Surgery Under Fire
The battle of Canada's valiant medical corps to save life and limb
L. S. B. SHAPIRO
Maclean’s War Correspondent
WESTERN FRONT (By Cable)—One day, while driving just behind the front, I visited a Canadian general hospital, a tented community sprawled over several fields beside a road which had come to be known as “Harley Street.” I enquired at the orderly room for the medical officer commanding and was informed he was busy at the moment in the resuscitation ward. I then asked for the lieutenant-colonel in charge of medicine; he, too, was occupied in the resuscitation ward. Well, wasthechief surgeon available, I asked. The orderly sergeant shook his head. The chief surgeon was also in the resuscitation ward.
My journalistic curiosity was thoroughly aroused and I strode across a dust-dry field to see what might be happening in the resuscitation ward to command the undivided attention of the hospital’s most skilful talent. In the dim light struggling through flaps of the big tent I could see about 20 stretcher cases being prepared for surgery. Bottles of blood plasma hung lavishly from pulleys. Nurses moved among the men, wiping the sweat from the stubbly faces of the wounded and injecting morphia into the arms of the most restive.
Huddled over one stretcher case was the officer commanding, the chief medical and surgery officers, another doctor and a nursing sister. I edged toward this bedside consultation to catch a glimpse of so distinguished a patient.
The wounded man was a German private. His left arm had been almost shot away at the shoulder and the consultation was being held to devise the best ways and means of saving the man’s life.
Here was a prime example of the curious irony of war. Perhaps an hour before, the whole of Canada’s wealth, energy and scientific knowledge had been concentrated upon the destruction of this German; and now a part of that wealth, energy and scientific knowledge was frantically concerned with trying to preserve the same German. It is only a short drive from the front line to the most forward hospital and the drive encompasses a strange commentary on human behavior. War is a field day for the sciences— the science of destruction plays in counterpoint to the science of preservation.
But if wars have to be, it is reassuring to know that the science of preservation is making strides at least as great as its rival. Of 10 men who died of wounds in the last war seven would have been saved by methods developed in the intervening years. To the front-line hospital of today there is infrequently such a thing as a hopelessly wounded man. If he retains the spark of life when he is brought in, the chances are that modern medical science will not only save his life but also return him to his home a useful human being.
Advances made in the chemistry of antiseptics and the technique of surgery are not wholly responsible for the new standards of lifesaving in war. An alert and courageous system of fully equipped yet highly mobile surgical units following close behind the assault troops has resulted in an immense saving of time between the battlefield and the operating table. In surgery timesaving is akin to lifesaving.
A classic example of how speed and skill combined to save a Canadian soldier’s life came in Normandy when a private from a Western regiment suffered a normally fatal wound in the battle for Caen. A thin piece of shrapnel, three quarters of an inch in length, had penetrated his heart. Within two hours he was on an operating table in a tent within our gun lines, and Major John Hillsman, Winnipeg, was cutting an opening, six inches by four, in his chest. While the
tent quivered under the blast of our heavy guns, Major Hillsmanclosedthe wound in the soldier's heart with three silk stitches. Now fully recovered, the man will carry a bit of shrapnel in his heart the rest of his life. Only a fully equipped surgical unit manned by expert technicians and located close to the battle area could have saved this life.
Canada—long noted for the excellence of her medical schools and the talent of her doctors—has endowed her fighting Army with a hospital system second to none in a world at war. The Royal Canadian Army Medical Corps is composed of men and women who combine technical ability of an exacting standard with the courage of front-line troops. They not only solve problems which would tax the ingenuity of a hospital staff in any quiet city in Canada but they work their miracles often in primitive conditions and frequently in momentary danger of losing their own lives. When you read of the Canadians launching an attack in Germany you may take it for granted that RCAMC officers and other ranks are braving enemy smallarms fire with the forward troops and that a hospital unit of varying size is close behind, well within deadly mortar range from German batteries.
When the Canadian Third Division stormed ashore between Bernieres and Courseulles on June 6 three field ambulance units, completely equipped to perform major operations, arrived with the troops and were functioning before the beaches were cleared of the enemy.
One of the toughest ordeals of the campaign was sustained by the Sixth Parachute Division, which held the left flank of our beachhead across the Orne River. For a full month the men of this Division clung to their position under almost constant mortar shell and machine gun fire from an enemy entrenched 300 yards away. It was vital to Montgomery’s battle plan that this position be held. Communication with this Division was precarious because the Germans could fire on our pontoon bridges over open sights. A Canadian parachute battalion was with the Sixth Division. As did the whole Division, the Canadians lived in slit trenches during the whole of this terrifying month. And with them were the medical officers of a field surgical unit, their sensitive scalpels and fingers saving lives within easy range of German rifles.
THE RCAMC is so intricately organized and so highly mobile that it functions equally effectively when the front is static and when the line surges forward at the rate of 20 miles a day, as it did when the breakout and pursuit developed out of Falaise. In order to understand how the system works let us examine the succession of medical units from the stretcherbearer, who goes in with the forward platoon, to the huge general hospital which operates in the rear areas with a capacity of from 600 to 1,200 beds. All units have varying degrees of mobility, from the legs of the stretcher-bearer to the great motor truck convoys which move a general hospital overnight.
The stretcher-bearer, who slithers forward with the platoon, reaches a wounded man within a few moments of the shellburst. He applies first aid— usually morphia and a spray of sulphapowder—and carries the man to a jeep especially equipped to accommodate four stretcher cases. The first stop for the patient is the regimental aid post where the unit’s regular medical officer goes a step farther in applying emergency treatment. Thence the patient is transported by jeep or ambulance to a field dressing station which usually includes a surgical unit for critical operations.
If patient’s condition allows further
movement he is driven a mile or two to the rear to a field ambulance unit, which is a slightly more ambitious establishment than a field dressing station. He may be given further treatment here, depending on his condition, or be moved directly to a casualty clearing station, a miniature version of a general hospital where every type of treatment is available. But the system is geared for fastest possible evacuation of patients able to be moved, in order that accommodation in forward units may be held open for new cases streaming from the battlefield. The final step is the general hospital, where a patient may remain indefinitely if necessary.
As a rule the regimental aid post is on the edge of
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Surgery Under Fire
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the actual battlefield; the field dressing station and the field ambulance unit about two miles back; the casualty clearing station is between five and eight miles from the battle area—just beyond normal effective shell range— and the general hospital anywhere from 15 to 40 miles to the rear.
Attached to no permanent unit but moving freely to where they are most needed are field surgical units. These mobile teams often function at regimental aid posts when a very heavy battle is raging, or they may bolster the surgical staff at a casualty clearing station when it is particularly crowded.
Quick Treatment Sure
The system is elastic enough to ensure that every soldier wounded in battle in the area of the First Canadian Army will not lack for immediate and expert medical treatment within the shortest possible time. When British, American and Canadian forces are fighting dose together there is complete interchange of medical services. The wounded, no matter of what nationality, are brought to the nearest medical unit for treatment. The urge for healing knows no national lines; it ignores even no man’s land.
On friend and enemy alike the frontline surgeons perform operations with endurance and ingenuity no less than technical skill. During a recent battle I watched a Canadian surgeon work in a tent pitched on a muddy field. An hour before the place was as wild as a swamp in northern Quebec; now the location was endowed with electricity, from a portable power plant, pure water, sterilized linen and all the paraphernalia necessary for major operations. The surgeon worked for 10 hours—from nine at night until seven in the morning—and averaged better than one operation per hour. His only respite was a smoke outside the tent while his assistant was applying anaesthetic.
As dawn was breaking the last patient was wheeled away and the surgeon removed his rubber apron. He was too exhausted to go immediately to his quarters. He sat on a ration box outside the tent and smoked and watched the dawn come up. Then an orderly appeared. “I wonder, sir,” said the orderly, “if you could look at one more patient. The R.A.P. is puzzled about the case.”
The surgeon nodded wearily. A few moments later the new patient was wheeled in. He looked in good shape; his eyes were bright and he was smiling.
“Nothing much wrong with me, doc,” he said, “just picked up a bit of shrapnel.”
For 15 minutes the surgeon examined the soldier. There was a small wound on the man’s right side, between his hips and his ribs, where a single flake of shrapnel had penetrated cleanly.
“Well, mister,” said the surgeon, “I’m going to put you to sleep for a while just to find out where that shrapnel has gone.”
While an anaesthetic was being administered, the surgeon smoked outside the tent.
“The man looks pretty good,” I said. “Why operate on him here when you’re so tired? Why not send him back to a
The surgeon shook his head.
“It’s a trick case,” he replied, “and I can’t take any chances with the boy’s life. If the shrapnel has penetrated his intestines he may be in a bad way at any moment. On the other hand I may find after I open him up that his intestines are intact. In that case I’ll
just sew him up and he’ll be no worse off, except for a scar on his stomach. But I’ll have to operate to find out for sure. He deserves every care we can give him. After all, he and a lot like him are the best we have in Canada.”
He smiled wearily, tossed away his cigarette and returned to the operating tent.
New Methods Found
It is this urge for healing, this frantic anxiety of medical officers to thwart the free run of tragedy on the battlefield, that has kept them at work devising new techniques. In the strange laboratory of a front-line operating tent they have continued their research and have presented medical science with new developments of permanent value.
Major William Mustard, Toronto, a casualty clearing station surgeon, has provided partial alleviation of the greatest fear that comes to a wounded man that he may lose an arm or leg. After long research Major Mustard has achieved notable success with a method called venous transplants, which was developed under easy gun range of the enemy. Major Mustard’s problem was this: when the main artery of a leg or arm was severed on the battlefield blood circulation ceased in that part of the leg or arm below the severed artery and it was almost always necessary to amputate in order to save the patient’s life.
Major Mustard developed a method of re-establishing circulation by a system of glass tubes to connect the severed artery and by the use of a solution called heparin which prevents blood clotting. Prompt use of venous transplants has already saved hundreds of men from a cripple’s fate. Major Mustard’s method has not yet been perfected; it does not work in every
case, but his work is being studied by research laboratories all over the world. Thanks to Major Mustard, amputation will someday be a rare occurrence.
Major Lawrence Rabson, Winnipeg, another CCS surgeon, has done distinguished research work toward saving the lives of men suffering from multiple wounds. Major Rabson’s method is known as interval surgery and it has resulted in a sharp drop in the number of soldiers who die on the operating table. Major Rabson observed that seriously wounded men can withstand only a limited amount of anaesthetic and operation trauma before the breath of life begins to falter. In the precious little leisure time left to a front - line doctor he developed a schedule of “staggering” the stages of surgery necessary to treat the patient’s wounds, thus giving the soldier’s natural urge for self-preservation an opportunity to rally. Major Rabson’s research has aroused interest among doctors everywhere.
Thus Canada’s front-line surgeons, oblivious of danger and discomfort, carry on in the spirit of the oath they took as graduate students. Some have been killed in action, many have been decorated for bravery. All of them have conducted themselves with courage and unselfish industry in the noble and exacting task for which they voluntarily gave up the comfort and profit of their Canadian practice. For those of us who must see humanity squirm and twist through the shadow of Armageddon toward the ideal of a better world it is comforting to watch the healers at work. They provide a glittering demonstration that all is not insanity, that the instinct of mankind for compassion and nobility runs strong within us and may yet become a flood tide.