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rfHE FRENCH MEDICAL 8ERVICE DURING THE WAR, 1914-18.

(Continl/ed /1'01/' 1'. 4tJ)

IN a previous editorial wehave dealt with the first and second volumes of M. Mignon's book. The third volume is devoted to the functioning of the medical services during the defensive and offensive battles of tbe armies of the North and North-east, from July, 1916, to November, 1918 This period of the war can be divided into three phases. In the first phase the object of the French offensive was to break the German front, this was the tactical objective of the battles of theSomme in Jnly, 1916, and of the Aisne in April, 1917. The two offensives of Flanders and of Malmaisol1 belong equally to this phase. The second phase commenced on March 2], 1918, with the German offensive; and it continued with short remissions until the middle of July, 1918; this has been called the defensive campaign of the Allies. The third phase began on July 18, 1918, when the allied armies in their ·turn began the offensive. Between the Somme and the Oi8e, between the Aisne and the Marne, Rheims and the Argonne, the French attacks took place under the direction of ).Vlarshal Focb and terminated with the capitulation of the enemy under cover of a demand for an armistice.

Up to the battle of the Samme, each army devised its OWll plan for the organization of the medical service, but after that General Headquarters (G.Q.G.) sent to the commanders of armies and groups of armies, directions which had to be carried out strictly. .

The organization of the medical service dnring the battle of the Sommewas devised on a plan in which it was the duty of the divisional and corps ambulances to put the wounded in a fit state to be evacuated. 'Vith this idea the ambulances were grouped between the front and the clearing hospitals. Groups of three, four or five ambulances were, so to speak, the antennae of the clearing hospitals, and on them was imposed the duty of operating on the slightly wounded, retaining the dying, and sending the severely wounded to the mobile surgical centres. The clearing hospitals were reserved for the treatment of severe wounds of the head, chest, abdomen and limbs. 'l.'he directors of the medical services of the corps took great pains in finding suitable sites for the grouped ambulances, but the programme was not carried out fully, and. the ambulances were not relieved of the wounded sufficiently quickly. The order which imposed 011

divisions and corp~ of the army, the duty of operating on their wounded before evacuating them did not give good results on the Somme, as there were not sufficient surgeons to do the work. One of the most important

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The, French Medical Serv'ice cl'wrin{) the War, '1914-1918 207

points arising out of the offensive was the attention that the staff gave to the organization and functioning of the medical services. The idea of constructing large clearing hospitals was evolved by the General Staff, they were very proud of the hospital cities which they had created; it was the General 8taff also who insisted on the grouping of the divisional ambulances and those of the corps of the army, and allotted to them the duty of attending to the slightly wounded, since they were convinced that this category could be dealt with at the front. It was also the Staff who pushed the group of ambulances almost under shell fire, in their anxiety to preserve effectives. The medical service had the same desire, but they did not think it could be attained in the way suggested by the StlLff; they thought that encumbering the front with a crowd of slightly wounded men was not the best way of. getting them back to their original units quickly.

Discussing the organization of the medical service during the offensive of the Aisne, 1\'1. Mignon says that. an order of .Tanuary 5, 1917, was given to establish divisional and corps amoulances as near as possible to the troops, so as to render aid to the wounded as rapidly as possible. They were the same measures as had been ordered during the attacks on the 80mme. The order of G.Q.G. of January 5 determined the capacity of the groups of ambulances; there were two or three ambulances in each group, with one or two BessoIlneau hangars for the classification (triage) of cases, and about ten Bessonneau tents, of which five or six were for hospital use, and two for general purposes. It was the duty of the medical service' of the army to decide on the positions, obtain the mlLterial,and deliver the complete units to the corps .of the army coming to take its place in the section. By an order from the G.Q.G. on December 14, 1916, the medical services were required to retain in the zone of the armies, the slightly wounded and slightly sick, as well as those inevacuable for a long distance, and to direct all other wounded Ol' sick into the interior.

The plan etf hospitalization and evacuation was the exclusive work of the Staff, and it was founded on three false ideas: (1) To .evacuate without delay the severely wounded to the clearing hospitals where the surgeons of the mobile surgical units would attend to them; (2) to retain the slightly wounded in the front; (3) to operate on the moderately wounded in the !{ronps of ambulances so that they might be in a fit state to enter the hospital trains on their arrival at the clearing station, without passing through the operation rooms. This system gave very mediocre results on the Somme and did not make any better figure on the Aisne; its great fault was the manner of treating the slightly wounded. According to the G.Q.G. the advanced medical posts ought to examine and classify the slightly wounded, retain the slight cases with 'them and send the others to the group of ambulances so that they could be put on motors and sent to the clearing hospitals. '1'he system failed as, on the average, slightly wounded formed at least forty per cent of the total, and endeavours to treat and classify them at the front upset the functioning of all medical



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formations from the extreme front right down to the clearing hospitals. According to M. Mign()D the proper measure to take would have been to turn away the current of slightly wouuded men from the route followed by the other wouuded, and to transport them at once beyond the clearing hospitals; this was done with the best results by the 1st Corps of the Colonial Army.

In 1918 when the medical service at G.Q.G. was directed by a surgeon of eminence, who waR also an experienced organizer. arrangements were made to convey. the slightly wounded direct to secondary clearing hospitals. -

The first offensive in Flanders was a comparatively small operation undertaken to drive the Germans away from the ports of Dunldrk, Calais and Boulogne. which they wished to use as bases for submarines. The front wa!l about eight kilometres in length, and the French forces engaged were only about an Army Corps of the First Army. The medical arrangements are given in some detail as they were considered to represent an ideal organization.

By a ministerial decree of May 11, 1917, medical officers had been attached to the General Staff in the same way as the personnel of other arms, so that the higher command could not make plans without the Director of Medical Services being aware of them, and it was llOW possible for him to discuss with the G.O.C. the plans suggested. At the same time a medical officer was attached to the regulating officer who directed the hospital trains; in this way a liaison was assllred between the regulating centres ana the evacuating centres.

In June, 1917, the General Staff comm~nced their preparations. The higher comIlland decided that there would be about 1,500 to 2,000 wounded on the first day, and the military objective would probably be reached at a single bound. Accordingly aid posts were prepared on the alignment Boesinghe-Reninghe, two kilometres to the east 01 the road from Ypres to Furnes, and three posts for the classification (triage) of wounded were established at Linde, Hoogbrrigge and Zuydhuis. There were hospit!ll centres at Crombeke, Zuydcoote and Rosendael; and in the rear there were hospitals at Bergues, Dunkirke and Bourbourg, and on the lines of communications at Amiens and Abheville. The D.M.S. also constructed a hospital for the severely wounded at Rousbrugge, and two clearing hospitals, one at Wayenburg for the severely wounded, and one at Haringhe for the slightly wounded.

The D.M.S. considered that the postes de triage constituted the essential ·units of the medical organization, and he took. particular care in their ,siting and in the choice of their personnel; he decided also that the .wounded should be grouped into categories and evacuated after the disinfection of their wounds to prepared surgical centres where their wounds could be sutured, or dressed if suture was not possible.

Of the postes de triage, that at Linde was the most important. A large



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The FJ'ench Medical Service during the Wm', 1914-UH8 209

Bessonneau hangar was' used for the classification of cases, and six Belgian huts and eight Bessonneau tents were employed for the reception of hospital cases. The hospital side of the formation had' ::300 beds: one block was reserved for abdomillal cases, head cases, or severe bone injuries; another for wounded under observation, and a third for tbe dying. 'l'be operating block was subdivided into centres for resuscitation, radiology, operation, sterilization and supply, Specially trained medical officers with the requisite apparatus were detailed to perform intravenous injections of normal saline,

EB L ~\'!iE cenrral h o'pi. To.\ o CI'~Ylng hospl.t6.l ~ Pos1'e de 't,.i zt.gt. + A~a post

or immediate transfusion of blood. Five ambulances and foCll' surgical groups (equipes) were concentrated at this poste de triage which was really a swall hospital organized to perform major operations.

'l'he :First Army had been warned tbat the Germans would probably nse gas on an extensive scale, and it was at the Battle· of Flanders that they used yperite (dichlor-ethyl sulphide) for .the first time .. The medical service of the First Army took the necessary precautions, and some 1,700 beds· were put aside for gas cases and arranged in three zones, the zone

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210 The F'rench M,edical Service during the War, 1914-1918

nearest the front for the most severe cases, and the zone furthest away for the Jigb teases.

One of the measures which contributed greatly to the rapid transpor~ o~ the wounded during the Flanders bo.ttle was the liaison betw~en the a.id posts and the classification centres (pastes de triage). Vehicles were authorized to advance to within 400 or 500, metres of, the aid posts according to the activity of the artillery, and in calnl periods the vehicles could even reach the aid posts. Very seriously wounded were sent at once froIll the aid posts direct to ROllsbrllgge or "\Vayenbllrg without passing through the classification posts. 'rhe wounded brought to these latter posts were sent to Linde or Rousbrugge if they appeared severe; slightly wounded grouped in the hangars of the classification posts were sent in motor wagons to the clearing hospital at Haringbe, which was reserved for them.

Professor Pierre Duval, Consulting Surgeon of the First Army, recommended that the wounds should be rapidly sutured so as to assure prompt recovery. M. Mignon says this procedure would have necessitated keepiug the wounded at the fron t for fourteen or fifteen days, so as to' allow their wounds to beal, and would have cansed a complete blocking of the units, The difficulty was got over by Professor Duval deciding that the slightly wounded should be disinfected at the front and then sent to the rear where surgeons warned in advanced of their arrival would suture them· immediately, or a(ter a delay of several days. General Anthoine, commanding the First Army, agreed to this course, and the wounded to be operated on and sutured were sent rapidly to Amiens. .

The second offensive in Flanders began on October g, 1917, and was repeated again on the 26th and 27th of the same month; Mt\decin Inspecteur Fm'raton adopted the same plan of hospitalization as in the former offensive. He insisted on the necessity of separating the slightly wounded from severely wounded as quicldy as possible and, as soon as the triage had been made, of conveying them to the clearing hospital reserved for them.

Discussing the medical services of the battles of Flanders, M. Mignon says that the ,medical urangements in Flanders were ideal and the good results obtained were due to the entente between the G.O.C. and the military representatives of tlle medical service.

The Offensive of Malmwison.-This was a limited operation with the object of occupying the plateau of Malmaison. The D.M.H. of the Sixth Army bad charge of tbe medical arrangements. .

Divisional' aid posts, whe+e it was hoped surgery could be carried out, were formed, Lnd ambulances of the corps were g.Nuped with the' object of classifying the wounded, retaining the inevacuable ·a~d operating on the slightly wounded. M. Mignon says .that as regards: the treatment of .the slightly wounded the grouping .of the; corps ambulances gave rise to considerable adverse critiGismi The thirty ,oper.ationunits ;placed in the four groupings had only l)een aH~ ~q operate qn about 8900,ut of the 5,000



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wounded; this was due to the encumuerment of the fo~mations close to the front line, with the slightly wounded. If the slightly wound~d had been directed to the rea.r, by the concentration of the thirty surgical units of the ambulances in fonr groups the severely wounded could ha.ve been operated OIl without undue baste and in perfect safety. At Malmaison it was shown that the sterilization of WOllnus could be deferred for an entire day after the injury without interfering with the possibility of suturing the wounds. Out of forty-nine wounded men who arrived on the lines of communications, thirty-six, or even forty-eight hours after being wounded, and who were then immediately sutured, forty-five had perfect immediate union. This sllccessful result showed the possibility of sending to a distance the olightly wounded, and indicated that they would have the same chance of a rapid cure as if the .intervention had taken place in close proximity to the field of battle. At lVIalmaison special arrangements were made for the treatment of fractures, and two centres were reserved for them. Sep~l'ate

surgical centres were also provided for the treatment of injuries of the face; they were in charge of specialists and the resul ts were extremely good.

'1'he defensive campaign of 1918 is the term applied by the Marshal commanding the French armies of the north and north-east for the period of the war from Marcb 21 to July 18, EllS, ill the course of which the Germans attacked with 200 divisions. Pressed by the German infantry the French and British troops retreated for thirty or forty kiloIlJetres. The medical services of the front .had to function without the vebiclesof the ambulances, and their only resonrces were the motor ambulance convoys which collected the wounded on the field of battle and carried them to the formations in the rear. M. Mignon. gives an account of the doings of the various armies. 'fhe Third Army was intended first to help aud then- to relieve the British line. Medecin Inspecteur Basseres forined seven centres for the classification of wounded at all average of ten kilometres from the front; behilld these. were the clearing hospitals and the large hospital centres of Amiens, Beauvais,' and Compiegnes. Basseres' proposals seem to have been based on the assumption of a stable front, or at least of olle which would be displaced only a few yards, as in the years 1915-16-17. As a result of the German advance, medical formatiolls and equipment were lost. 'fhe medical service was very defective; from the first to the last day divisions arrived without their technical material, without means of

_ tram;port, and without regimental vehicles. \Vith divisional stretcherbearers there were only horse vehicles which travelled slowly. ~M. Mignon says that medical otlicers with equipment and snpplies sbould have been conveyed ill motors like the troops and should have been able, on the first sound of alarm, .to follow the regiments without the risk of losing contact. The absence of groups of ambulancefl between the regimental aid posts and tbe hospital centres caused considerable suffering to the w'ounded owing to the great lellgth of the journey to the hospital centres. .



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212 'l'he F'rench ]![edical Service during the War, 1914-1918

The: same di~culties occurred in the organization of the First Army. The divisional ambulances were unable to do any surgical work and their personnel could only assist the regimental and divisional stretcher-bearers in putting the wounded into vehicles, and help to supply dressings .and apparatus in order to diminish suffering during trarisit. The slightly wounded were transported to It distance of fifteen kilometres from the front and placed ,in less than an hour in the railway embarkation centres: the severely wounded were brought to Beauvais, some fifty kilometres from the front.

The battle of the Aisne was the most remarlmble ot the German offensives : the enemy in four days marched from the Chemin des Dames to the Marne~, The Sixth Army had to sustain the first onset. Mcdecin Inspecteur Lasnet was in charge of the army and he considered that the divisions and, corps could treat a large part of their wounded and sick. Advanced surgical posts for major operations, abdominal and thoracic, were installed four or five kilometres from the front in caves or in dugonts, with which that region was dotted all over. These posts bad five to fifteen beds, X-ray apparatus, a surgical team and means of warming the wounded. Behind were the ambulances placed under the charge of the directors of the corps of the army. They were intended for severely wounded incapable of being carried to the clearing hospitals; they were supposed to be able to treat .the wounded. for three weeks and such groups were found ten to fifteen kilometres from the front. There were 6,000 excellent hospital beds available in the corps of the army in May, 1918. 'I'be clearing hospitals were splendidly equipped and were placed on a line about twenty kilometres from the front. In case of a retrea.t M. Lasnet had indicated various places to which each formation should retire. Each formation was required to leave a small aid post until the columns of the rear guard had passed. Motor ambulances held in reserve by the army were f!ent to the principal point of evacuation and were able to reinforce the units of the corps of the army which were most encumbered with wounded. Unfortunately the Sixth Army had a great reverse: Its principal medical formations· were captured on the first day by the vigorous advance of the German army. The first day was the most disastrous, four large clearing hospitals and twelve ambulances had to be abandoned to the enemy. The medical services had not sufficient wagons to remove the supplies and the General Staff were unable to satisfy the demands which arrived simultaneously from all the various services. M. Lasnet estimated that the total number evacuated was 33,754 wounded alld gassed, and 7,397 sick, and 6,000 English wounded. He had ordered only severely wounded to be placed in wagons, the others were to march on foot and t~e corps ambulances were to undertake the treatment of the inevacuable severe cases.

In' the battle of Matz on June 9 to 11; very much the same difficulties Wel"e met with; medical establishments were annihilated or reduced to aid posts. The wounded had to be evacuated without being operated on.



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The battle of Champeigne from .r uly 15 to 31, 1918, played a great part in the military history of the war. It was notable as giving the first check to the Germans. In obedience to the orders of G.Q.G. the first line of defeuce was voluntarily abandoned and a decisive battle fought on the second line. General Gouraud commanded the army; no ground was lost and the number of French dead and wounded was inconsiderable. About 18,000 lllen were evacuated between July 15 and 31; 12,(i94 wounded, 2,296 gassed, 3,000 sick. Of the wounded 5,866 were operated on before being evacu·ated. The transport of tbe wounded to the primary and seCOlldary clearing hospitals was carried out by the motor convoys with remarkable rapidity in spite of the bombardment of the communicating roads. Only about three to six hours elapsed between the men being wounded and their arrival at the clearing hospital. ~redecin Inspecteur Ruoot arrived at the following conclusions as a result of the battle of Challlpeigne. He believed that the battle had shown clearly the impossibility of doing surgical work in formations too close to the line. Formations placed on the principal roads of evacuation of the army could only serve as linkage posts for the motor ambulallces. .

According to M. Ruoot surgery ought only to be done in the primary clearing hospitals where the surgical units of the corps of the army could be combined. It was necessary, however, to have very large numbers of vehicles to insure rapid evacuation from the lines to the clearing hospitals. M. Mignon agreed with M. Ruoot's ideas Oll condition that the slightly wounded were separated from the other wounded at the point of evacuati·on from the divisions.

In 1918 at the Marne the Germans were once more compelled to retreat and on July 18 the general offensive of the allied armies commenced which resulted in driving the Germans from the trenches, aDd in three months forced them across the frontier without their having a single day of respite. The face of war was changed from July 18, 1918; mobility of the lines, and a flow towards the North-east, in varying waves succeeded the stabilization of the front. All that necessarily followed from a change from a war of the trenches to a war of movement had been foreseen by the higher command,·and on June 1,1918, an order was given by G.Q.G. that each army should he ready to pass at once to a war of movement. Commanders of groups of armies were to rednce their impedimenta, and to take all necessary measures for rapidly changing their dispositions. The stocks were to be reduced and parks were to be arranged in proximity to the regulating centres as they were from time to time formed. 'l'be medical service was requested by Major-General Anthoine to make all arrangements necessary to correspond with the general instructions of June 1, 1918. In this note instructions were given as to the transport of the wounded, the placing of primary clearing hospitals of the first line, the creation of secondary clearing hospitals, the care of the wounded ·in hospital trains. M. Mignon says it wn:s curious that the



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notes from G.Q.G. on the occasion of the offensive battles should have been as explicit as if there had not been four years of war, in which to gain individual experience. Divisional medical units were IJO longer to undertake a surgical role, they were required only to prepare the wounded for evacuation and to remove them from the sectors as quickly .. as possible. 'l'he surgical ambulances were to be removed from them and passed to the army corps; experience had proved clearly that surgery was impracticable at the front and l:nust be carried ont in the rear. It was the duty of the aid posts to apply first dressings and to splint all fractured cases. On June 17, 1919, an order was given grouping the ambulances of the corps and fixiug their duties. They were to receive all the wounded and assure a proper classification, to readjust insuflicieut or dirty dressings, to i mrnobili:tle all fractures, to give anti-tetanic injections; complete the Qiagnosti~ labels, to treat on the spot the inevacnable wounded, and those which required urgent treatment, such as abdollllDal cases, severe thoracic wounds, head cases and severe IHelllorrhages; to classify tbe other wounded in order of urgency of transport, giving tbose priority which required early treatment, and to direct them to the appropriate surgical centre. The consulting surgeon of the corps of the army was to be the -chief of the group of ambulances. The material supplied comprised Bessonneau hangars, Bessonneau and tortoise tents, bedding,.and a wagon for sterilization and radiology. It was in the matter of hospital capacity and the sitillg of clearing hospitals of the first line' that the higher -command foresaw the war of movement would bring the g-reaLest changes. It would be necessat·v now to maintain mobile forma.tions, which could mpidly follow the ar~ies and be erected along the sides of the railways at points of evacnation selected by commands. Attached to them should be a hospital centre and 'surgery, which would be carried on by a mobile surgical unit. Special arrangements were to be made for ~he immediate treatment of fractures, face injuries, and ophthalmic cases. Tbe consulting surgeo)) was to supervise the operations of the medical staff. The clearing hospitals were not to operate except on wounded cases which could be effectively disinfected and rendered immediately evacuable. Another duty of the primary clearing hospital was to IDspect the dressings of the slightly and moderately wounded men and then to send them on for operation to the secondary clearing hospitals. They bad also to evacuate by train operation cases aud those not requiring to Le operated on at once to hospital centres in the interior. The primary clearing hospitals were to retain slightly wounded. or those suffering from contnsions, etc., the slightly sick and slightly gassed, as well as skin and venereal cases. The creation of the secondary hospitals was necessary for the removal from tbe neighbourhood of the finctnating front line and aerial bombardment, of all the wounded, whose disinfection could be delayed for several hours. These hospitals were constructed on a large scale and contaiued from 3,000 to 4,000 beds, placed in tents and Bessonneau hangars, at .50 to 200 kilometres distant



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The French Medical Service dwring the War, 1914-1918 21!l

from the front, in open country and in places accessible byraiI. Numerous surgical units and medical personnel were necessary for the functioning of these new fQL·mations. 'l'he plan of hospitalization required in view of the war of movement consisted then of only three echelons of medical formations: (1) 'I'he classification celltres of the corps. (2) The primary clearing hospital. (3) The secondary clearing hospital. Personnel and material were freelydistrihuted to them, so that they might be able to carry out the work allotted to them. The separation of large medical formations from the battle ceutre required the maintenance of rapid means of transport by road and rail. Motor ambulance convoys had already often saved the day in defensive battles, they would now have to play a more importa.nt role in offensive battles since the distance which the wounded would have to travel would be much longer. Clearing hospitals might easily be 30 or 40 li:ilometres from the regimental aid posts.

Howeyer quickly the railways might advance they could llever keep pace with the victorious troops and the distance to be covered did not allow vehicles to make more than two journeys a day. A vehicle could not then count on evacuating more than eight lying wounded in the daJ. G.H.(l had only 200 motor convoys at its disposal, and motor cars and wagons for personnel, and material had to be obtained from other sources. The employment of so m11ch wheeled transport ann of s11ch varied kind could not be co-ordinated by the medical personnel. Assistance was given to it by G.Q.G., who added an officer of the motor service (Ann)' Service Corps) to the medical directorate. 'l'bis officer had large POWflfS, be had to distribute the vehicles and organize a liaison between the various medical establishments. A medical officer and this transport officer had power to· visit clearing hospitals and make sure that the wounded were regularly removed so as to avoid overcrowding of the medical units. 'l'hough the motor vehicles were adequate for short transport of 30 or 40 kilometres they could not be· relied upon to insure communication between the primary and secondary hospitals, which were distant from one another some 150 to 200 kilometres: this work had to be done by hospital trains.

The creation of the secondary clearing hospitals obviated the necessity of operating on all wounded at the primary clearing hospit,als. Most of the wounued classified at the primary clearing hospitals were placed on the trains without operation and were brought to the secondary clearing hospitals, where they arrived twenty to twenty-four hours after being wounded. There their wounds were resected, sutured and they were kept under observation as long as beds con Id be made available for them.

The abundant use of gas by the Germans required a new organization called" formations Z," and on July 16,1918, G.Q.G. ordered ambulances, hospitals and sections of clearing hospitals to be reserved for gas cases. They had a pers(11111el and material sufficient for their work. One or more Z formations were attached to all medical echelons. Gas cases leaving the divisions were taken to an ambulance Z of :the army'corps, which kept



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those who w~re inevacuable. The army had formations Z and sections for gas cases in the clearing hospitals; the medical consultalit of the army' was responsible for supervising the organization of all the gas centres in t4e zone of the army. Secondary clearing hospitals also had a section for ·gas cases, On the lines of cOIlllllunications medical formations for gas :cases were also formed, and in. order to prevent ·evacuation to long distances G:Q.G.· ordered the organizatioll of a special service, capable of receiving and treating 5.,000 gas cases. . The medical service on the lines of communication was given autonomy

on January 4, H1l7, by decision of G.Q.G., which constit)lted medical directorates of communications. The directorates associated. with the groups of armies were quite independent, like .the armies composing the groups ..

In June, 1918, in consequence of the enemy tactics and the bomb'ing of the r,oads in the rear, G.Q.G. decided to arrange large hospital centres on the lines of communication. By a note on J uue 17, HHS, the General Staff ordered the very soverely wounded to be retained in the hospital centres near the primary clearing hospitals; slightly wo.unded ~o he concentrated in hospital centres, or secondary clearing hospitals, ereated by the directorate of communications close to the rail way lines 50, 100, and 200 kilometres from tbe front. The nucleus of each of these secondary clearing hospitals was formed by a mobile surgical am bulancEO', around which three or ·four mobile surgical units were grouped according to the needs of case. rThese secondary clearing hospitals were called upon to receive tWI:) chsses of wounded--:-those who had not been operated on and those operated Oil, but not requiring furtheractive treatmellt. The wounded not operated on almost always arrived at the secondary clearing hospital in snfficier)t time to allow of the wounds being cleaned and resected and put into a state to he sutured. The wounded were then often evacuated immediately into the interior with an aseptic dressing,sntnring 'being deferred until the arrival in the territorial hospitals. 'l'he surgeons remarked ori the. poor results obtained when the wounded had I;>een operated on at the front and immediately evacuated to the secondary clearing hospitals .. The cause was thought to be moving the wounded immediately after operation .

. At the beginning of ,the war the zones of the· armies were separated from the interior by a definite .line indicated by the Minister. of War. Medical services behind this line functioned exactly as in times of peace; all the regions of the interior without distinction of situation were called upon to receive the wounded coming direct from the zones of the army, .and sometimes the t~'ains might takfl the wounded as far as the shores of the Mediterranean. Such long journeys of two or three days often bad a very bad ·effect on the wounded. At the end of 1916 the regions in the interior ,were divided into those near the front and those distant from the front; those near the front were reserved for the severely wounded, alld



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those more distant for wounded who were considered fit to travel long distances. In this way regions adjacent to the battle zones became a part of the lines of communication, and wounded could be sent to them without even being operatedon. Men whose wounds had been resected, but not sutured, arrived even in the distant territories in excellent condition, and after a short use of Carrel's tL'eatment the wounds could be sutured between the seventh and eleventh day following the infliction of the wound; healing usually took place without complications. If, however, disinfection had not been properly done, and there w·ere very numerous microbes present, the wounds were left to close ·natnrally. These cases were the exception.

During the defensive and offensive battles from March 21, 1918, to November 191B, 33~,180 wounded were evacnated, and there were 48,000 deaths in the medical units of the army, and 27,000 died in the territorial hospitals.

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