Part 5

THE SURGERY OF THIS WAR

"Please give us a drop of Johnnie Walker before you do my dressing," said my Irish sergeant, who had lost his leg in the fight at Kangata. Lest you might think that by "Johnnie Walker" he asked for his favourite brand of whiskey, I may tell you that we had no stimulant of that kind with us. It was chloroform he wanted to dull the pain that dressing his severed nerves entailed. Always full of cheer and blarney, he kept our ward alive, only when the time for daily dressing came round did his countenance fall. Then anxious eyes begged for ease from pain. But this once over, he laid his tired dirty face upon the embroidered pillow and jested of all the things the careful German housewife would say could she but see her embroidered sheets and the blue silk cushion from her drawing-room that kept his amputated leg from jars. We had no water to wash the men, barely enough for cooking and for surgical dressings, but there were silk bedspreads and eiderdown quilts and all the treasures of German sitting-rooms. And the fact that they were taken from the Germans was balm to these wounded men.

There was Murray, a regimental sergeant-major, his leg badly broken by the lead slug from a German Askari's rifle, ever the fore-most at the padre's services, chanting the responses and leading all the hymns. And Wehmeyer, the young Boer, who had accidentally blown a great hole through his leg above the ankle joint. And Green, the Rhodesian sergeant who had been brought in, almost in extremis, with blackwater. Nor was his condition improved by the experience of having been blown up in the ambulance by a land mine, hidden in the thick dust of the road. Thrown into the air by the force of the explosion, the car had turned over on him and the driver, who was killed. And there was Becker the blue-eyed German prisoner with a bullet through his femoral artery and his hip. Blanched from loss of blood before I could tie the vessel and stanch the bleeding, his leg suspended in our improvised splints, and on his way to make a splendid recovery. And Taube, another German prisoner, shot through the abdomen, and recovering after his operation. Gentle and conciliatory, with eyes of a frightened rabbit, he was the son of the great Taube, the physiologist of Dresden.

Cheek by jowl, in the best bed, was Zahn, the hated Ober-Leutenant, loathed by his own men, one of whom wrote in his diary that he loved to see the bombardment of Tanga, "for Zahn was there, the ----, and I hope he'll meet a 12-inch shell." Jealous of his officer's prerogative, and disinclined to be nursed in the same ward with our soldiers and his own, he gave a lot of trouble, demanding inordinately, victimising our orderly, unashamedly selfish. But he was sheltered from my wrath by the grave gunshot wound of his thigh. Cowardly under suffering, he was in striking contrast to Becker, who stood graver pain with hardly a flinch. After a great struggle he was eventually moved to Korogwe to the stationary hospital. There it became necessary to amputate his leg, and Zahn surrendered what little courage he had left. "No leg to-night, no Zahn to-morrow," he said to his nurse. And he was right, for at eleven that night he had no leg, and at two the next morning there was no Zahn upon this earth.

And there was Sergeant Eve of the South African Infantry, who got a D.C.M., a Londoner, and of unquenchable good humour. Vastly pleased with the daily bottle of stout we got for him with such difficulty, from supplies, he faced the awful daily dressing of his shattered leg without flinching, pretending to great comfort and an excellent position of his splint, which his crooked leg and my practised eye belied.

And there was Smith, yet a boy, but who always felt "champion" and "quite comfortable," though his days were few in the land and his pain must have been very severe. Yet in his case he had days of that merciful euthanasia, the wonderful ease from pain that sometimes lasts for days before the end. In great contrast with these was an individual with a wound through the fleshy part of the thigh, by far the least seriously wounded of all in the ward, who never failed with his unending requests to the patient orderlies and his eternal complainings, until a public dressing-down from me brought him to heel. And Glover who wept that I had lost his bullet, that unforgivable carelessness in a surgeon that allows a bullet, removed at an operation, to be thrown away with discarded dressings.

But, of all, the perfect prince was De La Motte, a subaltern in the 29th Punjabis, ever the leader of the dangerous patrols along the native bush paths that give themselves so readily to ambush. Shot through the spine and paralysed below the waist his life was only a question of months. But if he had little time to live, he had determined to see it through with a gay courage that was wonderful to see. Previously wounded in France, he yet seemed, though he cannot possibly have been in ignorance, to be buoyed up with the perfect faith in recovery with which fractured spines so often are endowed; never asking me awkward questions, he made it so easy for me to do his daily dressing, so grateful for small attentions, and so ready to believe me when I told him that it was only a question of weeks before he would be home again. And in spite of all fears I have just heard he did get home to see his people, and by his cheerful courage to rob Death of all his terrors.

MY OPERATING THEATRE AT HANDENI

Up the wide stone steps, under the arch of purple Bougainvillea and you are in my operating theatre. A curtain of mosquito gauze screens it from the vulgar gaze. Behind these big wooden doors a week ago was the office of this erstwhile German jail. To the left and right, now all clean and white painted, were the living rooms of the German jailor and his wife, but for the present they are transformed into special wards for severely wounded men. On the lime-washed wall and very carefully preserved is "Gott strafe England" which the late occupants wrote in charcoal as they fled. Strange how all German curses come home to roost, and move us to the ridicule that hurts the Hun so much and so surely penetrates his pachydermatous hide. That the "Hymn of Hate" should be with us a cause for jest, and "strafe" be adopted, with enthusiasm, into the English language, he cannot understand. To him, as often to our own selves, we shall always be incomprehensible.

Through the gauze screen on to the white operating table passed all the flotsam of wounded humanity in the summer months. All the human wreckage that marked the savage bush fighting from German Bridge to Morogoro came to me upon this table. And its white cleanness, our towels and surgical gloves and overalls, filled them with a sense of comfort and of safety after weary and perilous journeys, that was in no way detracted from by the gleaming instruments laid out beside the table. Even this chamber of pain was a haven of refuge to these broken men after long jolting rides over execrable roads.

But a particularist among surgeons would have found much to disapprove of in this room. Cracks in the stone floor let in migrating bands of red ants that no disinfectant would drive away. Arrow slit windows, high up in the walls, gave ingress to the African swallow, redheaded and red-backed, whose tuneful song was a perpetual delight. His nests adorned the frieze, but they were full of squeaking youngsters and we could not shut the parents out. So we banished them during operating hours by screens of mosquito gauze; and to reward us, they sang to our bedridden men from ward window-sills.

But despite these shortcomings of the operating theatre itself, we did good work here, and got splendid results. For God was good, and the clean soil took pity upon our many deficiencies. Earth, that in France or Gallipoli hid the germs of gangrene and tetanus, here merely produced a mild infection. Lucky for us that we did not need to inject the wounded with tetanus antitoxin. But an added charm was given to our work by the necessity of improvisation. Broken legs were put up in plaster casings with metal interruptions, so that the painful limb might be at rest, and yet the wound be free for daily dressings. The Huns left us plaster of Paris, damp indeed but still serviceable after drying; the corrugated iron roofing of the native jail provided us with the necessary metal. Then by metal hoops the leg was slung from home-made cradles, and I defy the most modern hospital to show me anything more comfortable or efficient. Broken thighs were suspended in slings from poles above the bed, painted the red, white and black that marked German Government Survey posts. Naturally in a field hospital such as this, we had no nurses; but our orderlies, torn from mine shafts of Dumfriesshire and the engine sheds of the North British Railway, did their best, and compensated by much kindliness for their lack of nursing training.

Sadly in need were we of trained nurses; for the bedsores that developed in the night were a perpetual terror. Ring pillows we made out of grass and bandages, but a fractured thigh, as you know, must lie upon his back, and we had little enough rectified spirit to harden the complaining flesh. But nurses we could not have at so advanced a post as this. The saving factor of all our work lay in the natural goodness of the men. They felt that many things were not right; for ours is a highly intelligent army and knows more of medicine and surgery than we, in our blindness, realise. But they made light of their troubles, as they learnt the difficulties we laboured with. So grateful were they for small attentions. That we should go out of our way to take pains to obtain embroidered sheets and lace-edged pillows, absolved us in their eyes from all the want of surgical nursing. Liberal morphia we had to give to compensate for nursing defects. I have long felt that I would rather work for sick soldiers than for any class of humanity; and in fifteen years I have come to know the sick human animal in all his forms. So that the least that one could do was to scheme to get the precious egg by private barter with the natives, and to find the silk pillow that spelt comfort, but was the anathema of asepsis. No wonder that such splendid and uncomplaining victims spurred us to our best endeavours and made of toil a very joy.

SOME AFRICAN DISEASES

This is the season of blackwater fever, the pestilence that stalks in the noontide and the terror of tropical campaigning. Hitherto with the exception of the Rhodesians who have had this disease previously in their northern territory, or men who have come from the Congo or the shores of the Great Lakes, our army has been fairly free from this dread visitation. The campaigning area of the coast and the railway line of British East Africa that gave our men malaria in plenty during the first two years of war, had not provided many of those focal areas in which this disease is distributed. The Loyal North Lancashires and the 25th Royal Fusiliers had been but little affected. The Usambara Valley along the Tanga-Moschi railway was also fairly free. On the big trek from Kilimanjaro to Morogoro the blackwater cases were almost entirely confined to Rhodesians and to the Kashmiris, who suffer in this way in their native mountains of Nepal. But once we struck the Central Railway and penetrated south towards the delta of the Rufigi the tale was different. British and South African troops began to arrive in the grip of this fell malady. It was written on their faces as they were lifted from ambulance or mule waggon. There was no need to seek the cause in the scrap of paper that was the sick report. All who ran could read it in the blanched lips, the grey-green pallor of their faces, the jaundiced eye, the hurried breathing. Thereupon came three days' struggle with Azrael's pale shape before the blackwater gave place to the natural colour again, or until the secreting mechanism gave up the contest altogether and the Destroying Angel settled firmly on his prey. At first, if there was no vomiting, it was easy to ply the hourly drinks of tea and water and medicine. But once deadly and exhausting vomiting had begun, one could no longer feed the victim by the mouth. Then came the keener struggle for life, for fluid was essential and had to be given by other ways and means. Into the soft folds of the skin of the arm-pits, breast and flanks we ran in salt solution by the pint. The veins of the arms we brought into service, that we might pour in this vitalising fluid. Day and night the fight goes on for three days, until it is won or lost. Here again, as in tick fever, we use the preparation 606, for which we are indebted to the great Ehrlich. Champagne is a great stand-by. So well recognised is the latter remedy that all old hands at tropical travel take with them a case of "bubbly water" for such occasions as these. Blessed morphia, too, brings ease of vomiting and is a priceless boon.

You ask me the cause of this disease, and I have to admit that among the authorities themselves there are no settled convictions. Some hold--and for my part I am with them--that the attack is caused by quinine given in too large a dose to a subject who is rotten with malaria. But there are others who maintain that it is a malarial manifestation only, and that the big dose of quinine, which seems to some to precipitate the attack, is only a coincidence. Be that as it may, there is little difference in the treatment adopted by either school. Death achieves his victory as frequently with one as with another. Certain it is that, to the common mind, quinine is the reputed cause and is avoided in large doses by men who have once had blackwater, or who are in that low rotten state that predisposes to it. In one point all agree, that one must be saturated with malaria before blackwater can develop. So great is the aversion shown by some men to the big doses of quinine as laid down by regulations, that men have often refused to take their quinine. Others, too, who have protested at first, take their quinine ration only to find themselves in the grip of this disease within twelve hours. Such a case was a Frenchman named Canarie (and the colour of his face, upon admission, did not belie his name), who had been treated for blackwater fever by the great Koch in Uganda many years before, and had been warned by him against big doses of quinine. That evening he was on my hands, fortunately soon to recover, and to win a prolonged convalescent leave out of this rain to the sunny and non-malarial slopes of Wynberg.

Seldom do the rumbling ambulances roll in but among their human freight is some poor wretch snoring into unconsciousness or in the throes of epileptiform convulsions. Custom has sharpened our clinical instinct, and where, in civil life, we would look for meningitis, now we only write cerebral malaria, and search the senseless soldier's pay-book for the name that we may put upon the "dangerous list." As this name is flashed 12,000 miles to England, I sometimes wonder what conception of malaria his anxious relatives can have.

For there is no aspect of brain diseases that cerebral malaria cannot simulate; deep coma or frantic struggling delirium. A drop of blood from the lobe of the ear and the microscope reveals the deadly "crescents"--the form the subtertian parasite assumes in this condition. No time this for waiting or expectant treatment. Quinine must be given in huge doses, regardless of the danger of blackwater, and into the muscles or, dissolved in salt solution, into the veins. The Germans have left me some fine hollow needles that practice makes easy to pass into the distended swollen veins. Through this needle large doses of quinine are injected, and in six hours usually no crescent remains to be seen. As a rule, conscious life returns to these senseless bodies after some hours; but, unhappily, such success does not always crown our efforts. Then it is the padre's turn, and in the cool of the following afternoon the firing party, with arms reversed, toils behind our sky-pilot to that graveyard on the sunlit slopes of Mount Uluguru, where our surgical failures are put to rest.

One can always tell, you know, the onset of such a complication as this; for when one finds the victim of malaria hazy and stupid after his fever has abated; and, more especially, if he develops wandering tendencies, leaving his stretcher at night to choose another bed in the ward, often to the protesting consternation of its present occupant, then one passes the word to Sister Elizabeth to get the transfusion apparatus ready. I shall not readily forget one stout fellow, a white company sergeant-major in the Gold Coast Regiment, who was lost in the bush and discovered after many days in the grip of this fell disease. Him they bore swiftly to me at Handeni, and after many injections and convulsions innumerable, he was restored to conscious life again. Sent back by me eventually to Korogwe with a letter advising his invaliding out of the country, he opened and read my report upon the way. But he was of those who do not take kindly to invaliding. Who would run his machine-gun section, if he were away, and his battalion in action? Who like he could know the language and the little failings of his dusky machine-gun crew that he had trained so long and so carefully in the Cameroon? So he appeared in the books of the Stationary Hospital at Korogwe as an ordinary case of convalescent malaria on his own statement. And when they would send him still further back to M'buyuni he broke out from hospital one night, and, with his native orderly, boarded the train to Railhead and marched the other 200 miles to Morogoro. Here I met him on the road starting out on the next long trek of 125 miles to Kissaki. For news had come to him that the Gold Coast Regiment had been in action and their impetuous courage rewarded by captured enemy guns and a long casualty list. But he was determined and unrepentant, one of his beloved machine-guns had been put out of action. How could I hold him back? So joining forces with another white sergeant of his regiment, who was hardly recovered from a wound, these two good fellows set out with a note that, this time, was not to be destroyed, for the instruction of their regimental doctor.

A third scourge responsible for frequent admissions into hospital is "tick-fever." Rather an unpleasant name, isn't it? And in its course and effect it fully acts up to its reputation. More commonly known as "relapsing fever," this illness attacks men who have been sleeping on the floor of native huts, which in this country are swarming with these parasites. Once in seven days for five or seven weeks these men burn with high fever--higher and more violent even than malaria--but sooner over. As you may imagine, it leaves them very debilitated; for no sooner does the victim recover from one attack than another is due. The ticks that are the host of the spirillum, the actual cause of the disease, live in the soft earth on the floor of native huts at the junction of the vertical cane rods and the soil. Here, by scraping, you may discover hundreds of these loathsome beasts in every foot of wall. But they are fortunately different from the grass ticks that, though unpleasant, are not dangerous to man. For the tick that carries the spirillum is blind and cannot climb any smooth surface. So to one sleeping on a bed or even a native "machela" above the ground, he is harmless. But woe betide the tired soldier who attempts to escape the tropical rain by taking refuge on the floor. In sleep he is attacked, and when his blind assailant is full of blood he drops off; so the soldier may never know that he has been bitten. I got twelve cases alone from one company of the Rhodesians, who sheltered in a native village near Kissaki. Of course, not every tick is infected, and for that we have to be very grateful. At the height of the fever the spirillum appears in the blood as an attenuated, worm-like creature, actively struggling and squirming among the blood corpuscles. A drop of blood taken from the ear shows hundreds of these young snakes beneath the microscope. For the cure we are again indebted to that excellent Hun bacteriologist Ehrlich, who gave us .606--a strong arsenical preparation that we dissolve in a pint of salt solution, and inject into the veins at the height of the paroxysm of fever. This definitely destroys the spirillum, and no further attacks of fever result; but this injection, once its work is done, does not confer immunity from other attacks. It is typical of the Hun and his anti-Semitic feelings that Ehrlich, the most distinguished of German scientists, perhaps, after Koch, has never received the due reward of all the distinction he has conferred on German medicine, for the offence that he was a Jew. We should have honoured him, as we have done Jenner or Lister.

Relapsing, or Rückfall fever, as the Germans call it, was one of the common dodges used by them to deceive the ingenuous British doctor. For the subtle Hun prisoner knew that, if he pretended to this disease, it would win him at least a week in the grateful comfort of a hospital, and perchance the ministering joys conferred by German nursing sisters, until the expected relapse did not occur; then the British doctor, realising the extent of his deception, would thrust these shameless malingerers to the cold comfort of the prison camp.

How is it, you might ask me, that there are any natives left, if tropical Africa is so full of such beastly diseases as this? Is it that the native is naturally immune, or is it that the white man is of such a precious quality that he alone is attacked by these parasites and poisonous biting flies? The fact is that the native is affected also, and in childhood chiefly, so that the infant mortality in many native tribes is very high. And there is little doubt that repeated attacks of malaria in youth, if recovered from, do confer a kind of protection against attacks in adult life. But this is not the case with newly introduced disease; for the sleeping sickness that came to Uganda along the caravan routes from the Congo, has swept away fully a million of the natives along the shores of Lake Victoria Nyanza.

But the native has a sure sense of the unhealthiness of any locality, and one must be prepared for trouble when one notices that the native villages are built up on the hillsides. This was specially remarked by us on our long trek down the Pangani, and thus we were warned of the fever that lurked in the bright green lush meadows beside the water, and the "fly" that soon overtook our transport mules and cattle and the horses of General Brits' 2nd Mounted Brigade. At first we thought the columns of smoke along the mountain-sides beside the Pangani were signal fires for the enemy; but before long, when the roads were choked with victims of "fly" and horse-sickness, we realised the wisdom that induced the simple native to take his sheep and cattle up the hillsides and above the danger zone. When one spends only a short time in some native huts, it is quite clear how he escapes infection. For the floor is covered with a layer of wood ashes that is usually deadly to bugs and fleas and ticks and other crawling beasts; and the atmosphere is so full of wood smoke that the most enterprising mosquito or tsetse-fly would flee, as we do, choking from the acrid smoke. So the native fire that burns within his hut day and night not only serves to cook his food and to keep wild beasts away, but also supplies him with an excellent form of Keating's Powder for the floor and smoke to drive the winged insects from the grateful warmth of his fireside.

HORSE-SICKNESS

Lying beside the road with outstretched neck and a spume of white froth on nose and muzzle are the horses of the 2nd Mounted Brigade; with bodies swollen by the decomposition that sets in so rapidly in this sun, and smelling to high heaven, are the fine young horses that came so gallantly through Kahe some ten days ago. "Brits' violets" the Tommies call them, as they seek a site to windward to pitch their tents. "Hyacinths" they mutter, as the wind changes in the night, and drives them choking from their blankets, illustrating the truth of the South African "Kopje-Book" maxim, "One horse suffices to move a camp--if he be dead enough." For weeks after the Brigade passed through M'Kalamo the air was full of stench, and the bush at night alive with lions coming for the feast. For this is horse-sickness, the plague that strikes an apparently healthy horse dead in his tracks, while the Boer trooper hastily removes bridle and saddle and picks another horse from the drove of remounts that follow after. No time to drag the body off the road; so the huge motor lorries choose another track in the bush to avoid this unwholesome obstruction.

Horse-sickness takes ten short days to develop after infection, and the organism is so tiny that it passes through the finest filter and is ultramicroscopic. That means that it is too small to be recognised by the high power of an ordinary microscope. There was horse-sickness in the bush meadows beside the river near Kahe. Careless troopers watered their horses, after sundown, when the dew was on the grass and death lurked in the evening moisture where it had been absent in the dry heat of the afternoon.

THE WOUNDED FROM KISSAKI

Two very busy days were before us when the wounded came in from Kissaki, so badly shaken and so pale and wan after their journey. They had been cared for by the Field Ambulance before I got them, and by the extraordinary excellence of the surgery paid the greatest of tributes to the care of the surgeons in front. The German hospital there, half finished--for our advance had been far ahead of German calculations-- fell into our hands and with it a German doctor and some nurses. The nurses had been very kind to our men and worked well for our doctors, but they had followed the usual German custom in this country, of being too liberal with morphia. That this drug can become a curse is well known, though it is, when given in reason, the greatest blessing, the most priceless boon of war. One feels perhaps that the sisters had given it without the surgeon's knowledge, and not entirely to give ease from pain, but also perhaps to give rest to the ward, the quiet that would allow these over-worked women to get some sleep themselves. It was written on the faces of the three amputation cases that they had had too much morphia. And as this drug robs men of their appetite, keeps them thin, and prevents their wounds from healing, it became my unpleasant task to break them of it. This was only to be done by hardening one's heart, by giving bromide and stout, and insisting on the egg and milk that interspaced all meals. It is so easy to get a reputation for kindness by being too complacent in giving way to requests for morphia. It made one feel such an absolute brute to disregard the wistful pleading eye, the hands that tugged at the mosquito curtains to show they were awake, when, late at night, I made my evening round. But it had to be done, and I fear the work and the sun and the tropics made one's temper very short, particularly when it was only possible by losing one's temper to preserve the indifference to these influences that was necessary to complete the cure. It was very hard on them at the time, especially as they were rotten with malaria and tick fever, in addition to their wounds. But there were other ways in which one made it up to them, if they did but know it. Nor did they see that quinine given by the veins, so much more trouble to me and to the sister, was better for them than the quinine tablet that was so easily swallowed, and so ineffectual. Nor could they, one thought, always know that 606 had to be given for tick fever, and that it was of no value save when given at the height of fever, when they felt so miserable and so disinclined to be disturbed.