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The long trip home: medical evacuations from the front

The BBC’s drama The Crimson Field provided viewers with a portrait of life in a fictional field hospital during the First World War. In this guest blog, Dr Jessica Meyer (University of Leeds) discusses how the sick and wounded made it to such hospitals and beyond, revealing the many caregivers they would have encountered on the road, rail and sea.

Medicine and those who administered it were central to a soldier’s experiences of the First World War. On enlistment or conscription, men went through a medical examination. While in the field they would regularly encounter their Regimental Medical Officer and sanitary squads.  Although such medical care was very much a part of everyday life for the British soldier, the most important aspect of the work of the Army Medical Services (AMS) was the evacuation of the sick and wounded from the battlefield.

Clearing battlefields promptly allowed both military actions to continue unhindered, and manpower to be conserved by ensuring that the wounded were treated promptly.  Locating medical establishments along the lines of communication in places that offered both access to transport and sufficient shelter was key to battle planning.  Diagrams such as these (all taken fromW.G. McPherson, Medical Services of the War: General Services, Vol. II, HMSO: 1923):

Diagram of the organization of medical services
Diagram of the organization of medical services
Diagram of evacuation plan - cambrai
Diagram of evacuation plan – Cambrai
Diagram of evacuation plan - Messine
Diagram of Evacuation Plan: Messine

were a standard aspect of Royal Army Medical Corps (RAMC) battle preparation and illustrate the routes that a wounded man might take from Regimental Aid Post (RAP) through Casualty Clearing Station (CCS) to Base Hospital and beyond.

Battle of Pilckem Ridge 31 July - 2 August : stretcher bearers struggle in mud up to their knees to carry a wounded man to safety near Boesinghe on 1 August.
Battle of Pilckem Ridge 31 July – 2 August : stretcher bearers struggle in mud up to their knees to carry a wounded man to safety near Boesinghe on 1 August.

So what happened to the many men wounded in battle? If he was able, he would probably apply a first aid dressing, with which all men were issued. If he could still walk he would go to a collecting station. If not, he would be carried to an aid post by volunteer regimental stretcher bearers. At the RAP he would have his details taken and an initial assessment would be made.  The first aid dressing would be changed for a more secure dressing, and he might get a drink and a cigarette. These posts were, however, usually extremely hectic places, located near the front lines with comparatively little shelter, so most care was superficial.

From the RAP the wounded man was then taken by stretcher bearers to a dressing station run by a field ambulance. The distance between an aid post and a dressing station could be some miles, often over ground dug up by shellfire. Bearers worked in relays in order to maximise the speed of transport. If they were lucky, they might have wheeled stretchers or even trolleys, but the ground was usually far too uneven for anything other than stretcher transportation.

The dressing stations were located near roads, often in abandoned buildings.  Here again men had their details recorded, their dressings changed and their condition assessed before they were loaded into the vehicles of the Motor Ambulance Corps for transportation by road.  In the early days of the war, horse-drawn waggons were used, but after they were overwhelmed by the number of casualties they were required to cope with at the Battle of Mons, motorized ambulances were increasingly brought into service. Many were adapted from donated private cars, but even when specialized vehicles were produced, the poor condition of the roads meant that the journey was extremely uncomfortable and could be fatal.

The wounded man’s next port of call, the CCS, was one of the most flexible and important establishments in the evacuation process. Originally mobile, by 1916 CCSs had become, due to the static nature of trench warfare, semi-permanent fixtures, located near railway termini or major road junctions.  This meant they were able to grow in size to accommodate up to 1000 patients.  Their staff also grew, mainly to include female nurses, the closest that such women were allowed to the front line. The number of operations carried out also increased, as the importance of forward treatment become clear. As a result, CCSs became increasingly specialised, with units and their staff specialising in everything from skin diseases or gas to particular types of wounds.

The CCS could treat those with less serious injuries and return them to their units via convalescent camps. It could also retain those with wounds so serious that they could not be moved further – one reason for the large cemeteries at former sites. If necessary, cases could be evacuated further down the line to base hospitals.  These evacuations were generally carried out by train, although some were carried out by hospital barges.  Hospital trains were staffed primarily by volunteers, including the St John’s Ambulance Brigade and the Friends’ Ambulance Unit, working under the aegis of the British Red Cross. A number of base hospitals were also run by voluntary units.  These large hospitals were based at the principle army bases, giving access to both railheads and ports.

About 50% of men who arrived at a base hospital would go on to be evacuated by hospital ship to Britain for further treatment or convalescence.  For the remaining 50%, survival rates if they made it this far were good, and most would go on to camps for six weeks of rehabilitation before returning to their unit or being reassigned to alternative duty if their wound or illness affected their medical rating.

Patients lie in beds with Red Cross nurses standing beside them.
Patients lie in beds with Red Cross nurses standing beside them.

For those with a ‘Blighty’ wound, evacuation to a Home hospital meant they would be taken to a hospital run by the RAMC with support from the British Red Cross. Here men with conditions requiring longer-term specialist care received the sort of complex treatment unavailable overseas. Over the course of the war many of these hospitals developed regional specialisms, such as the orthopaedic specialist designation of No. 2 Northern General Hospital (Beckett’s Park, Leeds) after 1917. Following their treatment, men would be sent to Auxilliary hospital for convalescence, the destination of some of those evacuated from Base hospitals as well. Many were located in donated country houses, with the lady of house acting as commandant, although an RAMC officer held a supervisory position as medical officer and the nursing was overseen by a professional matron. These hospitals were designed to ease the pressures on space elsewhere.

From their convalescence, men were discharged either to return to duty with their units or for reassignment for those no longer deemed fit enough for front line duty.  On their journey from the trenches, a wounded soldier would have been cared for by a huge variety of caregivers, not just doctors and nurses, but bearers, orderlies, General Service volunteers, radiographers, anaesthetists, dentists and chaplains. Their varied and important roles continue to be the subject of academic enquiry.