THE TRANSPORT AND TREATMENT OF THE SICK AND WOUNDED IN WORLD WAR I

 

The phrase "sick and wounded" appears in every report of the Army Medical Service and the Red Cross Society. It reminds us that the medical services had to deal with just as many "sick" soldiers as "wounded". Frost-bite was widespread; so also were rheumatism; trench fever, which was similar to typhus fever, and, like typhus, was transmitted by lice; dysentery; trench foot, due to prolonged exposure of the feet to water, and many others. Conditions in the front line were often horrendous, with cold weather, heavy rain resulting in knee-deep mud, lack of drinking water at times and infestation by lice.


In the early months of the war, epidemics of measles, mumps and chickenpox affected the young volunteer soldiers from the hills and valleys of Wales, from farms and villages in the north and from rural areas all over the country, who were mixing with townspeople in large numbers for the first time. In the Highland Division alone, eighty-five soldiers died in the autumn of 1914. When the Americans arrived in 1917 and 1918 their young soldiers experienced the same epidemics.
I shall trace the normal progress to the rear of a man who has been struck down in the firing line. Compared with previous wars, machine guns, artillery, grenades and mortar were much more advanced and deadly. The injuries they inflicted could be horrific. The wounded were often left lying in the open under a hail of bullets and shellfire


REGIMENTAL AID POSTS


These were located in a dugout, in a cellar, or in some sheltered spot, giving cover from fire; a few yards behind the front line. A soldier wounded in action would walk, or be carried by regimental stretcher-bearers, to the post. Treatment here was limited to a field dressing and a morphia injection. Good stretcher-bearers were highly regarded. It is no accident that the most decorated other rank of the war, Lance Corporal Bill Coltman, VC, DCM and Bar, MM and Bar, was a stretcher-bearer.
At the aid post the medical officer would make a quick assessment. Some men were so badly hurt that it was a waste of time and effort to move them further back. They would be made as comfortable as possible and left to die. A merciful overdose of morphine was the kindest treatment for a badly wounded man.
Other men could be saved by swift treatment. The medical officer would do his best for them, stopping bleeding and cleaning wounds. Then stretcher-bearers, sent forward by the bearer section of field ambulances, would carry them back to the tent section of field ambulance in the advanced dressing station. Some were taken by lorry or ambulance.
Walking wounded would be directed back, under their own steam, to a walking wounded collecting station, usually in the vicinity of the advanced dressing station.

ADVANCED DRESSING STATIONS


These were pushed forward as close to the front as possible, but generally about two to five miles behind. They were situated in houses alongside roads, so as to facilitate conveyance to and fro. Upon arrival of the patient at one of these, his wound is carefully attended to, and he is injected with anti-tetanic serum.
He is then carried by motor or horse wagon to one of the larger dressing stations, which has been opened possibly in a school, a convent or a church in some town or large village situated farther to the rear, where he is made as comfortable as possible, and is given food and drink. He will probably remain here for some hours, while he and other sufferers are sorted out, according to the nature of their wounds.
Many of the wounded who reached an advanced dressing station died there. They were buried in extemporised graveyards. These later formed the basis for several Commonwealth War Graves Commission cemeteries on the Western Front
Perhaps the best known former dressing station is Essex Farm, just north of Ypres, where the Canadian medical officer John McCrae wrote the poem "In Flanders Fields"
The journey from dressing station to clearing station was usually made by motor ambulance.


CASUALTY CLEARING STATIONS.


These were field hospitals, set up in tents, Nissen huts or commandeered accommodation, with up to 800 beds. They were located between seven and thirty miles behind the front line. They moved back and forth with the tide of battle, hence the need for tents. The hospitals were usually located in groups of three or four in the vicinity of a railway siding. This enabled patients to be easily loaded on to ambulance trains.
A clearing station might have half a dozen doctors and as many nursing sisters. By September 1917 there were fifty-nine of them on the Western Front, each capable of dealing with up to 1200 cases a day. At the peak of a battle there would be three surgical teams, working sixteen hours on and eight off. It is in one of these stations that the patient will for the first time experience the luxury of being tended by nursing sisters and of lying on a bed - probably one procured from the neighbourhood.
The length of the patient's stay depended on the railway facilities, but, as a rule, it would not be more than a few hours before he was placed on an ambulance train. He would then be moved to a base hospital or on to the French coast for transport to Britain.


AMBULANCE TRAINS OVERSEAS


For convenience and the comfort of the patients, ambulance trains were greatly superior to horsedrawn or motor ambulances. The history of ambulance trains goes back to the Crimean War of the early 1850's. An eight mile stretch of railway was built between Balaklava and Sevastopol to carry supplies to the front and bring back the wounded. Before the railway was built 2000 horses had been used to carry the 112 tons of supplies needed at the camp each day.
After the Crimean War ambulance trains were used extensively on the Continent in every war, and also during the American Civil War of 1862. Improvements in design were constantly being made.
But when war was declared on August 4th 1914, Britain had no properly constructed ambulance trains immediately ready for shipment overseas. The French had none to spare for British troops, because of their own heavy casualties, but they handed over 100 goods wagons and a few passenger carriages to the RAMC ambulance train personnel. They, in turn, divided them into three trains, cleaned, disinfected and equipped them.

A typical ambulance train in WW1 would consist of 15 to 20 carriages. These included ward coaches for lying patients, and for sitting cases, kitchens, dispensaries, and accommodation for medical staff, nursing sisters, and orderlies. Having separate coaches for infectious patients was important, for some had contracted diphtheria, enteric fever, measles, mumps, scarlet fever, influenza, pneumonia etc. The trains seemed to run non-stop from the casualty clearing stations to Boulogne, Le Havre or Rouen for embarkation on hospital ships; to base hospitals along the Channel coast, or to Paris, Marseilles and elsewhere.

During the battle of Loos over 22,000 casualties were evacuated by 16 ambulance trains in 63 journeys. A wounded soldier who took part in the advance of September 25th 1915 reported "The way the wounded were cleared from the front was simply marvellous. Hospital trains were running one behind the other so smoothly and regularly as the coaches in a Lord Mayor's procession. They were wonderfully fitted up and the whole of the medical corps must have worked at a speed they have never attained before."
In the course of the whole war, the British ambulance train service in France carried over five million sick and wounded patients from the front to the bases or from base to base.

CANAL BARGES


In certain cases seriously wounded men who required complete rest were carried by barges which had been specially converted into hospital craft. Northern France has an excellent system of canals. The barges were towed by tugs and could take serious cases from the casualty clearing stations to the most advanced hospitals.

BASE HOSPITALS


The Base is the great receiving and distributing centre of all manner of supplies for the army in the field. Here they are unshipped, accumulated and dispatched. The Base could be on the Channel coast, Boulogne, Rouen, Etaples, or on the Atlantic coast at a large seaport.
On arrival at a base, the wounded man is again carried in a motor ambulance to a fully equipped permanent hospital. These hospitals are of two kinds, general and stationary. The general hospitals are the largest and are elaborately equipped; fitted with all the modem appliances which are found in first-class civilian hospitals. Stationary hospitals would take fewer patients. In spite of their title, they are intended to be more mobile than general hospitals. A third category of hospital is composed of the Red Cross and other voluntary hospitals, for example, the Scottish Women's Hospital, founded by Dr. Elsie Inglis.
Patients who are unlikely to recover within three weeks and who will not be harmed by further transport are sent to England as soon as accommodation is available on board a hospital ship. The patients who are retained are either very serious cases whom it would be unwise to move, or slight cases who are likely to be fit for duty or discharge to a convalescent camp within three weeks.

HOSPITAL SHIPS


These were requisitioned liners which had been extensively adapted to transport the sick and wounded. In effect they were floating hospitals, and were medically and surgically equipped to deal with all cases of injury and disease. In order that they might be easily distinguished, military hospital ships were painted white overall, with a horizontal band of green, about a metre and a half wide, around the hull. They all had red crosses painted on the sides, fore, aft and amidships, and they flew their national flag as well as the red cross flag. The hulls were brilliantly illuminated at night. Identified in this way, they were protected from attack under the Geneva Convention.
Even when the antagonists obeyed the Geneva Convention, hazards still faced these gleaming white hospital ships. In the years 1915 to 1917 seven military hospital ships struck mines and were either sunk or badly damaged. In 1917 Germany decided to disregard International Law and hospital ships—no matter how prominently marked— were no longer protected by the Geneva Convention. In 1917 and 1918 eight hospital ships were torpedoed. The resulting casualties were tragic.
Altogether 77 military hospital ships and transports were commissioned during the war. Amongst them were three of the great liners of the period—the Aquitania, the Britannic and the Mauretania.
At the outbreak of the war Southampton became No.1 Military Embarkation Port and practically the whole port was taken over by the military authorities. From here the entire British Expeditionary Force, the "BEF", was dispatched to France, and here the sick and wounded arrived from the war zones. Only in 1915 did the port of Dover become operational to deal with hospital ships.


MILITARY AMBULANCE TRAINS IN THE UK.


The role of ambulance trains in the UK differed completely from that of the trains overseas. Abroad the patients were entrained, especially in France, from medical units scattered over an extensive area, often in the vicinity of the front line. In many cases their wounds and injuries still carried the mud and filth of the trenches. While in the train to the base they received proper attention, and this was continued at the base hospitals and in the hospital ships carrying them to the UK. Thus, when they arrived at homeports, they were in a presentable condition, and only the seriously ill or badly wounded needed much medical attention on the next stage of their journey.
Originally 12 ambulance trains were constructed by the various railway companies in the UK, and they all reached Southampton in the very early days of the war. The early "home" ambulance trains had red crosses painted on the roofs as well as the sides of the carriages.


When Dover was brought into use as a reception port for the sick and wounded from the BEF in 1915, a number of ambulance trains were permanently transferred there from Southampton.
The total number of home ambulance trains in service eventually reached 29, of which 24 were for the army and 5 for the navy. Additional emergency trains were made up when required, with vans to take lying patients on stretchers, while corridor coaches were attached for sitting patients. These trains, which were provided with a kitchen car, accommodated from 300 to 500 patients
Officers and nursing sisters were the first patients to be disembarked, the officers usually being sent to London in the War Department Ambulance Train. All hospital
ships were cleared on the day on which disembarkation began. Nearly 200 railway stations received convoys of sick and wounded, Strathpeffer in Scotland, 624 miles from Southampton, was the most distant.


The total number of British and Commonwealth sick and wounded dealt with at all ports in the UK during the war exceeded two and a half million, the number of sick being slightly in excess of the wounded.
The first ambulance train to reach Dundee arrived on 29fh October 1914, carrying 60 Belgian soldiers, sent as an overflow from Stobhill Hospital in Glasgow. From then on, ambulance trains arrived about every fortnight from the front via Southampton, each carrying 100 wounded. The most serious were sent to Dundee Royal Infirmary and the rest distributed among the Eastern Hospital [later to become Maryfield] and the other Red Cross Auxiliary Hospitals.
The Red Cross provided all the transport at any hour of the day or night to evacuate the ambulance trains when they arrived, and the evacuation was carried out most efficiently and expeditiously, under the charge of Mr. TNJ Bell and Mr. Thomas Shaw. The stretcher-bearers were supplied by the St Andrews Ambulance Association. The Red Cross also provided all the transport required for the sick and wounded from barracks, camps and billets to the hospitals.


THE DUNDEE BRANCH OF THE BRITISH RED CROSS


The British Red Cross Society was founded in 1870, and it linked up with the Order of St. John of Jerusalem in 1909, and formed the organisation known as the Voluntary Aid Detachment or VAD. The object was to maintain in time of peace an organisation which would enable it to render prompt and efficient aid in time of war to the sick and wounded, in the manner best suited to supplement the Army Medical Service.
In 1910 two Detachments were set up in Dundee, one at Broughty Ferry, the other at the College in Park Place. Two further Detachments were formed in the following year. When a person joined the Red Cross, they were enrolled after one year's probation as a member of a Voluntary Aid Detachment. Members were trained in First Aid, Nursing and Cookery. Many were middle or upper class women, keen to give up their time to do some useful work, mainly in hospitals.


Before the outbreak of war in August 1914, the organisation did not figure prominently in the eyes of the public. In fact a good many people questioned its usefulness. However the high state of efficiency which the Dundee Branch had achieved was demonstrated by the fact that ten days after hostilities commenced, the organisation was able to undertake the reception and treatment of wounded soldiers.
A request on the part of the Society that the Caird Rest, in the Nethergate, should be placed at their disposal as a Hospital was received by the Magistrates and the Special Committee in charge with great favour. Not only was the Caird Rest handed over to the Red Cross, but it was placed in a suitable condition and repair, free of expense to the Society. This was quickly followed, in the same excellent spirit, by the Dundee Parish Council who placed four wards of the Eastern Hospital, with the operating theatre there, at the disposal of the Society. In quick succession the Measles Pavilion at King's Cross was offered, followed by Mr. R B Don's offer of the Lodge at Broughty Ferry (This later became the Limb Fitting Centre). Messrs. Cox Brothers donated the Old School in Bright Street, Lochee as a hospital, and altered and equipped it fully. And so an excellent group of Red Cross VAD Hospitals was placed at the disposal of the Military Authorities for immediate use. Local doctors were invited to volunteer to act as Red Cross Medical Officers at the different Hospitals.


Fund raising enabled the local Society to present six motor ambulances for use at the Front. A shop at No. 19 Nethergate was used to receive items for the equipment of hospitals and clothing for the sick and wounded. St Luke's Church Hall in Lochee was used for the same purpose. VAD volunteers became fundraisers, cooks, kitchen maids, clerks, ward maids and ambulance drivers. The St. John's and the St Andrew's Ambulance Associations worked with the Red Cross.
Although the VAD nurses had received only a short period of training, compared with qualified nurses who had three years of training, the shortage of nurses when war broke out meant that any disagreements and suspicions were soon forgotten. Soon qualified nurses and VAD nurses began to work together for their mutual benefit.


All over Britain, just as in Dundee, auxiliary hospitals were set up, equipped and staffed by VAD nurses and trained nurses. The VADs washed dishes, swept floors, cleaned and dusted. In one such hospital there was a VAD called Elsie Doran, whose husband was a Brigadier-General in command of the 8th Infantry Brigade. One day the Sister in Charge met her in the hall, and said " Nurse Doran. I want you to take these sheets upstairs". And Sister handed her an armful of sheets, and proceeded to walk up the main staircase. Naturally Elsie Doran obediently followed her, carrying the sheets. Sister put her head over her shoulders and said in the most chilling voice, "Nurse Doran, nurses use the back stairs".
The VAD nurse who witnessed this incident went on to relate how very humble and polite they had to be to their officers. When they went in and out of the office, they had to be like parlourmaids, bringing in the tea, perfectly set out on the tray always on their best behaviour. In these days they had parlourmaids in their own homes, so they knew just how it was done. But when they came off duty and went home tired, their maid brought in their tea.


Many VAD nurses used social influence to get themselves to the conflicts in France to nurse the sick and wounded soldiers. The Dowager Duchess of Sutherland, attired in the uniform of a Red Cross nurse, marched down the gangway of a cross-Channel steamer and set her feet firmly on the soil of France, before the war was a hundred hours old. It was a strict rule that no foreigners were allowed to nurse in French hospitals, but, in the Duchess's philosophy, rules did not apply to her. Escorted by the British Ambassador, she called on the French Minister of War who broke every regulation in her favour, gave her a permit and expressed devoted gratitude for her services. She joined a group of nurses, every one a countess, and travelled to Belgium.


She joined the Belgian Red Cross and wired her instructions to England. A surgeon and eight trained nurses must be engaged at once and sent to join her in Belgium. They would be known as the Millicent Sutherland Ambulance and the Duchess would be their commandant. Two days later the doctor and nurses arrived, bringing with them drugs, disinfectant, dressings and, in accordance with her Grace's special instructions, a plentiful supply of glycerine for the hands.
A few days later the wounded began to arrive, and to her surprise the Duchess found herself washing wounds, dragging off clothing soaked in blood, holding basins full of blood, and soothing the groans of the wounded.


Three days later the Germans captured the town. The inhabitants were terrified, but not Sister Millicent. She marched off to the German Headquarters and sent in her card to the commandant. General von Bulow, whom she had met before the war. She was also acquainted with his aide-de-camp, Baron Kessler. Every day the
Duchess appeared at the Kommandatur with a fresh demand or complaint, quoting the Geneva Convention at the Germans until they were sick of the sight of her. Amazingly they remained consistently civil and courteous.
Finally she demanded and received a permit allowing her to visit the captured British wounded at Mons. The Germans meekly supplied her with a motor car and driver. As the Duchess remarked, The Germans like well-known people". She returned eventually to the British lines and, after many further adventures, the Duchess of Sutherland's Red Cross Hospital was set up just outside Calais, where it remained for the duration of the war.


THE STORY OF MAIRI CHISHOLM


It was not only the nobility who were keen to be involved in the action at the front. This is the story of an 18 year old Scottish girl, Mairi Chisholm, who was so keen to find war work in 1914 that she travelled to London on her motor cycle, became a dispatch rider for the Women's Emergency Corps, and finally joined the Flying Ambulance Corps in Belgium. She then teamed up with a nurse called Elsie Knocker. They realised that many soldiers were dying while being transported back from the front, and so they set up their own medical post right on the front line. They spent an incredible four years treating the wounded on the spot, sometimes carrying the wounded soldiers in from No Man's Land over their shoulders. They also ferried the wounded away from the front in ambulances, often in pitch-dark nights. They were the only women to live and work in front line trenches. Both were gassed during the major German offensive of M

arch 1918. After the war Mairi Chisholm briefly joined the Air Force, and raced cars at Brooklands.
There is no doubt that women played a major role in the First World War; in industry and on the land as well as in hospitals. The medical services could not have coped without the Red Cross VAD nurses and the auxiliary hospitals they organised and ran. They proved themselves worthy of the vote.
My final comment on the war is this. Wars bring untold death, destruction and misery, but sometimes there is a glimmer of good. The First World War is no exception. Advances were made in medicine and hygiene. Saline drips became routine to reduce the damage done by shock. Blood transfusion came to be used more often. Surgical treatment of wounds improved, so that gas-gangrene became much less common. There were advances in plastic surgery and the treatment of burns. The price paid for these advances however was high.