Private Albert Bullock, hard hit in the hip on 6 October 1918, shouted for stretcher-bearers after he fell, ‘and saw two not twenty yards from me … and they came out to me without hesitation’. They were machine-gunned on the carry, but ‘the two bearers stuck it like heroes till we were under cover’.199 Anthony French was carried from the field of the Somme in September 1916 after lying for a long time in a shell hole.
At first I was soothed by the unaccustomed motion, but when the bearers entered a narrow trench and had to stretcher bars together to follow its twisting course, I longed for the journey’s end. It was the easiest journey I have ever made. Reflected on senses already distorting the known and natural were ghastly images, a vague consciousness of things unseen. Clammy vapour rising from the ground. The stench of exposed death and decay. The phantom faces of unknown soldiers speaking only in whispers, absurdly, so I thought, since the enemy was thousands of miles away … At regular intervals the flash and bellow of a mighty gun and the rushing sound of its disgorged shell in flight, like a ghost-train cleaving the sky. A dim reddish light glowing opaquely through canvas between tree trunks. Figures moving softly hither and thither. A voice demanding: ‘What’s his trouble?’ And somebody answering ‘Right leg.’200
At the aid post the medical officer would make a quick assessment. This was often no easy task, for in any sort of serious action he would quickly be overwhelmed by the sheer weight of casualties. Ernest Parker had never really appreciated his MO until he saw him in a trench at Loos, ‘feverishly at work, his head swathed in a bloodstained bandage’.201 Harold Dearden’s aid post near Ypres was:
a perfect shambles of mud, rain and blood. It was quite impossible to get any cover for anyone … We were heavily shelled all night; and in the early morning a flight of Boche planes bombed us from very low down, and I had several of my wounded killed that way. I spent all night either in my slit [trench], sitting in quite two feet of muddy water, or else dodging round the aid post trying to explain to my poor fellows that I had no cover to give them, and had done all that was possible; but they kept asking to see me every five minutes and on the whole it was a ghastly night.202
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. Many doctors took the view that a merciful overdose was the kindest treatment for a badly-wounded man. Second Lieutenant Treffry was terribly mangled by a shell on the Somme. His comrade C. P. Blacker saw it happen, and rushed forward to find that:
One leg had been almost blown off with the jagged end of a femur sticking out. An artery was spurting. The other leg had been twisted back to front. His uniform had been ripped open and his abdomen gaped with bowels extruding. His face and moustache were a parched yellow. Stertorous sounds and blood were coming from his mouth.
Blacker briefly considered shooting him, but instead had him stretchered back to an aid post near Guillemont, where a young RAMC officer agreed that there was: ‘Nothing to do but put him to sleep … But Treffry had a tough constitution and did not die until nightfall.’203
There were times too when morphine was no use. Arthur Osburn, striving desperately to care for a group of cavalrymen hit by a heavy shell on the Aisne in 1914, found:
One terribly wounded … lay with both legs partly torn away at the knee, one arm broken and other wounds; he was still conscious.
‘Oh! My God! Shoot me! Shoot me!’ he moaned. ‘Quick!’ I injected some morphia into his breast. Someone who had rushed into the yard was standing, breathless, horror-stricken, beside me. The tortured man recognised him – his brother!
‘Shoot me. Tom! Oh! Shoot me! For the love of God! Shoot me, will you! WILL YOU!’ he began to scream piteously.
Irresolutely, the man appealed to, fumbled with his revolver and looked at me rather wildly. Then, suddenly dropping his revolver, he covered his face with his hands and staggered away.
I hastily soaked with chloroform a piece of clothing that had literally been blown from one of the other wounded, and doubling it, I laid it over the mouth of the agonised man beside whom I was now kneeling …
I was dulling pain with chloroform; morphia seemed quite useless.
My knees were soiled with manure from the yard; the spouting arteries that I had tried to check had drenched the front of my tunic and accoutrements and sprinkled my face, where the blood dried. My arms to the elbows were caked.204
Sidney Rogerson was a very experienced company commander by the time he fought on the Chemin des Dames in 1918, but little could have prepared him for it.
A vivid picture stands out in my mind of that moment. From the ridge in front, mutilated human beings, Englishmen and French, were being carried down on hurdles of ground sheets – such medical amenities as stretchers had disappeared long before. Bourdillon bent over to talk to one poor devil whose stomach had been ripped open, his entrails only held in by the sopping field dressing. He came across to me. ‘I can’t take him in the cars,’ he said, ‘he’s bound to die, and it would only mean pushing some one off who might recover. If there weren’t so many men about I’d do what he’s asking me.’ ‘What’s that?’ I asked. ‘Shoot him, and put him out of pain.’205
Other men could be saved by swift treatment. The medical officer would do his best with them, stopping bleeding and cleaning wounds, and then stretcher-bearers, sent forward by the bearer sections of field ambulances, would carry them back to the tent section of the field ambulance in the advance dressing station, where better treatment was possible. Soldiers whose wounds were less threatening might take longer to reach the advance dressing station; scarce places on stretchers were given to those whose need was greatest. ‘I know of no greater relief than that experienced by a Regimental M.O. on getting rid of the wounded,’ reflected Cyril Helm.206
Walking wounded would be directed back, under their own steam, to a walking wounded collecting station, usually in the same vicinity as the advance dressing station. Before leaving the regimental aid post a wounded man was tagged with a label giving an initial diagnosis and specifying what drugs, if any, he had been given. ‘These tickets were issued to us in book form,’ wrote Frank Dunham, ‘similar to a cheque book, so that we retained a complete list of all casualties passing through our Aid Post. This list we had to send to our Orderly Room daily, whence the information was passed on to the Base and thence to England.’207 When Harry Ogle was hit in the leg by a rifle bullet which remained in the wound, he was tagged wrongly: it took him several days to persuade the doctors to X-ray his leg, so convinced were they by the tag’s insistence that the wound was superficial.
Work at an advance dressing station during a major battle was unrelenting. In July 1917 Major Martin Littlewood RAMC, who had already informed his diary that ‘I develop lice and a touch of scabies’, wrote that his dressing station, near Ypres, received a ‘constant stream of wounded and now and then some who have been out two days. Awful. Busy all night until morning.’ When he got out of the line in November he was so affected by the experience that he found he could no longer sleep in sheets, and when he raised the blinds to enjoy the sensation of a naked light, thought ‘of the men lying around the Menin Road’.208
Chaplains were also busy, taking dictation from men who wanted to send letters home, comforting the badly hurt, and often, when there was a heavy surge of casualties, helping with first aid. Julian Bickersteth, in an advance dressing station just behind Gommecourt on 1 July 1916, supervised the loading of ambulances – four lying and four sitting cases apiece – and organised hot tea or Oxo for the wounded. He wrote that:
The worst wounded seemed often to feel less pain than those who had slighter wounds. The shock of a shattered limb seemed to destroy the nerves in that part of the body. One lad said to me, ‘Oh, my leg is so stiff, Sir,’ and the boy’s leg was smashed altogether … But I heard no word of complaint, and scarcely a groan.209
Doctors often commented on the resignation of their
wounded, and Lord Moran wrote that only once, during his whole time on the Western Front, did he encounter a man who was terrified of death when the moment came. He tried to give the man privacy by shoving a heavy box of dressings against the dugout door, but reflected that those who practised medicine became party to dreadful secrets.
At night Julian Bickersteth would go forward with the bearer sections of the field ambulance running his dressing station, collecting wounded from the battlefield and bagging up the identity discs and personal belongings of the dead, recording the details on a label attached to his tunic. Only his faith kept him going, he reflected, and ‘comforted me with the thought that those bodies are not down here – they are above …’. The division’s assistant provost marshal sent a squad of thirty men to dig a huge grave, 26 feet long, 6 feet wide and 4 feet deep, and on one occasion Bickersteth had to take cover in it to avoid shelling – by no means a unique experience of the close proximity of the quick and the dead. Because many of the wounded who reached an advance dressing station died there, the extemporised graveyards that surrounded so many 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.
In October 1918 Albert Bullock, with his hip wound, was taken by wheeled stretcher from his regimental aid post to the advance dressing station, and although he was very cold and wanted a drink they had nothing for him. His battalion, 8/Royal Warwicks, had suffered more casualties in forty-eight hours than it had for nearly a year in Italy, and it was not alone: the system was creaking badly. So badly, indeed, that nobody had yet relieved him of the grenades and flares in his pockets and he dumped these, with his gas mask and helmet, when he reached his next port of call, the casualty clearing station. The journey from dressing station to clearing station was usually made by motor ambulance. It could be easy enough if the system was not under pressure, but Frank Hawkings, walking wounded on the first day of the Somme, saw it close to meltdown.
Eventually we found the dressing station [actually his battalion’s regimental aid post], crowded with wounded, on the outskirts of Hébuterne. While I was waiting to be attended to, I suddenly felt giddy and fainted away. When I recovered, Captain Clarke, the doctor, was trying to rouse me. He soon bandaged me up. And off I went through the village to find the field ambulance … At the opposite side of the village I found a crowd of wounded waiting by a medical dugout for the arrival of motor ambulances. I joined this crowd … when a hail of long-range machine-gun bullets came pattering on the ground near us … we set off to walk to Saillyau-Bois. [Given a lift to the ADS there] we were inoculated against tetanus (lock-jaw), and were given a mug of tea … There were too many cases for the authorities to do more than inoculate us and dress our wounds and so it was left to us to drift on to the casualty clearing station at Couin as best we could … Here were hundreds of men on stretchers in the cornfields where they had been dumped by the ambulance men.210
The casualty clearing station was a field hospital set up in tents, Nissen huts or commandeered accommodation. A station might have half a dozen doctors and as many nursing sisters, and by September 1917 there were fifty-nine of them on the Western Front, each capable of dealing with up to 1,200 cases a day. At the peak of the third battle of Ypres there were twenty-three clearing stations behind the salient, each with three surgical teams working sixteen hours on and eight off. There was a conflict of opinion over the role of the clearing station. Traditionally, army doctors argued that the main role of the medical evacuation system was to shift soldiers along it as quickly as possible. However, there were those like Sir Anthony Bowlby, brought in as consulting surgeon to the BEF, who thought that the stations should be pushed well forward and should operate as quickly as possible, as many of the men evacuated so quickly would actually die. A change in practice brought good results, though there were suggestions that it led to the capture of part of two clearing stations during the German 1918 March offensive, for it was no easy matter to move a hospital and its patients at short notice.
But with the enhancement of the medical achievements of the casualty clearing station came, some argued, a decline in its practicality. Colonel David Rorie, assistant director of medical services, 51st Highland Division, thought that the clearing station personnel were ‘the spoilt children of the RAMC, arguing that they were always eager to obtain labour from the field ambulances, but slow to return it. And they sometimes complained when soldiers appeared with their pockets full of hand-grenades: ‘Tommy was a casual soul, and often carried an odd bomb or two inside the torn lining of his tunic pockets or otherwise bestowed about his person.’211 A man would probably not get out of his clothes till he reached a clearing station, revealing some unpleasant surprises. A captured German complained that he had not had his boot off for fourteen days. ‘Unfortunately,’ wrote Rorie, ‘before I managed to leave his side he managed to get the boot off. I decided at once that he was no liar.’ Some men were shocked into incontinence, or lost control of their bowels through pain or fear, and one Irish officer, in the grips of dysentery and the victim of a long carry, muttered repeatedly: ‘It’s not my fault …’
From the clearing station patients, British and German, would be moved to a base hospital or on to the French coast for transport to Britain. This part of the journey was usually made by rail, and Harold Dolby saw German prisoners, who, at least in theory, received exactly the same treatment as their captors:
being carried by our men to the ambulance train … Fat and smiling Germans were being carried on the shoulders of our orderlies to the train; here in clean linen on swing cots with English nurses and doctors to attend them they were going to make their way in comfort to St Nazaire.212
Private Alf Arnold, working at a field hospital behind the Somme battlefield in July 1916, told his parents that:
On two trains there were about 200 German wounded. Poor beggars they were knocked about too. One or two had died on the train and others were dying. No one who has not seen, can realise how badly some of them were mutilated. I was pleased to see how kindly they were treated by the English stretcher-bearers & RAMC men.213
Bernard Martin, wounded at Passchendaele, remembered little of his own train journey:
Flat on a stretcher … a glimpse from an ambulance window of the ruins of the Cloth Hall … mild indignation … I could have shown them a safer route avoiding Ypres … Somewhere before dark my stretcher was on flat ground in a field full of stretchers, as though we were a carefully cultivated crop of some choice plant ready for harvest, waiting to be reaped. My heart leaped up when I beheld an English girl kneeling beside me, gentle hands seeking where to give me an injection – then back to unconsciousness. Next, I was looking from the window of a stationary hospital train, recognising the harbour at Boulogne. Two days, I think, in a bed, a real bed, in the Casino – this time indignant to discover my legs still caked with Flanders mud … Probably I was under sedation because I next remember being aboard a hospital ship, SS St Denis, in the harbour awaiting nightfall, before crossing the English Channel.214
F. P. Roe had the good fortune to be wounded at Shrapnel Corner, just east of Ypres, in December 1916, when there was no major battle in progress and the chain of evacuation was working well. He remembered nothing of being treated at a dressing station, and:
When I next came to I was lying on the stretcher on a railway platform. I remember being dimly concerned that I could not tell what time it was as the wristwatch I had worn throughout my time in France and Belgium had somehow disappeared. I was later loaded into an ambulance train and was exhorted to roll off the stretcher onto the top bunk of one of the carriages … When the train finally stopped, I was again exhorted to … roll off the bunk and onto a raised-up stretcher …
When I woke up again I found that I had been admitted to an officers’ ward of the famous No. 14
General Hospital at Wimereux which was on the French coast near Boulogne. I shall never forget my first night there. There was an officer opposite me who at intervals throughout the whole night repeatedly called out in a loud and agonized voice, ‘Mabel, Mabel!’ The cries towards morning became quieter and quieter and he died peacefully early in the morning.215
Some soldier patients remained at hospitals on the continent, convalescing in special centres, some of them so tautly run that, as Harry Ogle observed: ‘they must have been designed to make soldiers desire fervently to get away … even back to the very line itself’.216 They were posted back to their units when passed fit. The more seriously ill went back to Britain, and were distributed about a range of hospitals and nursing homes, public and private, throughout the country. On 8 October 1918 Albert Bullock was operated on at No. 6 General Hospital in France: he came to and found that they had kindly stuck the bullet that had hit him, wrapped in muslin, to his chest. He crossed the Channel aboard Gloucester Castle and was in a military hospital in Weymouth on 11 October, five days after being wounded. His wound became infected and he nearly died, but he had nothing but praise for his treatment. When he was able to eat again he wrote that ‘the Staff Nurses are as pleased as me, especially Nurse Beanell who was a real trump to me’.217
Real trumps indeed. From 1916 nurses – military nurses of Queen Alexandra’s Imperial Military Nursing Services and the Territorial Force Nursing Services and a wide range of auxiliaries such as the Voluntary Aid Detachments (which had a total strength of 82,857 by the war’s end) – were increasingly numerous in France, although the sight of five English nurses behind the Somme in 1916 was so unusual as to persuade all around to stop work ‘to behold the fair “visions”.’ Sister May Tilton testifies to the fact that there was an extra dimension to female nursing. In May 1917 she was running a sixty-bed surgical ward with one VAD and ‘sometimes two orderlies’ to help.
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