A Scottish Women's Hospital Unit in Serbia

Kai Tiaki : the journal of the nurses of New Zealand, Volume XI, Issue 2, 1 April 1918, Page 79

A Scottish Women's Hospital Unit in Serbia

Some Notes by Dr. Agnes Bennett

Tho cases were straight from the battlefield of Kaymakchalan tl Straight " m this country meant that they had field dressings applied, were carried by hand, or on stretchers suspended one on either side of a mule, to a dressing station about five hours' journey down the mountain. Here they were placed m a " salle de pausements," the wound iodined, a suitable splint applied, and they were left lying m rows on straw m a. " Ladnyak" (shelter of boughs) till such time as our ambulances could go for them . Many, alas, were beyond human aid, and a sad enclosure of mounds and little wooden crosses is now all that marks the site of the aforetime dressing station. Of comforts there were very few — a few blankets only, and it was very cold at night. No attempt was made to take off clothes—these were cut at the site of the wound and the splints as a rule applied over the clothes. The splints, as a rule, were excellent, and excellently applied, but after first application were never taken off, and. sometimes cases arrived at the hospital not having been dressed for five or eight days. These probably had lain out higher up waiting for transport to dressing station. The ambulances usually went up and down m convoys, and some nine or ten or fourteen patients often arrived at the same time, hence they had to wait their turn m the iS Admission Tent," lying on their stretchers. On such occasions hot milk or soup was given to each on arrival, and photo thirty shows Miss Waugh, cook, administering this. The white stretchers on the ground are the reception tent stretchers, with white macintosh over them. This was a special institution of our own, and many medical visitors have complimented me on the system. The patient, always m his dirty, blood-stained, war-stained clothes, was put on these, lifted on to a table about the size and height of an operating table and on this all his clothes were removed, and he was washed from head to foot, shaved and specially cleansed if verminous (but this was a comparative rarity), put into clean pyjamas, and then transferred to the ward. This was much better than washing m bed,

and also much more thorough, and as there were always two or three being washed at the same time, plenty of extra labour was available for| momentary holding of injured limbs, or careful rolling over to adjust garments. We had always meant to give baths to our patients m this tent, but they were far too seriously injured to ever think of baths. Sometimes a dying man had to be carried straight to a ward. Some, alas — nine — were dead on arrival. This was hardly to be wondered at when one saw the passage down of the ambulances. This took some two hours, and was down the steepest of mountain roads, which zigzagged down the side of the mountain with sharp hair-pin bends. Often convoys of food and ammunition blocked the way, but it was wonderful the amount of consideration that was given to the ambulances. Going up would have been impos* sible if loaded, and even when empty the ambulances (fortunately light Ford ones for two cases only) had often to be pushed up. The soldiers used to know the difficult corners for us, and sometimes would wait to give a push at the right moment, and the sister attendants also got into the knack of jumping out at the right moment and giving a push. Always twice, sometimes oftener, the drivers had to wait to cool the engine. Only one mishap occurred on this dangerous road. In trying to pass an ammunition convoy, just when there was only a few inches to spare, the inside wheel knocked against a large stone, threw out the steering, and the car turned over the edge. Most fortunately there were no wounded m the car, and both occupants escaped with a severe shaking and a few bruises. The car was put on the road again at once by a contingent of soldiers, and went on for its load who were eventually safely landed at the hospital. The cases were of the worst possible variety, mostly " double," i. c., with two compound factures — two wounds m different parts. One was reported to have thirtynine shot holes m him. With a single compound fracture these cases would, many of them, have been considered worthy of

special nurses m our homo hospitals. We had three nurses (when one or two of them was not on sick list) to forty patients. Gangrene was rife, and the constant amputations were a terrible trial m the operating tent. This was frantically busy -one splendid little nurse knocked up after the first week, and as we could not possibly spare another, the rest of the work of these terrible few weeks had to be undertaken by one nurse and an orderly. It meant working into the night every night, for all the ward dressings had to be sterilised m a single small steriliser. The nurses worked absolutely heroically, and so did the o derlies, and it was amazing the rapidity with which the latter fell into line and the suitable ones wore soon valuable members of our staff. It was a constant nightmare to me who would break down next, for alas, dysentry and malaria soon asserted their presence, and our personnel sick tent itself absorbed workers and gave unending anxiety. One brave little orderly joined the long roll of victims of malignant malaria, and now a soldiers 5 cross marks her grave m the sad little cemetery m Salonique. Our first regular admission was on September 19th, and m the following eight weeks we admitted 523 cases — of these sixty died. As soon as a case was fit to travel at all we evactuated to a French Evacuation Hospital near Ostrovo station. At this hospital they simply rested m stretchers and were given some food till an ambulance train could be found with room for them. It grieved us sorely to know that the wounds we had cleansed and guarded so carefully would often have to remain m waiting for two days ere they could reach a base hospital. Later on, when the pressure ceased a little, the sisters used to beg to be sent with a bag of dressi ngs on the day following their evacuation to see if they were still waiting for a train. They would take boiled water and lotions, and manage everything themselves. The French doctor would allow them to dress our old patients. The chest cases were some of the most trying — very little could be done for them, only make them as comfortable as possible and keep the wound as clean as possible. One remarkable case was that of an officer who was shot right through, the bullet entered at the lower end of the breast bone

and emerged between the lower end* of the shoulder blade and the spine. He web greatly distressed on admission, but the quiet and comfort of a bed and pillows and careful feeding worked wonders, and he went about quite fit apparently. The men's appreciation of the beds was very great. " Dobra, Sestra," was the most frequent utterance m the wards. The improvement m the first twenty-four hours was wonderful, and it was always sad workto tell them they must move. There was seldom a bed empty even for a night. Each day we informed our D.M.S. how many we could discharge, and as many were sent m as were sent out During those weeks our X-Ray apparatus was m great demand, and far into every night we were developing plates, for m spite of most careful treatment and putting up of the dark tents, the light seemed to get m m the day-time. 172 plates were taken and developed, and about 250 cases were screened . There was not a great deal of localising done as we found the track of the bullet so patent m most cases that we found it more practical to follow these tracks. The valuable information was m the fact that a foreign body was present. In the wards all the trained sisters were working hard at dressings, tidying and cleaning wards, and giving food had to be left m the hands of our orderlies and the Serb ' bolnichars." These soon became very deft and picked up from signs what the sister wanted done Fortunately feeding the patients was comparatively easy, as there were not very many who could not take ordinary diet. They had two meals a day— one at eleven, one at five ; both these consisted of bread, soup with bread m it, and " sutliash," boiled rice with some milk m it. The amount of a Serbian's appetite after many days m the trenches is better imagined than described. They ate what would serve half a dozen of us, and thoroughly enjoyed it. It was wonderful the improvement ; m a few days they began to !ook quite fat. And with their warm, comfortable beds and regular food, m spite of their wounds, they were a wonderfully merry lot, and the chorus of ' Dobra dans " when one went into the ward and greeted them all had a very happy ring m it. The dressings were often terrible. Compound fractures with horrible septic wounds need-

ing thorough washing every day. It was often necessary to give anaesthetics and do minor operations m the wards — the number done m the operating tent was 350. The operating tent was a great success. The single marquee with double wall answering particularly well as the light was so good. This was the gift of the Ayrshire farmers. We made locking cupboards of boxes, and our precious store of instruments, all too few because we were only equipped as 100 surgical beds. Stools and small tables were made of wood from the equipment cases and packages, and we warmed up the tent by having two of the small lucifer stoves underneath the operating table. We found these also a great success and very little trouble to manage. Perhaps the admission department was the one that we received most congratulations on. This had not been done by any other hospital, and several O.C.s of other hospitals came and enquired into the details of it. In times like those of such pressure as we had, it is impossible to give a great deal of attention to the washing of patients when m the wards. A thorough good cleansing when they come m has to last the two or three days they are m, except when they can do for themselves. If by any chance a case was discovered to be verminous m the war, he was at once taken back to admission tent, cleansed all over, fresh clothes put on, and his whole bed and bedding ik stoved," and he was put into a fresh bed. This was the quickest way we found, as well as being th* most thorough. The Serbs as a whole are very clean — we find a very different state of things with the Russians. We had patients of many nationalities, Serbs, of course, mainly, a few French, Bulgars, Russians, a Senegalese (French Colonial), some Greek boys who had been playing with a bomb that exploded. Our very first patient was a woman sergeant m

the Serbian Army. She was not akt blesse " at that time, but was so delighted to hear she could consult a woman doctor, that she walked some miles from her camp near here for advice. Since then she has been wounded, and is now convalescent. After the splendid advance over Kaymakchalan we were left behind and out of the line of evacuation of the wounded. The dressing stations have now all moved to the other side of the range of mountains, and at present we are receiving the wounded by train. It takes five to ten days for them to reach us, but there is no great pressure, and the worst of these cases go to our outpost operating station ; a very lightly equipped section of the pospital, consisting of fort} 7 beds, for which we do all sterilising, store-keeping, disinfecting, and heavy work. As we have not been very busy lately, we have lent six sisters to a Serb. Convalescent Hospital, near here, where there is very little nursing done. In addition to this two of our number are helping the Serbian Relief Fund m giving out stores to the many homeless peasants, who have trekked down from villages on the fighting line. We have thus always had more or less work to do, though the main body of the hospital has been packed up ready for the move that has so often been said by our "D.M.S. would be m " quelques jours." Now that the " quelques jours " has been so prolonged, we are doing base hospital work, and we shall soon all be working hard again. The climatic conditions have been very severe, snow and frost for three days at a time, and it has been a great problem to keep warm However, with the exception of a few colds, our staff is now very well. We have the large wood ;t Perfection " stoves m the wards and the men are very comfortable, though their taste is for a much higher temperature than ours. A few warmer days gives us hope of spring and happier and more useful days.