'Stretcher-bearers': (26) Inferno Gully - dealing with the wounded and dying

Inferno Gully

Extract from Battleaxe Weekly, 1945.
" During the period of holding the line at Cassino, the mule track ADS and the Inferno Gully MDS, where seriously wounded men were operated on and often held for three weeks, will be remembered by many."

A few days after our withdrawal from the ADS (Advanced Dressing Station) and mule track at Cassino I began working in a gully at a Main Dressing Station some few miles from the previous post. It is quite safe.
I have been on night duty in a post-operational tented ward for over a week and there has been no chance until now, the ninth day, to keep up the diary, since the hours are long.
Yesterday's work gives a typical example.
We arrive on duty at 8 p.m. to find that Mahomet's colostomy operation has been carried out. We have two Indians patients, both with abdominal wounds. We set about cleaning up the blood and puss exuding from the abdominal wall, from which part of the smaller intestine is protruding. All this time Mahomet is in great pain. This completed, we change a glucose-saline bottle elsewhere in the ward. There are already four patients here receiving transfusions of blood, plasma or glucose saline.
Jones is taken to the theatre for the amputation of his left arm. He was put on oxygen yesterday morning . His chances of recovery are poor, but the operation must be performed because he has gangrene in his arm.
The second Indian has had his left leg amputated. That considered, he is fairly comfortable, but will need morphine later.
Reed, his lower mandible fractured in three places, is extremely restless and requires frequent mouth washes and drinks. He has a deep gash extending from his lower lip to his chin and the water seeps through this, making him more annoyed, because he thinks that we are deliberately letting the water fall on to his chest.
At the other end of the ward Cairns is in great pain with a penetrating abdominal wound. We give him a quarter grain of morphine. His glucose saline bottle will have to be changed soon.
Wesley, next to him, lies quietly enough. Apart from abdominal and thigh wounds he has also a head injury, which has caused him to be dazed, speech slurred. When he first came in he used to ask for a telephone, when he really needed a urine bottle. It is difficult to understand him. It is quickest to take down bed-pan, bottle, vomit bowl, and feeding cup at the same time. He may then be sleeping again.
In the centre of the ward Bell, a tall, broad-built New Zealander, gives little trouble tonight. For the past three days he has been expected to die from septicaemia and the medical specialist, noting that his mind was wandering, his condition at times comatose, said he could not last. Yet, tonight he looks much more cheerful and is chatting pleasantly as his blood transfusion passes into his vein.
At about 11.30 p.m. a new patient is carried in straight from the operating table, a major accidentally wounded by a grenade. His injuries are very bad indeed. His right arm has been amputated, his left thumb also, his right eye removed, his left arm fractured and he has a 'sucking' wound in the chest. I am hoping that he will not live to know his injuries.
He is still under the anaesthetic when Jones is brought back. His left arm has been amputated above the elbow in an attempt to eliminate the gangrene from entering the remainder of his body. His pulse is weak, the rate 126.
The major is now coming round from the operation and in his struggles needs two to control. He is pulling at the plasma drip passing into his right foot. He is very much shocked, is speaking unintelligibly and fast, in spasms. He is. so restless that O----has to sit on his knee to keep the canula in place.
We try to restrain his struggling, but the great pain he is suffering makes him almost uncontrollable. He continues rambling " Oh God --- the river!---look out, Tom! --- Christ ! --- yes, all right --- take it easy ---look out --- only a subaltern --- to the river -- - yes, must be quiet -- no don't. Tom, don't --- I can't make it---Christ --- the river!---."
He is so restless that we give him a quarter grain of morphine. Its effects do not last long, but in one short period he speaks sanely, saying "What's the sum total of all this? I've lost the best part of my arm, my eye has gone and one leg too."
We tell him that he has both legs, but he quickly lapses into incoherent speech, his respirations rise to 58 per minute. His pulse is imperceptible at wrist, temple and throat. I take an apex beat - 146.
His plasma drip is working very well, without once stopping, although it is still almost impossible to restrain his legs from dragging at the canula.
It becomes obvious that he cannot survive if he continues to expend his energy struggling.
At about 2 a.m. he half rises, vomits a stream of blood and dies. His insupportable pain is finished. We lay him out, wiping the wounds, applying clean bandages, detaching the plasma drip and covering him with a blanket. Since the tent is now lighted only by hurricane lamps, the other patients do not realise what we are doing. We remove him at first light.
Meanwhile Jones' breathing is becoming irregular. We give him oxygen at 6 a.m. and continue this treatment at short intervals until 8 a.m., when we hand over to the day staff.
Each night is about as busy as the one just described. Part of the difficulty is that, although a generator supplies rather poor light for part of the night, it frequently fails towards midnight, when we have five hurricane lamps between, on average, eight patients.
One night there were twelve seriously wounded men, six of whom were on transfusion for the whole night . In addition there were stomach lavages to complete and other wounded men who required constant attention.
Tribute is due here to the FSU (Field Surgical Unit) whose work saves many lives. It cannot be risked as close to the battle line as RAPs and ADSs. This unit is generally attached to Main Dressing Stations, where night and day they perform emergency operations.
From the outset, when they joined us, the FSU took the worst casualties, chiefly those with abdominal wounds, perforations of the chest, those needing major operations and others with extensive wounds to the muscles where gangrene was to be feared.
One day the FSU surgeons decided to evacuate four very serious cases to the CCS (Casualty Clearing Station) by an ambulance travelling most of the distance in low gear, with frequent stops on the way. This trial run proved a complete success and we were told that in future our ward would be used solely for post-operative patients who were not expected to live. Thus, in the past four days, there have been three deaths.
Cairns, who had been kept alive for a week on glucose saline and stomach suction drainage, died early one morning from penetrating abdominal wounds. An Italian with a bullet lodged near the heart lasted only a few hours, and a French Canadian died on the last night of our duty. His case was particularly harrowing because the day staff and FSU surgeon believed that the man was causing unnecessary trouble. He was extremely restless and spoke continuously about his ailments. This was unusual in a ward where the wounded lay quietly for the most part.
At 8 p.m. we found this man, Jardine, so uncomfortable, his right leg fastened in a Thomas' splint, his right arm in plaster of Paris, that we could not deal with him satisfactorily. He asked for bedpan and bottle so often, without being a able to use either, that it was decided to catheterise him. We attempted this four times within an hour without any success.
We gave morphine without much result and soon he was tearing off his hand bandages. The surgeon thought that Jardine's ureters might have been crushed by blast. He added that nothing could be done, but at about 2.30 a.m., when Jardine's condition was now critical, the surgeon decided to examine the leg. As soon as he began to remove the bandages we smelled the unmistakable, gas gangrene. With great difficulty we removed the Thomas' splint from his swollen limb and passed glucose saline into the vein of the other leg Strangely, the gangrene had travelled down the leg and the surgeon considered that immediate amputation might save the man's life.
Before 4.30 a.m. we had transferred him to the operating tent and had returned to the ward.. At 5 a.m. we carried his body to the makeshift mortuary. Jardine had died before the operation. A quick post mortem examination revealed that Jardine's ureters had in fact been crushed.
The unit was pulled out for a six day rest in Capua. April '44.

© Copyright of content contributed to this Archive rests with the author. Find out how you can use this.