am afraid they were a striking contrast to their brothers on this side of the water.

Chloroform does not mix well with alcohol in the human body, and the British working man is rather fond of demonstrating the fact.

With surgery on rather bold lines it was extraordinary how much could be done, especially in the way of saving limbs. During the whole of our stay in Antwerp we never once had to resort to an amputation.

We were dealing with healthy and vigorous men, and once they had got over the shock of injury they had wonderful powers of recovery.

We very soon found that we were dealing with cases to which the ordinary rules of surgery did not apply. The fundamental principles of the art must always be the same, but here the conditions of their application were essentially different from those of civil practice. Two of these conditions were of general interest: the great destruction of the tissues in most wounds, and the infection of the wounds, which was almost universal.

Where a wound has been produced by a large fragment of sh.e.l.l, one expects to see considerable damage; in fact, a whole limb may be torn off, or death may be instant from some terrible injury to the body.