Why Our Soldiers are Fittest in the World
The Marvel of Britain's Field Medical Services described
No one who has studied the present war can fail to be struck by the relatively low fatal casualty rate in the British and United States land forces. This is not due solely to the kind of war that is now fought, which offers the protection of armour to a large percentage of the fighting troops. Indeed, the armour has brought in its train the inevitable counter-weapons of long-barrelled high muzzle-velocity guns that can smash through the armour, and flamethrower tanks with both long-range and short-range flame projectors, and landmines.
And the fact that fatal casualties at sea have risen while their incidence on land has decreased is in itself significant. The reason is to be found in the modern organization for the collection and care of the wounded, which has made a remarkable reduction in the number of men who succumb to wounds.
The first thing I noticed in the battlefields to the east of Nijmegen was their extreme cleanliness. The recollection of the nausea occasioned by the smell of putrefying flesh, that was so common an experience of those who visited the front areas in the First Great War, was not revived by a visit to the fighting area on the Dutch-German frontier. Mud there was in abundance. The dirt roads were mud canals along which vehicles ploughed their way axle-deep, relying often on their four-wheel drive to pull them through. The men's clothes and faces were mud-bespattered, but when it dried it made an excellent natural camouflage.
But, though there was mud, and water, there was an absence of odour of death. In this modern mobile warfare, conducted in a series of wave-like advances, the Red Cross can conduct its work far more swiftly than it could in the stagnation of the trench warfare of the First Great War. Today, Red Cross trucks can often drive right up to the wounded. I saw Medical Officers driving up through Krannenburg in armoured Red Cross trucks. Each battalion has its own mobile medical section. No longer do the wounded have to lie in the pitiless sun as they did in the soldiering days of which Kipling wrote, or in the merciless rain of the last Flanders war.
Surgical Centres in Forward Areas
They are picked up quickly, given first aid, and sometimes a blood transfusion, loaded into stretcher-carrying trucks (when they are lying cases) and taken swiftly back to the Casualty Clearing Station. I saw light little Recce (reconnaissance) cars moving back fast with a couple of canvas-covered stretchers cots mounted on the roof and projecting over the body both in front and rear, passing though a procession of transport that pressed forward to the fighting front – tanks with 6-pounder and 17-pounder guns, supply trucks, self-propelled 25-pounder guns, half-track White scout cars, close-support and distant flame-thrower tanks, mine-clearing flail tanks, M.10 U.S. mobile guns, 25-pounder mobile guns, Ducks.
Mobility has made it possible to take the surgeon to the wounded, by the establishment of advanced surgical centres in the forward areas. Their curative work is aided by penicillin and sulphonamide drugs for the control of infection; and by the blood transfusion service which enables a wounded man to be brought up to strength required to stand an operation. Even after an enormous loss of blood a wounded man can be restored to life by the promptness and adequacy of a transfusion. In the First Great War such cases would probably have been fatal.
The Army Blood Transfusion Service has a base headquarters, advanced blood-bank, and the field transfusion units which work with the forward surgical centres. Blood is supplied in three forms – stored blood which, with refrigeration, can be kept for about a month; fluid plasma and dried plasma (plasma being the colourless coagulable part of blood wherein the corpuscles float). Plasma, especially dried plasma, remains constant without need for refrigeration; dried plasma only has to be dissolved in saline or water to make it ready for use. Plasma requires no grouping test for compatibility, as does blood, and it can therefore be administered to anyone without troubling about his blood group.
But, in cases of heavy blood loss, a proportion of blood must be given in addition to plasma, to reintroduce the necessary oxygen-carrying power of blood, and in this case blood compatibility tests must be made. Blood supplies are sent by air from the United Kingdom. When necessary they can be dropped by parachute, with the blood supply packed in airborne round wicker baskets fitted with shock-absorbing inserts. In the war zone one can see the Red Cross refrigerator wagons, marked Blood Bank, on the move distributing their supplies, which are carried in bottles about the size of beer bottles.
Interlinked with these modern services for the care of the wounded are Mobile Field Hospitals and the Air Evacuation Units. I visited a Mobile Field Hospital situated in a French town. This M.F.H. is a R.A.F. establishment under the command of Squadron Leader G. Gray. Sister Long, with rank equivalent to Flight Lieutenant, is the senior sister of the P.M.R.A.F.N.S. nursing side. This mobile hospital handles both R.A.F. and Army casualties, and can move at 24 hours' notice, carrying its own supplies, tented accommodation and stores. It has its own transport section with 14 Bedford trucks, six ambulances, tow car vans, two water bowsers, two 15-cwt. utility vans and one jeep. It has its own sanitary squad. Its normal field establishment is for 100 cases, but it is capable of carrying 150, and in the town where it was when I saw it, it could expand to take 400.
The wards were bright. Each had a solarium at one end. The patients looked as happy as any I have seen. They were obviously well-cared for. Some were reading, some smoking. They looked up with a smile as we passed. In one ward a radio receiver was playing softly. We met one patient who had come out of a ward and was shuffling along a corridor, slowly. “Where are you going?” asked the C.O. The patient smiled but did not seem to know. “You'd better get back to bed”, said the C.O. Still smiling, the patient turned and shuffled back. The C.O. told me, “He's just had a shot of penicillin. It often affects them like that.”
From R.A.F. Wings and three Army hospitals – one Canadian, one British, and one Scottish – cases for evacuation come to the hospital. (During the severe winter weather the hospital dealt with 250 men of the Pioneer Corps who were sick.) The day's patients arrive at about 11 to 11.30 a.m. The normal roll is examined and the serious cases are seen first, then the stretcher cases, and finally the walking cases.
The transport aircraft land at an aerodrome nearby, and by 11.55 a.m. aerodrome control can say how many planes are there and if flying will or cannot take place. Stretcher cases may remain in the ambulances unless there is not flying, when they can be taken in. The longest time of hold-up was six days during which bad weather prevented flying. The dangerous abdominal wound cases receive special attention, and are kept for 10 days before flying. Pilots avoid bumpy air, but generally fly low – 1,000 to 2,000 feet – so that patients will not suffer from any marked change in atmospheric pressure. All aircrew members of the R.A.F. automatically go back to the United Kingdom when they are involved in an accident that results in injury. Erks go back if likely to be off duty for over three months.
I heard great praise of Archibald McIndoe, civilian consultant in plastic surgery to the R.A.F., for his work on facial maxillary (jawbone) injuries; and of Reginald Watson-Jones, civilian consultant in orthopedic surgery to the R.A.F. There is no doubt that the British medical service is far ahead of the German. British airfields have their own disinfectors. Army and R.A.F. have mobile laundries. But when we overran France and Belgium about 50 per cent of the Jerry mattresses were found lousy. At Tournai about 2,000 German patients were under the care of two doctors, and many were in a terrible state, some even maggoty. German amputations are done by guillotine driving straight through the limb, with no flaps. With abdominals they shoot in serum (the non-coagulable liquid constituent of blood) and leave things at that, without worrying.
I talked with Flight-Lieut. D. H. Drummond (form Bethlehem, Orange Free State) in his mobile dental surgery, in which he spent half the week in one town and the other half in other town, taking the surgery half-way to the patients. The dental laboratory at the M.F.H. makes about 20 to 30 false teeth sets a week. In the mobile surgery Flight-Lieut. Drummond deals with about 300 to 400 dental patients a month. He is responsible for about 1,700 men, serving both the R.A.F. and the Army.
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