Medical care throughout the First World War was largely the responsibility of the Royal Army Medical Corps (RAMC). The RAMC’s job was both to maintain the health and fighting strength of the forces in the field and ensure that in the event of sickness or wounding they were treated and evacuated as quickly as possible.
Every battalion had a medical officer, assisted by at least 16 stretcher-bearers. The medical officer was tasked with establishing a Regimental Aid Post near the front line. From here, the wounded were evacuated and cared for by men of a Field Ambulance in an Advanced Dressing Station.
A casualty then travelled by motor or horse ambulance to a Casualty Clearing Station. These were basic hospitals and were the closest point to the front where female nurses were allowed to serve. Patients were usually transferred to a stationary or general hospital at a base for further treatment. A network of ambulance trains and hospital barges provided transport between these facilities, while hospital ships carried casualties evacuated back home to ‘Blighty’.
As well as battle injuries inflicted by shells and bullets, the First World War saw the first use of poison gas. It also saw the first recognition of psychological trauma, initially known as 'shell shock'. In terms of physical injury, the heavily manured soil of the Western Front encouraged the growth of tetanus and gas gangrene, causing medical complications. Disease also flourished in unhygienic conditions, and the influenza epidemic of 1918 claimed many lives.
Casualties had to be taken from the field of battle to the places where doctors and nurses could treat them. They were collected by stretcher-bearers and moved by a combination of people, horse and cart, and later on by motorised ambulance ‘down the line’. Men would be moved until they reached a location where treatment for their specific injury would take place.
Where soldiers ended up depended largely on the severity of their wounds. Owing to the number of wounded, hospitals were set up in any available buildings, such as abandoned chateaux in France. Often Casualty Clearing Stations (CCS) were set up in tents. Surgery was often performed at the CCS; arms and legs were amputated and wounds were operated on. As the battlefield became static and trench warfare set in, the CCS became more permanent, with better facilities for surgery and accommodation for female nurses, which was situated far away from the male patients.
Wounds to the extremities were so severe that many thousands of soldiers had to have limbs amputated. In France, a guillotine, a variation on the one used to cut off heads in the French Revolution, was used to amputate limbs. As traumatic as it was, amputation saved the lives of many men as it often prevented infection.
Infection was a serious complication for the wounded. Doctors used all the chemical weaponry in their arsenal to prevent infection. As there were no antibiotics or sulphonamides, a number of alternative methods were employed. The practice of ‘debridement’ – whereby the tissue around the wound was cut away and the wound sealed – was a common way to prevent infection. Carbolic lotion was used to wash wounds, which were then wrapped in gauze soaked in the same solution. Other wounds were ‘bipped’. ‘Bipp’ (bismuth iodoform paraffin paste) was smeared over severe wounds to prevent infection.
Delays in treatment could mean the difference between life and death, so innovations in transport changed the nature of medical care during wartime. In battles that took place on foot or horseback, medical treatment had to be close to the battlefield and the wounded were vulnerable to further danger. Men had to be removed from the battlefield by stretchers. Historically ships were used to transfer the wounded to safer locations where a doctor could treat them, and hospital ships were developed on board in which the wounded could be treated. During the Napoleonic Wars Dominique Larrey developed ambulances drawn by horses to get wounded soldiers away from the battlefield. In the First World War motorised ambulances and trains made this a faster process.
In addition to wounds, many soldiers became ill. Weakened immune systems and the presence of contagious disease meant that many men were in hospital for sickness, not wounds. Between October 1914 and May 1915 at the No 1 Canadian General Hospital, there were 458 cases of influenza and 992 of gonorrhoea amongst officers and men. Wounding also became a way for men to avoid the danger and horror of the trenches. Doctors were instructed to be vigilant in cases of ‘malingering’, where soldiers pretended to be ill or wounded themselves so that they did not have to fight. It was a common belief of the medical profession that wounds on the left hand were suspicious. In a secret report during the war, Colonel Bruce Seaton examined 1,000 wounds and injuries to Indian troops being treated at the Kitchener Hospital in Brighton to find out whether any of them were self-inflicted. After careful investigation, however, Seaton concluded that there was no evidence to support the theory of self-wounding among the Indian soldiers.
Wounding was not always physical. Thousands of men suffered emotional trauma from their war experience. ‘Shellshock’, as it came to be known, was viewed with suspicion by the War Office and by many doctors, who believed that it was another form of weakness or malingering. Sufferers were treated at a range of institutions. Officers went to Craiglockhart where they were treated by psychiatrists such as W H R Rivers, and the men went to hospitals such as Netley, or were placed in asylums. Treatment was vastly different at each institution: the officers at Craiglockhart were given therapies such as talking cures; the men at Netley were treated with more physical forms of ‘cure’ such as physiotherapy.
If a wound was serious enough it meant the soldier going back home to receive further treatment. The hospitals at home provided more technologically advanced treatment, away from the frantic activity of the care near the battlefield. Many soldiers had to have further surgery to clean up the hurried efforts of surgeons at the Front. A number of therapies were available at the hospitals far away from the battlefield. In Britain, the wounded were cared for in a range of buildings around the country, from schools to stately homes. In some cases, suitable surroundings were deemed an important part of the recovery process. The Pavilion in the seaside town of Brighton was repurposed to provide a hospital for many of the wounded Indian troops. These men were considered particularly vulnerable to the cold winters in France and Belgium and were given electrotherapy to cure conditions believed to come on from cold weather.
The First World War changed the ways that soldiers were cared for when they were wounded. New technologies including blood transfusion, control of infection and improved surgery ensured that, although many men were permanently wounded, many more survived than died as a result of their injuries.