Tag Archives: medicine

After the Guns Fell Silent: Researching the medical and social care provided to British disabled ex-servicemen of the First World War

In this Guest Blog, Dr Jessica Meyer, an AHRC WW1 Expert, talks Medical and Social Care provided to ex-servicemen.

AA075348 - Ministry of Pensions & National Insurance © Historic England Archive
A georgian house with cows on the front lawn probably in Herefordshire, occupied by the Ministry of Pensions and National Insurance.  Image similar to one featured in country fair magazine, march 1955. Image AA075348 – Ministry of Pensions & National Insurance
© Historic England Archive. Used with kind permission of Historic England.

One of the most significant legacies of the First World War across Europe was the return home of a large number of men whose lives were profoundly altered by war-attributable disabilities.  In Britain, many of these men received aid and care from the State, in the form of the Ministry of Pensions, and a range of charitable institutions. Most, however, relied on their families for support, particularly their wives, mothers and other female relatives, to provide the medical and social care necessary for them to reintegrate into civil society.

© IWM (Art.IWM PST 12222)
Recruits Wanted (Art.IWM PST 12222) Copyright: © IWM. Original Source: http://www.iwm.org.uk/collections/item/object/30892

Such support involved both physical and emotional labour. In 1921, Cannon Nisbet C. Marris wrote to the Regional Director of the Ministry of Pensions for the Nottingham Region about his son, Oswald, an ex-serviceman who suffered from functional paralysis, required ‘constant attention and is very helpless, requiring frequently two persons to move him in bed.’ [1] This work, Cannon Marris explained, was undertaken by himself and his wife.  Three years later, Mrs. W.H. Botterill described in her application for treatment assistance how, in addition to caring for her badly shell-shocked husband, she worked outside the home to ‘keep our home going, support myself, and provide my husband’s extra expenses, laundry, postage, etc.’ Just over a month later she suffered a breakdown due to what her doctor described as ‘overwork and strain.’ [2]

Mrs. Marris and Mrs. Botterill are only two of the women who appear in series PIN 26, (which are Ministry of Pension personal award files from the First World War held at the National Archives, London).  These 22,756 files represent only 2% of the approximately 1,137,800 First World War files ever created.  Nonetheless, they provide a rich resource of material for historians of the First World War and its medical, social and cultural legacy.  A tiny fraction of the available files have been used by historians to explore the cultural history of medicine and the war [3] but, as Michael Robinson has recently pointed out [https://fournationshistory.wordpress.com/2015/10/05/the-four-nations-and-beyond-the-post-armistice-experiences-of-shell-shocked-british-army-veterans/], a great deal of work on this material remains to be done.

© IWM (Art.IWM PST 5116)
New Scale of Separation Allowances (Art.IWM PST 5116)  Copyright: © IWM. Original Source: http://www.iwm.org.uk/collections/item/object/28413

The Men, Women and Care project, a five-year European Research Council Starting Grant-funded project currently underway at the University of Leeds, aims to facilitate future projects through the creation of a public database of the information contained in the PIN 26 files.  This will enable scholars to identify clusters of potentially relevant material by variables such as type of disability, amount of pension or gratuity, region of residence and existence of dependents. By publishing the database in conjunction with a separate catalogue series MH 106: Admission and Discharge Registers and Medical Sheets for Personnel of Expeditionary and Imperial Forces, 1914-1919 and the release of the 1921 national census, the project will provide resources to the next generation of scholars working on the legacy of the First World War in Britain.

© IWM (Art.IWM PST 11148)
Disabled Ex-Service Men (Art.IWM PST 13806) Copyright: © IWM. Original Source: http://www.iwm.org.uk/collections/item/object/31758

In the meantime, the four members of the Men, Women and Care team will be using the process of putting the database together to identify material within PIN 26 to further our own research into the ways in which care for disabled ex-servicemen shaped British society.  Our specific projects include looking at the nature and extent of family-based medical and social care, how distance from home influenced care provision, the role of stigma in care provision, and the work of religious charities in supporting disabled ex-servicemen and their families.

Through these projects we aim to recover the voices and experiences of both disabled ex-servicemen and the women who facilitated their reintegration into post-war society. Too often unrewarded for their efforts by the State and overlooked by scholarship, these women formed a vital element of the social order in the interwar years. Through the stories of women like Mrs Marris and Mrs Botterill we hope to learn more about the lives of women whose war work persisted long after the guns fell silent.

La Protection Du Reforme No2 © IWM (Art.IWM PST 11148)
La Protection du Réformé No. 2 [Protection for Category Two Invalided Soldiers] (Art.IWM PST 11148) Half-length depictions of two moustachioed, convalescent French soldiers, who face the viewer. The nearest man sits bare-headed with his hands crossed. The other soldier wears a serviceman’s kepi.  Copyright: © IWM. Original Source: http://www.iwm.org.uk/collections/item/object/22629
[1] The National Archives (TNA), PIN 26/19945, Cannon Nisbet C. Marris, Letter to Regional Director, Nottingham Region, Ministry of Pensions, 6th January, 1921.

[2] TNA, PIN 26/21239, Mrs W. H. Botterill, Application for Treatment Assistance, 5th March, 1924 ; Ella C. Flint, M.B., Report, 23rd April, 1924.

[3] See Joanna Bourke, Dismembering the Male: Men’s Bodies, Britain and the Great War (London: Reaktion Books, 1996); Jessica Meyer, Men of War: Masculinity and the First World War in Britain (Basingstoke: Palgrave Macmillan, 2009).

The girls behind the men behind the guns

In this post, New Generation Thinker Dr Sam Goodman (Bournemouth University) reflects on the role female nurses played in WW1, and on how the reality is embellished in historical dramas such as Downton Abbey.

In this time of renewed focus on the First World War, both in a commemorative and also a cultural sense, we are confronted regularly with the experience and imagery of suffering. Arguably, TV and film productions that dramatize the war have a responsibility to depict its various horrors, from the squalor of the dugouts through to the trauma of violent injury in battle, and very few shy away from doing so. Of equal importance as these male perspectives on war in the trenches though is the female experience of conflict. In many ways, the roles played by women in the First World War offer more varied accounts than their male counterparts, as they include the stories of those women in Britain either employed in industry or waiting for return of a loved one, or those overseas working in a range of capacities in support of the military. Of all of these roles, one of the most recurrent is that of the nurse. The nurse and her experiences are a staple of popular fiction, and have proved evident in recent televisual productions such as The Crimson Field and Downton Abbey, as well as the film adaptation of Vera Brittain’s memoir, Testament of Youth.

Lady Sybil Crawley as a nurse in Downton Abbey
Lady Sybil Crawley as a nurse in Downton Abbey

The representation of nursing in these productions typically follows a similar narrative pattern – a young and headstrong woman desires greatly to contribute to the war effort often in defiance of her parents’ wishes, her class status, or some other obstacle. She overcomes initial resistance and gets her wish but her ideals and illusions are shattered by the brutal reality of modern warfare, leaving her emotionally scarred but ultimately changed for the better as a result of her experiences. This is certainly the case with a character like Sybil Crawley from Downton Abbey, whose growing consciousness of the difference between her parents’ values and her own manifests itself successively in daring fashion choices, romance with the family chauffeur, and then a decision to join the Voluntary Aid Detachment (VAD) in 1916. Sybil’s actions cause all manner of narrative tension but her compassion and dedication to helping others ultimately convinces her parents that nursing is a respectable occupation befitting her social standing. Sybil’s experience appears to deliberately echo Vera Brittain’s journey in Testament of Youth, though does not, as in Brittain’s case, result in a life-long support for pacifism.

Whilst Downton is entirely fictitious and some liberties are taken with the events in Brittain’s memoir in the adaptation, the image of the ‘daring’ or ‘rebellious’ nurse that these texts project is not one created with dramatic licence. The history of nursing had always owed a great deal to the efforts of driven and determined women. At the beginning of the First World War, a professional, organised nursing service was still a relatively recent development within the world of the armed forces, and had only just begun to gain the respectability it would later acquire. A generation earlier and a professional, trained nursing service was a novelty, and a near practical unknown. Until the late nineteenth-century, nursing was mainly the work of religious orders or organisations, or relied on the voluntary actions of individuals; in the Crimean War of 1853-56, women such as Mary Seacole and, of course, Florence Nightingale would be celebrated for their charitable actions, conducted without any organisational support, and little interest from the military command they were aiding. Subsequently to the Crimea, nurses such as Nightingale and Ethel Gordon Fenwick would be instrumental in developing rigorous and professionalised training programmes and a national register for nurses within the United Kingdom. These schools later became affiliated with hospitals and, as a result of the efforts of Fenwick and others, as well as influential royal support, nursing grew into the organised body on which the modern service is based. With the founding of the Army Nursing Service (ANS) in 1881, the Imperial Military Nursing Service (QAIMNS) in 1902, the British Army’s First Aid Nursing Yeomanry (FANY) in 1907, and the VAD in 1909 nursing became more widely known and respected, and these services would provide crucial medical care when war came in 1914.


VAD_posterOf course the romanticised ideal of the Edwardian woman escaping the strictures of the household for a life of emancipation and liberation in the service of nursing owes a good deal to the recruitment drives mounted throughout the war. The image of the nurse created by the war was one of selflessness and sacrifice, determined to provide care no matter what the personal risks may be, a perception fuelled by the public feeling over the execution of Edith Cavell for espionage in 1915. Of course far more Edwardian women were already in work before the outbreak of war than most people assume, and the virtuous image of wartime nursing was ruthlessly satirised in Blackadder Goes Forth (1986) in which Miranda Richardson’s Nurse Mary Fletcher-Brown smokes, drinks and dryly declares that ‘it’s good to have someone healthy to talk to for a change’. However, for some women, service in VAD, QAIMNS, or FANY did nonetheless equip them with skills and experience, and instil confidence that they otherwise would not have had opportunity to acquire. Any fictional focus on these experiences, even if they do bend the truth a little for dramatic effect, plays an important part in remedying the notion that the First World War took place only in the trenches.

Professional Women and Unmanly Men? Care careers in the First World War

Along the lines of evacuation, wounded men encountered men and women serving in caring roles. In this guest post, Dr Jessica Meyer explores what the organisation and staffing of medical establishments in war meant for gender and gender roles.

For women, wartime medicine could, at one level, mean greater opportunity.  For doctors like Elsie Inglis, who led the Scottish Women’s Hospital, the desperate need for medical professionals at or near the front line provided the opportunity to demonstrate hard-won skills.  Doctors such as Inglis and her staff had the opportunity to prove that they were equal to their male colleagues in terms of their courage and resourcefulness as well as their skills.  For professional nurses, the war provided an even greater opportunity to lay claim to a professional identity through recognised service with both the military nursing services and the British Red Cross.  For unskilled middle class women, volunteering with the Voluntary Aid Detachments and social caregiving units such as the YMCA or train greeting committees was a socially sanctioned form of war service which took them beyond the confines of domesticity.  They could learn new skills, experience adventure, and even travel abroad.  Finally, for working class women, general service with the British Red Cross provided a form of war service that was safer, if considerably less well reimbursed, than munitions work.

Used with the permission University of Leeds Special Collections, Liddle/MUS/AW/118’
Used with the permission University of Leeds Special Collections, Liddle/MUS/AW/118’

Yet women’s experiences of medical caregiving in the war was not simply a story of female liberation and the establishment of professional female identities.  Indeed, the struggle to establish such an identity was, in some ways, severely limited by the war.  The Scottish Women’s Hospitals were not employed by the British military but served instead with allied nations, including the French, Belgian and Serbian militaries.  After the war, many continued in medicine until marriage, but without the recognition that was accorded to their male colleagues of the Royal Army Medical Corps.

For professional nurses, the war presented an opportunity and a challenge.  The service of volunteers, who were valorised not simply as nurses but as volunteer nurses, threatened military nurses’ claims to a specifically professional identity.  If nursing was something that could be done effectively voluntarily, then why accord special recognition to those who undertook it as a career?  The power of this challenge is reflected in the fact that cultural memory of First World War nursing is often dominated by the eloquent voices of VADs such Vera Brittain rather than the more restrained professionalism of military nurses.

A similar conflict can be seen in the opportunity for women to train in medical roles previously reserved for men, such as anaesthetists and pharmacists.  On the one hand this provided professional opportunities for women to gain previously unavailable expertise.  On the other hand, these roles were under the authority of the always male surgeon or hospital Commandant.  At the same time, the increasing number of women in medical care strengthened pre-existing cultural links between caregiving and femininity.  In a society where the marriage bar in most professions would exist for another half a century, this served to depress the status of medical care as much as it improved female emancipation.  It is arguable that the relatively low financial value accorded to hospital carers today can be traced in part to the rise of female dominance of hospital care during the First World War.

And what of the men engaged in caregiving roles?  For medical officers, the influx of civilian professionals served to enhance the professional identity of a service that had, before the war, struggled to define its status within the military.  The actions of men such as Noel Chavasse, one of two medical officers to win not only a VC but also a bar, helped the officer ranks of the corps lay claim to a heroic wartime identity despite being non-combatant.

Stretcher bearers similarly were able to define their work as heroic.  Forced to face the terrors of the front line and come under attack without even carrying a weapon, stretcher bearer heroism was built on the image of immense stoicism in the face of danger.  In a conflict where endurance was increasingly key to definitions of the soldier hero, their work under fire was increasingly a source of admiration for their combatant comrades.

Medical orderlies, by comparison, had a far harder struggle in defining themselves as masculine. Tent orderlies serving overseas with field ambulances and Casualty Clearing Stations could and did come under shellfire.  Many also volunteered as stretcher bearers, using the role to lay claim to the qualities of endurance and self-sacrifice that attached themselves to their colleagues.  Those serving in Base and, even more so in Home hospitals, found themselves labelled as ‘Slackers in Khaki’ and mocked as the diminutive ‘orderlim’. This was an identity that orderlies never appear to have fully shaken off.  The manpower crisis meant that men were increasingly ‘combed out’ for combatant duty to be replaced by men too unfit for front line service.  These men were unable to fulfil definitions of heroism which privileged physical fitness, but having lost that fitness through war service, their masculinity was less open to direct question.

In 1919 the RAMC was recruiting for men who wished to ‘learn a useful occupation which may help you in civilian life’, recognition that such service could help men achieve the appropriate masculine identity of provider as well as that of military hero.  While caregiving may have become an increasingly feminine occupation, particularly in diluted hospitals, by the end of the war the RAMC serviceman was able to define not only his wartime but his postwar role as appropriately masculine.

The Other War Dead: Asylum Patients during the First World War

In this guest blog, Caroline Nielsen describes how vulnerable patients were displaced from hospitals to make way for the casualties of war.

In a recent post for this blog, Dr Jessica Meyer discussed how wounded and sick soldiers were evacuated from the frontlines to large specialized hospitals in Britain. Images of these war hospitals and their military patients have appeared in publications as part of the centenary commemorations. These institutions have even been the subject of popular TV dramas, such as Downton Abbey, The Wipers Times, and The Crimson Fields. But the creation of these life-saving institutions had a hidden cost: the forced displacement of around 12,000 of the most vulnerable people in British society. This was because twenty-four of Britain’s largest war hospitals were requisitioned asylums for the mentally ill and those with learning disabilities.

Asylums and the War
The British military authorities were under considerable pressure in late 1914. There were simply not enough hospital beds in Britain to accommodate the ever-growing number of allied war casualties. Numerous patriotic individuals and organisations voluntarily opened their doors to soldier-patients, donating their time, money, and property to the war effort. But it was simply not enough. A drastic and ambitious scheme was developed to ensure that the nation remained fighting fit. Recovering soldiers needed beds but they also needed spacious grounds, recreational areas and sports fields to aid their recovery. Only a small number of institutions had all of these facilities already in place: residential schools, workhouses and the largest of them all, lunatic asylums. There were only two problems: the pre-existing large population of vulnerable patients and the stigma attached to them.

Every county in England and Wales had a lunatic asylum. Run by local committees overseen by the Government’s centralized Board of Control, these institutions offered residential care to a large population of men, women and children. There were over 102 psychiatric asylums in England and Wales in 1914. Over 108,000 men, women and children lived permanently in these institutions. This meant that each county and borough asylum cared an average of 1000 patients at any one time (Sarah Rutherford, The Victorian Asylum, 2011).

Asylum patients had a wide range of conditions, many of which would not fit with modern understandings of mental illness. As well as caring for those with depression, anxiety and delusions, asylums nursed those with long-term or degenerative conditions like epilepsy, tuberculosis, liver disease, alcoholism, and syphilis. A significant proportion of patients were elderly and frail, moved from out of their homes when they started to experience the disorientating symptoms of dementia. It was not uncommon to find those with learning disabilities living permanently in asylums (for example those with Down’s syndrome or who would now be placed on the autistic spectrum). It is important to stress that the majority of those with learning disabilities in the early twentieth century continued to live with their extended families. While some patients were sent by their families to these institutions, others were referred there by social welfare authorities: by doctors, charity workers, the Board of Education, or by the Guardians of the Poor who oversaw workhouses. Going into a workhouse or insane asylum carried a huge social stigma. But for the most impoverished, sick and desperate, they offered the only chance of free medical care.

The Asylum War Hospital Scheme, 1915-1919
Faced with mounting casualties, the British War Authorities approached the Board of Control for permission to empty a small number of asylums. Patients were either to return to their families or be transferred into different institutions. 9 asylums were initially selected, with others gradually added into the scheme whenever more beds were needed. All selected asylums were swiftly renamed as “war hospitals” so that soldier casualties would not be tainted with the stigma of receiving treatment in a lunatic asylum.

The most incredible aspect of the scheme was the speed with which it was carried out. Within 5 weeks of the scheme being confirmed, the selected asylums had been emptied of all but a few of their patients. The official estimate was about 12,000. Only the “gravely ill” [dying] and a few “quiet useful insane” men were allowed to stay on. The “useful” patients were to work as gardeners. (Board of Control, Official History of the War Asylum Hospitals, 1920). The insane were not even given the reassurance of familiar staff. Asylum nursing staff were requisitioned for the war effort along with the furniture.

Unsurprisingly, the immediate effect on the patients was severe. The official report of the Medical Officer of Norfolk County Asylum (later Norfolk War Hospital) is so shocking that it is worth quoting at length;

The scenes on departure aroused varying emotions in myself, my medical colleagues and the nurses. It was all interesting, some of it most amusing and much sadly pathetic. To not a few the asylum had been their home for many years, some for over fifty years, some since childhood; many even had never been in a railway train … so it will be readily believed that the whole gamut of emotion was exhibited by the patients on leaving, ranging from acute distress and misery, through gay indifference, to maniacal fury and indignation.

Casualties of War
That the Asylum War Hospitals Scheme saved lives is beyond dispute. By 1920, the hospitals had offered specialist care, pioneering treatment and friendship to over 440,000 men from all over the world. Approximately over 38,000 (9%) of these men were psychiatric cases; those suffering from shell-shock, nervous breakdowns, delusions, and sheer terror.

But the War Hospitals came at a terrible cost to the mentally ill and their families. Within 1 year of the first transfers, the Board of Control noticed that patients were dying at a higher rate than usual. Overcrowding had resulted in some of the remaining asylums, facilitating the spread of influenza, pneumonia and tuberculosis. The asylum patients were also subject to rationing and food shortages, weakening an already sickly population. A series of cold wartime winters and a shortage of psychiatric medical professionals only exacerbated the problem.

In its official 1920 inquiry on the War Hospital’s Scheme, the Government reported that the transferred insane should be viewed as quasi casualties of war. Their suffering during the war was immediately and irrefutably comparable to that of “normal” military casualties. The insane deserved respect and sympathy irrespective of the stigma attached to their condition.

This was never to be. In spite of the report-writer’s best efforts, the wartime experiences of the civilian insane were almost immediately forgotten by their communities. The stigma surrounding mental illness and disability meant that discussing their experiences became taboo. No war memorials were raised in the name of these men, women and children. But as the centenary passes, they too should be remembered.

 

The AHRC and BBC “World War One at Home” project will explore the asylum transfers further in the autumn. Detailed descriptions of the individual asylums can be found in the Board of Control’s official report, entitled “History of the Asylum War Hospitals in England and Wales”, 1920. Regional asylum death statistics can be in Lewis Krammer’s article “The Extraordinary Deaths of Asylum Patients, 1914-18” in the journal Medical History (1992).

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.