Tag Archives: front

Carrying, caring, comforting: the people behind medical evacuations

In this guest blog, Jessica Meyer introduces the many people a wounded soldier would meet on his evacuation from the front.

A regimental aid post somewhere on the Western Front during World War I. Wellcome Library. CC At 2.0.
A regimental aid post somewhere on the Western Front during World War I. Wellcome Library. CC At 2.0.

The first people a soldier was likely to encounter after being wounded would be very familiar. Regimental stretcher bearers were drawn from combatant units and were trained in basic stretcher drill and first aid.  During action, they exchanged rifles for stretchers and stood ready to bring wounded men in from No Man’s Land. They would help apply field dressings, and carry the injured to the Regimental Aid Post. The men there would, again, be familiar figures as part of the man’s regiment. The Regimental Medical Officer, a Royal Army Medical Corps (RAMC) officer, was the military equivalent of the GP, dealing with day-to-day illnesses and accidents as well as wounds sustained in action. Servicemen regularly encountered their medical officer and the orderly who accompanied him on sick parade or during inspections for trench foot and the like.

From there, the wounded man would be entrusted to a less familiar group of men, the stretcher bearers supplied by a field ambulance.  These men were members of the RAMC rather than a combatant unit, and their wartime role revolved entirely around the transport of sick and injured men. They had better levels of training in both wound care and stretcher drill than regimental bearers.  Indeed, as Emily Mayhew has argued, by the end of the war they had developed what might be defined as a professional identity as care providers, something they took great pride in (Emily Mayhew, Wounded: From Battlefield to Blighty 1914-1918 [London, 2013], 6). George Swindell, for instance, recalled in his memoirs the experience of transporting a man with an abdominal wound for two hours, only for him to die within ten minutes of arriving at an aid post when an infantry sergeant gave him water:

‘on our way back we looked up the men who had shouted at us, and told them we knew our work, that was why we were there, and as the result of an individual, who did not understand, that case was lying dead, we told them how his life would probably have been saved, but for the water opening up the wound again, and we also asked them to help us in future, not hinder us’

George Swindell, In Arduis Fidelus: Being the story of 4 ½ years in the Royal Army Medical Corps, Ts. Memoir, Wellcome Library, RAMC 421, p.151.

The stretcher bearers transported men to the aid posts where they were treated by RAMC officers and tent units of a field ambulance. Tent orderlies increasingly developed care-giving expertise with a focus on wound care, first aid and the dispensing of pain relief.  Like the stretcher bearers, they served under the authority of officers who were all medical professionals drawn from civil practice and the medical schools.

Women Urgently Wanted for the WAAC (IWM PST 005476)
Women Urgently Wanted for the WAAC (IWM PST 005476)

From the dressing stations, transport shifted from manual bearing to vehicles.  Motor ambulances replaced horse-drawn ambulance wagons in the early years of the war, resulting in a change in the character of the transport providers.  Instead of drivers drawn from the ranks of the RAMC, motor ambulances were primarily provided by the Motor Ambulance Convoys. Established in 1915 drivers had as much mechanical as medical knowledge.  From 1916, as the war went on, and the manpower shortage grew more acute, female drivers from the Women’s Army Auxiliary Corps increasingly replaced male ambulance drivers.

At the Casualty Clearing Station (CCS), the next stop along the line of evacuation, the wounded man would again encounter medical officers and tent orderlies.  This was also the first place he might expect to encounter female nurses, exclusively professional nursing sisters serving with the Queen Alexandra’s Imperial Nursing Service. As the war progressed, he might also encounter female anaesthetists and radiographers, as medical dilution in response to the army’s demands for manpower brought more women into these roles.  In exceptional cases, a man might find himself in one of the few hospitals run entirely by women, such as those provided by the Scottish Women’s Hospitals, although these units were under the authority of the British Red Cross or allied military commands, rather than the War Office. Indeed, Dr Elsie Inglis, who led the Scottish Women’s Hospital, was famously told by the War Office to ‘go home and sit still!’ when she offered her services to the war effort. The role of women working close to the front line remained a deeply contentious issue for British military authorities throughout the war.

British army operating theatre at Wimereux, near Boulogne. Wellcome Library.
British army operating theatre at Wimereux, near Boulogne. Wellcome Library CC At 2.0.

It was on the next stage of his journey that the wounded man would be treated predominantly by voluntary, as opposed to military, medical units. The British military regarded medical volunteers, who did not come directly under their authority, with some suspicion and did not allow them too near the front line. Voluntary units did, however, provide staff for the hospital trains, barges and motor ambulances which transferred men between CCS and Base hospitals.  These included both male units, such as the Friends’ Ambulance Unit, often formed of conscientious objectors, and female units of nursing Voluntary Aid Detachments. In 1914 there were 551 male detachments, as well as 1,823 female detachments; by 1918, there were 836 male and 3,247 female detachments. These units also served aboard the hospital ships, and volunteer units also provided ambulance transport between trains and hospitals in Britain, a service described as ‘a double role which truly merits the country’s admiration’, as it was carried out in addition to whatever regular work the volunteer did. (Ward Muir, Observations of an Orderly: Some Glimpses of Life and Work, in an English War Hospital [London, 1917], 207.)

In military hospitals, volunteers might provide nursing and general service, the latter performing the tasks of cooking, cleaning and mending that allowed the hospital to function while the former aided professional nurses and doctors in providing medical care.  Red Cross hospitals were supervised by professional nursing sisters and all doctors were honourary officers.  Those serving in home hospitals had probably been judged as unsuitable in some way for overseas service.  This could be related to age, health, areas of expertise (in the case of medical officers) or character (often cited in relation to volunteers).  As the war went on, home hospitals became increasingly feminine spaces, as women took on the roles of male orderlies who were increasingly combed out for combatant service.  At Base hospitals, men deemed unfit for frontline service, often having suffered wounds or illness, were substituted for fitter orderlies.

In Britain, further social care was offered. Groups of women provided the food and cigarettes at train stations, similar to the comforts, while committees such as the Leeds War Hospital Entertainment Scheme, founded in 1916, provided entertainment to men confined by the tedium of recovery.  The ‘lady visitor’ was mocked in hospital journals, personifying civilian ignorance and inconsequentiality.  She was, however, only one of the many people who cared for wounded men both medically and emotionally on the long journey from battlefield to hospital.

Find out more about how the line of evacuation functioned in another post on this blog.

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.

World War One at Home – Wednesday 26th February across the BBC

BBC News Magazine and BBC Scotland has been exploring the tale of Carl Lody, a German spy who reported on British warships in the Firth of Forth in Edinburgh. Lody, who used the alias Charles Inglis, was executed at the formidable Tower of London in 1914.

On Twitter at #ww1athome, people are sharing and posting stories like the one above. BBC Shropshire’s Genevieve Tudor posted a picture of a local women’s network who organised the collection of eggs for the frontline in Much Wenlock. Comedian Johnny Vegas joined the conversation, tweeting his approval, and suggesting that the woman on the left reminded him of his paternal grandmother.

eggsphoto

In the East Midlands, it is the history of the University of Leicester that is explored by a current medical student. Soldiers injured on the front were transported to the a hospital on the site, the former County Lunatic Asylum repurposed after the outbreak.. After the war, the University was established there as a living memorial.