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Evacuation and Treatment of the Wounded.

Updated: Apr 29, 2023

In addition to the many camps and gun sites around Poperinghe there were also the Main Dressing Stations and Casualty Clearing Stations. By 1917, the Royal Army Medical Corps had an established evacuation pathway for the wounded from the frontline all the way back to the base hospitals on the French coast, and onward to establishments in Britain such as the hospitals in Falkirk. Getting to these aid stations after being wounded was a different story. When troops went forward into the attack the wounded would be left to be collected by the stretcher bearers and the battlefield conditions meant that it could take several hours to reach an aid post.

Great War - The Ypres Salient, Belgium
Stretcher bearers at Boesinghe during Third Ypres 1917. Photo by John Warwick Brooke. IWM

Private William Scott, 1/7 Argyll & Sutherland Highlanders wrote home to his parents at 95 Wallace Street, Falkirk, of his experience as a stretcher bearer during the catastrophic attack by the 10th Brigade on 25 April 1915 at St Julian. He was wounded in the hand and knee and was himself hospitalised he wrote of the ‘one or two miles’ the stretcher bearers had to carry the wounded down to the Advance Dressing Station. Another Falkirk man Private Andrew McKerracher, was a stretcher bearer with the 35th Field Ambulance, Regimental Aid Post located at Minty Farm during Third Ypres, and was killed by shell fire.

In the rear areas two men can carry a stretcher on even ground. At the frontline, due to the conditions, it usually took four men to carry one man on a stretcher and it could take up to seven or eight men to carry one casualty. As a result, this severely limited the number of wounded that could be brought in before loss of blood, shock and the extreme weather conditions led to death. This sketch shows the scheme of evacuation for the 23rd Division casualties during the Battle of Messines in June 1917.

Great War - The Ypres Salient, Belgium

Regimental Medical Officer (RMO)

During the First World War every fighting unit had it's own Regimental Medical Officer (RMO). He was Royal Army Medical Corps (RAMC) but came under the commanding officer of the fighting unit he was attached to. In addition to an NCO he also had a number of stretcher bearers provided by the unit he was attached to. They were typically the regiments bandsmen. The RMO’s role was not only to attend to medical matters but also matters of hygiene, water supply, the preparation of food, and the supervision of sanitary areas all came under his control. In ‘Memoirs of a Camp-Follower’ Philip Gosse, an RAMC Captain wrote of the role of the RMO: 'A good M.O. to a battalion was a privileged and important officer. He was usually on intimate terms with his colonel, a friend to all his brother officers, and friend and confidant as well as doctor to the rank and file. Often I noticed that a battalion with a first-class M.O. was always a first-class battalion, had the smallest sick parade, fewer men falling out on a long march and the lowest quota of casualties from trench foot.'

Regimental Aid Post (RAP)

The RAP was located as close to the front line as possible ideally near the battalion HQ and in a central position. A yellow flag was raised to indicate its position to the wounded and the Field Ambulances. Facilities were limited with the RAP located in a communication trench, dugout, deep shell hole, ruined house or behind a knocked out tank. There was no capacity at the RAP. As the advance went forward the RAP had to keep up and the search for a new location similar to those above being used. Firstly, the casualty would be taken to the Regimental Aid Post to be assessed by the Regimental Medical Officer (RMO) or a senior RAMC NCO. His wound recorded and a Field Medical card with all the relevant details attached to his uniform. This card included the soldier's name, rank, and unit, a diagnosis, and any special treatments (like operations) performed. As the patient moved down the evacuation chain, the Field Medical Card remained with him so that information could be added to it and his full treatment could be known. If Morphine or a tourniquet had been used an ‘M’ or ‘T’ was marked on the forehead.

Great War - the Ypres Salient, Belgium
IWM Image Q5916

The patient was then taken by stretcher or walked, if he was able, to a designated collecting area to be picked up by stretcher-bearers of the Field Ambulance and taken to the Advanced Dressing Station.

The Field Ambulance was a mobile medical unit the function of which was to collect and transport the wounded to Clearing Hospitals whilst monitoring the casualty, and treating them if necessary to ensure their condition remained stable. It was made up of Advance Dressing Station (ADS), normally two ADS’s to a division, and Main Dressing Station (MDS) When at full strength the Field Ambulance had ten Officers and 224 men. There were eighteen stretcher squads each of six men (Bearer Division) who were responsible for collecting the wounded. Nine medical officers and one dental officer, as well as one Quartermaster of stores, batmen, clerks, cooks, dispensers, nursing orderlies (Tent Division) who were responsible for the treatment of the wounded. The transport which had 60 men attached from the Army Service Corps (Transport Division). All this made up the medical support for one infantry brigade of four battalions roughly 4,000 men and there were three brigades to every Division. So, in order to perform it's duties satisfactorily, the Field Ambulance was divided into A, B and C Sections These three sections were all capable of independent action when required. The headquarters of the Field Ambulance always formed part of 'A' Section. The stretcher-bearer division and tent division were divided in equal sub-divisions between three sections, so each section had an equal share of stretcher–bearer and tent personnel.

An ADS could be found in locations such as: large houses, schools, churches or dugouts but tents were used when required.

Great War - The Ypres Salient, Belgium
The Hop Store ADS on the Poperinghe - Vlamertinghe Road. The first gas cases arrived here in April 1915. Authors image.

One or more of the sub-divisions contributed to the establishment of the Advance Dressing Station. The tent division also set up the main dressing station, and were responsible for the walking wounded and sick collecting posts, and rest stations. A rest station was a convalescent hospital for casualties that did not need to be sent on and could be kept for up to two weeks before being sent back to their units. The function of the Advance Dressing Station was to process and clear the wounded back as quickly as possible.

The wounded would be triaged into three categories:

1. Lightly wounded - not seen as life or limb threatening

2. Severe but survivable wounds - sent to the appropriate Casualty Clearing Station

3. Non-survivable wounds - given pain relief and set aside to die. They did not consider wasting time on those who could not be helped and depriving those who could be helped of valuable time and medicines.

During Third Ypres the 51st Highland Division had their ADS at Essex Farm which was located on the west bank of the Yser canal. Colonel David Rorie provides a vivid account in ‘A Medico’s Luck in the War’: 'Our bearers had preceded us for the ADS at Essex Farm on the canal bank, a hot spot; and on the evening of our arrival four of them were killed by a shell which crashed into the shelter where they were at The Willows Collecting Post in front of this.' Essex Farm ADS was also where, in 1915, Lt Col. John McCrae wrote his famous poem ‘In Flanders’ Fields’

Great War - Ypres
Essex Farm ADS Today

The casualty would then be sent to the Main Dressing Station (MDS) by motor ambulance or light railway. After treatment at the ADS the casualty was moved onto a Main Dressing Station. The MDS typically included the Officer Commanding, two Medical Officers, a Dental Officer, a Quartermaster and 59 other RAMC ranks, along with one Royal Army Service Corps officer, and 44 other ranks Army Service Corps attached. Commanded by an RAMC Major and up to three miles behind the ADS they comprised a complex of either huts or tents or both and where the treatment of more serious wounds, shock and haemorrhages could be treated and observed for a minimum of 24-hours before being passed onto a Casualty Clearing Station. Those with minor wounds were treated but passed onto a Divisional Rest Station. There was normally one MDS to every Division. Ideally MDSs were sited roughly one-mile behind the ADSs. But in the First World War this was seldom the case, partly due to topography, but also because an MDS needed a large area of approximately 300 x 200 yards. The ideal location was a large building where water, light, heating and drainage were already supplied. If no buildings were available, then large tents were used, with one reserved as an operating room. They did not need protection from shell fire, but cover from the splinters of bombs had to be provided.

An MDS was typically organised into six sections:

1) Receiving Section provided hot drinks, sandwiches, and cigarettes.

2) Recording Section where clerks took patient information and examined Field Medical cards

3) Resuscitation Section for warming and reviving those suffering from shock or the effects of haemorrhage.

4) Dressing Station where dressings were applied, and any urgent surgical treatment, administration of

A.T.S. or morphia, if not carried out already.

5) Gas Section to keep gas victims away from other patients.

6) Evacuation Section where the patient's treatment was classified with whatever they were suffering from and how they were treated, and they awaited evacuation.

Other space was allocated for a mortuary, a cookhouse, stores, and living accommodation for officers and others ranks.

In 1917, Gwalia Farm Hospital, was the furthest MDS from the front, and was located a short distance from Poperinghe on the road to Elverdinghe alongside the Peselhoek-Poperinghe-Woesten rail Junction, and it was surrounded by Browne Nos. 1, 2 and 3 camps and the St John’s supply dump. On December 13th 1916, the 134th Field Ambulance moved to Gwalia Farm and took over the MDS and the ADS’s at Essex, Sussex Farms and the Canal Bank.

Great War - Ypres Salient
Location of Gwalia Farm Hospital MDS (Source: Linesman Memory Map Ypres)

Not all casualties were as a result of enemy action as they discovered. On 22nd December they had to deal with some cerebro-spinal cases and it was found that the ward orderly was the carrier of this disease and was immediately evacuated. From 31 July 1917, Gwalia Farm was the MDS for XIV Corps and the staff billeted in Browne No.3 camps. The site was temporarily evacuated between September and November 1917 due to enemy shelling.

Those casualties arriving at Gwalia Farm were taken to the Receiving Room, this was a large barn. They were then recorded and examined and given anti-tetanus injections and those cases that required resuscitation or were too ill to be moved were taken for immediate attention to a surgical dressing station. Gas cases were taken to a separate tent. When the casualties had been taken care of they were moved onto a large hospital tent to await evacuation by Motor Ambulance or light railway this was the responsibility of the Dispatching NCO’s. They were sent to the Casualty Clearing Station specialising in their particular wound. Colonel David Rorie, in ‘A Medico’s Luck in the War’ recorded his experience: 'Here came as much work for the despatching NCO’s: head cases and chest cases going to one CCS, fractured thighs to another, gas cases to a third, general cases to a fourth, and so on. As the nature of the casualties taken by the various CCS’s occasionally changed at short notice, everyone had to be alert and on the look-out to see each class of case reached its proper destination. A large diagram of the human body was at one time hung up in the receiving room with arrows pointing from each part - head, chest, and thigh - to the name of the CCS whither each special case should go. The figure being depicted as unclad bore, very properly, and after the manner of statuary, a fig leaf: and one bright morning I discovered that some brighter orderly had duly and appropriately adorned the divisions of the fig leaf with the touching legend APM.' Those awaiting evacuation were despatched to the relevant CCS. Those who had died were buried in the cemetery next to the MDS.

Great War - Ypres Salient
Gwalia Farm Cemetery. Authors image

Casualty Clearing Station

The CCS was commanded by a RAMC Lt Col. He had a staff of specialist surgeons, and medical support staff which included: eight Medical Officers, a Quartermaster, seven Queen Alexandra’s Imperial Military Nursing Service (Nurses), and seventy seven other ranks such as: clerks, cooks, nursing orderlies, theatre orderlies, stretcher-bearers etc. There was also a dentist and a pathologist attached with non-medical personnel made up of three chaplains, four lorry drivers, two Royal Engineers an electrician and engine hand, and men from the Army Service Corps, employed as ambulance drivers.

The CCS had three roles:

1. The most important was that the CCS was the site were the major limb and life-saving surgery was carried out.

2. They were sites for the assessment of minor wounds to be treated before they were sent back to the front line.

3. The CCS’s assessed casualties with wounds that were safe to be put on hospital trains and sent back to base hospitals for the final surgery.

A CCS could be found anywhere from 8 to 15 miles from the front line. Brandhoek CCS, which had opened in mid-1915, was located less than 10,000 yards from the front line. In July 1917, it had become a Field Ambulance incorporating CCS’s 32, 44, and 3 Australian. It was shelled on 21 August 1917 and this was recorded by Lt. Col. Arthur Martin-Leake VC in the 46th Field Ambulance War Dairy: 'About 11am today shelling began in this neighbourhood. Two shells fell in our area close to the building. There were lots of patients about at the time but nobody was hurt; this is to be accounted for by the wet and soft ground where the shells pitched. Shells have dropped in the three CCS, and Number 44 has had a nurse and orderly killed. The shelling continued on and off all day, mostly near the Railway. CCS evacuated in the evening.'

Brandhoek was abandoned on 25 August and moved to Remy Siding (Lijssenthoek). The nurse killed was Staff Nurse Nellie Spindler along with 44 others. She is buried in Lijssenthoek Military Cemetery. This was first used by the French whose 15th Hopital d’Evacuation was sited here in late May 1915, and by June 1915 it was being used by CCS’s of the British and Commonwealth forces. Evacuated here was Guardsman Hugh Connel listed on the Laurieston War Memorial. He died of wounds on 1 April 1916. Grave V.B.38. There are 10,786 burials of which 9,863 are from British and Commonwealth forces with 923 of other nationalities.

Martin-Leake was the first man to be awarded a bar to his VC winning his at Zonnebeke and was one of only three men to have won a bar to his VC. The others being Captain Noel Chavasse and Charles Upham of the New Zealand Military Forces. Martin-Leake commanded No.46 Field Ambulance, 15th (Scottish Division) at Red Farm which was located near Brandhoek CCS. On the 31 July 1917, 2,153 casualties passed through No.46 Field Ambulance. On 2nd August, Noel Chavasse was brought to the Field Ambulance as a patient. He was MO to the 1/10 Kings Liverpool Regiment, the Liverpool Scottish of the 55th Division. Martin-Leake had seen him but only later did the meeting assume any significance. Dr J A Campbell Colston, an American doctor attached to 46th Field Ambulance recorded the meeting in his diary:

Great War - Ypres Salient
Authors image

'An Ambulance came up late tonight and in it was Captain Chavasse, VC, RAMC, of the King’s Liverpool Battalions of the 55th Division. His face was unrecognizable, all blackened from a shell burst very near and he seemed to be unconscious, As he had an abdominal wound besides I did not take him out of the Ambulance which was sent on direct to 32 CCS where he will probably die.'

He was indeed fatally wounded and he died on 4 August. He is buried in New Brandhoek Military Cemetery one of three cemeteries opened for Third Ypres. Chavasse won his Bar posthumously, it was announced on 14 September, at Wieltje which is only a few miles from where Martin-Leake had won his. The experience of large numbers of battle casualties led to the grouping of two or three CCS’s together as we have seen with Brandhoek. The distribution of the wounded to the CCS was either geographical or according to the Corps engaged. The CCS at Brandhoek performed specialised abdominal, chest, thigh operations in addition to the removal of shell fragments. Remy Siding CCS, formed from 10, 17, and Canadian 2 and 3 took all the other sick and wounded from the front line.

Great War - Ypres Salient
Authors image

The names of the CCS’s reflected the dark humour of the Tommy and they found their way into the vocabulary of the troops. Located between Poperinghe and Krombeke was Dozinghem were numbers 4, 47, 61, 62 and 63 CCS which specialised in eye wounds, self-inflicted wounds, this area of the CCS was guarded, and in unidentified gases. Between Proven and Roesbrugge was Mendinghem were 12, 46, and 64 CCS which dealt with head wounds and chlorine gas casualties. Slightly further north of Proven and located at the village of Haringhe was Bandagehem which specialised in NYDN (Not Yet Diagnosed Nervous) and psychiatric cases. These were mostly casualties with concussion, shell-shock, battle fatigue, and Post Traumatic Stress Disorder (PTSD). The volume of work undertaken by CCS’s was enormous. In 1915, CCS’s only operated on 15% of cases during quiet times, and 5% when major fighting was taking place. This shows that the CCS’s were still sending the causalities directly to the base hospitals for surgery.

By 1917, the role of the CCS for dealing with the seriously wounded had been established. In ‘War Surgery 1914 - 18’, Thomas Scotland gave the numbers operated on at CCS’s during Third Ypres: 'During the battle, 61,423 of the wounded were operated on in casualty clearing stations. Some would be relatively lightly wounded, undergoing surgery before going back to the front line. Others would be the most seriously wounded, undergoing limb or life-saving surgery. This figure of 61,423 represents 30% of the total admissions.' The death rate at CCS’s during Third Ypres is put at 3.7%. This percentage can be given because of the cemeteries located near to the sites of the CCS where the dead can be identified compared to those in sites known as concentration cemeteries near the front line were between 60% to 70% of the graves are ‘Known Unto God’

Great War - The Ypres Salient, Belgium
Authors image.

Base Hospital

Casualties arrived by hospital train or by barge to one of the Base Hospitals and these had a number of locations in France Boulogne, Etaples, Wimereux, Hardelot, Camiers, Le Treport or St Omer. Barges were intended for casualties with wounds of the head, chest or gunshot wounds to the femur. All hospitals were located on railway lines and close to a port for evacuation to Britain. The Base Hospital was part of the casualty evacuation chain, further back from the front line than the Casualty Clearing Stations. They were manned by troops of the Royal Army Medical Corps, with attached Royal Engineers and men of the Army Service Corps. There were two types of Base Hospital, known as Stationary and General Hospitals. They were large facilities, often centred on some pre-war buildings such as seaside hotels. The 58th (Scottish) General Hospital was located in St Omer from September 1917 in the Caserne de la Barre a former barracks. At the beginning of the war General hospitals had a bed capacity of 520 with the stationary hospital at 200. By 1915, the capacity of a general hospital was 1,040 patients and a stationery hospital 400 patients. By 1917, three new general hospitals had been built with a capacity of 2,500 patients. Most of the hospitals moved very rarely until the larger movements of the armies in 1918. Some hospitals moved into the Rhine bridgehead in Germany and many were operating in France well into 1919. Most hospitals were assisted by voluntary organisations, most notably the British Red Cross.

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