Stage 5: Significant Injury

A significant injury required more medical attention than could be found on the battlefield. These injuries ranged from multiple bullet wounds to severe shrapnel injuries that often ended in amputation of a limb. First Aid Dressing Stations did not have the resources to handle multiple invasive surgeries and the troops had to be treated elsewhere. While significant, these wounds were not necessarily fatal. Troops were moved off the battlefield to a field hospital a few miles distant for treatment and recuperation.

Hollinger’s Diary:

Mon Jul. 29, 1918
No sleep yet not much work. Several dead
buried. About 9 moved back to Fads {First Aid Dressing Station}
in afternoon put on Amb avec {with} Buchy. Drove
out to about 5 bat AS with Krup. passed
overland held narrow Bosh {German} in morning. Under
shellfire nearby bastion {stronghold} top of hill.
on return took a load of Blcs to Chte held obvs
shock case all the way. Returned and cleaned. Wrote up this + turned in.
Beaucoup obvs {many observation balloons} going + coming. Sound
gas alarms: no gas.

Ambulance:

One of Hollinger’s most frequent duties was driving the ambulances from the dressing stations to the field hospital where troops could receive more thorough medical care. Driving an ambulance required Hollinger to think on his feet, maintain efficiency, and minimize additional injuries during travel. The precautionary measures taken at the dressing station could only do so much to keep wounded soldiers alive. Ambulance drivers were entirely responsible for getting the wounded to the next stage of treatment as quickly as possible.

Field Hospital:

Field hospitals were a few miles from the battlefield and handled the injuries that were too severe for the dressing station. In rare cases, the hospitals closest to the battlefield were underground, maintained and staffed by the troops in the medical corps. Hollinger took a picture of one, as seen below.

Interior of an underground hospital. It is not quite finished but shows how they are built.

Field hospitals aimed to have as much equipment as possible in a small and easily transportable space. The hospitals would move with the battlefield and all medical equipment would follow the front line. Constant movement restricted the quality and quantity of the medical supplies a field hospital could have at any one time. The medical tools listed below are all found in a field hospital and were essential in treating the wounded.

Chloroform Inhaler

While chloroform was a popular choice of anesthetic on the front lines, each particular type of anesthetic had its drawbacks.  Chloroform frequently caused skin irritation, making the deeper set design necessary to ensure the solution never came in contact with skin. Chloroform sickness, or vomiting, dizziness, and fever, made ether the more popular anesthetic choice.

Inhalers allowed surgeons and doctors like Stahr to treat their patients as efficiently as possible without causing additional cosmetic damage.

chloroform inhalter_Fotor

Ether Anestesia Mask:

The ether inhaler was one of the most popular methods of anesthesia used during the war. It knocked the patient out in a few moments and the style of the mask prevented skin irritation that was common with chloroform. Doctors quickly discovered that when ether and chloroform were used simultaneously, surgery was easier and a patient was less likely to wake up during surgery. The combination of ether and chloroform also prevented chloroform sickness, which had the potential to lengthen recovery time.

Both field and base hospitals were stocked with inhalers like this one. Unlike some of the other inhalers available during the war, this style of inhaler could be moved easily. Because it did not require a machine, it became a popular choice.

ether mask_Fotor

Ethyl Chloride:

Ethyl Chloride, or ether, was one of the most common anesthetic choices during the war. Doctors were not aware of the long term damage ether caused on internal organs, only relying on it to make the surgical process as easy as possible. It was lightweight and, therefore, easy to ship overseas. In addition, a small dose would go far on the battlefield, making it an all around economical choice.

ether bottle_Fotor

Irrigator:

Doctors used this type of syringe to irrigate wounds with antiseptic. The war brought a huge reliance on the Carrel-Dakin method for antiseptic aftercare[1].  Doctors pumped a diluted sodium hypochlorite solution over and into wounds using rubber tubing and air pressure to destroy as much bacteria as possible. These syringes sat above the contraption, forcing the solution into the tubing that was directly attached to the wound, often under the skin.

Although it was dangerous to use glass syringes in a chaotic war hospital, doctors agreed that glass ensured the antiseptic process was as clean as possible. Thus, doctors still relied upon these irrigators despite the risk[2].

While these items do not directly relate to Hollinger’s diary, each item was frequently used in the medical process of the war. In addition, because the 111th Ambulance Company was constantly transporting and assisting in the treatment of the wounded, even though it does not appear directly in the diary, Hollinger was probably familiar with these implements.

irrigator_Fotor

Hollinger’s Diary:

Sat. Aug. 24, 1918
Had remains of food for
breakfast. Loafed away
rest of morning
Cleaned and greased some of
the surgical instruments
of the Fads {First Aid Dressing Stations}
Bombing planes nearly but not too close

Military Pocket Surgery Kit:

Although pocket surgery kits like this one were used in dressing stations, they were essential to the field hospital. It was small enough that it could be taken anywhere a surgeon needed to go while still having all essential surgical equipment. If the wound was too severe to be patched up at the dressing station but not bad enough to require base hospital attention, it received treatment at a field hospital.

As the ambulance driver, Hollinger often found himself at or around a field hospital, and he became very familiar with their medical processes.

surgery kit_Fotor

 

Hollinger’s Diary:

Thurs Sept 19, 1918.
In the Foret of Argonne
Got up found some food + made breakfast
and about 2 hr. later started
dinner. Had dinner until 2.30
with some used food
Left about 4.30 on ambs. {ambulances} to Froidois[3]
to a big hospital. Found matches etc in
ward with Co. {Company} after supper put on duty
in ward which we opened up for cases
No one came in so slept all night in
an iron bed.

 

Base Hospital:

There were a few base hospitals in France while Hollinger served in the war. Click here to see a comprehensive list of all the base hospitals established by the American Expeditionary Force. Compared to a field hospital, a base hospital was better stocked with medical supplies and better staffed with both Medical Corps troops, nurses, doctors and volunteers. These hospitals did not move and handled thousands of wounded a day.

Inhalers:

Unlike the other two inhalers, this style of inhaler was found only in a base hospital. The smaller design was attached to an oxygen machine during surgery. Because the oxygen machines were too unwieldy to be moved with the field hospital, this inhaler was not commonly used. It was also very difficult to ship the oxygen machines to the front lines; only the largest and most central base hospitals had this type of inhaler. While the use of oxygen during surgery often produced the best results and the least number of complications, it was not always feasible during the war.

oxygen inhalers_Fotor

Catgut Ligatures:

The most common suture material used during the war was catgut. When compared to other suture materials, catgut was noticeably smoother and less likely to cause additional infection. The smoothness of the material ensured that the actual act of sewing the wound closed did not aggravate the injury further.

The other popular option during the war was silk, which was harder to obtain because it was a more expensive medium. While thinner than catgut, it was not nearly as sturdy. Catgut’s strength made it the preferred choice for wounds that required heavier stitching.

Dr. Stahr’s abilities as a doctor meant that while he might not have frequently been at a base hospital, he was more than capable of using this item in surgery. When assisted by nurses, doctors like Stahr were able to save lives and prevent infection.

catgut_Fotor

After treatment, the troops would either be sent back to camp to begin the entire process over again, or they might be injured so badly that they would be discharged.

[3] Froidos, France.

[1] “Instruments and Appliances” in The Military Surgeon: Journal of the Association of Military Surgeons of the United States. Edited by John Van R. Hoff. Vol XLII. (Washington D.C., 1918) 258.

[2]John Allan Hornsby, The Modern Hospital, 547.

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