From A Surgeon's Journal
, 1915-1918




Boulogne. Monday, May 3, 1915

THE companionable Muhr motored us up from Paris this lovely spring day. We had the road between towns practically to ourselves all the way from St. Denis to our destination. Through Presles, Beaumont-sur-Oise, Beauvais, Poix, where we stopped for lunch, Abbeville, where the Tommy and poilu join hands, and where England now governs by courtesy as long ago, under Henry the Second, she came to rule by force. We began to get a smell of the sea at Nouvion, and thence on through Montreuil---once sur-mer though now ten miles inland. As we crossed the wee Canche River a row of French veterans of 1870, wearing their medals with the green and black ribbons on their old frock coats, were sitting sunning themselves on a log---doubtless talking of Sedan, as another lot 45 years hence will probably be in the same spot talking of the Marne. Then through Samer, and about four we purred into busy Boulogne.

We were directed to No. 13 General Hospital, which occupies the large casino by the Avant Port at the edge of the bathing beach. There Gordon Holmes was encountered, and he escorted us up the narrow path to the château on the cliff where Sir George Makins, Colonel Sargent, Colonel Wallace, and he have their quarters. A room was provided for me, and we were promptly furnished with the inevitable tea, after which I was obliged to part from my gentleman chauffeur and companion, over whom there was some embarrassment. They appear to be much more strict here than in the French zones, and permission to visit the hospitals with us, which he would have been very glad to do, could not be granted without consulting officialdom,

Different armies, different customs, no doubt---even among the several French armies, as I have observed. They were aghast at the kodak with which I was armed and had freely used elsewhere, though I fired it from time to time openly and without being warned. There were no mysterious passwords such as we had been given in the sectors of the 2nd and 6th Armies. Road sentries were comparatively few, and most of them French except near the G.H.Q., where not only was there an alert, clean-shaven Tommy, but a stolid poilu alongside of him, each with his different manner of saluting.

But, in place of all this, one must learn to use at least some of the cryptic initials which the Britisher habitually has on the tongue's end: e.g., the G.H.Q. for General Headquarters; the R.A.M.C., Royal Army Medical Corps; a C.C.S. is a casualty clearing station; A.S.C. means Army Service Corps; the D.G.M.S., or Director-General of the Medical Services, is familiarly known as "the D.G.," of whom there are two, Sir Alfred Keogh in the War Office at London and Sir Arthur Sloggett, the overseas director, both of whom have their A.D.M.S.'s, namely, assistant directors---and so on down the line through other combinations of letters to the many M.O.'s, the regimental medical officers.

After tea, Holmes and Sargent took me back to No. 13, where I saw an amazing number of head and spinal wounds, for they often receive daily convoys of 300 recently wounded. With the proper backing these two men have an unparalleled opportunity, not only to be of service to the individual wounded, but, when this is all over, to make a contribution to physiology, neurology, and surgery which will be epochal. The things chiefly dwelt upon this afternoon were the group of longitudinal-sinus injuries, mostly from gutter wounds across the vault of the skull, which are characterized by a striking rigidity of all four extremities. The condition resembles the spastic paraplegia following birth injuries, and they attribute the clinical picture to a vascular injury of the sinus. However this may be, the condition is quite recoverable spontaneously, and they therefore no longer operate on wounds of this type unless there are some complications compelling them to do so. Though recognized and described in isolated cases, as in Osler's recent report, nowhere, so far as I am aware, has anyone observed and studied such a large group as these men have had. We must have seen ten or twelve examples this very afternoon, all of whom will be evacuated in a day or two, for these hospitals must endeavor to keep empty.

Another group of injuries that were new to me were the transections of the spinal cord in the lower neck, which show, in addition to the total paralysis, an extraordinary lowering of body temperature---sometimes as low as 93° F.---with suppression of urine and death in two or three days, consciousness being retained to the end. They already have full notes of one or more spinal transections for every segment of the cord, with the specimens preserved for future study---a life's work. Such of the cases as recover sufficiently to be evacuated are sent to Henry Head at the London Hospital, by whom they are subsequently followed.

On the whole, I take No. 13 to be a good example of the large overseas hospitals of the R.A.M.C. The comforts are slight, the attendance insufficient, the work, though it naturally varies, is from time to time, as at present during this second Ypres affair, simply overwhelming---perhaps as many admissions a day as the American Ambulance might get in a month. And the wounded, bear in mind, are seriously and acutely hit, rushed on from one and all of the casualty clearing stations a few miles behind the lines as soon as transportation is possible. Records, if kept at all, must necessarily be utterly inadequate, so that such clinical notes as Holmes manages to jot down are purely personal ones. Indeed, in rushes no notes whatever can be made, and the wretched tags, insecurely attached to a button of the wounded soldier's uniform, are often lost or become rumpled and completely illegible---far less practical than the French tags with which we have become so familiar. There were two poor aphasic chaps from some Scotch regiment who were necessarily listed as "unknown" since all identification marks had been lost in transit.

The wounded to-day at the casino number 520, not counting the 200 who are under canvas; but occasionally in active times they run up to 900, with an attending staff which varies in number from ten to sixteen. There were none but very ill men, all bed patients, and in the huge restaurants, which contained about 200 closely packed cots, there may have been three or four nurses and as many orderlies. Compared with this our leisurely job at Neuilly with 162 beds filled with subacute or chronic blessés and an auxiliaire or orderly for every 10 to 12 patients seems child's play. This is truly a man-sized job, in the midst of which the Britisher stops for tea, and everyone---even down to the Tommy---has time to shave; and it's this taking-it-quietly that possibly enables them to see things through with some measure of composure.

And so, at seven, back to dinner at the château, where there was a pleasant mess with pleasant guests, among them Sir AImroth Wright, as amusing and chatty as he was iconoclastic. A good deal about wounds, antiseptics, infections, and several digs at Wright, which he parried with his customary cleverness. Much about the Indian troops, who seem to have been disappointing on the whole, and who broke last Thursday before the gas at Ypres, so that the Germans might have got through to the sea but for the rally of the Canadians. Still, the poor things are in a cold season, in a strange land far from home, and they are paralyzed by this artillery business, to which kind of warfare they cannot grow accustomed. More, too, about self-inflicted wounds, of which there are many; for, as Sir George says, the skulkers in an ordinary war such as that in South Africa simply lag behind, whereas here the men must go into the trenches where a panic may seize them and where there is no officer's back to keep your eye on and to follow where he may lead. These wounds appear to be particularly common among the Indians. In a recent large convoy there were, say, 50 wounds of the left hand, five of them among the white and 45 among the Indian troops---a disproportion too great to be a mere accident of figures.

The men, when questioned, explain that the top of the trench gets shot away by the enemy's fire and that they have to push the earth and sandbags back with their left hands. Powder stains, of course, would tell; but they have learned to interpose something ---formerly a piece of wood, until the splinters found in the palm were recognized as a telltale. It is not always possible to be sure; and the Indian sergeants would hardly peach on their own men. And then more about asphyxiating gas and the question of retaliation and the difficulty of making the common soldier appreciate the moral reason for not fighting the enemy with his own and terrifying new weapon, even were the materials at hand.

As an example of how little the Tommy knows of what is going on around him in the larger field, and of the uselessness of questioning him, Wallace told of a man who had been brought in from a trench the other day with a minor head wound. He was trying to get some information as to what was taking place, particularly as the man was covered with tar. "Well, you see," says the Tommy, "my pal, 'e'd bought a pack of cigarettes an' 'e'd paid five francs for 'em and along comes a bloomin' shell and knocks 'is 'ead off afore 'e'd ever smoked a one of 'em!" "Yes, but tell me something about the tar and what you were doing at the time you got hit," said Wallace. "I tells you, sir, 'e'd never smoked a one of 'em when it knocked 'is bloomin' 'ead off." And that's all Wallace could get out of him, and it's the story of the fighting around "Wipers" he 'll tell to his grandchildren, and nothing more.

It is a drizzling night when we turn in with our shutters carefully closed. The town below is as dark as a pocket except for the four or five powerful searchlights which are burning holes in the low-lying clouds, for, as my hosts say, it's a good night for a Zeppelin raid.

Tuesday, May 4

After breakfast, with Sir George to pay our compliments to Col. Carr, the local A.D.M.S.; and this informal introduction will apparently suffice without the necessity of my carrying such papers as would have been required by the French.

We expected to visit not only the evacuation trains but the hospital ships as well, there being two at the moment in the port, but there was no time for the latter. One hospital train was just pulling out, and another was in preparation for leaving---French rolling stock, pretty well gutted, but mostly composed of the usual second-class cars, which, owing to their lateral doors and undivided compartment seats, take stretcher cases very well. It's disconcerting to think, in the case of our having a war, that none of our passenger coaches could be used for other than sitting cases, and that stretchers could only be put in the baggage cars or through windows after a train was made up.

Colonel Gallie, an effective and vigorous Irishman, was in charge of the transportation, and said that he had carried 184,000 people up to the end of March. In the past week alone, about 10,000 wounded have been brought back to Boulogne. I do not know how many trains they can keep moving, but at the moment there were nine at the Front---that is, I suppose, at the railheads near the clearing stations scattered along behind the thirty-odd miles of British Front, from just north of Ypres through Armentières to the neighborhood of La Bassée. And a pretty short line it appears on my Taride map in view of the munitions one sees going up and the destruction that comes back. Each one of Colonel Gallie's trains is about 300 metres long, this being the limit, and is composed of 23 cars, and can carry 250 stretchers and about 150 sitting cases---the couchés and assis of the French.

On each train, too, there are 45 attendants with three doctors and three nurses; and it takes as a rule from four to eight hours to get back from one of the clearing hospitals. There is a cross rail from Dunkerque south, which often ties them up, and, of course, food for guns and men has the right of way. Each train has a kitchen capable of cooking for 300 people, a supply car, and so on; but in view of the fact that one can pass from compartment to compartment, and, worse, from car to car, only on the outside footrail, it must require considerable dexterity on the part of the attendant, particularly if he happens to be dispensing soup. I hardly think this system is quite as impressive as at La Chapelle; but then I did not see any unloading, and as the army and Red Cross stretcher-bearers do it all, it is more simple than in Paris, where every small hospital has its car and its own drivers at the station.

So, after our long inspection, back to No. 13, where Sargent is finishing up his morning's operations, and afterward I saw a number of the recently "gassed" cases---two of them still conscious, but gasping, livid, and about to die, and I hope they didn't have to wait long, poor chaps.

And so to lunch, from which I escape for the proposed visit to the hospital base at Étaples, on the coast some fifteen miles south of Boulogne, where in course of preparation are seven large hospital units, each of which will accommodate 1040 wounded. These units correspond with those which the War Office is planning to turn over to contingents recruited from Harvard, Rush, the Johns Hopkins Hospital, and Columbia; and I gather that the first comers are destined to work here. With the available beds already in and about Boulogne, these seven hospitals will bring the number up to nearly 20,000. Sir William Leishman, the sanitary "boss" of the army, was there---pleasant and agreeable as ever; but Colonel Carr did the honors and we thoroughly inspected the place. For business only, unadorned and unattractive, and some day the heat reflected from these sand dunes on these corrugated iron buildings will make them nigh intolerable. Some of the wards were bad---so narrow that one row of cots must be placed end on; and the doors, wide enough for a stretcher, were too narrow to transmit a cot. But criticism is cheap, and there was much to commend.

We saw, too, many encampments of recruits in and about the , neighborhood, and an aviation field, and we finally return by another route along a very pretty road where are peaceful hamlets and little of war in evidence. And so about five, as planned, we pull up at the Meerut Hospital for wounded Indians on the heights behind Boulogne. It was becoming overcast and cool, but tea had been set out for us in the woods behind the hospital buildings---once an old ruined convent-where there were numberless songbirds and wild flowers in profusion, which for the moment interested Colonel Wall, the C.O., and Sir George far more than wounds and gunnery. Most attractive persons, these men of the Indian Medical Service. It may be that only a certain type of Britisher applies for foreign service, or possibly the contact with the natives, and the patience this requires, is a character-making experience.

It was fascinating to see the Indians close at hand, and I was agog over them, from the first glimpse of the cooks squatting over their little outdoor open ovens, patting and roasting their bread cakes or "chuputty," to seeing them stroll about with their variegated turbans, as nonchalant as though they were at home. They are congenital thieves, I judge, and only a day or two ago a cache in the woods had been unearthed where an Indian orderly had buried eight pairs of riding breeches---what disposition the magpie had expected to make of them I can't imagine. There are said to be about 40,000 Indian troops in France, and an ethnological tangle they certainly make---great, lank, bearded Sikhs, mostly six feet and over, moving along with a glide like a camel, and alongside the little slant-eyed Mongolian Gurkhas. It's tough for the little fellows when they have to go into trenches prepared by Sikhs or Coldstream Guardsmen, out of which they can hardly climb; and I presume it may work the other way, too, for there can't be much protection for a Sikh pulled off his horse and made to take his turn in a recent trench which sufficed to protect a Gurkha. The varied religious tenets, particularly those which apply to food, must try the souls of the I.M.S. commissariat.

In the hospital, where many except the attendants were without their turbans, one learned to distinguish some of these strange fellows. The tall Sikhs and Jats with their fuzzy crimped beards and long hair are unmistakable anywhere after a first introduction; the Dogras, hillmen from between the Punjab and Kashmir, wear a distinctive little moustache and a queer little tuft of hair at the crown of the head. The little Gurkhas and the Garhwals are Mongolian in type and wear a pigtail, and are like enough, I observed, to make Colonel Wall occasionally ask of a man whether he was Gurkha or Garhwal. One Gurkha had a badly wounded hand, which he will never use again for much, and he was begging to get back to the line; for two of his brothers had been killed, and he wanted to revenge them even if he lost his own life---but what matter, since they will all be transfigured! Because of this belief, I may add, they will rarely permit an amputation. Can one imagine a future life on one leg, or, if the case may be, on no legs at all?

And so back to the Château Marie Louise for dinner, with other guests, and more talk about the casualties, which to April were estimated at 180,000; about the changed site and character of the wounds, many of which, early in the war, when the trenches were shallow, were foot and lower leg wounds, whereas now with the deeper and squared trenches it's mostly heads; about the scarcity of bayonet wounds which are seen---for in these days of close fighting little if any quarter can be given, and not many prisoners can be brought back, horrible as this may seem; about the mediævalism of the war, not only going back to the bayonet but beyond, to the grenade and bomb-throwing devices like the Roman ballista, to casques and armor, to burning oil and the "stinkpot" of the Chinese, and, stranger still, to the belief in the legend of the Angel of Mons and the Agincourt bowmen. And finally Holmes, Sargent, and I slip away and have a powwow until midnight over neurological matters.

Meanwhile, I learned something about the medical consultants and their status in the army. The regular officers of the Army Medical Corps inevitably become swamped in administrative work at such times as this, and the actual treatment of patients is taken over by doctors who have enlisted as M.O.'s in the service. The character of their work is supervised by distinguished physicians or surgeons appointed by the D.G. as colonels with a ca. £1000 salary, many of them being "in for duration." Sir George Makins was among the first to be selected, and he oversees the surgical work in the base hospitals, or at least part of them, whereas Sir Anthony Bowlby does the same for the forward hospitals or part of them.

Bowlby's lifelong friend and colleague at St. Bartholomew's, Sir Wilmot Herringham, supervises the medical work in the forward areas, and Sir John Rose Bradford and Sir Bertrand Dawson at the Base. A number of these men had seen active service in the Boer War. There are also consultants, both medical and surgical, for each army and possibly for each division, beside numerous physicians and surgeons on special duty like the group I am visiting---Wright, who is a colonel, in charge of a laboratory, here at the casino, Sargent a lieutenant colonel, and Holmes a major. Since all of these consultants have heavy responsibilities and more or less roaming commissions, each is provided with a motor car and an orderly-chauffeur.

Wednesday, May 5

Sir George and I got away a little later than expected, headed for G.H.Q., fifty kilometres or so to the eastward, and through quite a different country from what I have heretofore seen. Hedges and willows line a busy roadside, where soldiers are at work trimming; cutting, and piling faggots and brushwood; and the road itself, which is undergoing repairs, is crowded with A.S.C. people and their horses and wagons. Past camps of recently landed boys in fresh khaki, past an aerodrome, and on into country which begins to have a Flemish tone, with windmills and canals, though we are still in France. The G.H.Q. is in a lovely old town (St. Omer), the occasional glimpses of whose handsome towers as we approach along the road are very fine.

We finally park somewhere on a side street, pass many sentinels, and mount the narrow dark stairs to the busy and crowded offices of that important person, the overseas D.G., General Sir Arthur Sloggett. He had heard from General Keogh, and we were to be shown everything. Indeed Herringham---who, poor man, has just lost his son in the trenches---was to accompany us. Meanwhile we were told something about the poison-gas attacks and ways of protection by hoods, with which the men are being provided through the prompt efforts of Haldane. Whether they will answer the purpose, no one yet knows---the general feeling distinctly gloomy---a dastardly business---protests useless.

Under Colonel Herringham's guidance and in company with Robert Bacon, who meanwhile had turned up, we then went to Malassise to visit the camp set up by the Society of Friends for the Belgian refugees.(5) An epidemic of typhoid fever had broken out among these unfortunates, large numbers of whom, after the bombardment of Poperinghe, crossed the border from the remaining tiny corner of free Belgium where, according to Mr. Bacon, there are only about 50,000 people left. The several hundred men and children, largely convalescent, were wandering in the grove where the many rows of hospital tents were pitched, or were working on the roadways---all wearing the familiar blue convalescent uniform.

After this, with Colonels Herringham and Makins in one car and Mr. Bacon and myself in another, we moved on into Flanders, through a country where were great hop fields and fascinating canals. Passing Cassel Hill, the present French forward headquarters on the British left, we turn off from the main road at Le Nieppe and cut across the country, where it becomes less easy going because of the huge A.S.C. lorries---miles of them--all the way from Caestre through Flêtre and Meteren till we reach Bailleul, situated some fifteen miles southwest of Ypres and an important casualty clearing station for the British sector.

In normal times Bailleul---a typical old Flemish town---is a peaceful lace-making place of some 13,000 inhabitants with two old picturesque churches. But to-day it is a bedlam, packed with motor cars of all kinds, though ambulances predominate, since, owing to the recent evacuation of the clearing station at Poperinghe, the burden has fallen heavily on this place. We visit only one of the several hospitals---an old monastery, where a long line of ambulances at the moment were being unloaded. Many of the field ambulances and stations have recently been targets for German shells, and there has been a very heavy "take in," as they say, for several days.

A most effective young officer, Captain Leek, is found methodically going over the cases which are being packed in the large receiving room---examining wounds, doing the necessary emergency operations, removing tourniquets, ligating vessels, giving antitetanic injections, and so on. Extraordinary how rapidly it is all done. Through this single hospital 43,000 wounded have gone, and there are three other clearing hospitals in Bailleul! No wonder Colonel Gallie is busy with his trains to and from Boulogne. I looked at the men's tags to see where they had come from---that is, from what field hospital---and was again disturbed to see how flimsy, insecure, and illegible the labels were---attached to a button merely by a slit in the tag. There have been 300 "gassed" victims admitted here in the past twenty-four hours, and all told they have received about 1000 cases since this business began, with about 30 deaths---not so bad after all---at least for those who manage to get back this far. Sir Anthony Bowlby joins us, also Col. Atkins, Sir John French's personal physician, and we are taken off to lunch at a mess where were a lot of overworked R.A.M.C. people. Bolwby has been in this forward area since Oct. 14th, following the German retreat to the Aisne, while Makins has held on at Boulogne; and he would like it better if they could rotate, each following a fresh batch of wounded to the Base; but there would have to be a dozen of them to do that effectively.

I gather that the English system of evacuating the wounded, not unlike the French, corresponds with the printed regulations prepared before the war, except that at present there is no need of stationary intermediate hospitals between the clearing hospital and the temporary overseas base hospitals at Boulogne and Rouen. The wounded are either brought off the fields by the regimental stretcher-bearers, or else they make their own way at nightfall as best they can to a regimental aid post, which, like the poste de secours of the French, is merely a place of temporary refuge in a copse, a dugout, or the cellar of a ruined building somewhere. Here their first dressings are usually applied, or first aid, such as in rare instances may have been given on the field or in the trenches, is supplemented. Thence by hand cart, or some horse-drawn vehicle, or possibly even by motor, they reach a field ambulance or dressing station which, like the one we are to visit at la Clytte, corresponds to the ambulance de première ligne of the French and is in the zone of battle.

From there the wounded are taken in turn by motor ambulances to such a clearing hospital as this at Bailleul; thence by a hospital train to one of the temporary base hospitals near Boulogne; then via Boulogne-Folkestone by hospital ship to "dear old Blighty," to a hospital train again, to a general hospital somewhere, to a convalescent home, whence comes a final discharge, or back into service, as the case may be. This is all very fluctuating as the local character of the war changes, and to-day the bearers from the field ambulance often work up to the aid posts, and the duties of the two may so overlap that the bearer party, which goes out every day from the field ambulance, may even camp near the trenches. And remember, too, that the wounded man may sometimes never leave his original stretcher in exchange for sheets and a bed until he reaches England.

The R.A.M.C. officers and men figure high in the casualty lists. It's dangerous business to-day near the Front, and much of the work must be done at night and without lights, for the Red Cross in this war does not serve as much of a protection. The main aim, of course, is rapid evacuation of the wounded from France, and I am told that wounded have been known to reach St. Thomas's Hospital in London eighteen hours after they have been in action. Yet in this particular sector in which we are, it is a variable three miles or so from the aid station to the field ambulance, another six or seven to this clearing hospital, and about fifty-five from here to Boulogne. Of course, the character of work of a clearing hospital such as we have seen is largely one of classification and proper distribution, and though its capacity may be small, say 200 beds, 1500 wounded may easily pass through in a day.

There is further talk at lunch of the gas attacks and possible ways of combating them without giving in to the Tommies' demand for retaliation, but the general feeling is distinctly discouraging; for if things keep on this way and the wind doesn't change, Calais may soon be in the enemy's hands. In the emergency the troops are being supplied with makeshift respirators. Haldane thinks the gas is cheap commercial chlorine, which always contains some bromine. It is blown through long tubes passed out of the loopholes of the trenches. It must have been long prepared for, and the recent German claim that the Allies had been using asphyxiating gas was probably the usual ruse to prepare the public mind. Undoubtedly in the high-explosive shells of the Allies, in melanite, lyddite, and so forth, there are gases which have asphyxiating qualities, but these effects are evanescent and subsidiary to the explosive quality of the agent.

Well, we've more than gobbled our simple lunch by this time and go back for another look at the station. The entire convoy of cases has been sorted over, relabeled, and passed on, and the great room is empty except for a few men who need immediate attention; a brachial artery is being tied for a secondary hemorrhage by a junior M.O. It is all very simple ---nothing so elaborate as an X-ray machine and no beds except the few for officers. In one large room, under a new wooden roof---for a Taube dropped a bomb on the old one ten days ago---there were closely packed rows of wounded awaiting further transport, lying on their stretchers with their muddy boots protruding from under heavy blankets. In one row were seventeen head cases---men in every possible stage of intracranial injury, many of them needing the immediate attention of Percy Sargent or someone like him in a fully equipped hospital, and they'll reach Boulogne to-night, I trust.

Then we saw many of the severely "gassed" men who had come in this morning---a terrible business---one man, blue as a sailor's serge, simply pouring out with every cough a thick albuminous secretion, and too busy fighting for air to bother much about anything else---a most horrible form of death for a strong man. Others seemed to be pulling through, though they looked bad enough. We went on into the officers' building, where were a lot of little cubicles and real beds, simple iron cots though they were, and here, too, were some queer things. One officer, also a victim of the gas and happily recovering, must have ruptured something in his mediastinum, for he was blown up with a surgical emphysema of astounding degree---cheeks, neck, thorax, abdomen, and thighs. It felt as though there were a layer of air between skin and chest wall about two inches thick. We saw, too, with John McNee, the young pathologist, some recent autopsy specimens which showed the extreme subpleural emphysema and the solidified lung which characterizes the terminal process. The fairly constant N.E. winds of late have greatly helped the Germans in this disgraceful business.



It's getting on toward three o'clock and, Bowlby taking Col. Atkins and me in his car while Sir George and Mr. Bacon follow, we proceed through Locre with windmills and hop fields on all sides. Dodging lorries and ambulances, and with the sound of continuous gunfire constantly drawing nearer, we finally reach No. 8 Field Ambulance at la Clytte, where I 'm surprised to find Henry Bazett the physiologist in charge. Almost as we dismount, an aeroplane circles up from this side of the line, and as it rises---we judge to about 5000 feet---it sails out to the eastward in the direction of the Ypres salient, and we hear the guns and see the white puffs of German shrapnel, all of the shells appearing to explode behind and below. And then another machine---a Taube---ascends from far beyond, and it looks like an engagement; but the Britisher appears satisfied with his reconnaissance and sails away to the north to disappear from sight.

The abandoned house serving as an Ambulance is about three miles from Ypres at the foot of a low hill near Mt. Kemmel. There were a number of desperately ill men, mostly with abdominal and cranial wounds, too ill to be evacuated; and we were shown some adjoining sheds where were other equally bad cases; but we do not care to examine them in any detail---it's too harrowing.

And so we finally leave friend Bazett to his forlorn job and take our way to the bottom of the hill, where we are to get a glimpse of Ypres and its surroundings, whence all the sounds of firing emanate. Up a short winding road, past a line of newly made English trenches, and then out on to a little cleared space. It would have been interesting enough as a simple, lovely, pastoral view across Belgian countryside; but here we were watching a distant struggle for a city---one of the most desperate as yet in this world's war. Col. Atkins says that from this same point on Scherpenberg Hill, King George, when here, watched the bombardment of Ypres---happening to have a cloudless day.

To-day is somewhat misty, but this may possibly after all add a little to the spectacle. On the horizon line, we can clearly see the cathedral clock tower and what remains of the Cloth Hall, and farther to the right the elevation of Hill 60, which has figured so much in the communiqués of late---and which this very afternoon is said to be again falling into German hands. The lines, have been drawing in on the Ypres salient since the 22nd, when this desperate battle began, and the Germans are only about a mile and a half away instead of three miles as before, despite the heroic counter-attacks of the Canadians.

Then we go up a little higher for a still better view, wondering whether we are to be permitted, as this is an important observation hill. But there are no sentries, and we see nothing of any observers except for a single engineer who is heliographing to some distant point. On the very top are a little stone farmhouse and an old mill and some women squabbling over a flock of geese. From the foot of the windmill a wonderful panorama is unfolded, and the cannonading continues, and one can see the line of battle by the smoke on the horizon encircling Ypres and running up on Hill 60. A most impressive sight. There was heavy firing from some big guns somewhere just to the right of us---Canadians, they said---and finally two aeroplanes appeared again and got fired at, and the tension was only relieved for me when, after about an hour, Sir George slowly straightened up and strolled over to the edge of the little clearing, and, picking a violet, put it in his buttonhole.

The Environs of Ypres. Shaded Area Showing the
Ground Lost during the "Second Ypres" and
the Pivot at Hill 60

We finally wandered down another path through a wood to the road where our motors were awaiting us. And so we started back via Locre and Bailleul, through the crowds of soldiers and their officers dressed so much alike that the latter wear a patch of some bright cloth sewed high up on the back of their tunics so the men can identify them in attacks---for officers still lead and soldiers after all merely follow---past lorries and ambulances and A.S.C. horses and men, and an aerodrome from which a biplane starts out drumming and throbbing just over our heads.

And so through Bailleul and back to St. Omer, where we were to meet Herringham in Bowlby's billet for tea. Again, there was rather indignant talk about German atrocities---the treatment of Belgium---of Belgian women---the holding of hostages and shooting them for feigned or actual sniping---the shielding of advancing troops behind civilian men and women---the submarine activity---asphyxiating gas---the bombardment of churches under pretense of their use for observation posts---treachery under a flag of truce, under which circumstances Bowlby's friend of the Black Watch was killed---the shooting of officers by captives after they had surrendered---all told, a serious arraignment.

Meanwhile, just across the way, sentries were pacing up and down in front of General French's quarters, and Col. Atkins proposed taking me over to meet him---good heavens! Refusing an invitation to dine at Gen. Sloggett's mess, Sir George and I start back in the hope of getting in by dark; but at a little place called Wizernes his driver, disregarding a sign pointing south which says "To Boulogne," continues on for several miles until an obdurate French sentry holds us up---"Nothing allowed to proceed west over this road to-night." A movement of troops, we presume, and we must retrace our steps. It begins to grow dark, and the orderly finds he can't light his acetylene lamps; so we have to feel our way in the dim reflected light of the road slowly to Clety and thence westward along an interminable and lonesome detour to Desvres and finally to Boulogne, long after nightfall.

After a pick-up supper, learning that Sargent was winding up a busy operative day at No. 13, Holmes guides me down there---literally so, for it is black as tar and he has to count the steps as we descend the twisting path down the hillside. And we are in time to see his final case, a bad shell wound of the right parietal region with a big piece of obus and countless fragments of bone, and a definite though well-localized infection. It was a very careful neat, and expeditious performance. And so back again through the pitch-black town we grope our way up to our lodgings; and this was plenty enough for the day, and making these heavy-eyed notes before turning in has been an effort.

Later; under the date of Wednesday, May 5, 10.40 p.m., Sir John French's laconic report states: "The general situation remains unchanged. Fighting is in progress on Hill 60 southeast of Ypres on which the Germans attained a footing this morning, under cover of poisonous gases which were extensively used and favored by weather conditions."



Thursday, May 6

The Boulogne-Folkestone packet was much less crowded than usual with furloughed officers, owing doubtless to the present activity at the Front; still there was a goodly number, and also many Red Cross nurses, some Tommies, and several aviators. Any idea that Boothby and I may have entertained concerning the hazards of this crossing was soon dispelled. At the end of the jetty there were mounted two rapid-fire six-inch guns; but the French guards basking in the sun were far more interested in fish than submarines, and every one of them had a line out.

It was warm; there was a sunny haze; the Channel was almost unruffled, with not a living thing anywhere except some wild ducks, at which the officers pulled out their field glasses as they would not have bothered to do for a man-of-war. Convoyed? Dear me! There was not a vessel of any kind in sight until we neared Folkestone, where in addition to a destroyer there was a peculiar-looking lot of mammoth floats for about a half mile, said to be a submarine net. Rumor has it that most of the German submarines have been trapped. Doubtless there is a mine field too, for we took a devious course into the Folkestone harbor, running down the coast a little distance and then backing in.

We landed about 12.30, passing the officials without difficulty, though every paper was scrutinized and there was particular inquiry as to whether anyone was bringing in uncensored letters, which I trust did not include this journal. The Tommies, of course, were fed as usual at the station in a Red Cross booth, and I procured a tea basket and some papers and subsequently slept most of the way to London, where we arrived at three. Then to the Metropole, where we get into civies just in time for me to catch the 4.45 from Paddington, where I became so engrossed with a new issue of Land and Water I failed to see Sir William with the Merrimans and did not know they were on the train until we met on the platform at Oxford.

A warm greeting at 13 Norham Gardens, where Lady Osler's sister is staying, and a quiet family dinner, after which delightful glimpses of Sir William's wonderful collection of books and manuscripts, for which he is planning to have a new sort of catalogue made. Also talk of Revere's growing interest in bibliography and the recent hoax which he, with his friend Bobby Emmons as an accomplice, played on his father---the fictitious sale of a valuable library in the hands of a hermit book collector in Norwich.

W.O. finally turns in, only to be aroused by news that Poynton's son has been killed---news which he must transmit to the family. And then Lady O. and her sister and I sit up long, talking the sort of gossip of the war to which W.O. never will listen, for he says he hears all he can bear during the day, being perforce in London most of the time. Also talk of the Belgians and their enormous families quartered in Oxford---Lady Osler's original scheme which has brought with it so many difficulties. So different, France and England! In Paris, everyone who has the remotest excuse wears black; in London, a ban has been put on the exhibition of any evidences of mourning.

Friday, May 7

London seems to all outward appearances no different from the London of ordinary times. People are leisurely and there are quantities of them in the streets. The men have time to shave and read the papers, the last page of which is full of racing and football, and they arrive at their places of business about 9.30 or 10 a.m. Disappointed is he who tries to get into a shop before that hour, as I have had occasion to learn. Then, too, there is abundant time for tea in the afternoon. All this shows itself down the line, even to Tommy Atkins, who is clean-shaven (by regulation, I doubt not), whereas piou-piou---or, as he is now commonly called, poilu ("shaggy" or "hairy") ---either doesn't have time or just doesn't. Paris is empty and serious; London by ten wakes up to its customary crowded roar and is outwardly carefree

Around the Nelson Monument are huge signs which conceal the lions and call upon Englishmen to do their duty, while windows and signboards and buildings are plastered with posters which imply, "Come in, boys, the water's fine"---and if you don't, what will your children say---and similar themes. Meanwhile, the cockney stands with his pipe in his mouth, hands in his pockets, cap on one side, and looks on, listening to the recruiting band while the educated pick of the country, like young Poynton, are enlisting. Many windows display service uniforms "to be fitted in 24 hours," and the cinema signs read "Men in uniform admitted free." These of course are straws to indicate an overseas war. Still, one might be here without being especially struck with them. In spite of all Kitchener's appeals for volunteers there is scarcely a smattering of khaki to be seen in the streets---so different from uniformed Paris.

Sir George Makins with Holmes, Wallace, and Sargent in Boulogne, 1915

Watching the Battle for "Hill 60" from the Scherpenherg Windmill

The Nelson Monument, Trafalgar Square, 1915

To the American Line office for my tickets on the St. Paul tentatively reserved in Paris, followed by a series of calls and errands. Then lunch at the Automobile Club with Sir William and Walter Morley Fletcher, the physiologist. He is secretary of the National Research Committee and has been appointed, in conjunction with Osler and Adami, to make preparations for a Medical History of the War. A colossal undertaking it will be, unless records can be more carefully kept than seems possible under present circumstances in France. This they hope to rectify.

Fletcher has been looking into the psychopathic ("shell shock") cases, of which there must be many-as I gathered from Pierre Janet to be true also in France---men who have broken down nervously under the terrific strain of trench warfare and the frightful bombardments. One story he told of an officer who, following the near-by explosion of a shell which did not injure him, has now a completely changed personality. He is at a hospital somewhere in Wiltshire, I believe, and has had to be reëducated to read and write and speak; he now uses a Wiltshire dialect whereas he came from an educated class in another part of England. He has absolutely no recollection of a previous existence, but when put in an hypnotic state he is his former self in every respect and perfectly clear on all events up to the moment of the explosion of the shell.

At 3 p.m. an appointment with Sir Alfred Keogh at the War Office, where a pink pass must be filled out to explain my business. An interesting and rather prolonged visit, with much about the American university project; and he has to-day received an acceptance from Rush for July 1st, I believe, with 33 surgeons and 75 nurses. Then about my views of the Service de Santé and how it compares with the R.A.M.C. I feebly criticized the flimsy tags such as I had seen Bazett hooking on to men's buttons; whereupon he produces this new one with an envelope, which does not seem so very practical either. He points out on the huge map hanging on the wall where all the hospitals---military and Red Cross, both at home and overseas---are located.

The map is thickly flagged with different colors for each type of hospital, and there are evident preparations for an amazing number of wounded---certainly a good thing. I hint on departing that I should like to have one or two samples of their recruiting posters and had asked in vain for them at the recruiting station in Cockspur Street. Of course; but I must ask Major General Lorn Campbell, the director of recruiting, which I subsequently do; and he suggests that I see a Mr. Davies of 12 Downing Street; and he in turn is very pleasant and telephones to the office at 42 Parliament Street, where not only am I presented with a complete new set, but they insist on mailing them home for me.

After some hurried shopping, I go at five to Brown's to see Mrs. Emmons, who has come up for an appointment made at Lady Osler's request. On my return, while making some purchases in the Burlington Arcade, an agitated bobby pokes his head in the door and loudly announces: "They've got the Lusitania!"

There can be no doubt about it, for by the time I get back to Trafalgar Square sandwich men appear bearing the news---nothing more than the bare fact, however, and there is a huge crowd gathered before the Cunard office with policemen holding them back. "Wot'll they do next?" says my taxi man. "When will England wake up?" say I. This may arouse them---and us!

A few hours later I stop again at the Cunard office. On the street there is the same gathering craning to read the bulletin boards, which give no additional news other than that some of the survivors are being taken to Queenstown and that lists will be published later. The office evidently will remain open all night; within is another crowd, with haggard, anxious, and tear-stained faces---waiting.

Saturday, May 8

There is little to be learned from the morning papers except the simple announcement-the Lustania has been sunk. Boothby and I take the train from Euston at 10.30 and share a compartment with a lady who is traveling with a parrot in a huge cage; the bird tries vainly to sleep and can't. About three we pull into Liverpool and are packed, bird cage and all, into a bus and have a long rattly ride to some remote wharf far up the Mersey where lies the St. Paul, and there we find many people in trouble.

We and the parrot were almost at the end of the long line of prospective passengers, all of whom, one by one, were obliged to produce passports properly viséd before they could go aboard.

None of the usual business of baskets of fruit and flowers and friends skylarking aboard, I can tell you. It was a serious matter. People enraged and trying to "put it over" the consular officer until gently removed by a burly bobby who stood alongside ---people in tears---or people simply stunned. One hysterical woman, whose papers were faulty, broke through and ran up the gangplank to the deck, where she was held by a couple of sailors until the policeman went aboard and started to pick her up bodily---they've had practice in England of late. At this point she became good, but we left her an hour later on the dock still protesting or wailing or fuming as the mood struck her.

Doubtless the Lusitania was a little on everyone's nerves. And doubtless, too, there had been a great many shifts of plans in the past twelve hours, both to go and not to go---and the "to go's" have had scant time to get their papers in order.

Well, we finally left some fifty despairing people on the dock and pulled out into the stream. We were locked down the Mersey and there, at the last stage, pulled up alongside of the mammoth Mauretania, in gray and black as though in mourning for her sister whose dangerous place she now must take. Some hours late, we are at last moving out into the Irish Sea between long rows of floating red and white flash buoys which mew at us disconsolately.

We sat at dinner with the Gifford Pinchots, who have just been turned out of Belgium by the Germans. They and others are wearing inflatable waistcoats such as are being distributed in the navy, I'm told. There was much indignant and wildly belligerent talk in the smoking room afterward on the part of certain fire-eaters, of whom we seem to have a goodly sprinkling.

Sunday, May 9, 11 a.m.

The St. Paul, once a cruiser herself in the Spanish War, has been hitting it up very fast, so that we are off the Old Head Kinsale an hour earlier than the passengers expected. It is a bright sunny day with just a little sea, and we have passed a destroyer or two, but nothing else.

Most of the passengers were at morning service and I was writing here when Boothby looked in and said I had better come on the forward deck. This I did, but rather wish I had not. We were going through the Lusitania wreckage---had been, indeed, for the past half hour. Steamer chairs, oars, boxes, overturned boats---and bodies. As I came out we passed quite near a collapsible boat which was bottom side up, with the body of a woman and a child floating alongside; they must have been tied to it in some way, else with the easterly wind the boat would have drifted, from them.

All told, I believe some fifteen bodies were counted, and this was only in our immediate lane; the wreckage must have been strewn for some twenty miles or more---we at least were passing through it for considerably over an hour. Once we veered off to get a nearer view of the only boat which was seen to be right side up; but the officers, all of whom were on the bridge scrutinizing everything with their glasses, appeared satisfied and we went back on our course.

That was about all. No, there was something else: a single little trawler a long way off on our port quarter, evidently patrolling for corpses---at a guinea each---on this sunny Sabbath morning.

Chapter Three
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