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Diagnosis of
Endometrial Biopsies
and Curettings
A Practical Approach
Tricia A. Murdock
Emanuela F. T. Veras
Robert J. Kurman
Michael T. Mazur
Third Edition
123
Diagnosis of Endometrial Biopsies
and Curettings
Tricia A. Murdock • Emanuela F. T. Veras
Robert J. Kurman • Michael T. Mazur
Diagnosis of
Endometrial Biopsies
and Curettings
A Practical Approach
Third Edition
Tricia A. Murdock Emanuela F. T. Veras
Department of Pathology Department of Pathology
The Johns Hopkins Hospital The Johns Hopkins Hospital
Baltimore, MD Baltimore, MD
USA USA
Robert J. Kurman Michael T. Mazur

Department of Pathology Department of Pathology and
The Johns Hopkins Hospital Laboratory Medicine, State University
Baltimore, MD of New York Upstate Medical University
USA Syracuse, NY
USA
ISBN 978-3-319-98607-4 ISBN 978-3-319-98608-1 (eBook)

https://doi.org/10.1007/978-3-319-98608-1
Library of Congress Control Number: 2018960871
© Springer Nature Switzerland AG 2019

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
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Preface
The third edition of Diagnosis of Endometrial Biopsies and Curettings: A

Practical Approach developed from positive comments received from the
second edition and recognition that several topics have advanced since the
last publication. The emphasis of this book is to provide a foundation for a
daily, pragmatic approach for common entities found in endometrial samples.
Our understanding of endometrial pathology has evolved, and clinical termi-
nology accompanying these specimens also has changed. Therefore, the
entire text has been updated; all illustrations are now in color.
As with the first two editions, the focus of this book is to assist the patholo-
gist in the routine evaluation of endometrial tissue specimens. The book is not
intended to be an all-encompassing text of endometrial pathology but to
guide the pathologist through the more common diagnoses such as artifacts,
benign entities, precursor lesions, and neoplasia. We recognize that for cer-
tain areas, such as precursors of endometrial cancer, there is ongoing debate
and study regarding the terminology for these lesions. Different investigators
and practitioners prefer different terminologies (hyperplasia/atypical hyper-
plasia versus hyperplasia/endometrial intraepithelial neoplasia [EIN]), and
we therefore attempt to provide a balanced discussion of both so readers can
decide which they prefer. For the majority of the text, the terminology and
classification schemes mirror the most recent edition (2014) of the WHO
Classification of Tumors of Female Reproductive Organs in an effort to pro-
mote uniform and comprehensive communication with our clinical col-
leagues as ultimately this is the most important role of the diagnostic surgical
pathologist.
In the second edition, immunohistochemistry (IHC) was largely discussed
in the final chapter on methodology, but as its use in diagnosis has greatly
expanded, the current edition incorporates IHC into each of the individual
chapters. Furthermore, IHC now has an important role as a surrogate marker
of genetic aberrations, knowledge of which is becoming increasingly impor-
tant for diagnostic and therapeutic purposes. For example, the use of fumarate
hydratase staining to detect fumarate hydratase-deficient leiomyomas can
lead to the recognition of the hereditary leiomyomatosis and renal cell carci-
noma syndrome.
Although molecular diagnostics currently are infrequently used in routine
evaluation of endometrial specimens, pathologists need to be familiar with
the advances in molecular genetics as this is transforming our understanding
of many of the pathologic conditions that can be found in endometrial
v
vi Preface
s amples. For example, the classification of endometrial stromal tumors has

been modified based on fluorescence in situ hybridization and targeted RNA
sequencing that have demonstrated different types of high-grade endometrial
stromal sarcomas depending on their molecular genetic features. Another
example is that through molecular genotyping, we are now able to defini-
tively diagnose partial hydatidiform moles, whereas in the past morphologi-
cal, immunohistochemical, and cytogenetic studies were insufficiently
reliable to make a definitive diagnosis.
In summary, we hope that this new edition continues to be a foundation for
the diagnosis of endometrial specimens with a strong emphasis on the impor-
tant morphologic features and that this will be useful to pathologists and
gynecologists.
Baltimore, MD, USA Tricia A. Murdock

Baltimore, MD, USA Emanuela F. T. Veras
Baltimore, MD, USA Robert J. Kurman
Syracuse, NY, USA Michael T. Mazur
Acknowledgments
We are grateful to Norman Barker, a friend and colleague, who provided his
expertise in the field of medical illustration and tirelessly assisted us with the
images depicted in this edition. We are also grateful to Dr. Lora Ellenson,
another good friend and esteemed colleague, for generously supplying
updated information that helped enrich the contents of this book.
vii
Contents
1 Introduction�� 1
Indications for Biopsy�� 1
Clinical History and Biopsy Interpretation�� 2
Abnormal Uterine Bleeding�� 2
Infertility Biopsy�� 4
Products of Conception�� 4
Hormone Therapy�� 4
Other Considerations �� 5
Clinical Queries and Reporting�� 5
References�� 6
2 The Normal Endometrium�� 9
General Considerations in Histologic Evaluation�� 10
Histologic Features of Normal Cycling Endometrium�� 13
Proliferative Phase �� 13
Secretory Phase�� 16
Menstrual Endometrium�� 20
Pitfalls in The Histologic Assessment
of The Normal Endometrium�� 21
Sample Adequacy and Standardized Reporting �� 24
Artifacts and Contaminants�� 27
Irregular Secretory Endometrium�� 31
References�� 35
3 Pregnancy, Abortion, and Ectopic Pregnancy�� 39
Endometrial Glands and Stroma in Pregnancy�� 40
Early Gestational Endometrium (1–3 Weeks
Postfertilization)�� 40
Endometrium in Later Pregnancy (4 or More Weeks
Postfertilization)�� 41
Arias-Stella Reaction �� 45
Other Glandular Changes in Pregnancy�� 47
Trophoblast and Villi�� 49
Trophoblastic Cells�� 49
Immunohistochemistry of Trophoblastic Cells�� 51
Placental Implantation Site�� 53
Chorionic Villi and Villous Trophoblast in the First Trimester�� 57
ix
x Contents
Hydropic Change and Other Pathologic Changes

in Abortions�� 59
Chorionic Villi and Villous Trophoblast After
the First Trimester�� 62
Placental Polyps �� 63
Placenta Accreta�� 63
Endometrium Associated with Ectopic Pregnancy�� 64
References�� 71
4 Gestational Trophoblastic Disease�� 75
Hydatidiform Mole�� 76
General Features�� 76
Complete Hydatidiform Mole�� 76
Partial Hydatidiform Mole�� 81
Cytogenetics�� 83
Differential Diagnosis�� 85
Abnormal (Non-molar) Villous Lesions�� 90
Other Considerations �� 91
Persistent Postmolar Gestational Trophoblastic Disease
and Invasive Hydatidiform Mole �� 91
Clinical Queries and Reporting of Hydatidiform Mole �� 93
Gestational Trophoblastic Neoplasms�� 94
Choriocarcinoma�� 94
Placental Site Trophoblastic Tumor �� 100
Epithelioid Trophoblastic Tumor �� 107
Nonneoplastic Lesions �� 110
Exaggerated Placental Site�� 110
Placental Site Nodule and Plaque�� 111
Clinical Queries and Reporting of Trophoblastic Neoplasms�� 112
References�� 113
5 Abnormal Uterine Bleeding�� 121
Morphologic Features of Glandular and Stromal Breakdown
in Menstrual and Abnormal Bleeding�� 122
Abnormal Uterine Bleeding: Nonstructural Causes�� 126
Estrogen-Related Bleeding�� 129
Proliferative Endometrium with Glandular
and Stromal Breakdown�� 129
Disordered Proliferative Endometrium
and Persistent Proliferative Phase�� 132
Atrophy�� 133
Progesterone-Related Bleeding�� 135
Irregular Secretory Endometrium�� 136
Irregular Shedding �� 137
Abnormal Secretory Endometrium with Breakdown
of Unknown Etiology�� 138
Contents xi
6 Effects of Hormones�� 145

Estrogenic Hormones�� 146
Progestins, Oral Contraceptives, and Selective
Progesterone Receptor Modulators�� 146
Patterns of Response�� 148
Decidual Pattern�� 148
Secretory Pattern�� 149
Inactive Pattern�� 150
Other Stromal Changes�� 151
Combined Estrogen and Progestin as Replacement Therapy
for Menopausal Women �� 153
Progestin-Like Effects with No Hormone Use�� 154
Effects of Other Hormones�� 155
Selective Progesterone Receptor Modulators�� 155
Tamoxifen�� 156
Raloxifene�� 160
Clomiphene Citrate�� 160
Danazol�� 161
Human Menopausal Gonadotropins/Human
Chorionic Gonadotropin�� 162
Gonadotropin-Releasing Hormone Agonists �� 162
Antiprogestin RU486 �� 162
Postmenopausal Hormone Replacement�� 163
Abnormal Uterine Bleeding�� 163
Treatment of Hyperplasia and Endometrioid Carcinoma�� 164
Infertility Therapy�� 165
7 Endometritis �� 173
Nonspecific Endometritis�� 174
Inflammatory Cells�� 174
Stromal Changes�� 177
Abnormal Glandular Development�� 178
Epithelial Changes �� 178
Glandular and Stromal Breakdown�� 179
Specific Infections�� 179
Granulomatous Inflammation�� 180
Actinomycosis�� 182
Cytomegalovirus�� 183
Herpesvirus�� 184
Mycoplasma�� 185
8 Polyps�� 199
Classification and Histologic Features�� 200
Common Polyps�� 205
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xii Contents
Proliferative/Hyperplastic Pattern�� 205

Atrophic Pattern �� 206
Functional Pattern�� 206
Mixed Endometrial–Endocervical Pattern �� 206
Adenomyomatous Pattern�� 207
Atypical Polypoid Adenomyoma (APA)�� 207
Adhesions�� 215
9 Precursors of Endometrial Carcinoma�� 225
Endometrial Hyperplasia/Atypical Hyperplasia�� 225
Behavior �� 240
Epithelial Cytoplasmic Change (Metaplasia)�� 241
Serous Endometrial Intraepithelial Carcinoma�� 251
Behavior �� 254
10 Endometrial Carcinoma�� 261
Classification of Endometrial Carcinoma�� 262
Important Issues in Interpretation of Biopsies �� 264
Criteria for the Diagnosis of Well-Differentiated
Endometrioid Carcinoma �� 264
Confluent Gland Pattern�� 264
Altered Fibrous or Desmoplastic Stroma�� 265
Extensive Papillary Pattern�� 265
Malignant Neoplasms: Classification, Grading, and Staging
of the Tumor�� 267
Classification�� 267
Grading�� 269
Clinically Important Histologic Subtypes�� 274
Typical (Endometrioid) Carcinoma �� 274
Carcinoma with Squamous Differentiation�� 278
Mucinous Carcinoma �� 281
Microglandular (Endocervical-Like)
Endometrial Carcinoma �� 283
Hereditary Syndromes �� 285
Hereditary Nonpolyposis Colorectal Cancer
(Lynch Syndrome) �� 285
Cowden Syndrome�� 288
Histologic Effects After Progestin Therapy �� 289
Serous Carcinoma�� 290
Clear Cell Carcinoma�� 295
Rare Histologic Subtypes�� 297
Contents xiii
Carcinosarcoma�� 301
Differential Diagnosis of Carcinosarcoma�� 305
Staging �� 309
Endometrial Versus Endocervical Carcinoma�� 310
Metastatic Carcinoma�� 317
Carcinoma Mimics�� 318
11 Mesenchymal Tumors and Other Rare Neoplasms�� 333
Smooth Muscle Tumors �� 333
Leiomyomas�� 333
Variants of Leiomyoma�� 334
Smooth Muscle Tumor of Uncertain Malignant Potential�� 335
Leiomyosarcoma�� 336
Tumorlets �� 337
Miscellaneous Mesenchymal Tumors�� 339
Perivascular Epithelioid Cell Tumor�� 339
Stromal Tumors�� 340
Endometrial Stromal Nodule and Low-Grade Endometrial
Stromal Sarcoma�� 341
High-Grade Endometrial Stromal Sarcoma �� 344
Undifferentiated Uterine Sarcoma �� 345
Uterine Tumors Resembling Ovarian Sex Cord Tumors �� 347
Mixed Epithelial and Mesenchymal Tumors �� 347
Adenofibroma and Adenosarcoma�� 347
Pathologic Features�� 347
Immunohistochemical Analysis �� 349
Molecular Analysis�� 350
Rare Neoplasms �� 351
Inflammatory Myofibroblastic Tumor�� 351
Lymphoma and Leukemia�� 351
Miscellaneous Tumors �� 352
Other Lesions and Tumor-Like Conditions �� 353
12 Methods of Endometrial Evaluation�� 363
Endometrial Sampling Techniques�� 363
Endometrial Biopsy �� 363
Dilation and Curettage �� 364
Hysteroscopy and Curettage�� 364
Other Aspiration Devices �� 365
Endometrial Imaging Studies�� 365
xiv Contents
Ultrasound�� 365
Magnetic Resonance Imaging�� 366
Histologic Techniques�� 366
Frozen Section �� 367
Index�� 373
Introduction
1
Contents
Indications for Biopsy 1
Clinical History and Biopsy Interpretation 2
Clinical Queries and Reporting 5
References 6
Endometrial biopsies and curettings are among the tion of any pathologic specimen, proper
most common tissue specimens received in the interpretation requires appropriate fixation, pro-
pathology laboratory. In several respects, these cessing, and sectioning of the tissue.
specimens present a unique challenge for the sur-
gical pathologist. The normal endometrium under-
goes a variety of morphologic changes, especially Indications for Biopsy
during the reproductive years, when cyclical hor-
monal influences and pregnancy affect uterine There are four main indications for endometrial
growth. Biopsy-induced artifacts confound this biopsy or curettage [5–9]:
heterogeneous group of morphologic changes.
Endometrial sampling techniques can vary from 1. Determination of the cause of abnormal uter-
hysteroscopy with curettage, which is considered ine bleeding
the “gold standard” [1–4], to a “blind” biopsy with 2. Evaluation of the status of the endometrium in
no visualization of the tissue sampled. The final infertile patients
specimen contains multiple, irregularly oriented 3. Evacuation of products of conception, either
tissue fragments mixed with blood and contami- spontaneous abortions, termination of preg-
nating cervical tissue and mucus. nancy, or retained tissue
Interpreting the biopsy material demands a 4. Assessment of the response of the endome-
logical approach that takes into account many trium to hormonal therapy, especially estrogen
factors, including patient history, the specific replacement in perimenopausal and postmeno-
requests of the clinician performing the biopsy, pausal women, progestin therapy in reproduc-
and an appreciation of the limitations, potential tive age women for treatment of endometrial
pitfalls, and complex array of patterns encoun- hyperplasia or endometrioid carcinoma, and
tered in the microscopic sections. As in evalua- tamoxifen therapy for breast cancer
© Springer Nature Switzerland AG 2019 1

T. A. Murdock et al., Diagnosis of Endometrial Biopsies and Curettings,
https://doi.org/10.1007/978-3-319-98608-1_1
2 1 Introduction
Other indications for biopsy may arise. An linical History and Biopsy
C
occasional patient will have atypical or abnor- Interpretation
mal glandular cells of undetermined signifi-
cance (AGUS) in a cervical–vaginal cytologic Abnormal Uterine Bleeding
specimen that requires endometrial sampling to
exclude hyperplasia or carcinoma. Uterine The most common reason for performing an
screening with transvaginal ultrasound can endometrial biopsy is abnormal uterine bleeding
show a thickened endometrial stripe in post- (AUB). Because of the inconsistent nomenclature
menopausal patients, and a biopsy can be per- used to describe variations of abnormal bleed-
formed to exclude significant pathology ing, the International Federation of Gynecology
[10–12]. Some clinicians sample the endome- and Obstetrics (FIGO) developed a classification
trium prior to hysterectomy to exclude signifi- system. Categorization is based on the acronym
cant pathology, although this procedure reveals PALM-COEIN (polyps, adenomyosis, leiomy-
little pathology in the absence of a history of oma, malignancy and hyperplasia – coagulopathy,
abnormal bleeding [13, 14]. Likewise, endome- ovulatory dysfunction, endometrial, iatrogenic,
trial biopsy for screening of endometrial cancer and not yet specified) and is used for AUB in non-
or precursor lesions in asymptomatic perimeno- gravid women of reproductive age. The first four
pausal and postmenopausal patients has a very terms are structural lesions, i.e., specific lesions.
low yield of significant abnormalities and is not The latter five (COEIN) are used to describe causes
cost-effective [15–17]. that are not defined by imaging or histopathology
At times, these indications for endometrial and were previously under the term dysfunctional
sampling overlap. For example, some compli- uterine bleeding (DUB) [18]. Abnormal uterine
cations of pregnancy, such as a missed abor- bleeding can be a sign of one or multiple uterine
tion or trophoblastic disease, are accompanied disorders ranging from nonstructural abnormalities
by abnormal uterine bleeding. Nonetheless, to structural lesions such as polyps, hyperplasia, or
these broad categories provide a clinicopatho- carcinoma [8, 11, 18–22]. For the FIGO classifica-
logic framework for approaching the micro- tion system, if the AUB is attributed to polyps, the
scopic analysis of endometrial biopsy patient chart would then read “AUB-P”; if a patient
specimens. The text has therefore been divided had multiple causes, such as a submucosal leiomy-
into chapters that correspond to these clinical oma and a coagulopathy, AUB-L(SM), C would be
indications. an acceptable term (Table 1.1).
Table 1.1 Clinical terms for abnormal uterine bleeding (AUB)

Abnormal uterine bleeding Abnormal uterine bleeding caused by structural lesions
(AUB) (PALM) Polyps (AUB-P)
Adenomyosis (AUB-A)
Leiomyoma (AUB-L)
Malignancy and hyperplasia (AUB-M)
Abnormal uterine bleeding Abnormal uterine bleeding with no structural cause
(AUB) (COEIN) Coagulopathies (AUB-C)
Abnormalities in ovulation (AUB-O)
Primary disorders of the endometrium (AUB-E)
Iatrogenic (AUB-I)
Other causes not yet specified (AUB-N)
Acute AUB Nongravid, reproductive-aged women with bleeding of sufficient quantity to
require immediate intervention to prevent further blood loss [18, 23]
Chronic AUB Bleeding that is abnormal in duration, volume, and/or frequency and has been
present for the majority of the last 6 months [18, 23]
Clinical History and Biopsy Interpretation 3
Age and menstrual/menopausal status are Table 1.3 Causes of abnormal uterine bleeding in peri-
menopausal years
especially important data to include in the pathol-
ogy requisition, as causes of abnormal uterine Common Uncommon
bleeding vary significantly according to parame- Ovulatory dysfunction Coagulopathies
Structural lesions Endometritis
ters, as discussed later. The prevalence of the
Hyperplasia Sarcoma
various abnormalities that lead to abnormal
Polyps (endometrial, Complications of
bleeding is difficult to determine precisely, vary- endocervical) pregnancya
ing with the patient population and the previous Iatrogenic
terms used by investigators [5–7]. The nomencla- Birth control
ture to describe menstrual bleeding related to Estrogen replacement
regularity or frequency of onset, duration, and Progestin therapy
heaviness (volume) of menstrual flow has been See Chap. 3 (Complications of pregnancy)
a
reclassified as well, and terms such as menorrha-

gia and menometrorrhagia have been largely patients [25, 32–34]. One consistent observation
abandoned. A practical approach to the possible in studies of postmenopausal patients is that atro-
diagnoses associated with abnormal bleeding phy is a common cause of abnormal bleeding,
takes age into account (Tables 1.2 and 1.3). In being found in 25% or more of cases [25, 26, 28,
adolescence, AUB may be secondary to ovula- 31, 33, 35, 36].
tory dysfunction, pregnancy, exogenous hormone There are a few exceptions where younger, pre-
administration, or coagulopathies. Pregnancy- menopausal women are at higher risk for endome-
related and nonstructural entities are more com- trial hyperplasia and carcinoma. Premenopausal
mon in younger patients, whereas atrophy and women (<45 years of age) with AUB and a body
structural lesions become more frequent in older mass index >30 kg/m2 are four times more likely
individuals [24]. Polyps in perimenopausal and to develop endometrial hyperplasia or carcinoma
postmenopausal patients have been found in than premenopausal women with a normal body
2–26% of patients [25–33] with a mean age of mass index [37]. Hereditary cancer syndromes
45.8 [34]. Hyperplasia is found in up to 16% of including Lynch, Cowden, Peutz-Jeghers, and
postmenopausal patients undergoing biopsy and Li-Fraumeni all have an elevated risk for endome-
endometrial carcinoma in fewer than 10% of trial cancer [38–41]. For Lynch syndrome, one
surveillance strategy is for annual transvaginal
ultrasound and/or endometrial sampling, followed
Table 1.2 Causes of abnormal uterine bleeding in the by risk-reducing hysterectomy upon completion
reproductive years
of childbearing [42]. In women aged 30–35 years
Common Uncommon
with Cowden syndrome, consideration for annual
Endometritis Neoplasia
transvaginal ultrasound and endometrial sampling
Complications of Endometrial
pregnancya carcinoma with a discussion of hysterectomy following
Ovulatory dysfunction Cervical carcinoma childbearing is a potential surveillance and risk
Anovulatory cycles Hyperplasia reduction strategy, respectively [42]. In addition
Inadequate luteal phase Coagulopathies to endometrial cancer, women with Peutz-Jeghers
Irregular shedding syndrome have a risk of developing sex cord

Structural lesions tumor with annular tubules (SCTAT) of the ovary
Leiomyomas and minimal deviation adenocarcinoma of the
Polyps (endometrial,
cervix [41]. Because of the additional ovarian and
endocervical)
Adenomyosis cervical cancer risk, an annual pelvic exam with
Iatrogenic Pap smear starting at age 18–20 years and consid-
Birth control eration of an annual transvaginal ultrasound is a
Progestin therapy reasonable surveillance approach. There are no
a
See Chap. 3 (Complications of pregnancy) clear surveillance recommendations for
4 1 Introduction
Table 1.4 Causes of abnormal uterine bleeding in post- Infertility Biopsy

menopausal years
Common Uncommon When a patient undergoes biopsy for evaluation of
Atrophy Endometritis infertility, the clinical information often is limited,
Structural lesions Sarcoma
but here, too, the history should include the date of
Hyperplasia Coagulopathies
the last menstrual period (LMP) to place an approx-
Polyps (endometrial)
Neoplasia imate time in the menstrual cycle. This information
Endometrial carcinoma is useful but not precise for determining the actual
Exogenous hormones day of the cycle, as ovulatory frequency and length
Estrogen replacement of the follicular phase are highly variable among
Progestin therapy patients. Usually the main objective of biopsies for
infertility is to determine whether there is morpho-
logic evidence of ovulation, i.e., secretory change
Li-Fraumeni syndrome and no clear risk reduc- (see Chap. 2). The gynecologist may seek other
tion strategies for Peutz-Jeghers or Li-Fraumeni specific information, such as response to hormone
syndromes [42]. therapy, so it is important that the pathologist be
Even among perimenopausal and postmeno- given any additional history that may be necessary
pausal patients, the proportion of cases attributable for the interpretation.
to any of the aforementioned conditions is age
dependent (Table 1.4). Atrophy and carcinoma
occur more frequently in patients older than Products of Conception
60 years of age, while polyps and hyperplasia are
more common in patients who are perimenopausal When endometrial sampling is performed to remove
or more recently postmenopausal. In addition to products of conception, clinical information often is
these uterine causes of bleeding, other abnormali- sparse, as the main goal of the p rocedure is simply
ties, such as genitourinary syndrome of menopause, to remove the placental and fetal tissue. Significant
can cause vaginal bleeding, and this may be difficult pathologic changes are rare. Nonetheless, it is help-
to distinguish from uterine bleeding until the patient ful to know if pregnancy is suspected, and, if so, the
undergoes thorough clinical evaluation. approximate gestational age of the pregnancy. If
A history of anovulation, obesity, hyperten- there is a suspicion of trophoblastic disease, this
sion, diabetes, and exogenous estrogen use should be stated. In such instances, the serum
should alert the pathologist that the patient is at human chorionic gonadotropin (hCG) titer is very
increased risk for hyperplasia and endometrioid important. If an ectopic pregnancy is suspected,
carcinoma, but this information is rarely included alerting the pathologist can ensure rapid processing
on the requisition. Typically, there is little and interpretation of the specimen.
accompanying clinical data except the patient’s
age and a short history of abnormal bleeding.
Consequently, hyperplasia and adenocarcinoma Hormone Therapy
must be diagnostic considerations for most
endometrial specimens received in the labora- Because the endometrium is responsive to hor-
tory. On rare occasions, hyperplasia or even ade- mones, the history of hormone use is important
nocarcinoma is found in biopsies performed information. Clinical uses of steroid hormones
during an infertility workup [28]. It should be (estrogens, progestins, or both) include oral, subcu-
kept in mind that women with unexplained infer- taneous or vaginal contraception methods, proges-
tility or diagnosed with polycystic ovarian syn- tin-releasing intrauterine devices, postmenopausal
drome (PCOS) at a young age are at risk of replacement therapy, and therapy for endometrio-
endometrial cancer [43, 44]. sis, infertility, hyperplasia, and endometrial endo-
metrioid or breast carcinoma. As with other facets
of the clinical data, this information may be absent Clinical Queries and Reporting
or, if present, unreadable on the requisition (in
which case the gynecologist should be contacted). Diagnostic terms such as “no pathologic diagno-
Consequently, the pathologist must be prepared to sis” or “no significant pathologic findings” are
recognize hormonal effects in the absence of his- unacceptable as there is a wide range of normal
tory indicating the use of hormones (see Chap. 6 – histology. When the tissue lacks abnormalities,
Effects of Hormones). stating the normal phase of the endometrium, for
example, menstrual, proliferative, or secretory,
provides useful information for the clinician.
Other Considerations In biopsies for abnormal uterine bleeding, the
pathologic information sought varies with the
Pregnancy history is useful, especially in pre- patient’s age and clinical history. The gynecolo-
menopausal patients, regardless of the indication gist wishes to know the following:
for biopsy, as recent and remote effects of preg-
nancy, such as a placental site nodule or gesta- 1. Is there an organic or structural lesion, such as
tional trophoblastic disease, may be encountered a complication of pregnancy, inflammation, or
in biopsy material. The history of recent or past a polyp?
pregnancies is expressed as gravidity and parity. 2. Is there evidence of active or old breakdown
The letter G (gravidity) followed by a number and bleeding?
(G1, G2, etc.) indicates the number of pregnan- 3. Is there evidence to suggest abnormalities in
cies, and the letter P (parity) followed by a num- ovulation?
ber indicates the number of deliveries. For 4. Is there evidence of hyperplasia or carcinoma?
example, G4, P2 indicates that a woman has had
four pregnancies and two deliveries. Further For example, in young premenopausal patients
information on parity often is designated by four with a normal BMI, the possibility of pregnancy
numbers indicating full-term pregnancies, prema- and related bleeding is a frequent question. In a
ture pregnancies (>20 but <37 weeks’ gestation), perimenopausal patient, the concern shifts to
abortions (<20 weeks’ gestation), and living chil- hyperplasia and carcinoma, and in postmeno-
dren. Thus a patient who is G5, P3013 is currently pausal patients, the importance of ruling out car-
pregnant and has had three previous full-term cinoma becomes paramount. In any of these
pregnancies and one abortion, and the three chil- conditions, glandular and stromal breakdown
dren from the term pregnancies are alive. may be present either focally or diffusely. It is the
The type of procedure, that is, biopsy versus underlying disorder that is most important to
curettage, is important for deciding whether focal report. The changes of breakdown and bleeding
changes represent significant abnormalities or are secondary and do not indicate a primary dis-
whether small specimens are adequate (see Chap. order by themselves. Nonetheless, when there is
12 Methods of Endometrial Evaluation). Although a history of abnormal bleeding, it can be helpful
office-based biopsies generally provide a repre- to note whether there is histologic evidence of
sentative sample, they may not contain sufficient glandular and stromal breakdown (see Chap. 5),
tissue to ensure that the endometrium has been especially if the tissue lacks evidence of an
adequately sampled. For example, the irregular organic process such as hyperplasia or carci-
glands of hyperplasia may resemble patterns seen noma. This information serves to document to
in some polyps, low-grade adenocarcinomas, and the gynecologist that bleeding is, in fact, endo-
even artifactually distorted normal endometrium. metrial in origin. Even when there is no evidence
Furthermore, atypia can be focal in hyperplasia; of active bleeding, foci of stromal foam cells or
therefore, biopsy specimens may preclude a defin- hemosiderin, sometimes with fibrosis, indicate
itive diagnosis. In these cases, a more thorough that abnormal bleeding has taken place and
biopsy or curettage is necessary. deserve comment.
6 1 Introduction
Besides reporting the morphologic changes tematic review and meta-analysis. Obstet Gynecol.
2017;130:803–13.
present, noting significant negative findings can 3. Gkrozou F, Dimakopoulos G, Vrekoussis T,
be helpful to the clinician. As an example, the Lavasidis L, Koutlas A, Navrozoglou I, Stefos T,
diagnosis of chronic endometritis is more helpful Paschopoulos M. Hysteroscopy in women with
if it includes a comment regarding the presence abnormal uterine bleeding: a meta-analysis on four
major endometrial pathologies. Arch Gynecol Obstet.
or absence of specific etiologic factors such as 2015;291:1347–54.
evidence of a recent pregnancy. Likewise, if an 4. Svirsky R, Smorgick N, Rozowski U, Sagiv R,
structural lesion such as a polyp is present, it is Feingold M, Halperin R, Pansky M. Can we rely
helpful to indicate whether noninvolved tissue is on blind endometrial biopsy for detection of focal
intrauterine pathology? Am J Obstet Gynecol.
present and, if so, its appearance. In perimeno- 2008;199:115.e1–3.
pausal and postmenopausal patients, if the gyne- 5. Baitlon D, Hadley JO. Endometrial biopsy. Pathologic
cologist indicates a specific concern regarding findings in 3,600 biopsies from selected patients. Am
the presence of hyperplasia, atypia, or carcinoma, J Clin Pathol. 1975;63:9–15.
6. Nickelsen C. Diagnostic and curative value of
then a statement noting the absence of these uterine curettage. Acta Obstet Gynecol Scand.
lesions is reassuring. 1986;65:693–7.
For all cases, specimen adequacy is a consid- 7. Van Bogaert LJ, Maldague P, Staquet JP. Endometrial
eration, but this needs to be specifically addressed biopsy interpretation. Shortcomings and problems
in current gynecologic practice. Obstet Gynecol.
only in limited samples in which the diagnosis is 1978;51:25–8.
not clear-cut. Scant tissue obtained by an office- 8. Galle PC, McRae MA. Abnormal uterine bleed-
based biopsy may be insufficient to allow thor- ing. Finding and treating the cause. Postgrad Med.
ough assessment of the status of the endometrium. 1993;93:73–6. 80–81
9. Merrill JA. The interpretation of endometrial biop-
In these cases, the pathologist should indicate in sies. Clin Obstet Gynecol. 1991;34:211–21.
the report that the specimen is scant. For instance, 10. Goldstein RB, Bree RL, Benson CB, Benacerraf BR,
small samples may reveal hyperplastic glands, Bloss JD, Carlos R, Fleischer AC, Goldstein SR, Hunt
but it may be difficult to determine whether the RB, Kurman RJ, Kurtz AB, Laing FC, Parsons AK,
Smith-Bindman R, Walker J. Evaluation of the woman
abnormality represents a localized polyp with a with postmenopausal bleeding: society of Radiologists
proliferative/hyperplastic pattern (see Chap. 8) or in ultrasound-sponsored consensus conference state-
a diffuse hyperplasia. Some assessment of the ment. J Ultrasound Med. 2001;20:1025–36.
endometrium can be done even on very limited 11. Patel V, Wilkinson EJ, Chamala S, Lu X, Castagno
J, Rush D. Endometrial thickness as measured
specimens, for example, noting whether the by transvaginal ultrasound and the correspond-
endometrium is proliferative or secretory phase. ing histopathologic diagnosis in women with
Atrophic endometrium typically yields a very postmenopausal bleeding. Int J Gynecol Pathol.
small amount of tissue, yet these specimens 2017;36:348–55.
12. Fleischer A, Abramowicz J, Goncalves L, Manning F,
should not be regarded as inadequate (see Chap. Monteagudo A, Timor I, Toy E, editors. Sonographic
5). The subsequent chapters consider in greater techniques for early detection of ovarian and endo-
detail the queries likely to arise in various cir- metrial cancers. Fleischer’s sonography in obstetrics
cumstances and the information that the patholo- and gynecology. 8th ed. New York: McGraw Hill
Education; 2018.
gist should incorporate in the final report. 13. Stovall TG, Solomon SK, Ling FW. Endometrial
sampling prior to hysterectomy. Obstet Gynecol.
1989;73:405–9.
References 14. Ramm O, Gleason JL, Segal S, Antosh DD, Kenton
KS. Utility of preoperative endometrial assess-
ment in asymptomatic women undergoing hysterec-
1. Clark TJ, Voit D, Gupta JK, Hyde C, Song F, Khan
tomy for pelvic floor dysfunction. Int Urogynecol J.
KS. Accuracy of hysteroscopy in the diagnosis of
2012;23:913–7.
endometrial cancer and hyperplasia: a systematic
15. Archer DF, McIntyre-Seltman K, Wilborn WW,
quantitative review. JAMA. 2002;288:1610–21.
Dowling EA, Cone F, Creasy GW, Kafrissen
2. Visser NCM, Reijnen C, Massuger LFAG, Nagtegaal
ME. Endometrial morphology in asymptomatic
ID, Bulten J, Pijnenborg JMA. Accuracy of endo-
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metrial sampling in endometrial carcinoma: a sys-
1991;165:317–20. discussion 320–322.
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patients without vaginal bleeding. Int J Gynaecol pathology in women with abnormal uterine bleeding:
Obstet. 2016;132:314–7. a prospective study of 1220 women. Facts Views Vis
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Patel DA, Xu X. Cost-effectiveness of endometrial 34. Ricciardi E, Vecchione A, Marci R, Schimberni
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18. Munro MG, Critchley HOD, Broder MS, Fraser polyps. Analysis of 1027 cases. Eur J Obstet Gynecol
IS. FIGO working group on menstrual disorders: FIGO Reprod Biol. 2014;183:121–4.
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19. Goldfarb JM, Little AB. Current concepts: abnormal 36. Gambrell RD. Postmenopausal bleeding. J Am Geriatr
vaginal bleeding. N Engl J Med. 1980;302:666–9. Soc. 1974;22:337–43.
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The Normal Endometrium
2
Contents
General Considerations in Histologic Evaluation 10
Histologic Features of Normal Cycling Endometrium 13
Pitfalls in The Histologic Assessment of The Normal Endometrium 21
Sample Adequacy and Standardized Reporting 24
Artifacts and Contaminants 27
Irregular Secretory Endometrium 31
References 35
The histologic features of what constitutes “nor- under sampling. These examples emphasize the
mal” endometrium change with a woman’s age, importance of clinical information including
through the premenarchal, reproductive, peri- patient’s age and hormonal status. In biopsy
menopausal, and postmenopausal years [1–3]. specimens, the combination of these cyclical
Throughout the reproductive years, the cyclical changes along with potential processing arti-
hormonal changes of the menstrual cycle pro- facts, limited sampling, or the presence of mim-
vide a continuously changing morphologic spec- ics can make normal patterns difficult to
trum from proliferative to secretory to menstrual interpret. Deviations from normal, either in his-
phenotypes which is considered “normal.” Once tologic pattern or in temporal relationship to
menopause is reached, the presence of only rare ovulation, often indicate underlying abnormali-
strips of atrophic epithelium in biopsy/curettage ties that may contribute to female infertility and
sampling becomes the new “normal.” The same abnormal uterine bleeding.
“normal” in a postmenopausal woman would be Over the past 6 decades, pathologists have used
deemed “abnormal” in a premenopausal woman the histologic criteria originally described by Noyes
or, alternatively, would raise the possibility of et al. [1, 4] to date secretory phase endometrial biop-
exogenous hormonal effect. Likewise, finding sies (Table 2.1), as part of an infertility workup. The
only cervical or lower uterine segment tissue in a original study by Noyes et al. described discrete
woman known to have an ultrasonographic changes that varied daily following ovulation, cul-
lesion such as thickened endometrium supports minating with menstruation. Over the last decades,
© Springer Nature Switzerland AG 2019 9

T. A. Murdock et al., Diagnosis of Endometrial Biopsies and Curettings,
https://doi.org/10.1007/978-3-319-98608-1_2
10 2 The Normal Endometrium
multiple studies critically evaluating the Noyes dat- use of terms such as “early,” “mid,” and “late” secre-
ing criteria have shown that they are not reproduc- tory endometrium suffices [13]. Nonetheless, an
ible and that the criteria themselves are seriously appreciation of the various morphologic changes
flawed [5–12]. More importantly, gynecologists that occur in the secretory phase of the cycle is
appear to be less inclined to utilize this information important for pathologists so that normal phases of
in the evaluation of infertility. For these reasons, the secretory endometrium are not misinterpreted as
traditional dating schema is not discussed in detail in abnormal (Table 2.1).
this chapter but is briefly outlined in Table 2.1. Of
interest, the Gynecologic Pathology Interest Group
of the Canadian Association of Pathologists (GPIG- General Considerations
CAP) published a guideline for pathologists stan- in Histologic Evaluation
dardizing terminology to assist in communicating
with our clinical colleagues. One recommendation Histologic evaluation begins with identification
was that formal “dating” of secretory endometrium of surface epithelium, a prerequisite for orient-
is optional but that it should be provided if specifi- ing the underlying glands and stroma. The sur-
cally requested by the clinician. Consequently, the face epithelium is less responsive to sex steroid
Table 2.1 Secretory phase endometrial changes

Interval phase, 14–15d.a No datable histologic changes for 36–48 h after ovulation
Early secretory phase, 16–20d. Glandular changes predominate
Early Histologic features
16 Subnuclear, irregular vacuoles
17 Regular vacuolation—nuclei lined up with subnuclear vacuoles
18 Vacuoles decreased in size
18 Early secretions in lumen
18 Nucleus approaches base of cell with supranuclear vacuoles
19 Few vacuoles remain
19 Intraluminal secretion
19 No pseudostratification, no mitoses
20 Peak of intraluminal secretions
Mid- to late secretory phase, 21–27d. Stromal changes predominate, variable secretory exhaustion
Mid
21 Marked stromal edema
22 Peak of stromal edema—cells have “naked nuclei”
23 Periarteriolar predecidual change
23 Prominent spiral arteries
24 More prominent predecidual change
24 Stromal mitoses recur
25 Predecidual differentiation begins under surface epithelium
Late
25 Increased numbers of granular lymphocytes
26 Predecidua starts to become confluent
27 More numerous granular lymphocytes
27 Confluent sheets of predecidua
27 Focal necrosis
24–27 Secretory exhaustion of glands—tortuous with intraluminal tufts (saw-toothed), ragged luminal borders,
variable cytoplasmic vacuolization, and luminal secretions
d. = day of ideal 28-day menstrual cycle
a
General Considerations in Histologic Evaluation 11
hormones than the underlying glands, but it epithelial cells are important features in the histo-
often shows alteration in pathologic conditions, logic evaluation. Under normal conditions, the
especially when the abnormalities are subtle or glands should be regularly spaced and have a per-
focal. For example, during the proliferative pendicular arrangement from the basalis to the
phase, estrogenic stimulation results in ciliated surface epithelium. In the secretory phase, the
cells along the surface [10, 14]. Ciliated surface endometrium also shows a stratum compactum, a
epithelial cells are, however, far more frequent thin region beneath the surface epithelium. In the
in pathologic conditions, particularly those stratum compactum, the stroma is dense, and the
associated with unopposed estrogen stimula- glands are straight and narrow, even when the
tion, such as hyperplasia and metaplasia (see glands in the functionalis are tortuous. The basa-
Chap. 9) [2, 3, 15–17]. lis adjoins the myometrium, serving to regenerate
The subsurface endometrium is divided into the functionalis and surface epithelium following
two regions, the functionalis (stratum spongio- shedding during menses. The endometrium of the
sum) and the basalis (stratum basalis) (Fig. 2.1). basalis is less responsive to steroid hormones and
The functionalis is situated between the surface typically shows irregularly shaped, inactive-
epithelium and is important to evaluate because it appearing glands, dense stroma, and aggregates
shows the greatest degree of hormonal respon- of spiral arteries. The spiral arteries of the basalis
siveness. The size and distribution of glands as (basal arteries) have thicker muscular walls than
well as the cytologic features of the glandular those in the functionalis. In biopsies, tissue
Fig. 2.1 Normal secretory phase endometrium. Surface epi- blood vessels demonstrate the typical patterns of maturation
thelium orients the tissue (far right). The midportion of the through the menstrual cycle. The stratum compactum is com-
tissue consists of functionalis where glands, stroma, and posed of the surface-type epithelium and a subjacent thin
layer of dense stroma
12 2 The Normal Endometrium
fragments that contain basalis often do not have mal cells with minimal cytoplasm seen in the
surface epithelium. The glands and stroma of the corpus.
basalis are unresponsive to steroid hormones. Tangential orientation of the functionalis in
Lower uterine segment/isthmus is another biopsies and the tortuosity of the glands, partic-
region of the endometrium that is less responsive ularly in the late proliferative and secretory
to steroid hormones. In the lower uterine seg- phases, often lead to irregular cross sections of
ment, the endometrium has shorter, poorly devel- the tissue. In this instance, gland development
oped, inactive glands dispersed in a distinctive can be difficult to assess. Furthermore, not all
stroma (Figs. 2.2 and 2.3). The columnar cells fragments of tissue in a biopsy or curettage
lining the glands resemble those of the corpus. include surface epithelium, which helps to
Some glands near the junction with the endocer- orient the glands. Nonetheless, at least focally,
vix show a transition to mucinous endocervical- portions of better-oriented glands usually can be
type epithelium. The stromal cells in the lower traced through the functionalis to the surface
uterine segment are elongate and resemble fibro- epithelium, and these foci are critical for
blasts with more abundant eosinophilic assessing appropriate glandular and stromal

cytoplasm, in contrast to the oval to rounded stro- development.
Fig. 2.2 Lower uterine segment in curettage specimen. which are juxtaposed to hormonally responsive endome-
At the right side of the image, lower uterine segment trium (left)
shows inactive glands embedded in a fibrotic stroma
Histologic Features of Normal Cycling Endometrium 13
Fig. 2.3 Lower uterine segment. Small, poorly developed glands are seen in nonreactive stroma. Tissue from the lower
uterine segment cannot be dated
istologic Features of Normal

H [1]. Five of these features affect the glands,
Cycling Endometrium namely, tortuosity, gland mitoses, orientation of
nuclei (pseudostratified versus basal), basal sub-
The endometrium displays two distinct phases in nuclear cytoplasmic vacuoles, and glandular ser-
ovulatory cycles. The first is the proliferative rations with increased luminal secretions and
(follicular or preovulatory) phase which is secretory exhaustion. Four features relate to the
characterized by growth of glands, stroma, and stroma: edema, mitoses, predecidual change, and
vessels that is influenced by estradiol produced infiltration of granular lymphocytes. Practically,
mainly by granulosa cells in the ovarian follicles. the most important glandular features are orienta-
Following ovulation, the secretory (luteal or tion of nuclei, subnuclear cytoplasmic vacuoles,
postovulatory) phase reflects the effect of the and luminal secretions with secretory exhaustion,
combined production of progesterone and estra- and the most important stromal features are
diol by luteinized granulosa and theca cells of the edema, predecidual change, and granular lym-
corpus luteum [18]. phocytic infiltration (Table 2.1).
The day 1 of the menstrual cycle was arbi-
trarily defined as the first day of bleeding in a
“normal” cycle of 28 days [1]. Proliferative phase Proliferative Phase
changes are not as discrete as those in the secre-
tory phase; the latter can be roughly divided into During the proliferative phase, the endometrium
early, mid-, and late secretory phases. grows from about 0.5 mm up to 4.0–5.0 mm in
There are nine histologic features of the glands thickness, so by the late proliferative phase, a
and stroma that determine the phase of the cycle biopsy obtains a moderate amount of tissue.
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Emery Walker Ltd. del. et sc.
THE FINAL ADVANCE
August-November 1918
Route of the First Battalion
PRINTED IN GREAT BRITAIN BY EMERY WALKER LTD., LONDON
Since the 21st August the Guards Division had been well
employed. Its 2nd Brigade, with the Second Division on its right, had
captured the Ablainzevelle-Moyenneville spur; and the Second
Division had taken Courcelles. By the night of the 23rd, when the
3rd Guards Brigade relieved the 2nd, and the Second Division had
captured Ervillers on the Arras-Bapaume road, the Guards Division,
with their 1st Brigade in support, was within half a mile of St. Léger,
and in touch with the Fifty-sixth Division on their left, which was
trying to work round the head of the Hindenburg Line and turn in
from the north. At this point resistance stiffened. The hilly ground,
cut and cross-cut with old trenches and the beginnings of new ones,
lent itself to the stopping game of well-placed machine-guns equally
from round Croisilles, where the Fifty-sixth Division was engaged;
from about St. Léger Wood, where the 3rd Guards Brigade,
supported by tanks, was renewing its acquaintance with the German
anti-tank-rifle; and from Mory, where the Sixty-second Division was
delayed by the Division on its right being held up. An enemy balloon
or two hung on the horizon and some inquisitive, low-flying
aeroplanes hinted at coming trouble. The line expected as much, but
they did not seem so well informed farther back.
T h e A f fa i r of St. Léger
On the 26th August orders arrived that the 1st Guards Brigade
would now take up the running from the 3rd, and advance eastward
from St. Léger towards Ecoust till opposition was met. There were,
of course, refinements on this idea, but that was the gist of it. The
2nd Grenadiers and the 2nd Coldstream would attack, with the
Battalion in support. The men were in their trenches by tea-time on
the 26th, No. 1 Company in Jewel Trench just east of the entrance
to the little Sensée River valley, and the others disposed along the
line of Mory Switch, an old trench now only a foot deep. Battalion
Headquarters lay in an abandoned German stores dug-out. Final
orders did not arrive till after midnight on the 26th, and there was
much to arrange and link up between then and seven o’clock,
barrage time. The Grenadiers were on the right and the Coldstream
on the left of the Battalion, the latter following a quarter of a mile
behind, with Nos. 1 and 3 Companies to feed the Grenadiers and
Nos. 4 and 2 for the Coldstream. As the front was so wide, they split
the difference and kept as close as might be to the dividing line
between the two leading Battalions, which ran by Mory Switch and
Hally Avenue. The hot day broke with a gorgeous sunrise over a
desolate landscape that reeked in all its hollows of gas and cordite.
A moment or two after our barrage (field-guns only) opened, the
enemy put down a heavy reply, and into the smoke and dust of it
the companies, in artillery formation, walked up the road without
hesitation or one man losing his place. No. 1 Company leading on
the right disappeared at once after they had passed their jumping-
off point at Mory Switch. Almost the first shells caught the leading
platoon, when Lieutenant J. N. Ward was killed and Lieutenant P. S.
MacMahon wounded. As soon as they were clear of the barrage,
they came under full blast of machine-gun fire and saw the
Grenadiers presently lie down enfiladed on both flanks. Four of our
machine-guns tried to work forward and clear out the hindrances,
but the fire was too strong. Both battalions were finally held up, and
the Grenadiers were practically cut to pieces, with their reserve
companies, as these strove to reinforce the thinned line. After what
seemed an immense time (two hours or so) Captain Thompson,
seeing that, as far as that sector was concerned, the thing was hung
up, ordered his men to dig in in support, and they spent till nightfall
“recovering casualties”—their own, those of the battalions ahead,
and of the Guards Machine-Guns.
No. 3 Company, which followed No. 1, suffered just as heavily
from the barrage. Very soon their commander, Captain Joyce, was
wounded and Lieutenant H. R. Baldwin killed. Second Lieutenant
Heaton, who took over, was gassed in the course of the afternoon,
and C.S.M. O’Hara then commanded. There was nothing for them to
do either save dig in, like No. 1, behind the Grenadiers, and a little
to the right of them.
No. 4 Company, under Captain Hegarty, following the Coldstream,
got the worst barrage of all as soon as they were clear of their
trenches, and found the Coldstream held up, front and flank, within
fifty yards of the sunken road whence they had started. No. 15
platoon of the Irish Guards was almost wiped out, and the remains
of it joined with No. 13 to make a defensive flank, while No. 14
crawled or wriggled forward to reinforce the Coldstream, and No. 16
lay in reserve in a sunk road. Sunk roads were the only shelter for
such as did not wish to become early casualties.
No. 2 Company (Captain A. Paget) following No. 4 had been held
back for a few minutes by the C.O. (Major R. Baggallay) on the
fringe of the barrage, to be slipped through when it seemed to
lighten. They also launched out into a world that was all flank or
support, of battalions which could neither be seen nor found, who
were themselves outflanked by machine-guns in a landscape that
was one stumbling-block of shallow trenches which suddenly faded
out. They crossed the St. Léger-Vraucourt road and bore east, after
clearing the St. Léger wood, till they reached the St. Léger reserve
trench, and held it from the Longatte road to where it joined the
Banks Reserve. Says one record: “At this time, Captain Paget was in
ignorance of the success or location of the attacking battalions, and
both of his flanks exposed as far as he knew.” The enemy machine-
guns were hammering home that knowledge, and one of the
platoons had lost touch altogether, and was out in the deadly open.
So in the trench they lay till an officer of the Coldstream came over
and told Paget the “general situation,” which, unofficially, ran: “This
show is held up.” He borrowed a section from No. 5 Platoon to help
to build up a flank to guard the east side of St. Léger and vanished
among the increasing shell-holes.
Well on in the morning a message arrived from Captain Hegarty,
No. 4 Company, that he and his men were on the St. Léger-
Vraucourt road and held up like the rest. Captain Paget went over, in
the usual way, by a series of bolts from shell-hole to shell-hole,
trying to clear up an only too-clear situation. On the way he found a
lost platoon, sent it to dig in on the left of No. 2 Company, and also
saw the C.O. 2nd Coldstream and explained his own dispositions.
They were not made too soon, for in a short time there was an
attack on No. 2 Company which came within sixty yards before it
was broken up by our small-arm fire. The Germans were followed up
as they returned across the Ecoust-Mory ridge by long-range
shooting in which, for the sake of economy, captured enemy rifles
and ammunition were used.
By this time the whole front was split up into small or large
scattered posts in trenches or under cover, each held down by
machine-guns which punished every movement. Two Companies (2
and 4) were near the St. Léger Trees, a clump of nine trees on the
St. Léger-Ecoust road, mixed up with the Coldstream posts. The
other two were dug in behind the Grenadiers on the right. Battalion
Headquarters circulated spasmodically and by rushes, when it saw
its chance, from one point to the other of the most unwholesome
ground. Even at the time, some of its shell-hole conferences struck
the members as comic; but history does not record the things that
were said by dripping officers between mouthfuls of dirt and gas.
Every battle has its special characteristic. St. Léger was one of
heat, sunshine, sweat; the flavour of at least two gases tasted
through respirators or in the raw; the wail of machine-gun bullets
sweeping the crests of sunken roads; the sudden vision of wounded
in still-smoking shell-holes or laid in the sides of a scarp; sharp
whiffs of new-spilt blood, and here and there a face upon which the
sun stared without making any change. So the hours wore on, under
a sense of space, heat, and light; Death always just over the edge of
that space and impudently busy in that light.
About what would have been tea-time in the real world, Captain
Paget, a man of unhurried and careful speech and imperturbable
soul, reported to the C.O., whom he found by the St. Léger Trees,
that there were “Huns on his right—same trench as himself.” It was
an awkward situation that needed mending before dusk, and it was
made worse by the posts of the Coldstream and some Guards
Machine-Guns’ posts, as well as those of our No. 4 Company, being
mixed up within close range of No. 2. The C.O. decided that if a
barrage could be brought to bear on the trench and its rather
crowded neighbourhood, No. 2 might attack it. A young gunner,
Fowler by name, cast up at that juncture and said it might be
managed if the Battalion withdrew their posts round the area. He
had a telephone, still uncut, to his guns and would observe their
registration himself. The posts, including those of the Guards
Machine-Guns, were withdrawn, and Fowler was as near as might be
killed by one of his own registering shots. He got his 18-pounders to
his liking at last, and ten minutes’ brisk barrage descended on the
trench. When it stopped, and before our men could move, up went a
white flag amid yells of “Kamerad,” and the Huns came out, hands
aloft, to be met by our men, who, forgetting that exposed troops,
friend and foe alike, would certainly be gunned by the nearest
enemy-post, had to be shooed and shouted back to cover by their
officers. The prisoners, ninety of them, were herded into a wood,
where they cast their helmets on the ground, laughed, and shook
hands with each other, to the immense amusement of our people.
The capture had turned a very blank day into something of a
success, and the Irish were grateful to the “bag.” This at least
explains the politeness of the orderly who chaperoned rather than
conducted the Hun officer to the rear, with many a “This way, sir.
Mind out, now, sir, you don’t slip down the bank.” They put a platoon
into the captured trench and lay down to a night of bursts of heavy
shelling. But the enemy, whether because of direct pressure or
because they had done their delaying work, asked for no more and
drew back in the dark.
When morning of the 28th broke “few signs of enemy movement
were observed.” Men say that there is no mistaking the “feel of the
front” under this joyous aspect. The sense of constriction departs as
swiftly as a headache, and with it, often, the taste that was in the
mouth. One by one, as the lovely day went on, the patrols from the
companies made their investigations and reports, till at last the
whole line reformed and, in touch on either flank, felt forward under
light shelling from withdrawing guns. An aeroplane dropped some
bombs on the Battalion as it drew near to the St. Léger Trees, which
wounded two men and two gunner officers, one of whom—not
Fowler, the boy who arranged for the barrage—died in Father
Browne’s arms. On the road at that point, where the wounded and
dying of the fight had been laid, only dried pools of blood and some
stained cotton-wads remained darkening in the sun. Such officers as
the gas had affected in that way went about their routine-work
vomiting disgustedly at intervals.
Battalion Headquarters, which had nominally spent the previous
day in a waist-deep trench, set up office at the St. Léger Trees, and
the advance of the Guards Division continued for a mile or so. Then,
on a consolidated line, with machine-guns chattering to the
eastward, it waited to be relieved. As prelude to their watch on the
Rhine, the affair was not auspicious. The Grenadiers, on whom the
brunt of the fight fell, were badly knocked out, and of their sixteen
officers but four were on their feet. The Coldstream were so
weakened that they borrowed our No. 4 Company to carry on with,
and the Irish thought themselves lucky to have lost no more than
two officers (Lieutenant J. N. Ward and Lieutenant H. R. Baldwin)
dead, and six wounded or gassed, in addition to a hundred and
seventy other ranks killed or wounded. The wounded officers were
Captain W. Joyce; Lieutenants P. S. MacMahon and C. A. J. Vernon,
who was incapacitated for a while by tear-gas in the middle of action
and led away blinded and very wroth; also 2nd Lieutenants H. A.
Connolly, G. T. Heaton, and A. E. Hutchinson.
The Division was relieved on the night of the 28th: the Battalion
itself, as far as regarded No. 1 Company, by the 1st Gordons, from
the Third Division, Nos. 2 and 4 Companies by another battalion,
and No. 3 Company under the orders of the 2nd Grenadiers. They
marched back to their positions of the night before the battle “very
glad that it was all behind us,” and their shelters of bits of wood and
rough iron seemed like rest in a fair land.
On the 29th August, a hot day, they lay in old trenches over the
Moyenneville spur in front of Adinfer Wood facing Douchy and
Ayette, where “three weeks ago no man could have lived.” They
talked together of the far-off times when they held that line daily
expecting the enemy advance; and the officers lay out luxuriously in
the wood in the evening after Mess, while the men made themselves
“little homes in it.”
Next day they rested, for the men were very tired, and on the last
of the month the whole Battalion was washed in the divisional baths
that had established themselves at Adinfer. But the enemy had not
forgotten them, and on the first of September their shelters and
tents in the delightful wood were bombed. Six men were injured,
five being buried in a trench, and of these two were suffocated
before they could be dug out.
Towards the Canal du Nord

And that was all the rest allowed to the Battalion. On the 2nd
September the Canadian Corps of the First Army broke that outlying
spur of the Hindenburg System known as the Drocourt-Quéant
Switch, with its wires, trenches, and posts; and the Fifty-seventh and
Fifty-second Divisions, after hard work, equally smashed the triangle
of fortifications north-west of Quéant where the Switch joined the
System. The gain shook the whole of the Hindenburg Line south of
Quéant and, after five days’ clean-up behind the line, the Guards
Division were ordered to go in again at the very breast of
Hindenburg’s works. No one knew what the enemy’s idea might be,
but there was strong presumption that, if he did not hold his defence
at that point, he might crack. (“But, ye’ll understand, for all that, we
did not believe Jerry would crack past mendin’.”)
The Battalion spent the night of the 2nd September, then, in
shelters in Hamel Switch Trench on their way back from Adinfer
Wood to the battle. The front had now shifted to very much the one
as we held in April, 1917, ere the days of Cambrai and Bourlon
Wood. The 1st Guards Brigade were in Divisional Reserve at
Lagnicourt, three miles south-west of Ecoust-St.-Mein, where the
Battalion had to cross their still fresh battle-field of less than a week
back, as an appetizer to their hot dinners. They occupied a waist-
deep old trench, a little west of Lagnicourt, and noticed that there
was no shelling, though the roads were full of our traffic, “a good
deal of it in full view of Bourlon Wood.” Going over “used” ground for
the third time and noting one’s many dead comrades does not make
for high spirit even though one’s own Divisional General has written
one’s own Brigadier, “All battalions of the 1st Guards Brigade
discharged their duty splendidly at St. Léger.”
Lagnicourt was shelled a little by a high-velocity gun between the
4th and the 6th of September, and seventeen bombs were dropped
on the Battalion, wounding two men.
By all reason there should have been a bitter fight on that ground,
and full preparation for it was made. But the enemy, after St. Léger,
saw fit to withdraw himself suddenly and unexpectedly out of all that
area. For one bewildering dawn and day “the bottom fell out of the
front,” as far as the Guards Division was concerned. It is a curious
story, even though it does not directly concern the Battalion. Here is
one detail of it:
On the 3rd September the 2nd Brigade toiled in from Monchy, in
full war-kit, and, tired with the long day’s heat, formed up west of
Lagnicourt before dawn, detailed to win, if they could, a thousand
yards or so of chewed-up ground. They “went over the top” under a
creeping barrage, one gun of which persistently fired short, and—
found nothing whatever in front of them save a prodigious number
of dead horses, some few corpses, and an intolerable buzzing of
flies! As they topped the ridge above Lagnicourt, they saw against
the first light of the sun, dump after German dump blazing palely
towards the east. That was all. They wandered, wondering, into a
vast, grassy, habitationless plain that stretched away towards the
Bapaume-Cambrai road. Not a machine-gun broke the stupefying
stillness from any fold of it. Yet it was the very place for such
surprises. Aeroplanes swooped low, looked them well over, and
skimmed off. No distant guns opened. The advance became a route-
march, a Sunday walk-out, edged with tense suspicion. They saw a
German cooker wrecked on the grass, and, beside it, the bodies of
two clean, good-looking boys, pathetically laid out as for burial. The
thing was a booby-trap arranged to move our people’s pity. Some
pitied, and were blown to bits by the concealed mine. No one made
any comment. They were tired with carrying their kit in the sun
among the maddening flies. The thousand yards stretched into
miles. Twice or thrice they halted and began to dig in for fear of
attack. But nothing overtook them and they installed themselves,
about dusk, in some old British trenches outside Boursies, four miles
and more, as the crow flies, from Lagnicourt! At midnight, up came
their rations, and the punctual home-letters, across that enchanted
desert which had spared them. They were told that their Brigade
Artillery was in place behind the next rise, ready to deliver barrages
on demand, and in due course the whole of our line on that sector
flowed forward.
The Battalion relieved the 1st Scots Guards in the front line near
Mœuvres on the 7th—a quiet relief followed by severe gassing. Here
they passed two days in the delicate and difficult business of feeling
all about them among the mass of old trenches, to locate enemy’s
posts and to watch what points of vantage might offer. The
wreckage of the houses round Mœuvres, into which the trenches
ran, lent itself excellently to enemy activity; and men played blind-
man’s buff round bits of broken walls wherever they explored. Their
left was in the air; their right under the care of Providence; and their
supports were far off. No. 3 Company (Captain G. L. Bambridge,
M.C.), while trying to close a gap between the two front companies
(3 and 1) by peaceful penetration with a bombing-party, found
enemy in the trench, drove him up it as far as they could, built a
barricade, and were then heavily counter-raided by a couple of
officers and twenty men whom they ejected after, as the Company
justly owned, “a good attempt.” The enemy “attempted” again about
midnight on the 8th, when he was bombed off, and again on the
afternoon of the 9th in an outlying trench, mixed up with smashed
cellars and broken floors, where he captured two unarmed stretcher-
bearers and three men who had not been in the line before. Though
it does new hands no harm to realize that front-line trenches are not
Warley Barracks (and stretcher-bearers, like orderlies, are prey to all
the world), still the matter could not be passed over. Our trench-
mortars attended vigorously to the enemy posts whence the raid had
been launched, and in the afternoon sent a strong patrol to make
the outraged trench secure. Later on, a platoon of No. 1 Company
got into touch with the battalion (8th King’s) on their left, and took
part in a small “bicker,” as it was described, but with no casualties.
They were relieved the same night, though they did not expect it,
by the 1/5th Battalion Loyal North Lancs who had not made sure of
their route beforehand, and so, in wet darkness, lost their way, failed
to meet the guides at the rendezvous, and were heavily shelled. The
relief dragged on till well towards dawn, when the battalions
straggled off into some drenching trenches without any sort of
accommodation. (“The whole thing the most appalling mess and
agony I have ever experienced.”) The worst was when a stray light
went up and showed the relieved Battalion under pouring rain
playing “follow my leader” in a complete circle like caterpillars, in the
hopeful belief that they were moving to their destination. They next
took the place of the 3rd Guards Brigade in reserve-trenches near
Edinburgh Support, where they stayed till the 14th September and
were not even once shelled. Salvage and cleaning up was their
fatigue—a dreadful job at any time, for the ground was filled with
ancient offal as well as new—lost French of ’14 mingled grotesquely
with the raw produce of yesterday’s bombing-raid. Yet men’s feelings
blunt so by use that they will scavenge yard by yard over the very
clay of the pit into which they themselves may at any instant be
stamped, nor turn a hair at shapes made last year in their likeness.
The Battalion was complimented by its Major-General on the extent
and neatness of its dump. No mere campaigning interferes with the
Army’s passion for elaborate economies. A little before this, the
entire British Expeditionary Force was exhorted to collect and turn in
all solder from bully-beef tins and the like. Naturally, the thing
became a game with betting on results between corps; but when a
dark, elderly, brooding private of the Irish spent three hours stalking
a Coldstream cooker with intent to convey and melt it down, every
one felt it had gone far enough.
On the 15th September they relieved the 1st Scots Guards in the
old trenches west of Lagnicourt. There they managed to put in a
little box-respirator drill which at the best is a dry fatigue, but, be it
noted with gratitude, “beer was obtained for the men and sent up
from transport-lines.” The whole area reeked of the various gases
which the enemy were distributing with heavies. They hung in the
hollows and were sucked up by the day’s heat, and no time or place
was safe from them. Gas-discipline had to be insisted on strongly, for
even veterans grow careless of a foe they cannot see; and the new
hands are like croupy babies.
On the 17th September they relieved the 2nd Scots Guards in
support, and No. 2 Company took over from a company of the Welsh
Guards. Their trenches were in what had been the British front line
of the old time—Fish Avenue, Sprat Post, Shark Support, Rat and
Rabbit Avenue, and so forth.
There was desultory shelling on the morning of the 18th, and
heavier work in the afternoon, causing six casualties, and slightly
wounding Captain Vernon, Intelligence Officer. Then the silence of
preparation for battle falls on the record. It was nothing to the
Battalion that on the 18th September the enemy “apparently
attacked south of the divisional front along the Bapaume-Cambrai
road.” The dead must bury their dead on the Somme. They had their
own dispositions to arrange and re-arrange, as men, for one cause
or other, fell out and no unit could afford to take chances, with the
Hindenburg Line ahead of them. (“An’ we knowin’ we was told off to
cross that dirty ditch in front of ’em all.”) Their world, as with every
other division, was limited to the Reserves behind them, who should
come up to make good their casualties; their trench-mortar batteries
alongside them; and their own selves about to be used in what
promised to be one of the bloodiest shows of the war.
Those who were for the front line enjoyed a week to work and
think things over. Those who were set aside for the second course
were bombed by night and—went mushroom-picking in back-areas
between parades, or played riotous cricket-matches with petrol-tins
for wickets!
Their Divisional Commander, Major-General Feilding, had left on
September 11 to succeed Sir Francis Lloyd in command of the
London District, and General T. G. Matheson, C.B., had been
appointed to the command of the Guards Division. The Battalion was
full strength, officers and men, for there had been little during the
past month to pull it down.
The Crossing of the Canal du Nord

Operations against the Hindenburg Line were to open on the 27th
September with the attack of fourteen divisions of the First and
Third Armies on a twelve-mile front from opposite Gouzeaucourt in
the south to opposite Sauchy-Lestrée, sister to Sauchy-Cauchy—
under the marshes of the Sensée River in the north. It would be
heralded by two days’ solid bombardment along the entire fronts of
the First, Third, and Fourth Armies, so that the enemy might be left
guessing which was to hit first. When the First and Third Armies
were well home, the Fourth would attend to the German position in
the south, and heave the whole thing backward.
The share of the Guards Division in the northern attack was to
cross the Canal du Nord at Lock Seven, north of Havrincourt, on a
front of a mile; then work through the complicated tangle of the
Hindenburg support line directly east along the ridge from
Flesquières village to Premy Chapel which stands at the junction of
the roads from Noyelles, Marcoing, and Graincourt, and to
consolidate on the line of the Marcoing-Graincourt road. Meantime,
the Third Division on their right would take the village of Flesquières;
the Fifty-second Division would take the Hindenburg Line that lay
west of the Canal in the bend of it, and would then let the Sixty-third
through who would swing down from the north and attend to
Graincourt and Anneux villages. The total advance set for the Guards
Division was three miles, but, if the operations were fully successful,
they were to push on to the outskirts of Noyelles; the Third Division
to Marcoing; while the Fifty-seventh, coming through the Sixty-third,
would take Cantaing and Fontaine-Notre-Dame. In the Guards
Division itself, the 2nd Brigade was to move off first, and ferret its
way through a knot of heavily wired trenches that lay between them
and the Canal, take the Hindenburg support trenches, and then form
a defensive flank to the left of the next advance till the Fifty-second
and Sixty-third Divisions should have secured Graincourt. The 1st
Brigade would pass through them and capture the trenches across
the Canal to the north and north-east of Flesquières. If resistance
were not too strong, that brigade was to go on to the spur running
from Flesquières to Cantaing, and help the Sixty-third turn the
Graincourt line. The 3rd Brigade, passing through the 1st, would
carry on and take the high ground round Premy Chapel.
Enough rain fell the day before to grease the ground
uncomfortably, and when at 3.30 a. m. the Irish Guards moved off
from their reserve trenches west of Lagnicourt to their assembly
positions along the Demicourt-Graincourt road to Bullen Trench, the
jumping-off place, it was pouring wet. They were not shelled on the
way up, but the usual night-work was afoot in the back-areas, and
though our guns, as often the case on the eve of an outbreak, held
their breath, the enemy’s artillery threatened in the distance, and
the lights and “flaming onions” marked their expectant front. Just
before the Battalion reached the ruins of Demicourt, there was an
explosion behind them, and they saw, outlined against the flare of a
blazing dump, Lagnicourt way, a fat and foolish observation-balloon
rocking and ducking at the end of its tether, with the air of a
naughty baby caught in the act of doing something it shouldn’t.
Since the thing was visible over half a Department, they called it
names, but it made excuse for a little talk that broke the tension.
Tea and rum were served out at the first halt—a ritual with its usual
grim jests—and when they reached the road in front of Demicourt,
they perceived the balloon had done its dirty work too well. The
enemy, like ourselves, changes his field-lights on occasion, but, on
all occasions, two red lights above and one below mean trouble. “Up
go the bloody pawnbrokers!” said a man who knew what to expect,
and, as soon as the ominous glares rose, the German trench-mortars
opened on the Battalion entering the communication-way that led to
Bullen Trench. Our barrage came down at Zero (5.20) more
terrifically, men said, than ever they had experienced, and was
answered by redoubled defensive barrages. After that, speech was
cut off. Some fifty yards ahead of Bullen Trench—which, by the way,
was only three feet deep—lay the 1st Scots Guards, the first wave of
the attack. On, in front of, and in the space between them and the
Irish, fell the rain of the trench-mortars; from the rear, the Guards
Machine-Guns tortured all there was of unoccupied air with their
infernal clamours. The Scots Guards went over among the shell-
spouts and jerking wires at the first glimmer of dawn, the Irish
following in a rush. The leading companies were No. 3 (Lieutenant
H. A. A. Collett) on the left, and No. 4 (2nd Lieutenant C. S. O’Brien)
on the right. The 1st Guards Trench Mortar Battery (2nd Lieutenant
O. R. Baldwin, Irish Guards) was attached experimentally to No. 3
Company in the first wave instead of, as usual, in support. No. 2
Company (Captain C. W. W. Bence-Jones) supported No. 3, and No.
1 (Lieutenant the Hon. B. A. A. Ogilvy) No. 4. They stayed for a
moment in the trench, a deep, wide one of the Hindenburg pattern,
which the Scots Guards had left. It was no healthy spot, for the
shells were localised here and the dirt flung up all along it in waves.
Men scrambled out over the sliding, flying edges of it, saw a bank
heave up in the half-light, and knew that, somewhere behind that,
was the Canal. By this time one of the two Stokes guns of the Mortar
Battery and half the gunners had been wiped out, and the casualties
in the line were heavy; but they had no time to count. Then earth
opened beneath their feet, and showed a wide, deep, dry, newly
made canal with a smashed iron bridge lying across the bed of it,
and an unfinished lock to the right looking like some immense
engine of war ready to do hurt in inconceivable fashions. Directly
below them, on the pale, horribly hard, concrete trough, was a
collection of agitated pin-heads, the steel hats of the Scots Guards
rearing ladders against the far side of the gulf. Mixed with them
were the dead, insolently uninterested, while the wounded, breaking
aside, bound themselves up with the tense, silent preoccupation
which unhurt men, going forward, find so hard to bear. Mobs of
bewildered Germans had crawled out of their shelters in the Canal
flanks and were trying to surrender to any one who looked likely to
attend to them. They saluted British officers as they raced past, and,
between salutes, returned their arms stiffly to the safe “Kamerad”
position. This added the last touch of insanity to the picture. (“We’d
ha’ laughed if we had had the time, ye’ll understand.”)
None recall precisely how they reached the bottom of the Canal,
but there were a few moments of blessed shelter ere they scrambled
out and reformed on the far side. The shelling here was bad enough,
but nothing to what they had survived. A veil of greasy smoke,
patched with flame that did not glare, stood up behind them, and
through the pall of it, in little knots, stumbled their supports,
blinded, choking, gasping. In the direction of the attack, across a
long stretch of broken rising ground, were more shells, but less
thickly spaced, and craters of stinking earth and coloured chalks
where our barrage had ripped out nests of machine-guns. Far off, to
the left, creaming with yellow smoke in the morning light, rose the
sullen head of Bourlon Wood to which the Canadians were faithfully
paying the debt contracted by the 2nd Battalion of the Irish Guards
in the old days after Cambrai.
At the crest of the ascent lay Saunders Keep, which marked the
point where the Scots Guards would lie up and the Irish come
through. Already the casualties had been severe. Captain Bence-
Jones and 2nd Lieutenant Mathieson of No. 2 Company were
wounded at the Keep itself, and 2nd Lieutenant A. R. Boyle of No. 1
earlier in the rush. The companies panted up, gapped and strung
out. From the Keep the land sloped down to Stafford Alley, the
Battalion’s first objective just before which Lieutenant Barry Close
was killed. That day marked his coming of age. Beyond the Alley the
ground rose again, and here the Irish were first checked by some
machine-gun fire that had escaped our barrages. Second Lieutenant
O’Brien, No. 3 Company, was hit at this point while getting his men
forward. He had earned his Military Cross in May, and he died well.
The next senior officer, 2nd Lieutenant E. H. R. Burke, was away to
the left in the thick of the smoke with a platoon that, like the rest,
was fighting for its life; so 2nd Lieutenant O’Farrell led on. He was
hit not far from Stafford Alley, and while his wound was being
bandaged by Sergeant Regan, hit again by a bullet that, passing
through the Sergeant’s cap and a finger, entered O’Farrell’s heart.
The officer commanding the remnants of the Mortar Battery took on
the company and his one gun. Meantime, Collett and a few of No. 3
Company had reached Silver Street, a trench running forward from
Stafford Alley, and he and Lieutenant Brady were bombing down it
under heavy small-arm fire from the enemy’s left flank which had
not been driven in and was giving untold trouble. No. 2 Company,
with two out of three of its officers down, was working towards the
same line as the fragment of No. 3; though opinion was divided on
that confused field whether it would not be better for them to lie
down and form a defensive flank against that pestilent left fire.
Eventually, but events succeeded each other like the bullets, Collett
and his men reached their last objective—a trench running out of
Silver Street towards Flesquières. Here he, Brady, and Baldwin drew
breath and tried to get at the situation. No. 4 Company lay to the
right of No. 3, and when 2nd Lieutenant E. H. R. Burke, with what
was left of his platoon before mentioned, came up, he resumed
charge of it without a word and went on. No. 1 Company
(Lieutenant the Hon. B. A. A. Ogilvy) had, like the rest, been
compelled to lead its own life. Its objective was the beet-sugar
factory in front of Flesquières ahead of and a little to the right of the
Battalion’s final objective, and it was met throughout with rifle,
bomb, and flanking fire. Lieutenant Ogilvy was wounded at a critical
point in the game with the enemy well into the trench, or trenches.
(The whole ground seemed to the men who were clearing it one
inexhaustible Hun-warren.) As he dropped, Lieutenant R. L. Dagger
and Sergeant Conaboy, picking up what men they could, bombed
the enemy out, back, and away, and settled down to dig in and wait;
always under flank-fire. The Sergeant was killed “in his zeal to finish
the job completely”—no mean epitaph for a thorough man. By
eleven o’clock that morning all the companies had reached their
objectives, and, though sorely harassed, began to feel that the worst
for them might be over. There were, however, two German “whizz-
bangs” that lived in Orival Wood still untaken on the Battalion’s left,
and these, served with disgusting speed and accuracy, swept Silver
Street mercilessly. The situation was not improved when one of the
sergeants quoted the ever-famous saying of Sergeant-Major Toher
with reference to one of our own barrages: “And even the wurrums
themselves are getting up and crying for mercy.” The guns were
near enough to watch quite comfortably, and while the men watched
and winced, they saw the “success” signal of the Canadians—three
whites—rise high in air in front of Bourlon Wood. Then No. 1
Company reported they were getting more than their share of
machine-gun fire, and the 1st Guards Brigade Trench Mortar Battery,
reduced to one mortar, one officer, one sergeant, four men, and ten
shells, bestowed the whole of its ammunition in the direction
indicated, abandoned its mortar, and merged itself into the ranks of
No. 3 Company. It had been amply proved that where trench-
mortars accompany a first wave of attack, if men are hit while
carrying two Stokes shells apiece (forty pounds of explosives), they
become dangerous mobile mines.
Enemy aeroplanes now swooped down with machine-gun fire;
there seemed no way of getting our artillery to attend to them and
they pecked like vultures undisturbed. Then Battalion Headquarters
came up in the midst of the firing from the left, established
themselves in a dug-out and were at once vigorously shelled,
together with the neighbouring aid-post and some German prisoners
there, waiting to carry down wounded. The aid-post was in charge
of a young American doctor, Rhys Davis by name, who had been
attached to the Battalion for some time. This was his first day of war
and he was mortally wounded before the noon of it.
The trench filled as the day went on, with details dropping in by
devious and hurried roads to meet the continual stream of prisoners
being handed down to Brigade Headquarters. One youth, who could
not have been seventeen, flung himself into the arms of an officer
and cried, “Kamerad, Herr Offizier! Ich bin sehr jung! Kamerad!” To
whom the embarrassed Islander said brutally: “Get on with you. I
wouldn’t touch you for the world!” And they laughed all along the
trench-face as they dodged the whizz-bangs out of Orival Wood, and
compared themselves to the “wurrums begging for mercy.”
About noon, after many adventures, the 2nd Grenadiers arrived to
carry on the advance, and Silver Street became a congested
metropolis. The 2nd Grenadiers were hung up there for a while
because, though the Third Division on the right had taken
Flesquières, the Sixty-third on the left had not got Graincourt village,
which was enfilading the landscape damnably. Orival Wood, too, was
untaken, and the 1st Grenadiers, under Lord Gort, were out
unsupported half a mile ahead on the right front somewhere near
Premy Chapel. Meantime, a battalion of the Second Division, which
was to come through the Guards Division and continue the advance,
flooded up Silver Street, zealously unreeling its telephone wires;
Machine-Gun Guards were there, looking for positions; the 2nd
Grenadiers were standing ready; the Welsh Guards were also there
with intent to support the Grenadiers; walking wounded were
coming down, and severe cases were being carried over the top by
German prisoners who made no secret of an acute desire to live and
jumped in among the rest without leave asked. The men compared
the crush to a sugar-queue at home. To cap everything, some
wandering tanks which had belonged to the Division on the right had
strayed over to the left. No German battery can resist tanks,
however disabled; so they drew fire, and when they were knocked
out (our people did not know this at first, being unused to working
with them), made life insupportable with petrol-fumes for a hundred
yards round.
About half-past four in the afternoon a Guards Battalion—they
thought it was the 1st Coldstream—came up on their left, and under
cover of what looked like a smoke-barrage, cleared Orival Wood and
silenced the two guns there. The Irish, from their dress-circle in
Silver Street, blessed them long and loud, and while they applauded,
Lieut.-Colonel Lord Gort, commanding the 1st Grenadiers, came
down the trench wounded on his way to a dressing-station. He had
been badly hit once before he thought fit to leave duty, and was
suffering from loss of blood. The Irish had always a great regard for
him, and that day they owed him more than they knew at the time,
for it was the advance of the 1st Grenadiers under his leading,
almost up to Premy Chapel, which had unkeyed the German
resistance in Graincourt, and led the enemy to believe their line of
retreat out of the village was threatened. The Second Division as it
came through found the enemy shifting and followed them up
towards Noyelles. So the day closed, and, though men did not
realize, marked the end of organized trench-warfare for the Guards
Division.
The Battalion, with two officers dead and five wounded out of
fifteen (killed: Lieutenant B. S. Close, and 2nd Lieutenant A. H.
O’Farrell; wounded: Captain the Hon. B. A. A. Ogilvy, Captain C. W.
W. Bence-Jones, and 2nd Lieutenants A. R. Boyle, G. F. Mathieson,
and C. S. O’Brien, M.C., died of wounds), and one hundred and
eighty casualties in the ranks, stayed on the ground for the night. It
tried to make itself as comfortable as cold and shallow trenches
allowed, but by orders of some “higher authority,” who supposed
that it had been relieved, no water or rations were sent up; and,
next morning, they had to march six thousand yards on empty
stomachs to their trench-shelters and bivouacs in front of Demicourt.
As the last company arrived a cold rain fell, but they were all in
reasonably high spirits. It had been a winning action, in spite of
trench-work, and men really felt that they had the running in their
own hands at last.
Back-area rumours and official notifications were good too. The
Nineteenth and Second Corps of the Second Army, together with the
Belgian Army, had attacked on the 28th September, from Dixmude to
far south of the Ypres-Zonnebeke road; had retaken all the heights
to the east of Ypres, and were in a fair way to clear out every
German gain there of the past four years. A German withdrawal was
beginning from Lens to Armentières, and to the south of the Third
Army the Fourth came in on the 29th (while the Battalion was
“resting and shaving” in its trench-shelters by Demicourt) on a front
of twelve miles, and from Gricourt to Vendhuille broke, and poured
across the Hindenburg Line, then to the St. Quentin Canal. At the
same time, lest there should be one furlong of the uneasy front
neglected, the Fifth and Sixth Corps of the Third Army attacked over
the old Gouzeaucourt ground between Vendhuille and Marcoing.
This, too, without counting the blows that the French and the
Americans were dealing in their own spheres on the Meuse and in
the Argonne; each stroke coldly preparing the next.
The Germans had, during September, lost a quarter of a million of
prisoners, several thousand guns, and immense quantities of
irreplaceable stores. Their main line of resistance was broken and
over-run throughout; and their troops in the field were feeling the
demoralisation of constant withdrawals, as well as shortage from
abandoned supplies. Our people had known the same depression in
the March Push, when night skies, lit with burning dumps, gave the
impression that all the world was going up in universal surrender.
Towards Maubeuge
But work was still to do. Between Cambrai, which at the end of
October was under, though not actually in, our hands, and
Maubeuge, lay thirty-five miles of France, all open save for such
hastily made defences as the enemy had been able to throw up after
the collapse of the Hindenburg systems. There, then, the screw was
turned, and on the 8th October the Third and Fourth Armies
attacked on a front of seventeen miles from Sequehart, north of
Cambrai, where the Cambrai-Douai road crosses the Sensée,
southward to our junction with the French First Army a few miles
above St. Quentin. Twenty British divisions, two cavalry divisions,
and one American division were involved. The Battalion faced the
changed military situation, by announcing that companies were “at
the disposal of their commanders for open warfare training.” After
which they were instantly sent forward from their Demicourt
trenches, to help make roads between Havricourt and Flesquières!
On the 3rd October they had orders to move, which were at once
cancelled—sure sign that the Higher Command had something on its
mind. This was proved two days later when the same orders arrived
again, and were again washed out. Meantime, their reorganisation
after the Flesquières fight had been completed; reinforcements were
up, and the following officers had joined for duty: Lieutenants H. E.
Van der Noot and G. F. Van der Noot, and 2nd Lieutenants A. L. W.
Koch de Gooreynd, the Hon. C. A. Barnewall, G. M. Tylden-Wright, V.
J. S. French, and R. E. Taylor.
On the 4th October the Commanding Officer went on leave, and
Major A. F. L. Gordon, M.C., took command of the Battalion. Once
more it was warned that it would move next day, which warning this
time came true, and was heralded by the usual conference at
Brigade Headquarters, on the 7th October, when the plans for next
day’s battle in that sector of the line were revealed. The Second
Division, on the left, and the Third, on the right of the Guards
Division, were to attack on the whole of the front of the Sixth Corps
at dawn of the 8th October. The Guards Division was to be ready to
go through these two divisions on the afternoon of that day, or to
take over the line on the night of it, and continue the attack at dawn
on the 9th. The 1st Guards Brigade would pass through the Third
Division, and the 2nd Brigade through the Second Division. As far as
the 1st Brigade’s attack was concerned, the 2nd Coldstream would
take the right, the 2nd Grenadiers the left of the line, with the 1st
Irish Guards in reserve. It was all beautifully clear. So the Battalion
left Demicourt, recrossed the Canal du Nord at Lock 7, and were
“accommodated” in dug-outs and shelters in the Hindenburg Line,
near Ribecourt.
On the 9th October the Battalion moved to Masnières, four miles
or so south of Cambrai. Here, while crossing the St. Quentin Canal,
No. 3 Company had three killed and three wounded by a long-range
gun which was shelling all down the line of it. They halted in the
open for the rest of the day. A curious experience followed. The idea
was to attack in the general direction of Cattenières, across the line
of the Cambrai-Caudry railway, which, with its embankment and
cuttings, was expected to give trouble. The New Zealand Division
was then on the right of the Guards Division; but no one seemed to
be sure, the night before the battle, whether the Third Division was
out on their front or not. (“Everything, ye’ll understand, was all
loosed up in those days. Jerry did not know his mind, and for that
reason we could not know ours. The bottom was out of the war, ye’ll
understand, but we did not see it.”) However, it was arranged that
all troops would be withdrawn from doubtful areas before Zero (5.10
a. m.), and that the 2nd Coldstream and the 2nd Grenadiers would
advance to the attack under a creeping barrage with due precautions
which included a plentiful bombardment and machine-gunning of the
railway embankment.
The Battalion, in reserve, as has been said, moved from Masnières
to its assembly area, among old German trenches near the village of
Seranvillers, in artillery formation at 2.40 a. m., and had its breakfast
at 5 a. m., while the other two battalions of the Brigade advanced in
waves, preceded by strong patrols and backed by the guns. There
was no shelling while they assembled, and practically none in reply
to our barrage; nor did the leading battalions meet opposition till
after they had cleared out the village of Seranvillers, and were held
up by screened machine-guns in a wood surrounding a sugar-factory
north of Cattenières. The Battalion followed on in due course,
reached the railway embankment, set up Headquarters in a road-
tunnel under it (there was no firing), and received telephonic orders
that at 5 a. m. on the 10th October they would pass through the
other two battalions and continue the advance, which, henceforth,
was to be “by bounds” and without limit or barrage. Then they lay
up in the railway embankment and dozed.
They assembled next morning (the 10th) in the dark, and,
reinforced by seven Corps Cyclists and a Battery of field-guns, went
forth into France at large, after a retiring enemy. Nothing happened
for a couple of miles, when they reached the outskirts of Beauvais-
en-Cambrensis, on the Cambrai-Le-Cateau road, where a single
sniper from one of the houses shot and killed 2nd Lieutenant V. J. S.
French, No. 4 Company. A mile farther on, up the Beauvais-Quiévy
road, they found the village of Bevillers heavily shelled by the enemy
from a distance, so skirted round it, and sent in two small mopping-
up parties. Here No. 4 Company again came up against machine-gun
and sniper fire, but no casualties followed. Their patrols reported the
next bound all clear, and they pushed on, under heavy but harmless
shelling, in the direction of Quiévy. At eight o’clock their patrols
waked up a breadth of machine-gun nests along the whole of the
front and that of the battalions to their left and right. They went to
ground accordingly, and when the enemy artillery was added to the
small-arm fire, the men dug slits for themselves and escaped
trouble. For some time past the German shell-stuff had been
growing less and less effective, both in accuracy and bursting power,
which knowledge cheered our troops. In the afternoon, as there
were signs of the resistance weakening, our patrols put forth once
more, and by five o’clock the Battalion had reached the third bound
on the full battalion front. Then, in the dusk, came word from the
New Zealand division on their right, that the division on their right
again, had got forward, and that the New Zealanders were pushing
on to high ground south of Quiévy. With the message came one
from No. 4 Company, reporting that their patrols were out ahead,
and in touch with the New Zealanders on their right. There is no
record that the news was received with enthusiasm, since it meant
“bounding on” in the dark to the fourth bound, which they
accomplished not before 10.30 that night, tired officers hunting up
tired companies by hand and shoving them into their positions.
These were on high ground north-east of Quiévy, with the Battalion’s
right on a farm, called Fontaine-au-Tertre, which signifies “the
fountain on the little hill,” a mile beyond the village. The 1st Scots
Guards were on their left holding the village of St. Hilaire-les-
Cambrai. Then, punctual as ever, rations came up; Battalion
Headquarters established itself in a real roofed house in the outskirts
of Quiévy, and No. 1 Company in reserve, was billeted in the village.
Next morning (11th October), when the 3rd Guards Brigade came
through them and attacked over the naked grass and stubble fields
towards St. Python and Solesmes, the Battalion was withdrawn and
sent to very good billets in Quiévy. “The men having both upstairs
and cellar room. All billets very dirty,” says the Diary, “owing to the
previous occupants (Hun) apparently having taken delight in
scattering all the civilian clothes, food, furniture, etc., all over the
place.” Every one was tired out; they had hardly slept for three
nights; but all “were in the best of spirits.” Brigade Headquarters had
found what was described as “a magnificent house” with “a most
comfortable” bed in “a large room.” Those who used it were lyric in
their letters home.
The total casualties for the 10th and 11th October were amazingly
few. Second Lieutenant V. J. S. French was the only casualty among
the officers, and, of other ranks, but three were killed and nine
wounded.
The officers who took part in the operations were these:
No. 1 Company
Lieut. H. E. Van der Noot. 2nd Lieut. R. E. Taylor.
2nd Lieut. J. C. Haydon.
No. 2 Company
Lieut. E. M. Harvey, M.C. 2nd Lieut. A. L. W. Koch
2nd Lieut. G. T. Todd. de Gooreynd.
No. 3 Company
Lieut. F. S. L. Smith, M.C. 2nd Lieut. J. J. B. Brady.
Lieut. G. E. F. Van der Noot.
No. 4 Company
Capt. D. J. Hegarty. 2nd Lieut. V. T. S. French (killed).
2nd Lieut. Hon. C. A. Barnewall.
Battalion Headquarters
Major A. F. Gordon, M.C. Capt. G. L. St. C. Bambridge, M.C.
Capt. J. B. Keenan.
They lay at Quiévy for the next week employed in cleaning up

dirty billets, while the 3rd and 2nd Brigades of the Division were
cleaning out the enemy rear-guards in front of them from the west
bank of the Selle River, and roads and railways were stretching out
behind our armies to bring redoubled supply of material. One of the
extra fatigues of those days was to get the civil population out of the
villages that the enemy were abandoning. This had to be done by
night, for there is small chivalry in the German composition. Quiévy
was shelled at intervals, and no parades larger than of a platoon
were, therefore, allowed. The weather, too, stopped a scheme of
field-operations in the back area between Quiévy and Bevillers, and
a washed and cleanly clothed battalion were grateful to their Saints
for both reliefs.
On the 17th October the Sixty-first Division took over the Guards
area, and that afternoon the Battalion left Quiévy by cross-country
tracks for Boussières and moved into position for what turned out to
be all but the last stroke of the long game.
The enemy on that front were by now across the steeply banked
Selle River, but the large, straggling village of Solesmes, of which St.
Python is practically a suburb, was still held by them and would have
to be cleaned out house-to-house. Moreover, it was known to be full
of French civils and getting them away in safety would not make the
situation less difficult.
St. Python
It was given out at Brigade conference on the 17th that the Sixty-
first Division would take place on the right of the Guards Division
and the Nineteenth on its left in the forthcoming attack, and that the
Sixty-first would attend to Solesmes, while the Guards Division
pushed on north-east between St. Python and Haussy on a mile-
wide front through the village of Escarmain to Capelle, a distance of
some three and a half miles. The 1st and 3rd Brigades would lead,
the 2nd in reserve, and the passage of the Selle would be effected in
the dark by such bridges as the Sappers could put up.
The Battalion moved nearer their assembly areas to St. Hilaire-les-
Cambrai, on the night of the 18th after Company Commanders had
thoroughly explained to their men what was in store; and on the
19th those commanders, with the Intelligence Officer, Captain
Vernon, went up to high ground overlooking the battle-field. It was a
closer and more crumpled land than they had dealt with hitherto, its
steep-sided valleys cut by a multitude of little streams running from
nor’-west to south-east, with the interminable ruled line of the Bavai
road edging the great Forest of Mormal which lay north of
Landrecies. The wheel was swinging full circle, and men who had
taken part in that age-ago retreat from Mons, amused themselves by
trying to pick out familiar details in the landscape they had been
hunted across four years before. But it was misty and the weather,
faithful ally of the Germans to the last, was breaking again. Just as
the Battalion moved off from St. Hilaire to their area on the railway
line from Valenciennes to Le Cateau, rain began and continued till six
next morning, making every condition for attack as vile as it could.
They dug them shallow trenches in case of shell-fire, and sent down
parties to reconnoitre the bridges over the Selle. Four bridges were
“available,” i.e. existed in some shape, on or near the Battalion front,
but no one had a good word to say for any of them.
There is a tale concerning the rivers here, which may be given
(without guarantee) substantially as told: “Rivers round Maubeuge?
’Twas all rivers—the Aunelle and the Rhônelle and the Pronelle, an’
more, too; an’ our Intelligence Officer desirin’ to know the last word
concernin’ each one of ’em before we paddled it. Michael an’ me was
for that duty. Michael was a runner, afraid o’ nothing, but no small
liar, and him as fed as myself with reportin’ on these same dam’
rivers; and Jerry expendin’ the last of his small-arm stuff round and
round the country. I forget which river ’twas we were scouting, but
he was ahead of me, the way he always was. Presently he comes
capering back, ‘Home, please, Sergeant,’ says he. ‘That hill’s stinking
with Jerries beyond.’ ‘But the river?’ says I. ‘Ah, come home,’ says
Michael, ‘an I’ll learn ye the road to be a V.C.!’ So home we went to
the Intelligence Officer, and ’twas then I should have spoke the
truth. But Michael was before me. I had no more than my mouth
opened when he makes his report, which was my business, me
being sergeant (did I tell ye?), to put in. But Michael was before me.
He comes out with the width of the river, and its depth, and the
nature of its bottom and the scenery, and all and all, the way you’d
ha’ sworn he’d been a trout in it. When we was out of hearing, I told
him he was a liar in respect to his river. ‘River,’ says he, ‘are ye after
calling that a river? ’Tis no bigger than a Dickiebush ditch,’ he says.
‘And anyway,’ says he, ‘the Battalion’ll rowl across it in the dark, the
way it always does. Ye cannot get wetter than wet, even in the
Micks!’ Then his conscience smote him, an’ when his company went
down to this river in the dark, Michael comes capering alongside
whishpering between his hands: ‘Boys!’ says he, ‘can ye swim, boys?
I hope ye can all swim for, Saints be my witness, I never wint near
the river. For aught I know it may be an arrum of the sea. Ah, lads,
thry an’ learn to swim!’ he says. Then some one chases him off
before the officer comes along; an’ we wint over Michael’s river the
way he said we would. Ye can not get wetter than wet—even in the
Micks.”
It was a quiet night, except for occasional bursts of machine-gun
fire, but there was no shelling of the assembly area as the 2nd
Grenadiers formed up on their right, with the 2nd Coldstream in
reserve. Nos. 1 and 2 Companies (Captain A. W. L. Paget, and
Lieutenant E. M. Harvey, M.C.) moved off first, No. 3 in support
(Captain Bambridge), and No. 4 (2nd Lieutenant O. R. Baldwin) in
reserve. The barrage opened with a percentage of demoralising
flame-shells. There was very little artillery retaliation, and beyond
getting rather wetter than the rain had already made them, the
Battalion did not suffer, except from small-arm fire out of the dark.
The first objective, a section of the Solesmes-Valenciennes road, was
gained in an hour, with but eight casualties, mainly from our own
“shorts” in the barrage, and several prisoners and machine-guns
captured. The prisoners showed no wish to fight.
The companies had kept direction wonderfully well in the dark,
and reached the second and last objective under increased machine-
gun fire, but still without much artillery. The 3rd Guards Brigade on
their left had been hung up once or twice, which kept No. 2
Company, the left leading company, and Nos. 3 and 4 (in support)
busy at odd times forming defensive flanks against sniping. By half-
past five, however, they were all in place, and set to dig in opposite
the village of Vertain. Then dull day broke and with light came
punishment. The enemy, in plain sight, opened on them with
everything that they had in the neighbourhood, from 7 a. m. to 10 p.
m. of the 20th. The two front companies were cut off as long as one
could see, and a good deal of the stuff was delivered over open
sights. It was extremely difficult to get the wounded away, owing to
the continuous sniping. But, through providence, or the defect of
enemy ammunition, or the depth of the slits the men had dug,
casualties were very few. Battalion Headquarters and the ground
where No. 4 Company lay up were most thoroughly drenched,
though an officer of No. 3 Company, whose experience was large,
described his men’s share as “about the worst and most accurate
shelling I have been through.” They were, in most places, only a
hundred yards away from a dug-in enemy bent on blessing them
with every round left over in the retreat. During the night, which was
calmer, our Artillery dealt with those mixed batteries and groups so
well that, although no man could show a finger above his shelter in
some of the company areas, the shelling next day was moderate.
The forward posts were still unapproachable, but they sent out
patrols from Nos. 1 and 2 Companies to “report on the River
Harpies,” the next stream to the Selle, and to keep it under
observation. This was an enterprise no commander would have
dreamed of undertaking even three months ago. The enemy sniping
went on. The 2nd Coldstream, who had been moved up to protect
the right flank of the 2nd Grenadiers (the Sixty-first Division, being
delayed some time over the clearing up and evacuation of Solesmes,
was not yet abreast of them), were withdrawn to billets at St. Hilaire
in the course of the afternoon; but word came that neither the
Grenadiers nor the Irish need look to be relieved. It rained, too, and
was freezing cold at night. Another expert in three years of miseries
writes: “One of the worst places I have ever been in. Heavy rain all
day and night.... More shelling if we were seen moving about. Heavy
rain all day.... Soaked through and shivering with cold.” The Diary
more temperately: “The men were never dry from the time they left
their billets in St. Hilaire on the evening of the 20th, and there was
no shelter whatever for any of the companies.” So they relieved
them during the night of the 21st, front Companies 1 and 2
returning to the accommodation vacated by their supports, 3 and 4.
Battalion relief came when the 24th Battalion Royal Fusiliers
(Second Division) took over from them and the Grenadiers and got
into position for their attack the next morning. An early and
obtrusive moon made it difficult to fetch away the front-posts, and
though the leading company reached the Selle on its way back at a
little after five, the full relief was not completed till half-past nine,
when they had to get across-country to the main road and pick up
the lorries that took them to “very good billets” at Carnières. Their
own Details had seen to that; and they arrived somewhere in the
early morning “beat and foot-sore,” but without a single casualty in
relieving. Their losses for the whole affair up to the time of their
relief were one officer (Captain and Adjutant J. B. Keenan) wounded
in the face by a piece of shell, the sole casualty at Battalion
Headquarters; ten other ranks killed; forty-two wounded, of whom
two afterwards died, and two missing—fifty-five in all.
The companies were officered as follows:
No. 1 Company No. 2 Company
Capt. A. W. L. Paget, M.C. Lieut. E. Harvey, M.C.
No. 3 Company No. 4 Company

Capt. G. L. St. C. Bambridge. 2nd Lieut. O. R. Baldwin.
Battalion Headquarters
Major A. F. Gordon, M.C.
Capt. J. B. Keenan.
Capt. C. A. J. Vernon.
Cleaning up began the next day where fine weather in “most
delightful billets” was cheered by the news that the Second Division’s
attack on Vertain had been a great success. In those days they
looked no further than their neighbours on either side.
Every battle, as had been pointed out, leaves its own impression.
St. Python opened with a wild but exciting chase in the wet and
dark, which, at first, seemed to lead straight into Germany. It ended,
as it were, in the sudden rising of a curtain of grey, dank light that
struck all the actors dumb and immobile for an enormously long and
hungry stretch of time, during which they mostly stared at what they
could see of the sky above them, while the air filled with dirt and
clods, and single shots pecked and snarled round every stone of
each man’s limited skyline; the whole ending in a blur of running

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Library of Congress Control Number: 2018960871

© Springer Nature Switzerland AG 2019

The third edition of Diagnosis of Endometrial Biopsies and Curettings: A

s­ amples. For example, the classification of endometrial stromal tumors has

Baltimore, MD, USA Tricia A. Murdock

Hydropic Change and Other Pathologic Changes

6 Effects of Hormones������������������������������������������������������������������������ 145

Proliferative/Hyperplastic Pattern������������������������������������������������ 205

© Springer Nature Switzerland AG 2019 1

Table 1.1 Clinical terms for abnormal uterine bleeding (AUB)

reclassified as well, and terms such as menorrha-

Table 1.4 Causes of abnormal uterine bleeding in post- Infertility Biopsy

© Springer Nature Switzerland AG 2019 9

Table 2.1 Secretory phase endometrial changes

 istologic Features of Normal

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Towards the Canal du Nord

The Crossing of the Canal du Nord

They lay at Quiévy for the next week employed in cleaning up

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s amples. For example, the classification of endometrial stromal tumors has

6 Effects of Hormones�� 145

Proliferative/Hyperplastic Pattern�� 205

Table 1.4 Causes of abnormal uterine bleeding in post- Infertility Biopsy

istologic Features of Normal