From A Surgeon's Journal
, 1915-1918

Chapter One: The Harvard Unit at the Ambulance Américaine, concluded



Monday, April 12

A visit this a.m. from Carrel, who extracts a promise that I pay him a visit at Compiègne for a day or two and, as things are quiet, why not to-morrow. He looks like a little bear in a great fur coat over his light blue uniform. We lunch at a quiet restaurant frequented by the War Office people and are joined there by Madame Carrel. In the p.m. saw Strong off with his teeth grimly set for an adventure in Serbia which sounds like a large order.

April 13. Compiègne

Alexis Carrel, an Americanized Frenchman, is not to be confused with a Gallicized Marylander, M. Charles Carroll de Carrollton----as he appears in the Social Register---who arrives at 7.45 driving his own militarized car and announces that, taking advantage of my request for transportation to Compiègne, he is to do an unneutral thing, namely, to carry a French officer back to his station not far from there. His friend the French officer, who calls him "Charlie," proves to be the Duc de Rohan, whom we soon pick up together with his pet terrier "Vicky" and innumerable bags, which leaves room for but one behind---viz., me. A handsome person is the Duc---a member of the Chamber of Deputies---one of the fourteen who preferred active military service to sitting behind a civilian desk---a lieutenant in the 27th Infantry.

Another cool misty morning with promise of a clear day as we leave again by the Porte de Villette, or should have done had not Charlie lost his way in Aubervilliers, over whose atrocious pavés we wandered about for some time before finally locating the Route de Flandre. This time I counted the lines of trenches defending Paris as we whisked by, for Charlie drives about as fast as Muhr. The first two at 19 and 21 km. and then Louvres, a picturesque place which marks the farthest point south reached by the German column along this road. At 28 km. another carefully constructed trench elaborately faced with interlacing wattles or gabion revetments; another at 32 km. with a network of entanglements before it. An aviator down in a field and a crowd gathering from nowhere and everywhere. At 15 km. beyond Louvres, the Duc points out where his regiment captured 15 German guns. On through Pontarmé and the delightful forêt of the same name: Senlis again, but this time out of it to the N.E. at high speed through lovely country and pretty villages---a beautiful view of Verberie from the side of a hill, and then through the Forest of Compiègne.

Nothing could be more peaceful and lovely than a well-groomed French forest in the early spring, its floor for miles on a stretch carpeted with flowers---lilies of the valley, anemones, and low-growing narcissus, the latter in such profusion as to give a yellow tone in among the trees as far as one could see---magnificent stands of beeches intersected by paths and formal allées of alluring kind. But our road lay tout à droit through it all.

Having a French officer aboard, our laissez-passer has rarely been called for, but the Oise divides the 2nd, to which the Duc belongs, from the 6th Army and we are frequently held up. Compiègne finally comes into view as we wind around a hillside road---a beautifully situated town---no wonder Nap.I picked it out for a residence. He would have felt at home there to-day. On through the town and across the Oise on a one-way temporary bridge, the old stone Pont de Compiègne having been destroyed by the English, I believe, during the retreat.

Once across, we climb the hill to Margny-lès-Compiègne, getting views across the river valley behind us almost as fine as that we had on approaching Verberie. Then in a northwesterly direction on the road to Montdidier which parallels the front in this sector, only seven or eight miles away---a neglected cobbly road lined by trees much shattered by shellfire and in process of being stripped of their lower branches, presumably for trench gabions. The Duc points out the line of hills which his division is holding as we arrive at the little crossroads village of Cuvilly, where he says he has been quartered the past three months.

Having been en permission 8 days, he was astonished to find Cuvilly deserted and to learn from some stragglers that the regiment had moved away to get a better water supply for the tirailleurs. So on we go in search of them, and after winding around interminably over atrocious back-country roads and asking many questions---the region was seething with troops and lines of artillery and convoys---we end up via Moyenneville at a place called Wacquemoulin where, surrounded by an eager crowd of his brother officers, the Duc distributes a bundle of papers purchased as we were leaving Paris, together with a huge box of confitures and a "bale" of cigarettes---a present from friend Charlie.

They were all eager to know what was going on, for, as we have found, the farther one gets from home and the nearer the seat of war, the less you hear about it and the less frightful it seems. As I was skirmishing for a favorable snapshot one of the officers came up and asked in English if I could give him any news of the war! I could have done so had I been in Boston. He told me they were training dogs to work in the trenches.

Henry D. Dakin and Alexis Carrel at Compiègne

Hôpital Complémetaire 21 (Rond Royal)

Rossignoli and the Zeppelin Trous in the Park

The Salle des Fêtes in Use as a Typhoid Ward

And so we left M. le Duc in the arms of his friends and turned back via Gournay and Monchy to Compiègne again, reaching our destination fully two hours late---an embarrassment, as it proved, for Carrel had expected us by 10 o'clock and, cherishing an idea that my transfer to Compiègne for some work might be requisitioned, had asked Gen. Nimier to meet us at that hour. We repaired to lunch promptly and I did the best I could to be polite to M. le Médecin Inspecteur Général de la Sixième Armée and his five colonels and to thank him for the inscribed copy of his Blessures du Crâne et de l'Encéphale which he presented to me. Having arrived two hours late and by mischance having excused myself for a moment to say good-bye to Mr. Carroll, which moment happened to coincide with the General's own departure, I could not have impressed him favorably. We then paid a visit to the large ward where Dr. Dehelly did a number of dressings---very badly I thought---unnecessary pain and bleeding from the extraction of adherent gauze. It was awful---wicked indeed---to see the poor devils, one of whom chewed a hole in his coverlet rather than utter a groan. The time will come when they will learn better methods, but meanwhile there will be much needless suffering.

What is known as Hôpital Complémentaire 21 is in a once fashionable hotel---the Rond Royal---on the very edge of the Forêt de Compiègne---an ideal spot and one which Carrel chose for his purposes on careful survey after he got free from his miserable detail, first in the Lyon hospital and then at the War Office. Here, backed by Rockefeller money and with an admirable staff, a great opportunity lies open for special studies of wound treatment. The lines along which they have started to work include the suction treatment of suppurating wounds without dressings; the employment of irrigation with bactericidal fluids which are being worked out by Henry Dakin; methods of increasing resistance to pathogenic organisms by turpentine injections, etc., etc.

There are at present 51 beds with 86 attendants, including slaveys of all kinds---11 scientific, medical, and administrative officers; 13 experienced Swiss nurses supplied by Theodor Kocher, numerous secretaries, laboratory technicians, linen-room people, scrub women, ambulance men; and 47 soldier orderlies who do everything from boots to waiting on table and keeping up the gardens. It is indeed a research hospital de luxe with running water in all the rooms, which are large, most of them having baths, comfortable beds, electricity, and all modern improvements. Over the dramatis person--- Madame Carrel rules as housekeeper and "general tyrant," according to her husband.

There are also stables and four chauffeurs whom I had forgotten to mention---one of them a professional racing driver who has figured in international events---another Sarah Bernhardt's leading man on her last tour of the U.S.A.---the third an equally celebrated actor from the Odéon---the fourth an underling. These deserve special mention because late in the afternoon behind chauffeurs 1 and 4 in an open car we went on an expedition, meanwhile clutching everything that was detachable and only coming up for breath when stopped by a sentry, gun on high. Thus for some 10 km to the west, where, in the château of the Duchesse de Quelquechose, an English lady of title has well-meaningly established an Ambulance under the direction of a most unprepossessing English surgeon, with a rachitic build and bad teeth, who has a single amateur nurse to help him---neither of them speaks a word of French, and they appear to have a comparable familiarity with surgery. We are plied with tea and English marmalade while he bitterly complains that the French don't send him the kind of wounded that make it worth while for him to remain---only minor injuries and few of those. In short, M. l'Inspecteur must have sized up the situation.

Then back in the other direction along the north bank of the Oise to Janville, where the Spahis---the Chasseurs d'Afrique---are quartered. Picturesque, fine-looking fellows who made an effective color scheme against the stone houses of the village with their black and white turbans, dusky faces, and scarlet cloaks or bernous reaching to their heels. Some of them were in their working uniforms, a jacket made of some sort of coarse brown cloth like overall material with the black baggy corduroy trousers of Zouaves drawn tight around the ankles. These daring horsemen have had little chance to show what they are good for---scarcely since the Marne---and like the French dragoons they now take their trick in the trenches on foot, I am given to understand.

Then farther on until we finally turn into a side road which leads us through groves uphill to the handsome Château d'Annel at Longueil, with the line at Ribécourt in German hands only six km. distant. Here we found quite a different sort of place from that we had just seen. Shortly before we arrived six badly wounded men had been brought in from Montmacq, a short distance away. Half the château is still occupied by the family and the staff---Mr. and Mrs. Depew and a daughter, Stanley, a nice-looking Bart's man of recent years in a British uniform, a Dr. Eaton of Albany who acts as his assistant and is soon to leave, Dr. Frere, one of Henry Head's London Hospital pupils, nurses and others. The other half of the building has been dismantled to provide beds for about 40 soldiers and 10 officers, together with operating rooms and a satisfactory X-ray equipment to which one of the patients was taken and fluoroscoped for me, showing a shrapnel ball in the left frontal lobe. Another of the men was dying from a ball which had entered over the right kidney and was palpable under the skin in the pectoral region, where was a huge hæmatoma. It is quite possible that a transfusion might have saved him had there been provision for such.

In spite of the severe character of the wounds they receive, they have done reasonably well with 20 per cent fatalities, a large number of which occur soon after the patients are admitted. Their beds are full most of the time and they evacuate promptly to Compiègne. It would seem to be an ideal place for some young man of skill and quick judgment, for it is the sort of work a mobile Ambulance might do, indeed what the Ambulance at Neuilly practically was doing in September and October. It is possible here because the château happens to be near the present rather stationary line and was spared by the Germans supposedly because a U.S. flag was flying.

Mrs. Depew, an energetic American fifteen years resident here, got Joffre's ear early enough to secure a permis which lets her do about as she chooses, and she says the place was equipped by August 7th, before the Ambulance at Neuilly was started. She was then driven out and did not get back until September 27th after the retreat, to find the château undamaged---only some wine looted. Since that time they have been continuously busy. There are 7 nurses for the 40 patients, an ambulance corps consisting of 4 Ford cars; the large soldiers' ward is in a handsome hail with timbered ceiling---I presume the banqueting hall of better days. Just where this château, with its privileged Anglo-French-American staff, comes in on the scheme of things I fail to see, but I suppose it may function as an ambulance de première ligne. Nine acute cases yesterday; seven so far to-day.

April 14. 2nd day at Compiègne

A beautiful warm spring morning---buds swelling perceptibly---birds singing melodiously---artillery horses exercising in the open space in the forêt outside my window. Meanwhile distant cannonading recalls the more serious matters of the day and place. From the experience of yesterday afternoon it is apparent that society dotes on the excitement of war and loves to provide---however badly---for the wounded, particularly if they are presentable and can be wheeled in to afternoon tea---neither of which they ordinarily are.

So confused have I become as to where these privately run château-hospitals stand in the strictly military organization that Lieut. Rossignoli---a member of the French Ambulance Corps stationed here at the Rond Royal and one-time director of a chain of hotels spread from Paris to the Riviera---has taken the trouble this a.m. to give me such details of the Service de Santé as may some day be useful:

It is divided into two sections-the service de l'avant and the service de l'arrière, which have naturally somewhat different functions. He has drawn a diagram to show how those unsung heroes of the war, the brancardiers régimentaires (musicians, tailors, shoemakers, barbers, etc., without rank), bring the wounded from the champ de bataille to a refuge pour blessés or poste de secours located in a comparatively protected spot or in an artificial abri actually underground. There the regimental médecin chef or one of his aides applies an emergency dressing, gives an injection of antitetanic serum, and attaches to the man's clothing a sort of baggage tag---pink for transportable cases and white for the more seriously injured. Then the brancardiers divisionnaires---actual infirmiers for the purpose---take those fit to be evacuated, by night, on stretchers or litters or two-wheeled push carts (brouettes), to the ambulance divisionnaire, i.e., ambulance de première ligne, where, unless actually under fire, they may remain for a few hours or even days until they can safely be picked up by the section sanitaire automobile divisionnaire (each army corps has 60 motor ambulances for the purpose) and transported (the farthest practical distance being 30 km.) either (1) to a centre d'hospitalisation or (2) to a gare d'évacuation from which they are finally forwarded to a gare régulatrice (such as we saw Sunday at Montdidier) for further distribution either by trains sanitaires to distant points or, as in Paris at La Chapelle, by motor ambulance among the several hospitals there. A gare d'évacuation and centre d'hospitalisation may of course be in the same place, as at Amiens and here in Compiègne, where in the hospital centre the severely wounded and critically ill---like the typhoid cases---may necessarily remain for weeks.

During the battle of the Marne, Rossignoli was in charge of 50 motor ambulances which were running day and night---oftentimes direct from the postes de secours to a gare d'évacuation either at St. Mord or at Nanteuil. There were two men to a car and they covered from 300 to 350 km. daily. The drivers took turns sleeping en route and had to carry their benzine in tins. The chief difficulty was in finding water, as the pumps and wells had been destroyed.

To see Compiègne as a hospital centre we then go off in a car behind one of the actor-chauffeurs, first to Royallieu, where some recently erected barracks have been turned into a hospital with accommodations for 1200---chiefly for the sort of minor injuries we are unaccustomed to see at Neuilly. There Dr. Landolt, a celebrated Paris ophthalmologist, conducts a huge clinic for diseases (chiefly trachoma) and injuries of the eye. He was in process of enucleating the eyeball of a man who had been shot from behind while in the attitude of aiming his rifle. The ball, having passed through the right shoulder, had entered the mastoid process to emerge through the very centre of the cornea, completely destroying the eye.

A no less distinguished aurist was hard at it in another room full of minor ear cases, a great many of them ruptured drums from the near explosion of bombs. The men are apt to be "batty" for a day or two after such an experience even when they have not actually been hit. We were shown a mobile bacteriological outfit ready to be moved at a moment's notice wherever it might be needed. Then back to Compiègne and to the palace, which from the time of Louis XV has been a favorite residence for the rulers of France.

It would have surprised them to see the famous Salle des Fêtes as it is to-day, lined with beds containing African troops laid low by typhoid, malaria, and other fevers. Edouard Rist, "the best doctor in Paris," Hartmann's medical colleague at the Laënnec whom we met at the London Congress two years ago, is in charge ---a delightful person who in appearance and speech is more English than French. He showed us several other beautiful rooms with their walls covered by historic paintings and similarly utilized for bed patients; but of the makeshifts for water and baths and toilets for the sick, the less said the better. Louis Quinze didn't put in much plumbing---especially with the present state of things in mind.

Then lunch at the Rond Royal with Babinski's assistant from La Pitié, and some médecins majors of the district, one of whom subsequently, behind the racing chauffeur and Rossignoli, takes me to inspect a first-line Ambulance at Offemont, some 15 km. to the east in the direction of Soissons. We crossed the Aisne at Rethondes and then in a northeasterly direction toward the line along a road which winds through a valley to the east of the Forêt de Laigue, flanked with hills held by the French. It was about as busy a valley as one can imagine, with the road undergoing repairs by Territorial reserves, and the whole district alive with soldiers of all kinds in all sorts of uniforms, going or coming, of officers on horseback, of convoys taking up supplies or ammunition, and an occasional ambulance taking back something else. Across the fields there were batches of soldiers in groups or pairs making their way to the rear for their period of rest. They were very quiet---only one body of men, whom we passed later on, were singing, and they were merely keeping step with a sort of grunting chant. There is no martial music heard these days---at least on this side of the line.

We finally get into a more wooded part of the road and begin to see the dugouts and huts---grottes---that the officers and men have built for themselves. Every imaginable kind of structure of every possible form and size, from mere earthen excavations to quite pretentious arborized huts half underground. One cluster was labeled "Indian Village," and many of the huts were given individual names, Villa this or that, some even in English---"House of Hope," for example, printed on a bit of cardboard over a rustic door. A place to fascinate children!

The side of the hill at the edge of the large park surrounding the Château d'Offemont was literally honeycombed with these rustic coverings of holes dug in the hillside where the men live. Little roadways concealed by gabion mats have been built, and there are paths or streets which wind in and out and up and down the side of the hill between them. These primitive abodes must seem palatial in comparison to life in the trenches. Finally at the end both of the road and of the valley, we come to a small cluster of four or five stone farm buildings where doubtless tenants of the landowners once lived and where now the ambulance de première ligne of Offemont is quartered.

We were cordially received by the médecin chef, a Dr. Marie, who turned us over to his aide-major, Ferras by name. He, to expedite matters further, sent for one of the brancardiers---a young fellow called Hanon, lately a Catholic missionary in Natal, S.A., who speaks English and German like a native---wants an official position as an interpreter and begs me! of all people! to intercede for him.(2)

Well, we are shown through the buildings where are some recently wounded men, one badly hit---a serious head wound received this morning and just operated on by Ferras, who says that in their present quiet stage they get an average of about 20 wounded a day. Very crude surroundings without question---just bags of straw for beds. There was one large tent which I surmise is not unlike our own American Army hospital tents, with double canvas walls and six or eight little windows 2 feet square on each side with a stove in the middle. It has kept them comfortable during the winter, we 're told---for they've been in this place several months. I try to take a time exposure inside of the tent, for they are willing that pictures be taken---many of the officers and not a few soldiers indeed carry cameras.

On a bench outside we are shown a large German shell the men have just put together---a shell which fell yesterday near by and buried itself fully a metre in the ground, as proved by Mr. Hanon, who climbs in to be kodaked. It was a cent cinquante-cinq obus which did nothing more than make a loud noise---and the men, having recovered every fragment by scratching about in the hole, had put the pieces together with as great delight as children would have in making a picture puzzle. I was requested to take a snapshot of it, and one jovial Arab rushes off and gets a rifle, turns up his moustachios, and imitates the Kaiser to the entertainment of his fellows.

There are other obus holes in the adjacent field; but most of the holes have been made for another purpose, for there is a sizable burying ground in which the graves are about equally divided between those with Christian and those with Mohammedan markers. Near by is a rustic altar for religious services, and at the far end of the field a stake for executions. There have been three, of men who purposely shot themselves through the hand and were found out---not a difficult kind of wound to recognize, one would think. However, it is not always easy to spot a malingerer whether or not he bears a self-inflicted wound, and it is always possible that injustice may be done to one who gets sick or injured in some justifiable way.

On the way back from the chateau we stopped at "Indian Village" to visit the regimental surgeon, who had been there, he says, for six months without shift. His little cabin he shows with pride---an arbored front room with a big shell fragment as a weight to keep the rustic door to---and he is particularly delighted with a wash basin moulded out of some cement which had been brought up for use in the trenches and which has a hollow for his soap, and above hangs a tin petrol can from which he siphons off his water by means of a rubber tube. Then a little back sleeping room actually dug out of the hill and lined by gabion mats; and right alongside was his horse in another larger dugout. He has just equipped a little place where, now that the weather is moderating, the men, provided they carry up the water, may get a makeshift shower bath at least every 14 days when they are out for a rest. Regular camping out! And they all---the wounded---look very well and chipper and hopeful.

An offer to go and see some 75's which we could hear at work was refused as it was growing late. And so we leave these modern cave dwellers and their fascinating huts and depart with the impression that they are cordial, patient, companionable, brave fellows who deserve the evident affection their troops have for them. May the victory be theirs!



Saturday, April 17. Paris

Morning, in the wards at the Ambulance---in the X-ray, dental, and photographic departments. The Unit---both doctors and nurses---are all doing excellent work, and the condition of the patients and their wounds could not be better.Much telephoning in the evening from the Château d'Annel, where they wished to borrow someone from our groups but Greenough rather thinks complications would ensue. If this keeps up we are likely to get fined and may even have our telephone taken out, for talking English over the lines is forbidden here, this being the language of an ally.

Tuesday, April 20

Our admitting day, and last night 25 wounded were brought in ---all recent cases from the 2nd Regt. Zouaves and curiously enough from the line at Tracy-le-Val where we were last Wednesday. There had been an unsuccessful German surprise attack Sunday evening---a hand-to-hand affair armes blanches. They had come via Offemont and Compiègne, évacués assis as their tags indicate. Quick work....

There is a strange medley of unassorted people working here. The orderly in No. 28, for example, I chanced to meet at dinner. He turns out to be an Englishman of widely traveled sort; has a home in Naples and another villa in Florence, seems to know everyone, and is attractive, informed, and modest. We talked of the early days when the Ambulance was sending cars to the Marne battlefields and getting patients from Meaux when dead and wounded lay all along the roadsides. The disgraceful motor parties from Paris to see the gruesome sights were soon stopped by the authorities. It was easy then to get passes---pendant la guerre.

Wednesday, April 21

Autopsy on a poor fellow from Mignon's ward with a spinal paralysis. He had been hit while lying face down awaiting an attack, gun in hand. The ball had passed through the right scapula and on into the spinal column, dividing the cord.... In the afternoon while waiting for Jougeas to fluoroscope a man with a shrapnel ball in his cerebellum, a person appears in the garb of an ambulance driver who asks loudly for me, and, on my being presented, says, "Oh yes, of course, I'm Washington Lopp, you know; it was I put the salt in the water---ha, ha!---and I'm going to make up for it; and here are some wives of the cabinet ministers who will make it all right with you." And sure enough, he was followed by four females in black who might well enough have been wives of cabinet ministers. I was much mystified and did the best I could with "heureusements" and "avec plaisirs"and "vos connaissances" ----all this while the corridor was thick with patients and nurses and stretchers and waiting attendants.

Well, they finally left without removing any salt from the water, so far as I could see. Not until later did I learn that M. Lopp is a terpsichorean person who teaches, or once taught, the high life of Paris to tango---cabinet ministers' wives being his specialty, and possibly their husbands, also. He, having retired well-to-do, now keeps (or kept in ante bellum days) a large establishment where balls and dinners and dances and other social affairs are held. It is called, I believe, Washington Palace, which is better than Lopp Palace---a little. He is now an active and busy ambulance driver, but has many ears to whisper into; and learning through his wife, an auxiliaire, that a member of the Harvard Unit, newly arrived, wanted "head cases," he went about it. So this accounts for the twenty-five shattered jaws with which we were swamped the day Cutler and I went to Gare d'Orléans for blessés. M. Lopp and the cabinet ladies will have this all changed---the salt in the water, ha, ha! Of such is the Ambulance Américaine.

Thursday, April 22

The morning passed with Tuffier, and now waiting for him for a moment at his private hospital. Here at this place are several officers, one a general with half his face blown off and quite blind. T. says most of the officers have been killed, and that is why the men are so brave! It puts courage into them. Queer idea; but possibly I don't quite understand.

The Harvard Unit at the American Ambulance

Standing: Wilson, Benet, Barton, Rogers, Coller, Cutler, Smith-Petersen. Nurses: Wilson, Cox, Martin, Parks. Seated: Boothby, Vincent, Greenough, Cushing, Strong, Osgood

He tells me of peculiar wounds that he has seen. An officer, hit in the trenches by an explosion of an enemy hand grenade, had a small wound of entrance near the inner canthus of the right eye, without special symptoms. An X-ray showed an undeformed cartridge in the frontal lobe of the brain.This was extracted and it proved to be an intact French Lebel cartridge! I give it up. He explains that the captured French ammunition, which of course does not fit the German Mauser rifles, is used with whatever else may be handy to fill the hand grenades, now so murderously thrown about in the trench fighting.

Another instance was that of a woman who had been injured in the thigh by a fragment of the first of the aeroplane bombs dropped on Paris. There was in addition a trifling wound of the scapular region, and a point of tenderness low down in the back, where subsequently an X-ray showed the presence of a French rifle bullet! She had been hit by a falling ball that had been fired from a mitrailleuse ("devil's coffee mill") at the aeroplane. Strange coincidence that she should have got both injuries at one and the same instant.

Lunch with T. and a Belgian officer, who constitute a committee to supply artificial limbs to the amputees. A month ago 7000 were needed and the French can only make 400 a month at the best--- the American manufacturers 500. Hence it will take the better part of a year to supply those already wanted. Many more will be needed before we 're through. Later to see a review at the Invalides of the 29th and 30th Regiments (territorial) of infantry---very moving. There is something about French troops on the march that dims one's eyes.

Saturday, April 24

This afternoon, in response to a call to the Ambulance for all of its many cars, Boothby and I went in one of them to La Chapelle, which is the present single distributing station-gare régulatrice for all the wounded forwarded to Paris.

Red Cross ambulances of every pattern, and from a great many hospitals, were being picked up from all sides as we neared our destination---a rather unusual sight here at midday, for the authorities do not like to have the recent wounded carted through the streets by day even though it be in closed cars. As a matter of fact the larger number of our admissions occur in the late hours or at night.

A large, high building, once a freight shed, I presume, possibly 250 feet long, has been transformed for the present purpose. The train runs in on a single track behind a curtained-off side of the building---curtained off by a huge heavy black canvas which opens at one place through which the wounded successively come----first the petits blessés on foot, then the men in chairs, then the grands blessés on stretchers.

The impressive thing about it is that it is all so quiet. People talk in low voices; there is no hurry, no shouting, no gesticulating, no giving of directions---nothing Latin about it whatsoever. And the line of wounded---tired, grimy, muddy, stolid, uncomplaining, bloody. It would make you weep. Through the opening in the curtain, beyond which one of the cars of the train could be seen, they slowly emerged one by one---cast a dull look around saw where they were to go---and then doggedly went, one after the other, each hanging on to his little bundle of possessions. Many of them were Moroccans, though for the most part they were downright French types. Those with legs to walk on had heads or bodies or arms in bandages or slings, in the hurried applying of which, day before yesterday, uniforms and sleeves had been ruthlessly slit open. Not a murmur, not a grunt---limping, shuffling, hobbling ---in all kinds of bedraggled uniforms, the new gray-blue as well as the old dark blue with red trousers---home troops and African Zouaves, and occasionally a Marine, for they too have been in the trenches of late.

The procession wound directly by us, for the American Ambulance drivers are privileged to go into this part of the shed, owing to their known willingness to lend a hand. They were sitting in a quiet group, evidently moved, though many of them had been through the Marne days when cattle trains would come in with the wounded on straw, without food or water for two or more days, stinking and gangrenous. Things of course are very different now, and here at La Chapelle Dr. Quenu, of Hôpital Cochin reputation, has finally got a perfect system arranged to replace the utter confusion of those early weeks.

It has been only two days since these fellows were hit, and many of them, regarded as sitting cases, have stuck it out, believing they could walk off the train. But not all could. One poor boy, who collapsed before us, they put on a stretcher and took to the emergency booth. Others had to be helped as they walked on between the two rows of booths to the farther end of the building, where were two large squares of benches arranged in a double row about an iron brazier in which a warm charcoal fire was glowing; for it was a cold, raw, and drizzly afternoon. There was a separate place for the slightly wounded officers, of whom there were some six or eight.

The wounded all have their tags dangling from a button somewhere ---a tag from the poste de secours, another from the ambulance de première ligne, and possibly one or two more indicating where they had stopped for a dressing; and in addition, on the train, to save trouble, each has been chalked somewhere on his coat with a big B (blessé) or an M (malade), so that they can be sorted readily.

It was soon whispered about that this lot had come from Ypres and that they had all suffered greatly from some German gaz asphyxiant; but I hardly believed the tale, or thought I had misunderstood, until this evening's communiqué bears it out. Many of them were coughing; but then, as I've said, most of the wounded still come in with a bronchitis. We have heard rumors for some days of a movement of German troops in the direction of Ypres, and this attack is apparently the result.

By the time the wounded were all congregated, many Red Cross nurses were serving them hot soup and other things, ending up with the inevitable cigarette. The men were quiet, immovable, sitting where and how they first slumped down on their benches. No conversation---just a stunned acceptance of the kindly efforts to comfort them.

Meanwhile Quenu and his assistants were going about listing the men and distributing them as they saw fit among the hospitals in accordance with the empty beds at the disposal of each. Our drivers had handed in the number their cars could take and the number of patients the Ambulance Hospital could receive---possibly fifty, I 'm not quite sure---and we finally went away with our due proportion of the 250 that the train had brought in.

Quenu, though busy, was very polite---they all are---pretended he knew me and asked if I should like to see the room where the petits pansements were being made. Among the several who had been singled out as needing immediate dressings because of pain, dislodged bandages, or recent bleedings, was the poor boy we had seen collapse as he walked out of the train. He had a high fever and a trifling first-aid dressing on his badly fractured left arm. This was surely enough, but when the young doctor cut off his circa six layers of clothing an undressed chest wound in his right pectoral region was disclosed. We then sat him up and found the wound of exit near the shoulder blade---at which the boy said, "C'est bon, je guérirai."He was in our lot and I saw him landed later at Neuilly spitting blood.

When we got back to the Ambulance, the air was full of tales of the asphyxiating gas which the Germans had turned loose on Thursday---but it is difficult to get a straight story. A huge, low-lying greenish cloud of smoke with a yellowish top began to roll down from the German trenches, fanned by a steady easterly wind. At the same time there was a terrifically heavy bombardment.The smoke was suffocating and smelled to some like ether and sulphur, to another like a thousand sulphur matches, to still another like burning rosin. One man said that there were about a thousand Zouaves of the Bataillon d'Afrique in the lines and only sixty got back either suffocated or shot as they clambered out of the trenches to escape. Another of the men was en repos five kilometres away and says he could smell the gas there. He with his fellows was among those of the reserves who were called on to support the line, but by the time they got up the Germans were across the canal, having effectively followed up their smudge. They seem to have been driven out later, or at least the seamen thought they had been. We 'll have to await the official communiqués, and perhaps not know even then. In any event, there's devil's work going on around Ypres, and the heralded "spring drive" seems to have been initiated by the Germans.

Sunday, April 25

It has apparently been a large affair at Ypres, with the Germans the aggressors. Several hundred more wounded at La Chapelle this morning---all the ambulance men out---all our beds full.... We fluoroscoped two of yesterday's head cases this morning and operated on one of them---a young lieutenant named Daumale who was looking through his field glasses when a Mauser bullet made a direct hit of the lens in front of his right eye, exploding the cylinder and producing an ugly wound not only of his hand but of his right orbital region and cheek. Some metal fragments could be seen by X-ray, driven back into the base of the skull. The eye had been immediately enucleated by the regimental surgeon, but the whole region had become badly infected---an ugly affair. It was necessary to open and drain the antrum. The other man proved to have a fragment of obus deep down in his right hemisphere.

Invited by Madame Benet to a supposedly informal Sunday supper in their apartment. Quite unsuspecting, I went "as was," direct from the Ambulance, and to my embarrassment found a large party all in full evening dress---the Ambassador and Mrs. Sharp, Poincaré and his wife, Mrs. George Munroe, and some others. There were no introductions and I was seated at a long narrow table opposite an unprepossessing-looking man who if possible said less than I did during the course of an elaborate dinner.All ears were turned to the end of the table where a woman was holding forth, indiscreetly I thought, about her impressions of Berlin, including a recent visit and conversation with the Kaiser.

After dinner I made myself scarce and retreated to a corner divan, where I was soon joined by my vis-à-vis of the dinner table, who evidently had taken pity on me. We sat and smoked silently for a while, when he finally said without looking round: "I understand your name is Cushing."This I admitted. After a puff or two he added laconically: "Brother named Harry?" At this I sat up and said, "Yes; how did you know?" "Roomed with him at Cornell," he replied. "May I ask your name?" said I. "House," said he. That was about all but I may add that I liked him.

Monday, April 26th

Operation on a knee this a.m. to extract a shrapnel ball which had traversed the joint and lodged in the inner condyle of the femur---a case inherited from our predecessors and here several weeks. Osgood and I agreed on the procedure---contra the others. It was very simple by using a perforator and burr. The ball had carried a piece of cloth in with it. (After a 48-hours culture--- rather slow---it had fractured the media-gas bacillus! ! Why no serious infection?) Many more wounded being brought in from Ypres, worthy Canadian-Scottish have been distinguishing themselves---by holding the line last Thursday after the French Colonials gave way. Everyone singing their praises....

Inevitable that ructions should from time to time occur among the volunteer personnel at a place like this---all emotionally keyed up and working long hours under considerable strain. Oil occasionally has to be poured on the waters, and no one better able to do this than Robert Bacon, who turns up at the right moment wearing a British Red Cross uniform.

He is full of plans regarding the cluster of 1040-bed British Hospital Units now being erected near the coast south of Boulogne. He and Osler eager to have some of them taken over and officered by American doctors recruited from the several university medical schools, much as we are acting here, but for six-month periods. According to terms of Geneva Convention, Germany must be notified of the intention. Gives me a dossier of documents and letters on the subject to present to the Harvard authorities and thinks it desirable that I should stop at Boulogne on the way home to get first-hand information.We dine with the Charles Carrolls at their home, and there is more about this novel project during the evening.

Tuesday the 27th

Our first warm summery day and full of work. With misgivings I operated on poor Jean Césare, one of the several long-time derelicts in Mignon's ward---and I fear M. did not fully approve, but all the others did. He has been paralyzed for six months or more from the effects of a ball which had passed (October 29th) directly through the spinal canal. Complete paraplegia below the lumbar level with a huge bedsore---and latterly such awful pain that he has been going downhill fast. It was a long and difficult three-hour job to section all of the spinal roots at the level where they passed into a dense and snarled scar around a piece of bone that had been driven into the canal.

Then after lunch another operation on the man we had X-rayed yesterday, disclosing a foreign body about 5 cm. in and forward from a small defect at a plan d'erstree in the cranial vault, which had been promptly trephined at a poste de secours.

There were a lot of in driven bone fragments evidently infected, and at the bottom of the track the fragment of shell or whatever it was could be detected, but it would have taken a lot of manipulation with consequent damage to the brain to get it out. So we packed up and lugged the man down three flights to the first floor, where Chaveau happened to be operating, and there I tried the famous magnet. I missed the fragment the first time and feared that after all it was lead and a piece of shrapnel ball---but on the second try, out it came, hanging to the end of the large probe. It was the more satisfactory because they have had little or no success heretofore with the extraction of missiles from the brain in this manner.

Then some dressings for several visitors, chiefly to demonstrate the use of gutta-percha "protective" for painless and bloodless dressings---among them Lt. Daumale, he of the exploded field glass. He's doing well and presents me with the empty envelope of his pansement individuel which he had attempted to apply on the field---it must have done about as much good as a postage stamp to stop a faucet. It had been picked up, together with the fragments of his field glasses, by the infirmier who led him to the poste de secours.

Dinner with Nicholas Roosevelt and a Mr. Orr, another of the young men at the Embassy---also Major Logan. At Ciro's. Very interesting to hear Logan talk, for he is full of valuable information, and this disheveled envelope--with"War Department" and "Official" carefully torn off the corner, when I asked for it as a memorandum---indicates that it was with a pencil in his hand.

It was a good dinner, but largely forgotten with Logan's illuminating description of the tactics of trench warfare, gunnery, sanitary corps, and the like---as well as his views of why von Kluck did not enter Paris---a proper thing to do from a strategic standpoint. He has been here since early August---one of the very few military observers permitted by our government to remain. Not a West Pointer, he broke into the army through Spanish War service, and is a most valuable man for us to have over here. What's more, he's an ardent admirer of Leonard Wood.

Wednesday April 28

Still very busy and the hospital is crowded. I had a strange time operating for du Bouchet on one of his patients---Lafourcode in No. 77 supposed to have a gouttière bullet wound of the skull, which I did not question, though murmuring something about the desirability of an X-ray.

At all events, I was persuaded to take the case in hand and it proved to be not a gutter wound at all, the presumed wound of exit being merely where the man had fallen and cut his head on some sharp object. The track of the missile, along which an aluminum probe could be passed, led directly downward toward the base of the brain. This afternoon an X-ray showed a fragment of obus just over the sella---not a bullet at all.... Letter from Osler that arrangements made through Generals Keogh and Sloggett for me to be shown the overseas hospital organization of the R.A.M.C., with the possibility of Harvard's supplying officers and nurses for a 1040-bed hospital. He admits it to be a large contract.... The British have launched a Dardanelles expedition and troops are said to have landed at Gallipoli. It seems very far away.

Thursday, April 29

Several unsuccessful trials this morning to extract the shell fragment by the aid of the magnet from the brain of poor Lafourcode. I was afraid to use the huge probe which they have and so determined to make, or have made, another---of which later. We had tried every possible thing in our own cabinet and in those on the lower floors without success. Finally, while I was at lunch, Boothby hit upon precisely what was needed in the shape of a large wire nail about six inches long, the point of which he had carefully rounded off.

Well, there was the usual crowd in the X-ray room and approaching corridor, and much excitement when we let the nail slide by gravity into the central mechanism of smiling Lafourcode; for at no time did he have any pressure symptoms, and all of these procedures were of course without an anesthetic.While the X-ray plate was being developed to see whether the nail and missile were in contact, who should drop in but Albert Kocher with a friend from Berne; and then shortly a card was sent in by Tom Perry's friend, Salomon Reinach, Membre de l'Institut, author of the History of Religions, and much else.

So all together we finally traipsed into the first-floor operating room, where Cutler mightily brings up the magnet and slowly we extract the nail---and---there was nothing on it! Suppressed sighs and groans. I tried again, very carefully---with the same result. More sighs, and people began to go out. A third time---nothing. By this time I began to grumble: "Never saw anything of this kind pulled off with such a crowd. Hoodooed ourselves from the start. Should have had an X-ray made when the man first entered the hospital." The usual thing, as when one begins to scold his golf ball.

I had taken off my gloves and put the nail down; but then--- let's try just once more! So I slipped the brutal thing again down the track, 3 1/2 inches to the base of the brain, and again Cutler gingerly swung the big magnet down and made contact. The current was switched on and as before we slowly drew out the nail---and there it was, the little fragment of rough steel hanging on to its tip! Much emotion on all sides, especially on the part of A. Kocher and Salomon Reinach, both of whom could hardly bear it.

April 30, 1915

The Ambulance is chockablock and they are at last putting in more beds. A thousand wounded last night at La Chapelle, from which friend Lopp deliberately picked out a lot of head cases before the very eyes of the attendants---thus getting the salt out of the water, I presume. Too late for me, however, for Boothby's and my time is about up and there has been much to do about getting our passports from the Prefecture de Police, permitting us to enter England---a most complicated business which took all the morning. Then a quick lunch and two urgent cranial operations- --one of them a young Arab with a through-and-through occipital wound, causing complete central blindness.

Saturday, May 1st

My last operation this morning on a man with multiple shell wounds, one in the left temporal region---aphasic and with a right facial palsy supposed on X-ray to have no cranial fracture. There was one, however, with a very wet brain, and a completely softened and disorganized area near Broca's convolution, without great extravasation of blood.

This over, they begin to bring in patients from various parts of the hospital, expecting snap diagnoses---cases which need a week for study---e.g., a man probably shot through the splanchnic area, greatly distended, with a remarkable tremor, possibly an adrenal injury. Finally G. W. Lopp appears with the attending surgeons at La Chapelle, one of whom from his card seems to know more about accouchements et maladies des femmes than gunshot wounds of the head---and in some unaccountable fashion they are soon whisking me in a military ambulance down to Hottinguer's, where at one minute before twelve I succeed in drawing out the small residue of my funds. Then back to find de Martel lunching at the Ambulance with Heitz-Boyer and du Bouchet, and after a hurried bite we show them some of our cases---de Martel much taken with the wounds, some of which are pretty good, and he wants to know the secret of making "invisible" scars.

With them at 2.30 in another military car way across Paris to the great supply depot of the Service de Santé at Bercy, to see the new mobile-ambulance unit---"Auto-chir"---of the French Army(3)---a bit late it is, but admirable now that they have it. Evidently this is the first exhibit and there are many people on hand---perhaps 50 besides ourselves---officers mostly: Toussaint, the old director of the Service, Quénu, of the triage at La Chapelle, Dumont, who gave the demonstration, Gosset, Joe Blake, Carrel, and many others.

In addition to four motor ambulances of a new model to accommodate four stretcher cases, there were perhaps five or six other cars, the most important part of the whole equipment being the operating pavilion---quite perfect for its purpose---capable of being completely dismantled and packed for transshipment in two and a half hours, and of being set up in three hours. It has a receiving compartment; an operating room large enough for four tables; a room with four tables for dressings, into which opens the autoclave---big enough to sterilize four outfits at once---and alongside is the car with the furnace and boilers to run it. Then a good X-ray room, and little steam radiators!! and electric lights! provided by another car in which are two large dynamos run by the motor.

This car also carries all necessary supplies, admirably put up in cases and baskets---catgut, ether, drugs, bandages, etc., in ample amounts. This is roughly the story---what they should have had, and the Germans possibly did have, in the beginning. It makes the little group of American Army field ambulances staked out at Bagatelle for a demonstration look silly. There are, or are to be, fifty of these units, one for each army corps, largely paid for by private subscription at 100,000 francs per unit.

Very good indeed, but I don't see where the personnel is going to sleep and eat. It would not be bad if our U.S.A. tent outfit could accompany such a motor caravan; and they might engage some of Ringling Brothers' employees, who could set it all up after a night's move in a twinkling. There is much talk of my coming back on a government invitation (!!) to do neurological work for three or four months in one of these things, with Craig and Martel and others. It would be interesting.

The late afternoon was a scramble, getting sauf conduit for to-morrow's outing; making necessary changes at the War Office in our laissez-passer for Monday owing to altered plans for transportation; paying final adieus to the many friends we have made at the Ambulance; gathering samples of the convalescents' work tagged with the blessé's name and photo to take home for sale---an excellent job Mlle. du Bouchet is organizing; and paying a final visit to the wards, where Cesare asks to be scratched under his plaster cast and Lt. Daumale, who has been decorated with the Légion d'Honneur, presents me with his damaged field glasses as a souvenir. In the midst of all this, Cutler's classmate, Norman Prince, appears in a jaunty blue French aviator's uniform and gets pumped about the new speedy "Baby" Nieuports, the Caudrons with wireless installation, the old Voisins, the first machines to be armed, the Maurice Farmans for air raids, the still older Morane "parasols" which carry a passenger armed with a carbine, etc., etc.(4) We've just had our last supper at the pension. Our landlady, Mme. Marty, has secured a job giving ether for Tuffier at the Beaujon a long letter from our spirited companion, Helen Homans, is read about her work as a V.A.D. probationer nursing English Tommies at Yvetot in Normandy.

Sunday, May 2nd

A farewell outing to-day for the hard-working juniors of the Unit. They stay on for another two months and have been cooped up in the Ambulance since our arrival, with no opportunity for sight-seeing. Sauf conduit to Meaux had been secured at the Préfecture de Police and we find the early train from the Gare de l'Est full of sight-seers like ourselves, souvenir hunters, soldiers en permission) and mourners---all bound for the Marne battlefields evidently a favorite Sunday trip.

Eight months have passed since that eventful sunrise of the 6th of September when the German tide was checked in this very region north of Meaux, but it might almost have been yesterday. A battle leaves enduring scars. The dead still lie in shallow graves where they fell---the fields and roadsides are dotted with crosses; and every hay mow of last autumn's harvest shows by the grim evidence about it how its futile protection had been sought against the scythe of another reaper.

"En Avant." The Piou-pious
of the Early Marne Days

The Road from Meaux to Vareddes, Showing German "Stances" in the Embankment

The roads leading north from Meaux had to be held if the Germans were to extricate themselves, and evidences of the bitter struggle of those first three or four days between Nanteuil and the Ourcq are clearly apparent. The roadside poplars show the effects of the cross-artillery fire from the French 75's on the west and from the British guns on the south as they turned to recross the Marne. The hastily excavated stances made by the German infantry on the west side of the road to Vareddes and Etrepilly are as fresh as though newly dug. So on to Puisieux and then back by another road through Barcy---much knocked about ---and Chambry, with its tragic cemetery wall, and thus back to Meaux, whose ancient bridge the British had blown up in their retreat.

The towns had all been severely damaged by shell fire and the debris of battle still litters the fields---a lure for curio hunters. Because of the risk of detonating unexploded and half-buried shells, they have not yet been ploughed for planting and were dotted with boys carrying duffel bags to fill with souvenirs for sale on the streets of Paris. One urchin in the field near Barcy emptied out his pack to show us his plunder---caps of German and French shells, cartridges, buckles, a battered canteen, a blood-stained gray-green cap and piece of tunic. If the picking is good to-day, what must it have been after the opposing armies had swept by to dig in ten days later at the Aisne!

We managed to engage for the day two decrepit one-horse fiacres driven by still more decrepit cochers of an ancient vintage. Ours was stone-deaf and talked a toothless French, so communication by speech was limited, but his actions were unmistakable and spoke loud enough. He drew up at every estaminet and would disappear---ostensibly to get a pail of water for the horse, but it always took him a long time to return the pail, and before the day was over succussion sounds were plainly audible in both cheval and cocher.

Chapter Two
Table of Contents