The First World War created major problems for the Army's medical services. In a conflict involving mass casualties, rapid evacuation of the wounded and early surgery became their most important functions. Put under great strain, initial systems for dealing with the wounded had to be significantly modified and greatly expanded. What developed was a highly complex, bureaucratic but remarkably effective system that was characteristic of this war.
The survival of a soldier wounded on the Western Front often depended on prompt medical treatment. During a major battle hundreds or even thousands of men were in a similar situation. It was essential to have an efficient system that could retrieve the wounded, transport them to a safe area and then treat them.
However, just getting off the battlefield could take hours – even days. While those with light wounds might scramble to safety, others relied on teams of stretcher-bearers. Too often, these were overwhelmed with casualties. They were also under orders to retrieve the least badly wounded first.
Ideally, the wounded first made it to a Regimental Aid Post, then on to a mobile Advanced Dressing Station. These were basic care points. Here, often in appalling conditions, injuries might be cleaned and dressed, injections given and – in the case of Dressing Stations – emergency amputations carried out.
Reaching either care point was not easy. In the crowded trenches priority of movement was given to ammunition, then reinforcements and only thirdly to the wounded.
In these early stages men were assessed then labelled with information about injuries and treatments. Medical Officers had to prioritise. Using a procedure known as triage, patients who would benefit most were marked for immediate treatment, while the others had to wait. Many were beyond help. Morphia and other pain-killing drugs were often the only treatment given.
Except for the very lightly wounded, the next stop was a Casualty Clearing Station (CCS). These were more substantial places several miles behind the front line. Initially the wounded had been transported there in horse-drawn ambulances – a painful journey. Over time motor vehicles, or even narrow-gauge trains, took over the job.
As they had many of the staff and facilities common to standard hospitals, major surgical operations were possible at a CCS. Unfortunately, in these pre-penicillin times, men who had survived this far often succumbed to infections.
Only the seriously injured travelled further. As the means to organise grew, these men were transported en masse in ambulance trains, road convoys or even by canal. Their destinations were either the large base hospitals near the French coast or a ship heading to England. Once ashore, men were dispersed into a growing system of hospitals and convalescent units or in some cases sent back home. As the war dragged on, more facilities were established in France – partly to avoid U-boats but also to quicken the return of convalesced men to active duty.
When working successfully the system transported men through a series of increasingly sophisticated medical posts, each positioned progressively further away from the front line. It was the nature of warfare on the Western Front that allowed the growth of such a rigid, well-ordered network.
The system was vulnerable however. Even medical posts set well behind the lines could be shelled or even overrun in the course of battle. Damaging bottlenecks could arise in the chain through a sudden tidal wave of wounded men – as happened during the Somme campaign. While such a system could function on the Western Front, its complexity was less appropriate for other theatres of the war.