First World War - Wounded on the Western Front
An urgent call goes down the line – ‘stretcher bearers, stretcher bearers’. Another man has been wounded or killed on the Western Front. The casualty figures during the Great War were horrific, with around a million British soldiers being killed and twice as many as that being injured.
Many of these injuries could lead to the soldier being permanently disabled or disfigured, so what medical treatment could he expect to receive, where was he treated and how was he evacuated away from the front line trenches?
Despite all the images we have seen of grim-faced troops bravely scrambling to go over the top and advance into a hail of machine gun bullets or artillery fire, most of the time life in the trenches was one of routine, even boredom. The big pushes, or battles, were terrifying for the men and claimed a lot of casualties but on a day to day basis the troops still faced the risk of being picked off by a sniper, hit by a shell or shrapnel or coming under attack from poison gas. Disease also stalked the trenches with men coming down with trench foot from the wet, muddy conditions, rheumatism from the intense cold, infections caught from the rats and lice and the most common of all, venereal disease.
So what would happen to you if you were the one who was unlucky enough to have been wounded and the call for stretcher bearers was for you? The Army knew the key to a wounded man surviving was prompt medical treatment and swift evacuation to a hospital behind the front lines.
At the start of the Great War these processes were often chaotic, but in a surprisingly short time a relatively efficient, though highly bureaucratic, system was put in place to assess casualties and get them to the kind of medical treatment they required.
If they were going to be wounded most soldiers dreamed of a clean ‘Blighty’ one, an injury serious enough to get them back home to Britain but one that did not involve losing a limb or being disfigured. However, because of the modern weaponry used in the First World War, many men suffered horrific abdominal injuries, facial wounds, burns and lung damage from poison gas.
The first place you would have been taken was the Regimental Aid Post, situated in or just behind the trenches. These Aid Posts were staffed by the Regimental Medical Officer, a few orderlies and some troops who had been trained as stretcher bearers. The stretcher bearers themselves could do very little in the way of first aid when they picked you up. Each soldier carried a field dressing in their tunic and all the stretcher bearer could often do was pour a phial of iodine onto the wound to clean it and apply the dressing.
This was dangerous work for the medical staff as the Regimental Aid Post would come under constant shelling and the stretcher bearers often had to go out into ‘no man’s land’ or onto the battlefield to retrieve the injured. This was so perilous that wounded soldiers would sometimes have to wait for hours until the sun went down before the stretcher bearers could start their work under the cover of darkness.
If your wound was too serious to be successfully treated at the Regimental Aid Post your next stop would be at a Main or Advanced Dressing Station. However, if you were wounded during a big battle it could take many hours to get you there as the trenches would be clogged with men and equipment going in both directions.
During a battle moving the wounded back to a Dressing Station was not prioritised, with getting ammunition and then reinforcements up to the battlefield both being deemed more important. Dressing stations were usually staffed by the Mobile Field Ambulances of the Royal Army Medical Corps and on arrival you would go through a triage process where your injuries were assessed.
As battle was raging the wait could be many hours and it was those casualties who could easily and successfully treated who were likely to be seen first. The seriously wounded or those judged to be beyond help were given morphine and left to wait. The priority was getting as many men as possible patched up fast and sent back to their units to fight on.
The more seriously injured were then evacuated back to a Casualty Clearing Station, usually located well behind the lines. Initially you would have been transported in a horse drawn wagon, with every bump and rut in the track causing you extra pain and misery.
Later in the Great War these were replaced by motor ambulances and even narrow-gauge trains. The First World War brought many women into the war zone to work for the first time and many became ambulance drivers, a dangerous and arduous job on the Western Front.
Casualty Clearing Stations were better equipped and had more trained medical staff than the Dressing Stations, so urgent amputations, operations and more complex medical treatment could take place. The Casualty Clearing Stations were generally static medical facilities made up of tents or huts and there would often be a few scattered around one location, usually near a railway line.
They could accommodate around 1,000 casualties at any one time and would accept the wounded in rotation with the other local Casualty Clearing Stations in batches of between 15-300 men. However, if a Big Push was on, they could be overrun by the wounded and then the priority would change to ship as many of the more serious cases back to the Base Hospitals on the Channel Coast as possible
Many soldiers sadly died of their wounds at the Casualty Clearing Stations and large military cemeteries were established in their vicinity. If you were lucky enough to survive then you were treated and returned to the trenches or sent on a specially equipped ambulance train or canal barge to a Base Hospital.
The CCS’s also cared for soldiers who were ill rather than injured and there were specialist Casualty Clearing Stations for shell shock, infectious diseases, or the specialist treatment of certain types of injuries such as burns. Often it was not the initial injury that killed a soldier, it was the gangrene or infection that developed as the wound got contaminated by the dirt and the filth of the trenches.
There were no antibiotics to treat these dangerous infections, so it was up to the medical officers at the Casualty Clearing Stations to clean the wounds effectively or make the hard decision to amputate a limb to save a man’s life. To get an idea of the scale of the casualties the CCS’s had to deal with; in 1916 alone on the Western Front 734,000 injured or sick troops were evacuated to hospitals by ambulance train and a further 17,000 by canal barge.
These casualties were sent to the Stationary Base Hospitals clustered around the army bases at Etaples, Le Touquet, Le Havre, Rouen and Boulogne. Each army division had two of these Base Hospitals which had 400 beds and there were also larger General Hospitals which could care for 1040 casualties.
The larger General Hospitals would have a large, well-trained medical staff of around 32 Medical Officers, 73 nurses and 206 orderlies. There would also be chaplains of the various denominations attached to the hospital staff to look after the men’s spiritual welfare. During the big battles of 1917 the General Hospitals had to be expanded and some could accommodate as many as 2,500 casualties and sick at any one time.
If you made it as far as a Base Hospital, you stood a good chance of being sent back to Blighty for further treatment in a Home Hospital. These were the pre-war military hospitals which had been expanded, civilian hospitals adapted to take military patients or auxiliary units created in public buildings or large private homes.
Wealthy families also gave up their country houses for use as private hospitals for the duration of the war. If the soldier recovered they may have been sent on somewhere to convalesce or to a specialist rehabilitation unit. If your wound or illness was so disabling that you would never be fit for front line duty again, you were discharged. If not, once you had been passed fit by the Army Medical Board, you would be transferred to a Command Depot to wait to be shipped back to the trenches.
Some soldiers were injured or got sick more than once during the First World War. You can only wonder at how they felt as they waited at the Command Depot to hear when they were being shipped back up the line to face the bullets, shells and poison gas again. But although the casualty figures were horrific, the vast majority of British soldiers did survive the First World War.
The sheer numbers of casualties and new types of wounds that were seen during the fighting also led to major advances in medicine, such as battlefield blood transfusions being given, new ways of treating gangrene and more extensive use of x-ray equipment. But although an efficient, if sometimes overburdened, system for treating and evacuating casualties was set up during the First World War, if you got wounded it was likely to be a long, painful journey back to health.
Wikipedia - World War 1 casualties - http://en.wikipedia.org/wiki/World_War_I_casualties
1914-1918 net - http://www.1914-1918.net/wounded.htm
1914 org - http://www.1914.org/podcasts/podcast-29-wounded/
Imperial War Museum - http://www.iwm.org.uk/history/medical-services-in-the-first-world-war
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