Being Wounded

I’ve been working on my essay on ‘Woundscapes of the Western Front, 1914-1918’.  What follows is the section dealing with the act of being wounded, drawn from a series of diaries, letters and memoirs; it’s followed by a section fleshing out the concept of a woundscape which I’ll post in due course [for a preliminary sketch, see here].

Subsequent sections reconstruct the precarious journey of casualties from the point of injury through the aid posts, dressing stations and casualty clearing stations to the base hospitals on the French coast and beyond (for a quick sketch, see here, and for an experimental version inspired by Harry Parker‘s Anatomy of a soldier, see here).

This is very much a working version, so please read it as such – and as always I’d welcome any comments or suggestions.  I’ve added some links and images (most of them from my presentations), though those included in the final version are likely to be different.

I should add that this is one part of a much larger project that also considers medical care and casualty evacuation in other war zones: the Western Desert in the Second World War, Vietnam, and Afghanistan and Syria today.

***

John Keegan once remarked that in military histories the wounded seem to ‘dematerialize as soon as they are struck down’. [1] This matters for more than historical reasons, however, because the wounded serve as a testament to what Elaine Scarry insists is ‘the main purpose and outcome of war’, which is to say injuring. This ugly fact, she argues, can be ‘made to disappear from view along many separate paths.’ [2] In order to bring it back, I attempt to have the wounded reappear on – and through – the paths they followed after they were injured. Most of what I have to say is confined to the British Army and its colonial and imperial counterparts from Australia, Canada, India, New Zealand and South Africa on the Western Front. [3]  The details differ in other militaries and other theatres, but the elemental geography of casualty evacuation was a general one.  My focus is confined to the effects of physical injury and I do not directly address what was eventually diagnosed as ‘shell shock’, but it will soon become clear that the trauma of being wounded was far from a purely physical affair and that it was suffused with emotional reactions that played a vital role in rescue and recovery. [4]

Trauma typically ruptures ordinary language – another of Scarry’s astute insights – and it is scarcely surprising that many witnesses to the broken bodies trailing across the battlefields should have turned to metaphor to convey the enormity of the toll.[5] On 1 July 1916, the first day of the battle of the Somme [above], a British officer found his trench ‘blocked with wounded men who were trying to make their way back to the dressing station’, and as Capt Radclyffe Dugmore surveyed the scene he was struck by the mechanical nature of both military violence and military medicine.

 ‘Here was this line of men, who little more than an hour ago were normal men in the finest of health and strength, and now maimed, and with every degree of injury, they painfully made their way back to the human repair department. The well men were rapidly moving eastward in countless numbers, going forward to the assistance of their comrades, while the injured so laboriously dragged their way back, two human streams, the sound and the unsound. Before us, all energies were devoted to destruction; behind us, all human power and skill tried to repair the damage.’ [6]

.The language of ‘wrecks’ was commonplace.  To Sister Kate Luard ‘the wards [were] like battlefields, with battered wrecks in every bed.’   The task of casualty evacuation, explained one medical orderly, was ‘to move these helpless pieces of wreckage, as rapidly and comfortably as may be, to the place where they will in due course be repaired.’ [7]  The language of ‘repair’ was a common one too, and I will return to its significance shortly.

Three weeks after Dugmore’s observation, and not far from his position, a wounded Australian soldier making his way from aid post to dressing station described the same awful scene but in a different, animate register:

‘Ahead of us and behind us as far as the eye could see, a long column of walking wounded slowly made their way through the valley and across the ridges.  From a distance the khaki column resembled a huge brown snake crawling across the country.’ [8]

Hartnett’s pained allusion was evidently not to a serpent entwined around a staff, the classical symbol for medicine; the intended effect was altogether more venomous. [9]  Still more sinister was the common imagery of the shambles and the slaughterhouse. Wilfred Owen described the infantry training camp on the French coast at Étaples as ‘neither France nor England, but a kind of paddock where the beasts are kept a few days before the shambles.’  In the sixteenth century a shambles was an open-air slaughterhouse, and the term was readily extended to the modern battlefield. Watching the stretcher-bearers file past after the Battle of Festubert with their burden of bloodied bodies one Guards officer recoiled in horror: ‘fine upstanding fellows only a few hours before’, they had become ‘nauseatingly repulsive’,  ‘hideously injured carcases.’ Doctors sometimes had the same reaction and resorted to the same imagery.  ‘Although but a middleman,’ confessed Capt Lawrence Gameson at a dressing station on the Somme, ‘one gets sick of blood’s smell and of the endless everlasting procession of red raw human meat passing through our hands.’If the injured survived they were consigned to a Casualty Clearing Station, what one senior medical officer – one of many, as it turns out – called his ‘Butcher’s Shop’, wherein Philip Gibb was nauseated by the ‘great carving of human flesh’.  One chaplain remembered a surgeon who had been working 24 hours without a break: ‘In the middle of it all he turned away from one table and looked up as another one was being carried in, and he shook his head.  He was covered in blood – we all were – and he said, “This isn’t a hospital, it’s a butchery.”’ [10]

Those two imaginaries, the mechanical and the animate, collided most explosively and intimately in the act of being wounded.  Those who wrote about it often expressed their surprise, even disbelief that it had happened to them – pain came later – or registered the immediate sensation of a tremendous blow. On the first day of the Somme it never occurred to Lt Edward Liveing that he had been wounded:

‘Suddenly I cursed. I had been scalded in the left hip. A shell, I thought, had blown up in a water-logged crump-hole and sprayed me with boiling water. Letting go of my rifle, I dropped forward full length on the ground. My hip began to smart unpleasantly, and I felt a curious warmth stealing down my left leg. I thought it was the boiling water that had scalded me. Certainly my breeches looked as if they were saturated with water. I did not know that they were saturated with blood.’ [11]

But when Sgt R.H. Tawney was hit later the same day he had no doubt he had been hurt:

‘I felt … that I had been hit by a tremendous iron hammer, swung by a giant of inconceivable strength, and then twisted with a sickening sort of wrench so that my head and back banged on the ground, and my feet struggled as though they didn’t belong to me. For a second or two my breath wouldn’t come. I thought – if that’s the right word – “This is death”, and hoped it wouldn’t take long. By-and-by, as nothing happened, it seemed I couldn’t be dying. When I felt the ground beside me, my fingers closed on the nose-cap of a shell. It was still hot, and I thought absurdly, in a muddled way, “this is what has got me”. I tried to turn on my side, but the pain, when I moved, was like a knife, and stopped me dead. There was nothing to do but lie on my back.’ [12]

Three weeks later, still on the Somme, Lt Robert Graves had a similar sensation when he was seriously wounded. ‘An eight-inch shell burst three paces behind me,’ he recalled.

‘I heard the explosion, and felt as though I had been punched rather hard between the shoulder blades, but without any pain.  I took the punch merely for the shock of the explosion; but blood trickled into my eye and, turning faint, I called to Moodie [his company commander]: “I’ve been hit.” Then I fell…’ [13]

His friend Lt Siegfried Sassoon’s reaction to being wounded during the Battle of Arras the following year)was much the same.  He too knew at once that he had been hurt, even if he was not sure how. ‘No sooner had I popped my silly head out of the sap,’ he wrote much later, ‘than I felt a stupendous blow in the back between my shoulders. My first notion was that a bomb [grenade] had hit me from behind, but what had really happened was that I had been sniped from in front…To my surprise I discovered that I wasn’t dead.’ [14]

As these accounts indicate, for many wounded soldiers the proximity of death was palpable: space sensibly contracted to their wound, their body and its immediate surroundings.  ‘A man badly knocked out feels as though the world had spun him off into a desert of unpeopled space,’ Tawney admitted: a feeling heightened by the standing order forbidding troops from stopping to aid the wounded during an advance. ‘Combined with pain and helplessness,’ he continued, ‘the sense of abandonment goes near to break his heart.’ [15]  When Pte David Jones was shot in the leg on the Somme shortly after midnight on 11 June 1916, and left barely able to crawl, a corporal hoisted him on his back until a major saw what he was doing and told him:

 ‘“Drop the bugger here” for stretcher-bearers to find. If every wounded man were to be carried back, their firepower would be cut in half. “Don’t you know there’s a sod of a war on?”’ [16]

Many of the seriously wounded stumbled or crawled into shell-holes to wait for their rescuers; some lay out for days.  On the first day of the Somme Pte A. Matthews was escorting German prisoners back across No Man’s Land, that narrow strip between the opposing lines of trenches, when he was shot in the thigh.  An officer dragged him into a disused trench and bound up his wound as best he could before rejoining the advance. While the trench sheltered Matthews from direct fire (‘shells were bursting all around me’), he realised that unfortunately it also concealed him from the view of any rescuers.  Later that day a company runner chanced to see him and left his water-bottle, but Matthews was unable to move – ‘I might as well have been chained to the ground’ – and as night fell all he could do was shout for help.  Nobody came.  He eked out his iron rations and water, but by the third day it was all gone. The next night a group of wounded men making their way back found Matthews, and shared the iron rations they had scavenged from the dead.  They could do no more for him, but promised to get help.  An hour or two later they returned, disoriented,  and set off in a different direction.  The next night they came back again, ‘in a terrible state’, one of them crawling on his hands and knees.  They shared some biscuits and water before setting out once more; Matthews never saw them again.  The next morning a shell-burst buried the biscuits and pierced his water-bottle, and he was reduced to catching rain in his helmet and drinking from pools of water in the trench. He drifted in and out of consciousness until, ten days later, an officer on patrol found him – ‘nearly treading on me’ –  and dug him out before getting him onto a stretcher. When he reached the Advanced Dressing Station at Sailly he was ‘a mere skeleton’: he had been lying out in No Man’s Land for 14 days. [17] This was something of a record; Matthews’s experience combines bad luck and good luck in equal measure, and it is impossible to know how many others succumbed to their injuries while waiting or, perhaps like the party of wounded men who stumbled back to his trench time and time again, never made it to safety.

If they were fortunate the wounded would have others for comfort and company while they waited, but all any of them had for first aid was a field dressing and an ampoule of iodine.  Capt Harold McGill reckoned that  ‘the obsessing fear of the men was death from hemorrhage’ – understandably so in the absence of effective blood transfusion until late in the war – and the field dressing was the first vital response to bring bleeding under control. [18] One soldier explained:

‘The first field dressing which each man carries sewn in the lining of his tunic has saved many lives. Comprising as it does two pads of gauze and cotton-wool and a bandage, it can be ripped out of its case and clapped on to the wound, and so save the injured man, who may have to lie out hours before he can be taken back to a dressing-station, many risks from loss of blood or outside infection.’ [19]

 

Of course, the utility of the dressing depended on the nature of the wound. The same man recalled a lecture from his Medical Officer, who had explained that a field dressing could be used to stop bleeding from an arm or a leg, but ‘if the man was hit in the body or head – well, the doctor shrugged his shoulders in a way that made us think.’ [20]If they were not alone the wounded might also be able to improvise a tourniquet or even a splint with their bayonet or rifle, and if the iodine bottle had not smashed – unlikely, McGill thought: ‘The men reported to me that during the action they had nearly always found their pocket ampoules of iodine tincture broken when the time came to use them’ [21]– they could make a rudimentary attempt at cleaning the wound.

Given the cascading combination of immediacy, difficulty and uncertainty it is scarcely surprising that the space of the wounded should have contracted so drastically. And yet at the same time that space expanded, partly through what had become the taxing task of traversing even a short distance to relative safety, and partly through the tantalizing prospect of a ‘Blighty’, a wound judged sufficiently serious to require evacuation to Britain (and perhaps beyond for troops who came from elsewhere in the Empire). [22]

Arthur Empey came round from surgery at a Casualty Clearing Station to find rows of soldiers lying on stretchers: ‘The main topic of their conversation was Blighty. Nearly all had a grin on their faces.’ [23]  One medical orderly explained that ‘a wound, even when serious, is the messenger of freedom’ – and he had never met a wounded man who wanted to return to the trenches. [24]Another had ‘only heard of one who said that he was anxious to return there, and he was subsequently transferred to No. 2 General Hospital in Le Havre, where the huge numbers of mental cases were cared for.’ [25]

Even so, the extended space of evacuation was a fraught and dangerous one.  Many of the wounded fell in No Man’s Land, in the front-line trenches themselves, or in broken land during the fluctuating tides of advance and retreat in the opening and closing phases of the war. They were injured in major offensives (‘pushes’), in small raids (‘stunts’) and by routine, almost ritualized shelling and firing (‘the morning hate’).  These were the most immediate danger zones in space and in time, extending back towards the reserve trenches and the small towns and villages in the rear.  The wounded were supposed to move within a legal envelope that protected them from further attack.  The Hague Regulations stipulated that ‘all necessary steps must be taken to spare’ – as far as possible – ‘places where the sick and wounded are collected.’  But that possibility was none the less limited.  Firing and shelling were often notoriously inaccurate, casualty clearing stations were routinely located close to batteries and railheads, and it was not always easy to make out the red cross symbol that was supposed to guarantee protection.  In the final months of the war even base hospitals on the French coast were bombed, while hospital ships crossing the Channel ran the gauntlet of mines and torpedoes. [26] If the wounded imagined travelling through an extended space towards safety, then it was a safety rendered conditional by the continued risk of attack. And the journey itself always exacted its own, sometimes deadly toll on the wounded body, which prompted Patrick MacGill to write of being ‘a passenger on the Highway of Pain that stretched from Lens to Victoria Station’. [27]

My purpose is to reconstruct that highway and the relationship between wounded bodies and the journeys they undertook.  Many of those planning for war had a remarkably sanitized view of both.  When one hard-pressed volunteer with the British Red Cross Society, working at a field hospital in Belgium in September 1914, described her pre-war training she recalled

‘the drill and the white-capped stretcher-bearers at home, and the little messenger boys with their innocuous wounds, which were so neatly and laboriously dressed.

The messenger boys’ wounds were always conveniently placed, and they never screamed and writhed or prayed for morphia when they were being bandaged. And shoulders were not shot away, nor eyes blinded, nor men’s faces – well, not much good ever came of talking of the things one has seen, and they are best left undescribed. “These are not wounds, they are mush,” I heard one surgeon say; and then I thought of the little messenger boys and their convenient fractures.’ [28]

 

The wounds were not the stylised, artfully coloured images of the text book and when G.H. Makins suggested that a survey of them ‘forcibly reminds the observer of the water-colour drawings made by Sir Charles Bell’ he was referring to Bell’s extraordinary ability to convey the horrific damage wrought by musket balls and shrapnel during the Peninsular War.  Bell was a military surgeon and his sketches were no less remarkable for their rendering of the agony, despair and sheer terror of the wounded: a far cry, as he noted, from the text-books. [29]

Similarly, schemes for medical evacuation typically displayed an elegant linear geometry, an abstract grid of transmission lines that resembled what Fiona Reid called ‘a modernist dream’ with no catastrophic breaks or nightmare tangles (Figure 3). [30]  This highly imaginative geography of an evacuation machine, carefully oiled and smoothly running, intersected with debates around a politics of speed. [31]  [For much more, and a detailed case study, see my post on ‘The Leaden Hours’ here].  In the first months of the war there were complaints that it was taking far too long for the wounded to be brought from the firing zone to hospitals on the French coast. These reports provoked sufficient public unease for Lord Kitchener, Secretary of State for War, to send Col Arthur Lee to France to investigate.  In a series of private communications Lee conceded that ‘in surveying the scene from London, or studying it upon a map, questions of transport present no very serious difficulties’, whereas once in France it quickly became obvious that getting the wounded to railheads was complicated by intense enemy shelling, and that the railways were under enormous pressure – ‘the wounded must of course give way to food, ammunition and reinforcements for the fighting forces’ – and with many bridges destroyed and signalling systems dislocated the hastily improvised ambulance trains, often little more than cattle trucks filled with straw, had ‘to slowly explore their own way back towards [the hospitals at] the Base.’ [32]  Two years later the politics of speed had reversed; the concern now was that the RAMC had become so fixated on rapid evacuation that the injured were suffering needlessly.  The debate reached its climax when Sir Almroth Wright, Consultant Physician to the British Expeditionary Force, criticized what he saw as the preoccupation with rapid evacuation, ‘hustling the wounded from hospital to hospital’ he called it, and the overwhelming importance attached to ‘the fact that a [Casualty Clearing Station] has passed so many thousands or tens of thousands of wounded through the wards, evacuating these in a minimum of time so as to be at disposal for reception of more patients.’ He claimed that as soon as a new convoy arrived at a base hospital, and as a direct result of ‘the catastrophes which are associated with long journeys’ from the Casualty Clearing Station, ‘amputations and other operations in large numbers have to be performed upon men who had been judged fit to travel’ (my emphasis). Wright’s complaints were summarily – and angrily – dismissed as ignorant and even ‘stupid’ in what was a bitter personal dispute, and the official response doubled down on the machine-like efficiency of the evacuation system.

What flickers in the fissures of these exchanges is the stubbornly, viscerally bio-physical: injured bodies did not present themselves as pristine plates in a medical atlas and their precarious journeys were not inscribed on the paper trails of an evacuation plan.   The relations between the two were not only intimate; they were also reciprocal. The nature of the wound materially affected evacuation.  Treatment times and pathways for ‘walking wounded’ and stretcher-cases were different, for example, and the worst cases were often the last to reach a Casualty Clearing Station and – if they survived – they travelled much further down the line and ultimately back to Britain.  Those journeys in turn affected the wound: rescuing casualties from No Man’s Land was almost always at the risk of further injuries from enemy fire, for example, and as bearers struggled to carry stretchers over shell-shattered ground and through waterlogged trenches, as ambulances bumped and skidded over muddy tracks and torn-up roads, and as ambulance trains clanked and wheezed their way to the coast, the spasmodic jolting greatly aggravated pain and increased the risk of haemorrhage.

To be continued

[1]John Keegan, The Face of Battle(London: Pimlico, 2004), p. 40; Keegan was referring specifically to General Sir William Napier’s account of the battle of Albuera in 1811, but he was also sharpening a general point.

[2]Elaine Scarry, The Body in Pain: the making and unmaking of the world (New York: Oxford University Press, 1985) p. 64.

[3]Regiments were raised from other British colonies in the Caribbean and Africa too, and also in Newfoundland; in some cases colonial and imperial casualties were treated by their own medical services, and in others by the RAMC, though they all worked in close concert with one another.  For a general discussion, which extends to the French and German medical services, see Leo van Bergen, Before my helplesssSight: suffering, dying and military medicine on the Western Front, 1914–1918 (London: Routledge, 2016).

[4]On ‘shell shock’ and, of direct relevance to my discussion, what was known as ‘wound shock’, see Stefanos Geroulanos and Todd Myers, The human body in the age of catastrophe: brittleness, integration, science and the Great War(Chicago: University of Chicago Press, 2018) especially Ch. 2.

[5]Casualty estimates are notoriously difficult, but on the Western Front more than five million from the Allied armies were wounded, most of them from France and the United Kingdom, and more than three million from the Central Powers, principally Germany and Austria-Hungary.  There were also tens of thousands of civilian casualties, from towns and villages close to the front lines but also from long-distance shelling and air strikes much more distant from battlefields whose boundaries were already dissolving.

[6]Captain A. Radclyffe Dugmore, When the Somme ran red(New York: George H. Doran, 1918) pp. 201-2.  Hence too Mark Harrison’s apt description of a ‘medical machine’ assembled on the Western Front: The Medical War: British Military medicine in the First World War (Oxford: Oxford University Press, 2010).  The imagery of two streams was a common one too, and so was its mechanical rendering. ‘One of the most stabbing things in this war,’ wrote Sister Kate Luard, ‘is seeing the lines of empty motor ambulances going up to bring down the wrecks who at this moment are sound and fit, and absolutely ready to be turned into wrecks’: John Stevens (ed) Unknown warriors: the letters of Kate Luard1914-1918(Stroud, UK: History Press, 2014) 8 May 1915.

[7]Stevens, Unknown warriors, 10 April 1917; Ward Muir, ‘An intake of wounded’, in Happy though wounded: the book of the 3rdLondon General Hospital(London: Country Life, 1917) p. 64.

[8]H.G. Hartnett, Over the top(Sydney: Allen and Unwin, 2009) p. 60; Hartnett wrote his memoir in the early 1920s from diaries he had kept during the war.

[9]His own journey was a long and painful one. ‘After tramping five or six miles in search of medical attention,’ Hartnett continued, he and his mates ‘finally reached Albert, where the confusion was even worse if that was possible. Long lines of wounded men along the footpaths and roadways were waiting their turn to get attention from doctors and their assistants, stationed at intervals along the roads, out in the open’ (p. 61).  From Albert he was taken by lorry and light railway to a casualty clearing station and, after his wound had been dressed, by ambulance train to Rouen; then it was on to Le Havre and a hospital ship bound for Southampton.

[10]Wilfred Owen, Collected Letters(ed. Harold Owen and John Bell) (Oxford: Oxford University Press, 1967) 31 December 1917; ‘An O.E.’ [G.P.A. Fildes], Iron times with the Guards(London: John Murray, 1918) pp. 74-5; Lawrence Gameson, Private Papers, IWM Doc 612; Philip Gibbs, Now it can be told(New York: Harper, 1920) p. 374; Capt Leonard Pearson, in Lyn MacDonald, The Roses of No Man’s Land(London: Penguin, 1993) p. 187.

[11]Edward G.D. Living, Attack: An Infantry Subaltern’s Impression of July 1st, 1916 (New York: Macmillan, 1918) pp. 69-70.  He managed to walk out after one of his men applied iodine and a field dressing to his wound, but walking became steadily more painful; eventually, weak from loss of blood, he was placed on a stretcher and wheeled to an advanced dressing station, and from there he was taken by ambulance to a Casualty Clearing Station.

[12]R.H. Tawney, ‘The attack’, Westminster Gazette, 24-5 October 1916.

[13]Graves confessed that his memory of what happened next was ‘vague’. He was not expected to survive, and was taken to a dressing station where he remained unconscious; when his commanding officer went down and saw him lying in a corner ‘they told him I was done for.’But the next morning an ambulance took Graves to a Casualty Clearing Station, where he remained until 24 July when he was put on an ambulance train for a Base Hospital on the coast and was eventually repatriated to Britain. Meanwhile his commanding officer had written to his mother tendering his condolences at the loss of her son.  Robert Graves, Goodbye to all that (London: Penguin, 2000; first published in 1929) pp. 180-2.

[14]Siegfried Sassoon, Memoirs of an infantry officer(London: Faber, 1930).  This is a fictionalised account of Sassoon’s experience on 16 April 1917; he recorded his more immediate reactions in his journal but said virtually nothing about the initial shock of being hit.  He left the trench as ‘walking wounded’ and, after his wound was dressed at an aid post, was driven to a Casualty Clearing Station: Sassoon Journal, Cambridge University Library MS Add. 9852/1/10.h

[15]Tawney, ‘Attack’.

[16] Jones resumed his crawl and was eventually found by a bearer party:  Thomas Dilworth, David Jones and the Great War (London: Enitharmon Press, 2012) p. 117. Tiplady, Soul of the soldier, p. 131 explained the logic behind the injunction: ‘When a man falls his neighbor cannot stay with him. He must press on to the objective, otherwise, if the unwounded stayed to succor the wounded, there would be none to continue the attack.’ This was of course emotionally hard. ‘The grimmest order to me was that no fighting soldier was to stop to help the wounded,’ one sergeant confessed.  ‘The CO was very emphatic about this. It seemed such a heartless order to come from our CO who was … looked upon as a religious man. I thought bringing in the wounded was the way Victoria Crosses were won. But I realized that this would be an order to the CO as well as us from the General and that the whole of the attack could be held up if there were many wounded and we stopped to help them’: Sgt Charles Moss, in Richard van Emden,  The Somme(Barnsley UK: Pen and Sword, 2016) p. 00.

[17]A. Matthews, ‘I was fourteen days in No Man’s Land’, I Was There!pp. 688-691; Capt A.W. French, War Diary (Liddle Collection), 14 July 1916.  For another vivid account of a survivor, see the memoir written after the war by John Stafford describing his wounding on the Somme on 8 August 1916:https://www.europeana.eu/portal/en/record/2020601/contributions_3155.html?q=%22John+Stafford%22.

[18]McGill, Medicine and Duty, pp. 118-9.

[19]Arthur Mills, Hospital Days(London: T. Fisher Unwin, 1916) p. 14.

[20]Mills, Hospital days, p.

[21]McGill, Medicine and Duty, p. 157.

[22]‘Blighty’, a corruption of the Urdu vilayati(‘foreign’ or ‘European’)  was first used by Indian soldiers to refer to Britain in the Boer War; its use became widespread in the First World War.

[23]Arthur Empey, Over the top(New York: G.P. Putnam, 1917) p. 00.

[24]Christopher Arnander (ed), Private Lord Crawford’s Great War Diaries(Barnsley, UK: Pen and Sword, 2013) 30 September 1915.  ‘To these men,’ Crawford added, ‘the relief of leaving the front honourably wounded is inconceivable after months of killing, anxiety and fatigue.’ David Lindsay, the Earl of Crawford, enlisted in the RAMC as a private in April 1915 at the age of 43; in July 1916 he returned to the UK as a member of the coalition government.

[25]M.R. Werner, Orderly!(New York: Jonathan Cape & Harrison Smith, 1930) p. 76.

[26]Stephen McGreal, The war on hospital ships, 1914-1918(Barnsley UK: Pen and Sword, 2009).

[27]Patrick MacGill, The Great Push: an episode of the Great War(New York: Grosset and Dunlap, 1916) p. 254. This was a memoir lightly disguised as fiction; MacGill was wounded at Loos on 28 September 1915, and in the preface wrote that he had ‘tried to give, as far as I am allowed, an account of an attack in which I took part’ (p. 7).

[28]Sarah Macnaughtan, A woman’s diary of the war(London: Nelson, 1916) p. 23.  Similar make-believe drills took place behind the front lines, where they were met with a healthy cynicism by ‘wounded’ and stretcher bearers alike.  ‘After heavy losses we would get reinforcements and this would be followed by a Field Day to break in the newcomers’, explained one orderly with a Field Ambulance.  ‘Men with labels describing their supposed injuries were hidden in unlikely spots and had to be found and dealt with as if actually wounded’: Edwin Ware, Diary,p. 94 [WL:RAMC/PE/1/707].  One private recalled a rehearsal for a ‘special stunt’ in which he played a casualty: ‘My wounds were not too painful to prevent my enjoyment of the spectacle while waiting for the stretcher bearers, who did not seem in a great hurry. Casualties here had their own choice of wounds, and they all seemed to prefer some wound which made it impossible to walk a step, much to the disgust of the stretcher bearers.After some argument with the stretcher bearers who came at last to attend to me, I was bundled unceremoniously on to a stretcher with my mess tin making itself unpleasant in the middle of my back, despite the fact that both my legs had been shattered (in theory)’: Doreen Priddey (ed.), A Tommy at Ypres: Walter’s War(Stroud: Amberley Publishing, 2011) 5-9 December 1916.

[29]G.H. Makins, ‘A note upon the wounds of the present campaign’, The Lancet, 10 October 1914 (p. 905); M.K. H. Crump and P. Starling, A surgical artist at war: the paintings and sketches of Sir Charles Bell 1807-1815 (Edinburgh: Royal College of Surgeons, 2005).  Bell uncannily prefigured the horrors for which his successors were equally ill-prepared one hundred years later.  ‘The cases I have had under my care,’ he wrote in his Dissertation on gunshot wounds(1814), ‘have proved to me that the books we possess upon the subject of field-practice do not even hint at the nature of the difficulties the surgeon has to encounter there.’

[30]Fiona Reid, Medicine in First World War Europe: Soldiers, Medics, Pacifists (London: Bloomsbury, 2017) p. 19.

[31]Derek Gregory, ‘The politics of speed and casualty evacuation on the Western Front, 1914-1918’, forthcoming.

[32]

More-than-human casualties

Apologies for the long silence – I’ve made several trips to the UK to deliver lectures, but I’ve also been (almost literally) in the trenches.  My supposed-to-be 8,000 word essay on ‘Woundscapes of the Western Front’ has morphed into a monster: 35,000 words and I’m still not done….  More on that eventually (I so hope…).  But en route, and in part as a response to a question I was asked after one of my presentations, I want to elaborate on a footnote.

My essay is about the evacuation of wounded soldiers, but human bodies were not the only ones requiring medical attention on the Western Front. By August 1917 the British Army had 368,000 horses and 82,000 mules in Belgium and France.  At the outbreak of the war the cavalry were expected to play their traditional role –

[Image: National Library of Scotland]

– but by the end of the war most horses were pulling gun limbers, ammunition trains, supply waggons and ambulances [more here].

Horse-drawn ambulances were never made obsolete by motor ambulance convoys.  Their capacity was limited and they were very slow – ‘hopelessly immobile’, according to one senior RAMC officer – but they remained the only option in some places. On the Somme in July 1916 the ground was so pitted with shell-holes that motor ambulances could not be used close to the line and horse ambulances worked for 24 hours or more at a stretch, ferrying casualties to motor ambulance convoys waiting further back:

Not surprisingly, horses (and mules) were highly vulnerable to shelling and shrapnel, to gas attacks and, wherever environmental conditions deteriorated, to injuries from traversing near-impossible terrain:

There is a haunting scene in Erich Maria Remarque‘s  All quiet on the Western Front:

‘The cries continued. It is not men, they could not cry so terribly.
“Wounded horses,” says Kat.
It’s unendurable. It is the moaning of the world, it is the martyred creation, wild with anguish, filled with terror, and groaning….

They’ve got to get the wounded men out first,’ says Kat. We stand up and try to see where they are. If we can actually see the animals, it will be easier to cope with. Meyer has some field glasses with him. We can make some bigger things, black mounds that are moving. Those are the wounded horses. But not all of them. Some gallop off a little way, collapse, and then run on again. The belly of one of the horses has been ripped open and its guts are trailing out. It gets its feet caught up in them and falls, but it gets to its feet again. Detering raises his ri e and takes aim. Kat knocks the barrel upwards. ‘Are you crazy?’ Detering shudders and throws his gun on the ground. We sit down and press our hands over our ears. But the terrible crying and groaning and howling still gets through, it penetrates everything. We can all stand a lot, but this brings us out in a cold sweat. You want to get up and run away, anywhere just so as not to hear that screaming any more. And it isn’t men, just horses.

Yet far more equine losses were attributed to disease than enemy action, in contrast to troop losses (the First World War was the first in which deaths from wounds exceeded deaths from disease by a ratio of 2:1). One driver had a simple explanation. ‘Owing to the importance of the horses, whose lives were of greater value than those of the men, the horse-lines were usually in places free, or practically free from “strafing”’: Charles Bassett, Horses were more valuable than men (London: PublishNation, 2014) p. 65.

The horse-lines were indeed in the rear (see the remarkably pastoral image below: Glisy, on the Somme), but the nature of their work ensured that horses and mules had to be taken right up to the fire zone; between 1914 and 1916 battle losses accounted for 25 per cent of equine deaths, and they soared thereafter.

Last year Philip Hoare described these animals as ‘the truly forgotten dead.’ He continued: ‘Sixteen million animals “served” in the first world war – and the RSPCA estimates that 484,143 horses, mules, camels and bullocks were killed in British service between 1914 and 1918.

Yet, just as with human bodies, the toll of the equine dead overlooks that of the wounded.  In response to the military importance of horses and mules, the (Royal) Army Veterinary Corps [the ‘Royal’ prefix was granted immediately after the war] established a system of veterinary medicine parallel to the casualty evacuation system of the Royal Army Medical Corps.

The equivalent of the Field Ambulance was the Mobile Veterinary Section; animals needing more extensive emergency care were transferred to Veterinary Evacuation Stations (the equivalent of the Casualty Clearing Station) located at railheads.  They were moved either by horse-drawn ambulance –

– or by special motor ambulances designed to carry two horses each (there were 26 of them, donated by the RSPCA and subscribed from public donations):

Like wounded soldiers, horses needing further medical or surgical attention were transported by barge (mainly in Flanders: each barge could carry 32 animals)  –

– or by rail to Veterinary Hospitals at the base on the French coast.

In the first months of the war cattle trucks on supply trains returning empty to the base were used (here too the parallels with the evacuation of wounded soldiers are exact!) but once the Veterinary Evacuating Stations had been established special horse trains were introduced.  These had to be more or less self-sufficient: supplies of water were especially vital.  Major-General  Sir John Moore emphasised: ‘In transporting sick and enfeebled animals, particularly by train, which during hot seasons of the year is very exhausting, the greatest care must be exercised in watering and feeding en route.’  The need was compounded by the slow and often circuitous journeys made by trains that – like the ambulance trains carrying wounded soldiers – always had to yield to troop trains and supply trains rushing up to the front.

Between 18 August 1914 and 23 January 1919 over half a million sick and wounded animals passed through the British Army’s Mobile Veterinary Sections and Veterinary Evacuating Stations in Flanders and France.  On average a special train carrying 100 sick or injured horses would arrive twice a day at each Veterinary Hospital; between 2,500 and 3,500 horses were admitted to hospital each week, and at their peak more than 4,500 were being cared for at any one time.

The capacity of these hospitals was originally set at 1,000 animals, but this was subsequently doubled.  It was not uncommon, Moore explained, ‘to see three animals in the operating theatre under chloroform at the same time.’

Very few animals were allowed to stay more than three months at the base, where the hospitals operated in conjunction with Convalescent Horse Depots.

According to Moore, the core principle of the Army Veterinary Corps was ‘to get down from the front as many animals as it was possible to save; in other words to give every animal a chance.’  But what lay behind this was the same instrumentalism that guided the RAMC’s casualty evacuation model and its system of triage: the need identify the casualties most likely to survive in short order and to treat them expeditiously so that they could be returned to the front and the fight.

***

You can find more from these sources:

  • Simon Butler, The war horses (Halsgrove, 2011);
  • Stephen Corvi, ‘Men of Mercy: the evolution of the Royal Army Veterinary Corps and the soldier-horse bond during the Great War,’ Journal of the Society for Army Historical Research 76 (308) (1998) 272-84;
  • M-G Sir John Moore, Army Veterinary Service in War (London: Brown, 1921) [available here]
  • Rachael Passmore, ‘The care, development and importance of the British horse on the Western Front in World War I,’ MA thesis, Department of History, University of Leeds, 2009 [accessible here];
  • John Singleton, ‘Britain’s military use of horses 1914-1918’, Past & Present 139 (1993) 178-203.

Like my original essay, this post is confined to the British Army; for a remarkably detailed and beautifully illustrated account of the veterinary medical system of the US Army on the Western Front see here.

Unless otherwise credited, ALL IMAGES are Copyright Imperial War Museum, London

Paper trails

For an update and succinct review of attacks on hospitals and medical facilities in Syria – see also my ‘Your turn, doctor’ here – I recommend the latest fact-sheet from Physicians for Human Rights:

Attacks on health care, in gross violation of humanitarian norms and the Geneva Conventions, have been a distinctive feature of the conflict in Syria since its inception. PHR has documented and mapped 553 attacks on at least 348 separate facilities from March 2011 through December 2018. The reduction in the number of attacks over the past year is a clear reflection of the diminishing intensity of the conflict, which came as a direct result of the Syrian government’s takeover of most opposition-held areas. The systematic targeting of health facilities has been a crucial component of a wider strategy of war employed by the Syrian government and its allies – who are responsible for over 90 percent of attacks – to punish civilians residing in opposition- held territories, destroy their ability to survive, and draw them into government-held areas or drive them out of the country. This strategy of unbridled violence – which in addition to attacks on healthcare has included chemical strikes, sieges, and indiscriminate bombing of predominantly civilian areas – has devastated the civilian population, weakened opposition groups, and translated into direct military gains for the Syrian government.

Of the total number of documented attacks on health facilities, nearly 73 percent were carried out from the air. Nearly 98 percent of attacks on health facilities perpetrated from the air are attributable to the Syrian government and its ally Russian, which entered the conflict in 2015.

The share of attacks on health facilities from the air has grown from 38 percent of the total in 2012 to 90 percent in 2018. The Syrian government became steadily more reliant on airpower as the conflict evolved. Through their air forces, the Syrian government and Russia extended their strategy of collective punishment deep into opposition-held territory and far beyond hardened front lines. The Syrian government and its allies disabled or destroyed hundreds of facilities through aerial bombardment, leaving countless civilians without access to vital medical services.

The latest 20-page report from the Independent International Commission of Inquiry on the Syrian Arab Republic to the UN’s Human Rights Council is here.  I’ve drawn on many of these reports for my continuing work on siege warfare in Syria (see for example here, here and here), and this report – based on investigations carried out from 11 July 2018 to 10 January 2019 – makes for grim reading.  Here is the summary (but you really need to consult the full report):

Extensive military gains made by pro-government forces throughout the first half of 2018, coupled with an agreement between Turkey and the Russian Federation to establish a demilitarized zone in the north-west, led to a significant decrease in armed conflict in the Syrian Arab Republic in the period from mid July 2018 to mid January 2019. Hostilities elsewhere, however, remain ongoing. Attacks by pro-government forces in Idlib and western Aleppo Governorates, and those carried out by the Syrian Democratic Forces and the international coalition in Dayr al-Zawr Governorate, continue to cause scores of civilian casualties.

In the aftermath of bombardments, civilians countrywide suffered the effects of a general absence of the rule of law. Numerous civilians were detained arbitrarily or abducted by members of armed groups and criminal gangs and held hostage for ransom in their strongholds in Idlib and northern Aleppo. Similarly, with the conclusion of Operation Olive Branch by Turkey in March 2018, arbitrary arrests and detentions became pervasive throughout Afrin District (Aleppo).

In areas recently retaken by pro-government forces, including eastern Ghouta (Rif Dimashq) and Dar’a Governorate, cases of arbitrary detention and enforced disappearance were perpetrated with impunity. After years of living under siege, many civilians in areas recaptured by pro-government forces also faced numerous administrative and legal obstacles to access key services.

The foregoing violations and general absence of the rule of law paint a stark reality for civilians countrywide, including for 6.2 million internally displaced persons and 5.6 million refugees seeking to return. For these reasons, any plans for the return of those displaced both within and outside of the Syrian Arab Republic must incorporate a rights- based approach. In order to address effectively the complex issue of returns, the Commission makes a series of pragmatic recommendations for the sustainable return of all displaced Syrian women, men and children.

A report from Elizabeth Tsurkov in Ha’aretz confirms many of these findings.  Describing Assad’s Syria as a police state with rampant poverty’ and a ‘playground for superpowers’, she writes:

Eight years into the crisis, Syria’s economy is in tatters, half of its population displaced, hundreds of thousands of Syrians are dead, many of Syria’s cities and towns lie in ruins. Yet on top of this pile of ashes Assad sits comfortably, quite secure in his grip on power.
In areas reconquered by the regime — or as the regime euphemistically describes it, areas that “reconciled” and whose residents “returned to the bosom of the nation” — the Syrian police state is back, more aggressive than ever…

In 2011, Syrians took pride in “breaking the barrier of fear.” But fear now prevails, as the various branches of the regime’s secret police launch raids and arrest suspected disloyal elements. Many of those arrested are former activists, rebels, health and rescue workers, and civil society leaders. Syrians who wish to prove their loyalty to the regime, obtain power through it or simply settle personal scores inform on others to the regime. Suhail al-Ghazi, a Syrian analyst based in Istanbul, told Haaretz that Syrians are informing on each other “because they have been doing it for years or because they need money or favors from the regime.” In areas recently recaptured by the regime, “some locals were always pro-regime and stayed there to work as informants or just could not leave. Now they have the chance to take revenge on the majority of civilians who apparently held a more favorable view of the opposition,” Ghazi explained.

Most of Syria’s population now lives below the poverty line. Across all parts of Syria unemployment rates are high, as the normal economy has been disrupted by years of war and the mass flight of businesspeople and capital out of the country. Syria’s middle class has largely disappeared — many of them fled to neighboring countries or Europe, while others are now living in abject poverty, along with most Syrians.
A small group of war profiteers linked to the various armed groups have been able to enrich themselves by trading in oil, weapons, antiquities, stealing aid, and smuggling people and goods in and out of the country and into besieged areas, while most Syrians struggle to survive. Nearly two-thirds of Syrians are dependent on aid for their subsistence. Basic services like electricity, cooking gas, clean water and health services are lacking in many parts of the country.

Speaking on the condition of anonymity, a resident of Latakia — an area where many of the regime’s leadership and their relatives reside — told Haaretz: “You have corruption everywhere. Bribing was common before the war, but now it is endemic.”
He described the ostentatious displays of ill-gotten wealth: “High-ranking officials, they and their families, have more rights. They roam the city in fancy cars and do whatever they want. Half of the country is dying from hunger, while the sons of officials are arrogantly showing off their wealth. With money you can do everything. This is not new, but it has become more obvious because of the lawlessness prevailing in Syria.”

At the sub-regional scale Enab Baladi filed a revealing report last month on conditions in the Ghouta (which it describes as ‘military-ruled ruins’):

Today, Ghouta is living in a state of siege similar to that it witnessed between 2013 and 2018 at the service, relief and security levels, but the difference is that food is available.

With dozens of announcements about the restoration of electricity to areas east of the capital, as well as the restoration of water and communication services, the needs of civilians are still not covered by those services repeatedly announced by the regime.

Enab Baladi spoke to five people from the eastern Ghouta who returned to it, all of whom refused to be identified for fear of the regime prosecution. They described the service situation as “miserable”, especially with regard to the water and electricity services.

According to the five sources, the electricity is continuously cut for five hours, operates for only one hour, and then it is cut again, while water reaches homes one hour a day, and people rely on submersibles and artesian wells which they dug during siege in the previous years to get water.

Some areas of Ghouta also lacked many of the services that were the top priorities of organizations before the regime forces controlled the region, while food today enters without manipulated prices, unlike in the past….

The report describes Eastern Ghouta as riven by checkpoints; an emphasis on demolition rather than reconstruction; and continuing arrests and detentions.

In early August [2018], al-Assad forces launched a campaign of arrests, which has been considered as one of the largest security operations since the regime took over Ghouta, for it has targeted the regime dissidents and activists in the Syrian revolution. The campaign was carried out in the cities and towns of Saqba, Hamuriyah, Duma, Mesraba, and Ein Tarma.

The regime also subjected local activists, civil society workers, and former media professionals, as well as members of local councils and relief agencies, to investigations into the aids they received when the area was held by the opposition.

Security branches launched arrest campaigns targeting members of the former “local council” and other members of Rif-Dimashq Provincial Council in the city of Kafr Batna in central Ghouta, according to Enab Baladi referring to local sources.

Sources affiliated to the council told Enab Baladi that Syrian security forces raided the houses and workplaces of the detainees before taking them to an unknown destination. Other local council members, who preferred to stay in Ghouta rather than go to northern Syria, are detained for the same reasons.

In the face of all that, it’s not easy to find grounds for optimism, but there is a glimmer of hope in a report from Maryam Saleh at The Intercept:

Syrian activists and lawyers are testing the bounds of international law, making two new attempts to bring the government of Bashar al-Assad before the International Criminal Court.

Syrian refugees in Jordan, through London-based lawyers, sent communications to the office of the ICC prosecutor, asking her to exercise jurisdiction over Syria based on a precedent set last year in a case involving Myanmar’s persecution of Rohingya Muslims. The communications are the latest push by Syrian civilians to hold accountable the government whose brutality upended their lives. In recent years, Syrian lawyers and human rights activists have experimented with rarely utilized aspects of international law, succeeding in getting European and American courts to weigh in on atrocities committed in Syria.

“Because of how politicized the war in Syria became, lawyers and those fighting for accountability really had to be creative,” said Mai El-Sadany, the legal and judicial director at the Washington-based Tahrir Institute for Middle East Policy. “The most recent ICC Article 15 submissions” — a reference to communications with the ICC on information about alleged international crimes — “are evidence of this, that there is space for creativity in the accountability space.”

She continues:

Even when the evidence of potential crimes exists, investigations into crimes committed in states that have not ratified the Rome Statute are near impossible because of jurisdictional issues, and U.N. Security Council members are quick to use their veto power to block investigations into crimes potentially committed by their allies.

That’s what makes the various avenues Syrians are pursuing so significant. As of last March, more than two dozen cases had been filed in European courts regarding atrocities committed by the Syrian regime, rebel fighters, and the Islamic State and other fundamentalist militant groups. The family of Marie Colvin, an American journalist killed in 2012 while reporting from the city of Homs, sued the Syrian government in a U.S. district court; in January, the court found Syria responsible for killing Colvin.

Many of the cases in Europe were brought under a legal doctrine known as universal jurisdiction; application of the doctrine varies from country to country, but it essentially allows for courts to prosecute cases regardless of where the crime was committed or whether the accused party has any links to the prosecuting state.

The biggest success so far has been in Germany, where authorities last month arrested a former high-ranking Syrian intelligence officer and two others who are accused of crimes against humanity for torturing detainees in Syrian prisons. Other cases remain pending in France, Sweden, and Spain….

These attempts are possible in part due to an unprecedented level of documentation of crimes in Syria. The victims in some of the cases were identified from a trove of 28,000 photos of people killed in Syrian detention centers, smuggled out of the country by a military defector codenamed Caesar. The U.N. General Assembly, in December 2016, took the step of creating the International, Impartial, and Independent Mechanism to investigate crimes in Syria since 2011. The IIIM, as the body is known, does not have independent prosecutorial authority, but it exists to collect information that could later be provided to courts or tribunals with jurisdiction over the crimes. Last year, 28 Syrian nongovernmental organizations committed to collaborating with the IIIM on its work.

This is heartening in its way, but whenever I’ve been asked about attempts to enforce accountability in relation to the systematic attacks on hospitals, I’ve had to say that the hideous intimacy between torturer and tortured allows for an identification and assignment of culpability that is much more difficult in the case of the extended ‘kill-chain’ involved in bombing.

But that doesn’t mean it’s impossible: we know, from the courageous work of activists cited in Maryam’s report, that Assad’s security apparatus fetishized record-keeping, and that many of those records have been smuggled out of Syria so that they can now serve as testimony and evidence  (For other testimonies, see the work of Forensic Architecture on Saydnaya Prison that I described here: scroll down).  To sharpen the point, hare some of the slides from a presentation I once gave around precisely these questions:

If my work on bombing in other theatres of war is anything to go by, there will also be extensive trails (paper or digital) that animated the air strikes: though how they can ever be exposed is another question.

War Doctor

I’m still converting my ‘Trauma Geographies‘ lecture into an essay – which has involved writing a prequel of sorts, ‘Woundscapes of the Western Front‘ – so, with my head buzzing with first-person accounts of trauma surgery on the front-lines, I was thrilled to see that David Nott has just published an account of his marvellous work in Syria (and many other conflict zones), War Doctor: Surgery on the Front Line (Pan Macmillan):

For more than twenty-five years, David Nott has taken unpaid leave from his job as a general and vascular surgeon with the NHS to volunteer in some of the world’s most dangerous war zones. From Sarajevo under siege in 1993, to clandestine hospitals in rebel-held eastern Aleppo, he has carried out life-saving operations and field surgery in the most challenging conditions, and with none of the resources of a major London teaching hospital.

The conflicts he has worked in form a chronology of twenty-first-century combat: Afghanistan, Sierra Leone, Liberia, Darfur, Congo, Iraq, Yemen, Libya, Gaza and Syria. But he has also volunteered in areas blighted by natural disasters, such as the earthquakes in Haiti and Nepal.

Driven both by compassion and passion, the desire to help others and the thrill of extreme personal danger, he is now widely acknowledged to be the most experienced trauma surgeon in the world. But as time went on, David Nott began to realize that flying into a catastrophe – whether war or natural disaster – was not enough. Doctors on the ground needed to learn how to treat the appalling injuries that war inflicts upon its victims. Since 2015, the foundation he set up with his wife, Elly, has disseminated the knowledge he has gained, training other doctors in the art of saving lives threatened by bombs and bullets.

War Doctor is his extraordinary story.

There’s a good review in The Guardian here,

If you’re unfamiliar with David’s extraordinary efforts in Syria, I touch on them – all too briefly – in ‘Death of the Clinic’ here.  And the David Nott Foundation Facebook page is here.

The Leaden Hours

Ever since I attended a conference at Nijmegen on Transmobilities I’ve followed the current interest in ‘mobilities’, though from a distance and perhaps in strange ways: but I think that the following study contributes to that debate as well as to quite different preoccupations with the intersections of military geography, medical geography and my current research on woundscapes and ‘trauma geographies‘. Let me know what you think.

Modern trauma response pays close attention to what happens in the ‘platinum ten minutes‘ immediately after injury and treats the ‘golden hour‘ to definitive medical treatment as the standard to which casualty evacuation should adhere.  I explored the implications of these metrics for treatment outcomes and survival rates in Afghanistan in ‘the geographies of sixty minutes‘, and as part of my comparative work I’ve been examining the speed of casualty evacuation on the Western Front in the First World War.

The politics of speed

This turns out to be a complicated issue, and one that attracted considerable controversy – both professional and political – throughout the war.  There are summaries in Ian Whitehead‘s Doctors in the Great War and in Ana Carden-Coyne‘s The politics of wounds, but some of the sharpest exchanges (in early January 1917) were sparked by a memorandum from Sir Almroth Wright, Consultant Physician to the British Expeditionary Force, criticising what he saw as the preoccupation with rapid evacuation at all costs.  His charges were summarily dismissed by General Sir Arthur Sloggett, (right, shown in 1917), the Director-General of Medical Services for the British Expeditionary Force – in angry memoranda and meetings and in acerbic private correspondence – as being entirely without foundation and, indeed, ‘ignorant’ and even ‘stupid’ (see RAMC 365/4 here).

Some front-line medical officers were more perturbed than these exchanges suggest.  Surgeon Henry Kaye, for example, addressed the issue in his diary for 24 January 1916, when he sought an explanation for the mortality rates from ‘different classes of wounds’ passing through his casualty clearing station:

‘I should surmise that the only controllable factor is that of transport – ie that a certain percentage of the mortality is due to the transport of seriously wounded men – people are so pleased with the excellence of the transport arrangements (ambulances, trains, and ships) that they forget what a great additional strain any transport imposes on the patients, and are apt to lay approving stress on how quickly they have transported thousands of cases to England, without regarding (or at least mentioning) how many men this express transport has cost their lives. (Diary, Wellcome Institute, RAMC 739/4)

Notice that word ‘surmise’.  Given the joined politics of speed it is surprising that there should have been so few detailed studies at the time.  In their survey of ‘The development of British surgery at the Front’, published in the British Medical Journal on 2 June 1917, Surgeon-General Sir Anthony Bowlby and Colonel Cuthbert Wallace (Consulting Surgeon to the British Army) showed that out of 200 abdominal cases received at one casualty clearing station (CCS), 164 arrived within 12 hours, another 35 arrived in the next 12 hours, and 31 took over 24 hours to reach the CCS (p. 706).  

Another surgeon concluded from these figures that one third of the casualties ‘arrived so late that they had little chance of recovery because of the elapsed time alone’ (Daniel Fiske Jones, ‘The role of the evacuation hospital in the care of the wounded’, Annals of Surgery 68 (2) (1918) 127-132: 130).  In a second tabulation Bowlby and Wallace drew on a different sample of abdominal cases which confirmed that 51 per cent of those who arrived at a CCS within 12 hours survived (at least long enough to be transferred to a base hospital on the coast), but for those who took longer than 12 hours the survival rate fell to 33 per cent (p 716).

If nothing else, these figures confirmed the importance of evacuation rates, but their wide dispersion raised a series of important questions. The Australian Army provided two later studies that attended more closely to the geographies of casualty evacuation – and, to some degree, addressed the dispersion in the figures from Bowlby and Wallace – and for the rest of this post I’ll focus on the most detailed of the two.

This related to the evacuation scheme in operation for what became known as the Battle of Menin Road (20-25 September 1917). The image above is Paul Nash‘s celebrated rendering of The Menin Road, which he completed in February 1919.  Nash served on the Ypres Salient from February 1917 as a second lieutenant, but a few months later he missed his footing in the dark, fell into a trench and broke a rib.  He was evacuated to England, and returned to the Salient in November as an official war artist. (There is a fine discussion of Nash’s art and its relation to the war in Paul Gough‘s A Terrible beauty: British artists in the First World War; for The Menin Road in particular, see pp. 150-62 ).

Third Ypres: the first two phases

The Battle of Menin Road was the third phase of ‘the Third Battle of Ypres’ (July-November 1917) that culminated in the fall of Passchendaele (the name by which the whole series of offensives is often known).  The object of the campaign was to seize control of the line of low hills – ‘the ridge’ – running south and east of Ypres.

The first two phases were directed against Pilckem Ridge (31 July to 2 August) and Langemarck (16 to 18 August).

For the medical services there were two pressing problems.  The first was the retrieval of casualties by relays of stretcher bearers.  The terrain had been reclaimed from marshland by an elaborate system of drains but these were destroyed by savage and relentless artillery bombardments, and  Colonel A.G. Butler explained that ‘with the rains – expected in the autumn – the low, flat countryside reverted to primitive morass’ (Official History of the Australian Army Medical Services in the War of 1914-1918, Vol. II: The Western Front, p. 184n).  Confounding the Allies’ expectations, however, the rains broke at the end of July.  The conditions were frightful, the casualties horrendous, and on 1 August Lt John Warwick Brooke took what turned out to be an iconic photograph that caught the intersection of the two: no fewer than seven bearers struggling to carry a stretcher through the thick, plastering mud-slime near Boesinghe:

That same day Private Walter Williamson was ordered to a ruined building – he had no idea what it used to be – where his Regimental Medical Officer had established an aid post:

The place had simply been battered with shell fire and the road ploughed up, but this had now settled down to one horrible level surface of water and oozing mud….

Stretchers with their pitiful burdens were brought out from the inner recesses of the ruins, and we were detailed each four to a stretcher … containing a badly wounded lad who was only conscious enough to feebly moan to us to put him straight in the boat [to ‘Blighty’]. We heaved the stretcher to our shoulders, and started off that long remembered journey down the St Julien road. In addition to being weak and tired, our uneven heights made carrying difficult, and it must have been torture for the poor occupant of the stretcher. In the best places, the road was nearly knee deep in mud, and shell holes could not be located except by testing each foothold. Planks had been put down in places where the whole width of the road had been blown up, but these were now floating aimlessly about, and any attempt to use them would have resulted in a spill, and hurling our burden into the mud. Rain still poured down unceasingly and the road was being shelled viciously. We could not well duck at the shells, with a badly wounded man dependent on steady shoulders, and all we could do was to plod through and trust to good luck…

The road was a gruesome nightmare, bodies lay in the mud all along the road and burial parties were busy collecting them as best they could. Dead mules, horses, wrecked guns, limbers and all the terrible debris of battle lay in the mud. We were getting now, that we could not carry the stretcher more than a hundred yards at a stretch, and each time we rested, we found it more difficult to heave it up again, but we plodded along with red hot shoulders and cracking backs, sometimes having to get nearly waist deep to find a foothold across some huge hole that stretched from one side of the road to the other’ (Doreen Priddey (ed), A Tommy at Ypres: Walter’s War).

They eventually succeeded in delivering the poor man to a motor ambulance, which would have taken him to a dressing station or a casualty clearing station.  

The walking wounded didn’t fare much better, and the distinction between them and stretcher cases was by no means clear-cut or constant, as the experience of Private Alfred Warsop makes horribly clear.  Hit by shrapnel in the jaw, arm and chest, he passed out and when he came round ‘a doctor was just finishing bandaging me up and he said, “Get a stretcher for this man as soon as you can.”‘  Realising there were unlikely to be enough bearers available to carry him through the mud, he decided to walk out:

‘I persuaded a first aid man to put his hand in the middle of my back and hoist me on my feet. I tottered out determined to get down to the Menin Road or die in the attempt –on this occasion no idle phrase. It was all slippery mud, shell holes and trenches. I soon found that I had lost nearly all sense of balance with both arms useless. No doubt I was able to make that journey because I was suffering from shock and not feeling things as you normally would’ (in Steel and Hart, Passchendaele: the sacrificial ground)

Similarly, Gunner Walter Legg recalled coming to the aid of a badly wounded young soldier – carrying him to a shell hole and applying a field dressing, then helping him stumble to the aid post:

‘I remember vividly that with each step he took, blood oozed out on to the loose loop of his braces and fell drop by drop on his trousers.  From where we were I could see the forward dressing station about a quarter of a mile to the rear…  We managed to make progress a few yards at a time.  We’d shelter for a bit in a shell-hole, and then if the shelling seemed to be easing up we’d crawl into the next one and wait there for a bit, then try and get to the next one a yard or two away.  After a couple of hours … we’d only gone thirty or forty yards…

It took us ten hours to cover that quarter-mile to the dressing station, and when we got there we were absolutely drenched to the skin and thick with mud’ (in Lynn MacDonald, They called it Passchendaele).

The second problem emerged as soon as the injured reached a road: their transfer to a main dressing station or casualty clearing station was often slowed because the roads were in a poor condition, many of them full of craters and badly degraded by the constant traffic of convoys and marching columns, but also because the ambulances had to struggle against the flow, yielding to fresh troops, ammunition and supplies moving in the opposite direction.  The priority was clear. ‘The conditions of warfare demand … that wounded men shall be got out of the war,’ wrote one senior medical officer, so that supplies of reinforcements, ammunition and food to the fighting line are not interfered with’ (Col. H. M. W. Gray, ‘Surgical treatment of wounded men at advanced units’, New York Medical Journal 107 (1917)).

To regulate the flow, elaborate arrangements were made to control the direction of traffic, sometimes with special routes designated for ambulances.  The map below shows the traffic circuits established by the Fifth Army around Ypres by 27 July 1917:

[Roads shown in red could be used in both directions; roads shown in blue only in the direction indicated; roads not coloured were not to be used by lorries and could be used by ambulances or light traffic; there was ‘no restriction placed on Motor Cars containing Officers on duty’.]

Despite the slow journeys faced by wounded soldiers, the casualty clearing stations were hard pressed to keep up with the tide of injured bodies.  This was particularly true for those fed by by broad-gauge train from dressing stations in Vlamertinghe and Ypres.  That was how most of the nominally ‘walking wounded’ arrived at the CCSs at Remy Siding on the night of 31 July/1 August.  ‘They consequently arrived in very large batches,’ Major-General Sir W.G. Macpherson explained, ‘instead of coming down in small numbers at a time by lorries and charabancs.’  This overwhelmed the CCSs and delayed the departure of ambulance trains to the base hospitals, which could not leave until the casualties had been cleared, and the congestion was compounded because the trains bringing them in used the same siding as the ambulance trains waiting to come up and load: eight of them were scheduled in the first 24 hours (Medical Services, General History, Vol. III, pp. 160-1).

On that first day US surgeon George Crile, working at No 17 British CCS at Remy Siding, described how

‘The stream of wounded began to increase in volume, slowly at first, then rapidly, until the entire Remy Siding was swamped.  By the night of August first, every bed, every aisle, every tent, every inch of floor space was occupied by stretchers – then the rows of stretchers spread out over the lawn, around the huts, flowing out towards the railway…

The operating rooms ran day and night without ceasing.  Teams worked steadily for twelve hours on, then twelve hours off, relieving each other like night–day–night shifts.  There passed through the Remy Siding group of [three] CCSs over ten thousand wounded in the first forty-eight hours.  I had two hundred deaths in one night in my service.  The seriously wounded piled up so fast that nothing could be done with them, so I told the sister to administer as near an overdose of morphine as was possible to keep them alive but free of suffering’ (Autobiography, pp. 301-2).

It was the same everywhere.  Here is another American surgeon, Harvey Cushing, writing in his journal at No 46 British CCS near Proven at 0230 the next morning:

Pouring cats and dogs all day – also pouring cold and shivering wounded, covered with mud and blood…. The pre-operation room is still crowded – one can’t possibly keep up with them; and the un-systematic way things are run drives one frantic. The news, too, is very bad. The greatest battle of history is floundering up to its middle in a morass, and the guns have sunk even deeper than that. Gott mit uns was certainly true for the enemy this time.

Operating from 8.30 a.m. one day till 2.00 a.m. the next; standing in a pair of rubber boots, and periodically full of tea as a stimulant, is not healthy. It’s an awful business, probably the worst possible training in surgery for a young man, and ruinous for the carefully acquired technique of an oldster. Something over 2000 wounded have passed, so far, through this one C.C.S. There are fifteen similar stations behind the battle front (From a surgeon’s journal, p. 175).

(In his biography of Cushing, Michael Bliss remarked that having such a great surgeon perform brain surgery at a CCS – with exquisite care and meticulous attention to detail – was ‘like a master chef working at McDonald’s’, but Crile told Bowlby he was a model technician and advised him to organise the other surgical teams to handle the overflow).

The combined toll of these two phases in July and August was sobering, but they advanced the line to the east of Hooge (or, more accurately, to what was left of it: ‘even the road was untraceable,’ Charles Bean explains, ‘and the village site was only marked by a cluster of mine craters’ (Official History of Australia in the War of 1914-18, Vol. IV: The A.I.F. in France [sic]: 1917).  With that, the offensive appeared to have ground to a halt – literally so – and the German High Command concluded that Third Ypres was over.

The third phase: Menin Road

They were mistaken.  On 25 August British field command had been transferred to Lt General Herbert Plumer who devised a new, more measured plan for the third phase, which involved four short steps across a narrow front, separated by breaks to bring up the guns and supplies.  It would be spearheaded by Australian and New Zealand troops, with British and South African support.

Plumer took the next three weeks to prepare the ground for the first of his graduated steps, which was the Battle of Menin Road.  The road had been what one NCO called ‘the artery of the battlefield’ during the limited advance of the summer (Corporal J. Pincombe, in Lynn MacDonald, They called it Passchendaele, p. 144), and it remained a live fire zone.  ‘They had to keep the Menin Road open,’ recalled one driver with the Royal Artillery,

‘because it was the only way you could get up to that sector with horses and limbers, and it was shelled day and night.  The Germans had their guns registered on it to a T, and the engineers had to keep filling up the shell-holes … and keep the traffic going’ (Driver J. McPherson, in Lynn MacDonald, They called it Passchendaele, p. 177)

Paul Ham describes the scale of the preparations:

Plumer packed every ounce of energy and action into those few weeks. Within the next seventeen days, 156 trainloads carrying 54,572 tons of matériel arrived at the railheads, all of which had to be trucked, entrained, dragged or carried on mule-back to the front.  Light tramways were hastily reconstructed and roads rebuilt out of wooden planks. Shell holes were filled in and stamped down; gun emplacements firmly laid; telephone lines unrolled and buried; rations and medical supplies prepared and brought forward –all of which proceeded within range of German shellfire. Miles of duckboards were laid, latticing the drying plain, connecting little islands and ridges of high ground in the hardening mud. The men trained all day, rehearsing new platoon tactics, pillbox flanking manoeuvres and how to coordinate their advance with the creeping barrage, worked out to mathematical certainty (Ham, Passchendaele, p. 245).

In the interval the ground dried out and the terrain ‘changed from a morass into a desert’ (Bean, AIF, p. 748).  But it was still immensely difficult terrain, riddled with shell holes and all the hideous detritus of war.  In a letter written from Vlamertinghe on 17 September Hugh Quigley painted a bleak picture:

‘The country resembles a sewage-heap more than anything else, pitted with shell holes of every conceivable size, and filled to the brim with green, slimy water, above which a blackened arm or leg might project.  It becomes a matter of great skill picking a way across such a network of death traps, for drowning is almost certain in one of them (in Martin Marix Evans,  Passchendaele: the hollow victory).

The next map shows the line two days later, on 19 September – the night before the new offensive began:

Plumer’s plan called for clockwork precision.  The infantry were to advance behind a devastating rolling barrage, whose opening curtain would fall just 150 yards (130 metres) in front of the troops; after three minutes, as the troops moved up, it would roll forward at 100 yards every four minutes for the first 200 yards, and then at a rate of 100 yards every six minutes until the first objective, the Red Line, was reached: a distance of 750 metres.  The barrage would then halt for 45 minutes before rolling on at 100 yards every eight minutes until the Blue Line was reached: a further 400 metres.  After a pause for two hours the barrage would advance again at the same rate to the Green Line, the last objective of the day: a further 200 metres.

The slow rate of advance – compared to other rolling barrages – and the short distances eased the difficulty of picking passages through the pock-marked terrain, but there was little room for error or misstep.  Observing a rehearsal, Captain A.M. McGrigor recorded that

‘it did bring home to one how appallingly mechanical everything is now, and how every man must conform to the advance of the barrage.  Initiative and dash must to a certain extent be fettered as every forward movement is worked out so carefully and mathematically’ (in Robin Prior and Trevor Wilson, Passchendaele: the untold story)

Planning for casualties

These precise timings were complemented by similar calculations in the accompanying plan for medical provision drawn up by General Arthur Sloggett, perhaps still smarting from and certainly still contemptuous of Wright’s criticisms (above), and Surgeon-General G.B.M. Skinner (Fifth Army), which was intended to remove the extraordinary frictions that had bedevilled the evacuation chain during the summer.  Butler makes the parallel explicit: ‘The machinery for clearing our own casualties had to move with the same clockwork precision as that designed by us to create them in the enemy’ (Australian Army Medical Services, p. 211).

Their plan was guided by two imperatives.

(1)  Casualty Clearing Stations  The first was to bring casualty clearing stations as close to the line as possible.  This entailed a continuation of the system that had emerged during the summer.

In July and August three CCSs had been deployed just five miles from the front at a railway siding at Brandhoek, located just off the main Ypres-Poperinghe road, and offering direct rail access for hospital trains to the base hospitals at Boulogne and Calais.

Sister Kate Luard was thrilled with the experiment, writing in her diary that ‘we … shall be near enough to the line to get them from the dressing stations direct, without long journey and waits which is what the C.C.S.’s are out to prevent nowadays.’  She arrived at Brandhoek on 27 July, and while she was delighted at what she found (not least because she would be working at a specialist CCS for the treatment of abdominal wounds) she again emphasised the experimental nature of the location:

The hospital had only been pitched since last Saturday and it was already splendid. This venture so close to the Line is of the nature of an experiment in life-saving, to reduce the mortality rate from abdominal and chest wounds. Their chance of life depends (except where the injuries are such as to be beyond any hope of recovery) mainly on the length of time between the injury and the operation. As modern Field Surgery can now be carried out under conditions of perfect asepsis, the sooner the infection always introduced into every wound with the missile is dealt with, and the internal repairs carried out, the more chance the soldier has of life. Hence this Advanced Abdominal Centre, to which all abdominal and chest wounds are taken from a large attacking area, instead of going on with the rest to the C.C.S.’ s six miles back….

Sir Anthony Bowlby turned up later. ‘How d’you like the site this time? Front pew, what? front row dress-circle.’ It is his pet scheme getting the operations done up here within an hour or two of getting hit, instead of farther back or at the Base. That is why our 30 Medical Officers include the largest collection of F.R.C.S.’ s [Fellows of the Royal College of Surgeons] ever collected at any Hospital in France before, at Base or Front, twelve operating Surgeons with Theatre Teams working on eight tables continuously for the 24 hours, with 16 hours on and 8 off.

The location was ideal for rapid medical treatment; but as was often the case, the railway line also made it an optimal location for artillery batteries and ammunition dumps.  When Harvey Cushing visited Brandhoek two days later he observed that ‘the three CCSs were ‘necessarily alongside both road and railway, for hospitals and ammunition dumps must compete for sites of the same kind – and hence they are likely to be heavily shelled.’  And as Colonel A.G. Butler confirmed in the official history of the Australian Army’s medical services, ‘the site had the grave disadvantage that some British 15-inch guns were near by, and huge supply and ammunition dumps covered the adjoining area’ – all, as he concedes, ‘legitimate and obvious targets for German artillery’ (Australian Army Medical Services, p. 188).

It was quiet when Bowlby and Cushing visited, but the medical staff did not have long to wait before their fears were confirmed.  On 30 July Luard wrote:

‘Soon after 10 o’clock this morning [the Germans] began putting over high explosive. Everyone had to put on tin-hats and carry on. He kept it up all the morning with vicious screams. They burst on two sides of us, not 50 yards away – no direct hits on to us but streams of shrapnel, which were quite hot when you picked them up. No one was hurt, which was lucky, and they came everywhere, even through our Canvas Huts in our quarters. Luckily we were so frantically busy that it was easier to pay less attention to it. The patients who were well enough to realise that they were not still on the field called it ‘a dirty trick.’ 

It is doubtful that the CCSs were the intended target (and they were treating many German prisoners).  Rather, as Sister May Tilton recorded, the area was ‘a huge city of canvas, batteries and ammunition dumps’ – the question of co-location constantly dogged casualty clearing stations and base hospitals alike (see here) – and throughout the next month Brandhoek was subjected to regular shelling and air raids.

On 2 August Luard wrote that ‘it made one realise how far up we are to have streams of shells crossing over our heads’ – from the German lines and from the British batteries around Brandhoek – but the danger was also a more proximate one.  Here she is a few days later:

There is a cheery little Military Decauville Railway for ammunition only, running immediately between our Compound and the main Duck Walk cutting our Hospital in two, and you are always having to wait to cross the rails while a series of baby trains puff through loaded to the teeth with shells, or coming back with empty cases.

The attacks intensified, and on 14 August Tilton wrote that last night

‘No one slept, day or night staff. Our bell tents were dugouts. They had lowered us considerably and sandbagged the outsides so heavily, we felt quite comfortable. It needed a direct hit to get us…’

At 10.30 pm ‘the Gothas [bombers] were over’ and ‘shells were bursting quite close’, but the British batteries responded with alacrity: “Big Bob” [the 15-inch guns] set our tents rocking and vibrating with his fierce and mighty roar.’

On 18 August Luard was outraged at German attacks on hospitals – but she was specifically referring to those in the rear:

He [‘Fritz’] played about all night till daylight. There were several of him. He went to C.C.S.’ s behind us. At one he wounded three Sisters and blew their cook-boy to pieces. The Sisters went to the Base by Ambulance Train this morning. At the other he wounded six Medical Officers among other casualties. A dirty trick, because he has maps and knows which are hospitals back there. Here we are in a continuous line of camps, batteries, dumps, etc., and he may not know.

That last sentence was crucial, but the CCSs at Brandhoek were subjected to sustained shelling throughout the day on 21 August, and two days later Sister Elsie Grant wrote to her sister from Brandhoek with no hesitation in assigning blame:

‘We have been shelled out three times but this last time was too dreadful. Those brutal Germans deliberately shell our hospital with all our poor helpless boys but really God was good to us we had four killed but it was just miraculous that there were not dozens killed. Of course we (the sisters) were put into dugouts as soon as the shelling got bad but I can’t tell you how cruel it was to leave those poor helpless patients. In a few hours the whole hospital was evacuated & one consolation we saw our last patient carried out before we were sent away.’

Two of the CCSs were immediately moved back to ‘Nine Elms‘ (below), five miles behind Poperinghe, while Luard’s remained to provide treatment for walking wounded until it too was evacuated in early September.

Throughout these attacks and dispersals, the CCSs had continued to work at full capacity to deal with the thousands of casualties.  But by September the closest CCSs for the Battle of Menin Road were now all much further back: at Nine Elms, at Remy Siding, and three other groups near Proven known in the British Army’s ironic Flemglish as ‘Mendinghem’, ‘Dozinghem’ and ‘Bandaghem’.  Cushing explained:

The place…  is called “Mendinghem.” This was originally a joke and was to have been “Endinghem”; but this on second thought was changed as being too much even for the Tommy. The army has a professional name maker, I may add. Mendinghem is already on the printed maps and there is in this district a “Bandagehem” and “Dosinghem” which I have not located as yet.

They are all all shown on this map:

These relocations did not end the raids, and the official British medical history by Major-General W.G. Macpherson includes a detailed list of enemy shelling and bombing of CCSs from 3 July to 29 October (pp. 163-4); Mendinghem and Dozinghem were repeatedly attacked. According to Cushing, the staff at Dozinghem were particular upset ‘because General Skinner had ordered an electric Red Cross to be shown at night – a good mark to shoot at’ (A surgeon’s journal, p. 193).  In fact, Macpherson concluded that these attacks

‘were of so exceptional a character as to give rise to the belief that they were deliberate.  The medical units were indicated by the usual red cross signs on roofs of huts, and also on large squares on the ground such as could be seen by aircraft.  The positions of casualty clearing stations had also been notified to the enemy’ (Medical Services, General History, Vol. III, p. 162).

Macpherson, wise after the event, commented that Brandhoek ‘had always been regarded as too far forward’ – he claimed the CCSs were only there at the insistence of the Fifth Army commander and his Director of Medical Services – and concluded that the whole affair showed ‘that a journey of twenty minutes to half-an-hour to a more secure locality farther back is not likely to be so great a risk to the patient as his retention in a more forward position which is in danger of being shelled by the enemy’ (p. 156).

(2)  Direct evacuation  The retreat of the forward CCSs placed a still greater premium on the second imperative, which involved another experiment, a concerted attempt to expedite the movement of the wounded to the rear.  In practice, this resolved into marking and co-ordinating evacuation routes for bearer teams and ambulances, minimising treatment at all intermediate dressing stations (even the administration of anti-tetanus serum had to wait until a casualty arrived at the CCS), and separating casualty streams from the Advanced Dressing Stations (ADS) into the three circuits shown on the diagram below:

I’ve seen many similar maps – the war diaries of Field Ambulances are full of them, either superimposed over or based on trench maps, and Regimental Medical Officers were accustomed to draw up their own annotated sketch maps showing the location of aid posts and the routes to be followed by the regimental stretcher bearers – but this one is unusual because it extends beyond the immediate recovery zone and (following directly from the emphasis on direct evacuation) includes a series of timings from the front line all the way back to the CCSs at Remy Siding.

As the map shows, ‘walking wounded’ made their own way to the collecting point at Hooge on the Menin Road and then (by ambulance or light rail if space were available, otherwise on foot) to the ADS designated for them in Ypres.

The more seriously wounded were brought to the same collecting point by regimental stretcher bearers in a series of relays; this was estimated to take between 10 and 40 minutes during the day and around 60 minutes at night.  The casualties were then transferred by motor ambulance to the ADS for stretcher cases, just across the road from the ADS for walking wounded (below).

The location of the two ADSs made sound logistical sense, but they were uncomfortably close to heavy artillery batteries and naval guns and were repeatedly shelled.  Together the ADSs acted as the hub for what the Medical History calls the ‘elaborately detailed’ system of onward evacuation (Australian Army Medical Services, p. 202):

  • Those who could withstand the journey – a further 80-120 minutes, according to the map – followed Circuit A (‘long distance’) to the CCSs at Remy Siding; 58 per cent of stretcher cases followed this route.
  • Those suffering from shock, gas or haemorrhage followed Circuit B (‘short distance’) to the Main Dressing Station at Dickebusch, a journey of 20-30 minutes; 27 per cent of stretcher cases followed this route.
  • Those who needed immediate surgery were sent direct to Remy on Circuit C  – a journey of 90 minutes – and 15 per cent followed this route.

It’s not clear how these timings were established: they were almost certainly estimates written in to the plan rather than observations after the event.  But there is a clear consensus that, if that were the case, the estimates were realised and according to official historian Charles Bean the first day of the battle itself ‘went almost precisely in accordance with plan’ (AIF in France, p. 761).

The Battle of Menin Road

It started to drizzle during the evening of 19 September, and when it changed into steady rain and the dust turned back into mud there were understandable jitters.  But shortly after midnight the rain eased and Plumer was determined to press on.  Zero hour was 0540 on 20 September, when ‘the whole of the British artillery and machine-guns, breaking in with the suddenness of a great orchestra, gave the signal for the attack to start’ (Bean, AIF, p. 757).  Frank Hurley, the Australian Official Photographer, was there to capture the scene, but his words (Diary, pp. 87-8) are as evocative as his photographs:

We were just walking along the Menin road in the twilight, near Hellfire Corner, when our barrage began. Simultaneously from a thousand guns, & promptly on the tick of five, there belched a blinding sheet of flame: & the roar – Nothing I have heard in this world or can in the next could possibly approach its equal. The firing was so continuous that it resembled the beating of an army of great drums. No sight could be more impressive than walking along this infamous shell swept road, to the chorus of the deep bass booming of the drum fire, & the screaming shriek of thousands of shells. It was great, stupendous & awesome.

The walking wounded were the first to pass through the collecting post, followed by the stretcher cases.

There were delays in moving them down the Menin Road (below; the first photograph is another Hurley), but according to the officer commanding the 3rd Field Ambulance these were ‘due to the amount of traffic – ammunition limbers, lorries, etc. – which held up the ambulance waggons.’  There was ‘practically no delay by enemy shelling on the road, which we all so greatly feared.’  (They were wise to do so; the reprieve was short-lived and  the German batteries soon re-registered on the Road). 

The Red Line was secured at 0611.

By 0700 the first walking wounded started to arrive at their Advanced Dressing Station, followed by the first stretcher cases at 0900 (again, the photographs below are by Hurley):

 The Blue Line was secured at 0815 and the Green Line at 1015.

At first the light railway was used to clear cases from the ADSs to the CCS, but the service was disrupted (in part by enemy shelling and part by a backlog at Remy) and lorries took over until the trains were restored by mid-morning.  In the first 24 hours 2,200 Australian and 1,000 British wounded passed through the twin ADSs; the proportion of walking wounded to stretcher-cases was roughly 3 : 1 (though, as I’ve noted previously, the distinction between the two was by no means hard and fast) (Australian Army Medical Services, pp. 208-9).

Further down the evacuation chain at the CCSs at Remy Siding casualties started to arrive ‘so rapidly as to cause some embarrassment’ but the stations started to take in by turns – a standard practice – and this successfully relieved the congestion: thereafter casualties arrived in a steady stream.    

Meanwhile stretcher bearers were moving up as the line advanced and new relay posts were being established.  From 1800 a light railway ferried the walking wounded directly from Birr Crossroads via the MDS to the CCS.

The official history has nothing but praise for the execution of Plumer’s plan, and Bean attributed the success of the first day to the artillery: ‘The advancing barrage won the ground; the infantry merely occupied it’ ( AIF, p. 761).  It is perfectly true that the German troops fell back under the sustained barrage, and that their counter-attacks were all repulsed, but this one-liner does an extraordinary disservice to the infantry that ploughed forward.

The medical history tells a more cautious story, and Butler emphasised that ‘throughout the day shell-fire was severe in the captured area’ – a situation with awful consequences for the troops and for the regimental stretcher-bearers who came to their aid.

Again Frank Hurley captures the dreadful scene that same day with a visceral immediacy:

I pushed on up the duck board track to Stirling Castle – a mound of powdered brick [below] and from where there is to be had a magnificent panorama of the battlefield. The way was gruesome & awful beyond words. The ground had been recently heavily shelled by the Boche & the dead and wounded lay about everywhere. About here the ground had the appearance of having been ploughed by a great canal excavator, & then reploughed & turned over and over again. Last nights shower too made it a quagmire; & through this the wounded had to drag themselves, & those mortally wounded pass out their young lives.

The shells shrieked in an ecstasy overhead, & the deep boom of artillery sounded like a triumphant drum roll. Those murderous weapons the machine guns maintained their endless clatter, as if a million hands were encoring & applauding the brilliant victory of our countrymen. It was ineffably grand & terrible, & yet one felt subconsciously safe in spite of the shell burst & splinters & the ungodly wanton carnage going on around.

]
I saw a horrible sight take place within about 20 yards of me. Boche prisoners were carrying one of our wounded in to the dressing station, when one of the enemy’s own shells struck the group. All were almost instantly killed, three being blown to atoms. Another shell killed four & I saw them die, frightfully mutilated in the deep slime of a shell crater. How ever anyone escapes being hit by the showers of flying metal is incomprehensible. The battlefield on which we won an advance of 1500 yards, was littered with bits of men, our own & Boche & literally drenched with blood (Diary, pp. 91-3 ).

And this, as Paul Ham reminds us, ‘was a battle that had gone well, in which everything had proceeded according to the plan’ (Passchendaele, p. 305).  The total British and Dominion casualties on that one day were around 21,000, expended in order to advance one and a half miles and to hold an area of 5.5 square miles.

Hurley recognised the extraordinary sacrifices made by those bringing in the wounded (above), and that same evening he wrote of his admiration for ‘the magnificent work of the stretcher bearers who go out in the thick of the strife to succour the wounded.’  Many of them were killed or injured, and by the end of the day one subaltern with the 3rd Field Ambulance reported that he had

ended up with four fit squads, fifteen men wounded, five missing and five worn out. Bearers all thoroughly done up.’

Not surprisingly, it was difficult for the bearers to find (let alone recover) all those who had been wounded.  On 28 September Harvey Cushing was operating on a British soldier at Mendinghem and asked him his division and regiment:

“Oxford Bucks; 20th Division, sir.”

“How can that be, they went over on the 20th, a week ago?”

“I went over with ’em, sir.”

He actually did, and has been lying for a week in a shell hole, until, during the attack of yesterday, someone found him. He said he had eaten nothing, for his bully beef went “agin” him and he wasn’t hungry — indeed thought he had been out of his head for two or three of the days. Then when it got dark he used to holler, but no one came….

He doesn’t seem to think his escapade anything out of the ordinary …  I asked him if he was in the barrage of yesterday morning and whether he knew there was an offensive under way. No, he just heard a terrible rattle and crawled up to the edge of his shell hole and waved his hand: some stretcher-bearers came along and took him away—that’s all he knows (A surgeon’s journal, p. 214).

You might think he was an outlier to all those accounts of rapid evacuation, physically and statistically, but he plainly wasn’t the only one.  And as the phased advance continued, so conditions deteriorated and the dangers increased.

By 4 October the rains returned with a vengeance, and as the battle for Passchendaele ground on and the toll mounted so one nightmare day became indistinguishable from the next.  The carries became longer and longer; bearer parties found it harder and harder to find their way in a landscape (or what Samuel Hynes calls an anti-landscape) devoid of any permanent markers; even those areas stitched together by duckboards became dangerously slippery:

From 8 to 11 October, one medical officer reported,

‘the work was so heavy that for a large part of the time 6 men had to carry one stretcher – 8 and even 12 men were used in parts. Under these conditions the stretcher-bearers rapidly became exhausted, and absolutely so after 24 hours’ work. Usually they were relieved after 24 hours, but owing to the universal shortage some 36 and even 48 hour shifts were done. About 200 bearers (ambulance and infantry) were continually at work’ (Australian Army Medical Services, p. 234).

It’s not my purpose here to chart the unfolding geography of casualty evacuation in any detail – it was modelled on the plan for Menin Road but constantly adapted to the changing circumstances: ‘the medical scheme for each battle was an extension, at most a variant, of that for the preceding one; they were built up, as the line advanced, in the general “arrangements” described’ above: Australian Army Medical Services, p. 212) – but one stretcher-bearer epitomises the wrenching experience as well as anybody.  Frederick Noyes was with the 5th Canadian Field Ambulance, which was posted to Ypres on 1 November:

Who could ever forget those two weeks of the Passchendaele show? Looking back now it all seems like one long, weird, and terrible nightmare of water-filled trenches, zigzagging duck- walks, foul slime-filled shell-holes, half-buried bodies of dead men, horses and mules, cement pillboxes, twisted wire, shrieking shells, flying humming metal, crashing aerial bombs, stinking mud, water-logged and blood-soaked stretchers – a Slough of Despond such as even a Bunyan couldn’t conceive of.

That long, wearisome “carry” from Tynecot to Frost House was like a never-ending Via Dolorosa to all who made the journey. Passchendaele was the Somme multiplied and intensified ten times over. Dark, wet, hopeless days were followed by almost endless, cold, marrow-congealing nights of despair and exhaustion. Every man was soaked through to his skin the whole time we were there, and the added weight of his sodden, muddy uniform and equipment seemed to sink him deeper into the prevailing mire. After the first few hours we moved about like so many dazed automatons, stumbling, staggering, blundering along the heaving duck-walks and erupting roads – almost too stunned to care whether we lived or died and totally indifferent to the volcanoes of smoking shell-craters about us. The hours and days and nights seemed to merge with one another into a cruelly indefinite whole and it is doubtful if any man was afterward able to distinguish one Passchendaele day’s experiences from another (Stretcher bearers at the double! p. 177).

From geometries to geographies

It’s now possible to return the evacuation map and its clockwork timings that set my discussion in motion.  Maps like these display the system of evacuation as a linear geometry – an abstract grid of transmission lines that resemble what Fiona Reid in her Medicine in First World War Europe: Soldiers, Medics, Pacifists calls ‘a modernist dream’ – with no catastrophic breaks or nightmare tangles.  Many official and semi-official accounts endorsed this view of ‘the cogs of the evacuating machine’, beautifully oiled and running smoothly.

But it should now be clear that this is a representation of a space that never existed beyond the paper landscape on which the military offensives were themselves planned (cf. my ‘Gabriel’s Map’, DOWNLOADS tab).  Casualty evacuation was not only a geometry but also a geography; it was confounded by the bio-physical terrain through which the wounded were moved, and threatened by the savage continuity of military violence.  Routes constantly had to be changed, particularly for bearer parties, and aid posts and dressing stations were endlessly re-located as medical officers struggled to adapt to changed circumstances: improvising their own posts, sketching their own maps.  By extension, the analytical mapping of casualty evacuation cannot be limited to a cartography but necessarily extends to a corpography (see also ‘Corpographies’, DOWNLOADS tab) for, as Reid emphasises, the stories the wounded told of their journeys were, like so many of their injuries, ‘complicated and messy’.  There was a vital reciprocity between those journeys and the bodies that made them, and I’ll elaborate on that in later posts about the woundscapes of the Western Front.

Coda

On 22 September Harvey Cushing operated on a British soldier with a serious head injury, who had been wounded the previous day.  He had reached the Field Ambulance at 1230 and was admitted to the CCS at Mendinghem at 0647, whereupon he ‘got lost somehow in the crowded wards’ and was finally lifted on to Cushing’s table that afternoon.  Nothing unusual about any of that, except for Cushing knowing the time when his patient had reached the Field Ambulance.  He observed in passing ‘that they are noting the hour as well as the date since our discussion of last Tuesday’ (A surgeon’s journal, p. 209).  His journal records that meeting, presided over by General Sloggett, but there are no details of the discussion to which Cushing refers.  It’s all the more remarkable given the debate over the politics of speed – and the fact that the medical plan for Menin Road was all about minimising data recording and administration before the casualty was admitted to the CCS.

This leads me to the second Australian Army study I noticed at the start, which was carried out by the 7th Australian Field Ambulance on the Somme in July 1918 [see Appendix 16 of FA War Diary here].  It provides a useful counterpoint to the Battle of Menin Road.  Here too the objective was ‘to get the men as quickly as possible to the CCS’ and this too included minimising the number of dressings and treatments en route.  But where the plan for Menin Road also restricted data recording at the ADS and the MDS for the same reason, except for deaths and cases treated and returned to duty, the 7th FA added a layer by recording the time each casualty arrived at each station on the field medical card pinned to his tunic (below).

The corresponding scheme of evacuation is shown in the following sketch:

750 cases were recorded; 200 of these were retained at one of the intermediate stations (either because they were lightly wounded or because they needed emergency intervention); and of the remainder evacuation times were remarkably constant.  Including treatment and travel, it took casualties 1 hour 45 minutes to be brought from the Advanced Ambulance Post (where motor ambulances collected the casualties from the regimental stretcher bearers) to the Main Dressing Station at Saint Acheul, and a further 2 hours 15 minutes (including treatment at the MDS) before they reached the CCS at Crouy: the total elapsed time of 4 hours to travel those 22 miles was reduced for some ‘special cases’ to around 3 hours.

These travel times were maintained outside any ‘push’ (a major offensive) or a ‘stunt’ (a raid).  The FA provided statistics for two stunts that punctuated the steady process of attrition and these – unlike the schemas I’ve been describing thus far – incorporated the time it took stretcher bearers to retrieve casualties from the field and bring them to an aid post.  The first stunt kicked off at 0310 on 4 July; the time from the Advanced Ambulance Post to the CCS was more or less unchanged (around 3 hours 30 minutes) but factoring in   the time from the field to the Advanced Ambulance Post the first casualties took 5 hours 45 minutes to reach the CCS from the point of injury, and as the troops advanced further forward this increased until it took 9-10 hours for stretcher cases to reach the CCS.  The second stunt started at 2030 on 7 July, and the darkness combined with rain to change the calculus: it now took 4 hours 30 minutes to 5 hours to transfer casualties from the Advanced Ambulance Post, and the first casualties took around 7 hours to reach the CCS from the point of injury; others must have taken much longer though no details were given.

‘Is this thy body’s end?’

There are all sorts of ways in which the war on Syria has been a throwback to the First World War – and all sorts of differences too – but today brought news of yet another (and, unusually, a welcome one).  Peter Walker reports for the Guardian:

The UK government is taking part in a pioneering international aid project which could see consignments of maggots sent to crisis zones such as Syria as a simple and effective way to clean wounds, it has been announced.

So-called maggot therapy has been used since the first world war, when their efficacy in helping wounds heal was discovered by accident, and it is sometimes used in the NHS, for example to clean ulcers.

The initiative, co-sponsored by the Department for International Development (DfID), will develop techniques to help people in conflict zones or areas affected by humanitarian crises to use maggots where other medical facilities might not be available, such as Syria and South Sudan.

Over at the Telegraph Sarah Newey adds:

Modern larvae treatment was developed following WWI after an American scientist, William Baer, noticed the benefits of maggots on soldiers wounds. Today the therapy is used in hospitals in developed countries, including the NHS, but they are yet to be used in war zones.

While photos of the maggots at work are unsavory, the treatment is highly effective.

Flies are reared in a lab, where their eggs are sterilised. The hatched maggots are then grown for a day or two, before they are applied to skin and soft tissue wounds either directly or in a biobag, which is wrapped around the injury.

Not only do the maggots remove dead tissue and flesh, but they control infection as their spit and saliva act as a natural disinfectant and promote healing. The maggots can be used to treat anything from burns to bedsores to gunshot wounds, and are left on an injury for two to four days.

The martial history of maggots is an interesting one.

In ‘Trauma Geographies‘ I described the experience of one young soldier, John Stafford, who was wounded on the Somme in the early hours of 8 August 1916, and I’ll draw on that account here.  He managed to crawl (and fall) into a shell-hole, where he examined his wound:

‘A bullet had passed through the flesh of the upper left thigh and entered the extreme inner high point of the right leg.  The thigh bone was considerably shattered, the bullet having travelled downwards towards the knee.  My field dressing was used and I lay flat again…’

There was no sign of rescue.  His thirst increased as the sun climbed higher, but he knew nobody would venture out to rescue him until it was dark.

When night fell his hopes rose, though he was weak from loss of blood, but still nobody came.  The next day the bleeding had stopped so Stafford removed the field dressing and to his horror ‘discovered that it was one mass of white grubs … I saw that my wounds were infested with maggots.’ Sickened, he hurled the heavy dressing away, but worse was to come:

‘Eventually the maggots spread over my leg from hip to knee and then settled on the other leg which was not so badly wounded.  Occasionally I looked at their swelling rhythm, then finally turned away in disgust.’

He was eventually – and accidentally – rescued, but the maggots had probably already saved his life.  In eating the damaged flesh they had performed a ‘natural’ debridement of the wound,

Stafford’s experience was by no means unique.  It was not uncommon for wounded men to lie out in the open for days before they were recovered by stretcher-bearers, and often their wounds became infected – but the problem was bacterial infection not maggot infestation.

That same month (and in more or less the same place) Captain Lawrence Gameson was stationed with the RAMC’s 45th Field Ambulance in a shattered cellar at Contalmaison (above).  It was a bruising experience;, and he said there ‘was hardly a part of the body I did not see cut or exposed’:

Maggot invasion was common. I can recall an unconscious man who arrived with part of a frontal lobe protruding through a hole in his skull. The protruding portion of brain was moving with maggots. When men had had to be left out wounded for some time, often their shoulders, buttocks or whole back were invaded by the creatures in the areas of skin compressed by the weight of their immobilised bodies. One man I saw had been lying out because both his legs were wounded. Prolonged pressure had caused necrosis of the skin over his buttocks and of the superficial portions of muscle beneath it. Maggots had invaded the deeper tissues. I had to pick them out with long forceps. The man was unaware of his condition. Maggot invasion was always accompanied by a foul smell, since it flourished only in tissues undergoing some degree of decomposition. As a rule, the victim did not notice the stink, or did not know that it came from his own body if sensitive enough to notice it.

The association of maggots with death, decay and decomposition was pervasive.  Gameson described how he was called to extricate the body of a dead German soldier from a captured dugout:

He had fallen head foremost and was stuck there. On my preliminary examination in the dim light I could see only his field boots. I had come without my torch. Subsequently, on looking closer, I found that his flesh was moving with maggots. More precisely, I noticed that portions of his uniform were heaving up and down at points where they touched the seething mass below.

The smell was pretty awful. None of the men would touch him, although troops as a rule are not noticeably fastidious. The job was unanimously voted to me, because it’s supposed, quite wrongly, that doctors don’t mind. I went down the stairway with a length of telephone wire and lashed it round the poor chap’s feet. We hauled him up and dragged him away for some distance. The corpse left behind it a trail of wriggling, sightless maggots…

And yet, writing in the British Medical Journal on 3 March 1917 about the treatment of compound fractures, Captain Basil Hughes observed that ‘the presence of maggots in … wounds seems to exert an inhibitory action on the growth of the most virulent bacteria, and so acts beneficially.  Maggots only thrive in dead tissue and seem to hasten its removal.’

This should have been – could have been – a crucial finding, for Hughes also emphasised that ‘all shell wounds are bound to become infected, whatever care be taken’, and listed ‘the bacteria most to be feared’.  But it was those other associations – the smell of decay and the seething sight of the maggot-riddled bodies – that inhibited an appreciation of the therapeutic agency of maggots.

As Sarah notes, William Baer (left) had made a similar observation while treating two soldiers also with compound fractures of the femur.  These were among the most serious wounds of the war because the penetration of the skin by the bone made them peculiarly vulnerable to sepsis.  In 1917, he wrote,

‘two soldiers with compound fractures of the femur and large flesh wounds of the abdomen and scrotum [shades of Trey Parker] were brought into the hospital. These men had been wounded during an engagement and in such a part of the country, hidden by brush, that when the wounded of that battle were picked up they were overlooked. For seven days they lay on the battlefield without water, without food, and exposed to the weather and all the insects which were about that region. On their arrival at the hospital I found that they had no fever and that there was no evidence of septicaemia or blood poisoning. Indeed, their condition was remarkably good, and if it had not been for their starvation and thirst, we would have said they were in excellent condition. When I noticed the extent of the wounds, of the thigh particularly, I could not but marvel at the good constitutional condition of the patients. At that time the mortality of compound fractures of the femur was about seventy-five to eighty per cent…’

He continued:

‘I could not understand how a man who had lain on the ground for seven days with a compound fracture of the femur, without food and water, should be free of fever and of evidences of sepsis. On removing the clothing from the wounded part, much was my surprise to see the wound filled with thousands and thousands of maggots, apparently those of the blow fly. These maggots simply swarmed and filled the entire wounded area. The sight was very disgusting and measures were taken hurriedly to wash out these abominable looking creatures. Then the wounds were irrigated with normal salt Solution and the most remarkable picture was presented in the character of the wound which was exposed. Instead of having a wound filled with pus, as one would have expected, due to the degeneration of devitalized tissue and to the presence of the numerous types of bacteria, these wounds were filled with the most beautiful pink granulation tissue that one could imagine. There was practically no bare bone to be seen and the internal structure of the wounded bone, as well as the surrounding parts, was entirely covered with the pink, rosy granulation tissue which filled the wound. Bacterial cultures were made and, while one found a few Staphylococci and Streptococci still remaining, they were very few in number and not sufficient at that time to cause a pus formation. These patients went on to healing, notwithstanding the fact that we removed their friends which had been doing such noble work.’

Bauer drew on these findings to pioneer the use of ‘maggot therapy’ (myiasis) –  but he did so at the Children’s Hospital in Baltimore ten years after the war ended.  His first step was to grow maggots on raw meat ‘so he could observe their effect on destroying tissues,’ a colleague recalled, setting up the experiment in the hospital’s dining hall—’an unfortunate location for unwitting visitors’.

In fact, the use of maggot to treat wounds has an even longer history.  They have been a common resource in many forms of indigenous medicine for thousands of years, and within a recognisably Western tradition Baron Dominique Larrey, Napoleon’s field surgeon (above), had observed their beneficial effects a hundred years before Bauer:

‘While the process of the suppuration of their wounds was going on, the wounded were much annoyed by the worms or larvae of the blue fly… These larvae are indeed greed only after putrefying substances, and never touch the parts which are endowed with life.’

Ironically, this was during the Syrian campaign (1798-1801).

(If you want more after all that, try here and here).

The Longest Journey

The Field Ambulances from the Royal Army Medical Corps were put to work in the war-ravaged landscapes of the Aisne, the Somme, Arras and Ypres; the broken bodies in their charge (above) were transferred to Saint-Pol-sur-Ternoise in northern France, and at noon the next day a battered military ambulance rattled its noisy way to the Quai Gambetta at Boulogne where HMS Verdun was waiting.

The ship slipped anchor shortly before noon and ploughed through the mist across the Channel to Dover, where it rode outside the Western entrance before steaming along the southern breakwater to the Eastern entrance, like countless hospital ships before it, and finally made fast at Admiralty Pier.

At ten to six that same evening a special train steamed out of Dover Marine Station into a cold, wet and moonless night.  No local people had been allowed on to the pier at Dover, but it was a different story all along the route to London:

‘At the platforms by which they rushed could be seen groups of women waiting and silent…  Many an upper window was open, and against the golden square of light was silhouetted, clear-cut and black, the head and shoulders of some faithful watcher.  In the London suburbs there were lines of houses with back doors flung open wide, and framed in the lampshine flooding out into the gloom two or three figures of men and women and children gazing out at the great lighted train whirling by…’

The train arrived at Victoria shortly after 8.30 p.m., where crowds had been waiting patiently for hours.

In many ways it was a journey like all the others.  Between September 1914 and November 1918 hundreds of thousands of wounded soldiers from Britain and across its Empire had been rescued from the battlefields in Belgium and France, and many of the most seriously wounded had made the precarious crossing from Boulogne (below) and other ports to ‘Blighty’.  

(c) IWM (Imperial War Museums); Supplied by The Public Catalogue Foundation

At Dover (below) or Southampton they were loaded on to special hospital trains:

Along the permanent way, ‘all the women and children by the side of the railway were at their windows or in their gardens, waving their hands’ as the hospital trains thundered by.

When they reached London they were greeted by large crowds, policemen snapping to attention and saluting as they stopped the traffic to allow the stream of ambulances to pass slowly through the streets: 

Imperial War Museum, London; (c) IWM (Imperial War Museums); Supplied by The Public Catalogue Foundation

Yet this particular journey was no was no ordinary one, for those bearer parties had been deployed on 7 November 1920 and the special train arrived in London three days later. 

The body was that of the ‘Unknown Warrior’, selected from one of four that had been transported to the chapel at Saint-Pol – the other three, according to some accounts, were unceremoniously ‘tipped into a shell hole beside the road near Albert’ –  and its journey ended with a solemn procession past Edwin Landseer Lutyens‘ newly inaugurated Cenotaph (which, true to its name, remained empty) and burial in Westminster Abbey on 11 November 1920.

It was also, in its way, the long journey of all.  Not many of those who were wounded made it back to Britain in four days, as I will show in a later post, but the chronology of the Unknown Warrior’s passage was deceptively protracted (and I use that adverb advisedly).  The intention was to allow grieving families and friends to believe that the Unknown Warrior could be their husband, lover, brother, or son, killed in any year of the war and drawn ‘from any of the three services, Army, Navy or Air Force, and from any part of the British Isles, Dominions or Colonies.’  Yet the Field Ambulances received secret instructions stipulating that the remains they recovered had to be of soldiers mortally wounded in 1914.

The reason, according to Neil Hanson in The Unknown Soldier, was to ensure that ‘decomposition was sufficiently far advanced to obviate the need for cremation’ and, presumably, to minimise the possibility of identification.  Then he adds:

‘For military traditionalists this also had the side-benefit of ensuring that the Unknown Warrior would be an Anglo-Saxon member of the British Expeditionary Force – a regular soldier – rather than one of Kitchener’s New Army of civilian volunteers or one of the hundreds of thousands of soldiers drawn from the far-flung reaches of the Empire’ (p. 432).

But this is misleading: even in 1914 it was not ‘all white on the Western Front’; troops from the Indian Army arrived at Marseilles at the end of September, and the Lahore Division played a vital part in resisting the German advance in October and November around La Bassée and Neuve Chapelle.

The passage of the Unknown Warrior was distinguished not only by its ceremony but also by its rarity.  In the first months of the war the bodies of some servicemen who had been killed were returned to Britain, but these were private arrangements that were abruptly terminated by an official order in April 1915 forbidding exhumation or repatriation (reaffirmed by Haig in a General Routine Order in December 1917). As a result precious few of Britain’s war dead made that final journey home: most were buried close to where they died, and their bodies were eventually gathered into military cemeteries across Flanders and northern France, at first by the British Red Cross Society’s Mobile Unit and then by the units of the Graves Registration Commission attached to the Army Service Corps (later the Imperial War Graves Commission).  

Here is one officer, Rowland Feilding, describing the aftermath of the Somme in a letter to his wife in 1917:

‘A land whose loneliness is so great that it is almost frightening. A land of wooden crosses, of which, wherever you may stand, you can count numbers dotted about, each indicating a soldier’s grave, and the spot where he fell.

After several miles of this I came upon the first living human beings —parties of the Salvage Corps, working forwards from the old battle line, gathering up all that is worth saving of the relics…

Further back, I came upon the work of the Graves Registration Unit, which, behind the Salvage men, follows the Army forward. Its job is to “prospect” for the dead, and, so skilful have its members become at detecting the position of a buried soldier, that their “cuttings” seldom draw blank. Indeed, this is not surprising, for, no matter where they look, they are almost certain to find what they are searching for. Then they dig up the decomposed fragments, to see if they can identify them, which they seldom do; —after which they re-bury them, marking the spot with the universal wooden cross.’

‘The names of the dead,’ Feilding continued, ‘are generally undiscoverable’ – and it was this sober realisation, and the sight of a grave outside Armentières in 1916 marked ‘An Unknown British Soldier’, that gave an army chaplain, the Reverend David Railton MC, the idea of a collective memorial in London.

As Feilding’s letter makes plain, the scale of the slaughter would have made identification and repatriation immensely difficult, but the decision was plainly prompted by more than practicality (though the task of keeping track of the dead was formidable in itself: the image below is an extract from a ‘body density map‘ produced by the Directorate of Graves Registration and Enquiries after the war; it records, grid square by grid square, the number of bodies recovered from just a fragment of the Somme battlefield before their reinterment in military cemeteries).

But the decision to forbid repatriation was more than a matter of logistics or even cost.  Reading lists of officer casualties in the Times was sober enough – and only officers’ families received the dread telegram; the families of other ranks had to wait for a form letter – but it would have been a far cry from the effect of seeing the physical return of so many dead.  The debate was not settled by the end of hostilities, and a politics of repatriation continued to swirl around the landscape of memorialisation.

(You can find much more in David Crane, Empires of the Dead: how one man’s vision led to the creation of WWI’s war graves (London: Collins, 2013) and the brilliant Richard van Emden, The Quick and the Dead: fallen soldiers and their families in the Great War (London: Bloomsbury, 2011).

It is those numberless dead who haunt the collective memory of the First World War: the white crosses in military cemeteries, the black names on war memorials, and all those nameless, placeless bodies represented by the Unknown Warrior.

That is understandable; but behind the remembering is a forgetting. John McCrae’s elegiac poem ‘In Flanders Fields’ is recited on Remembrance Day every year – ‘In Flanders fields the poppies grow, between the crosses, row on row’ – but he wrote those lines on 3 May 1915 to commemorate the death of a close friend who had been buried the night before, and he did so sitting on the tailboard of an ambulance at Essex Farm Advanced Dressing Station near Ypres. How many remember that McCrae was a Medical Officer with the Canadian Field Artillery, who knew better than most that what lay behind his haunting lament – and beyond his medical post dug in to the side of the Yser canal – was a vast field of wounded men?

And when the two minute silence (introduced in Cape Town in 1918 and first observed in London in 1919) descends at 11 a.m. on 11 November every year how many of those who mark it know that the original purpose was not only to remember and reflect on those who gave their lives but also, in the first minute, to honour those who returned from the fight? Many of them had been wounded (often more than once) and they had made their own precarious journeys back from the battlefields.  It was a shockingly common experience: Emily Mayhew reminds us that on the Western Front ‘almost every other British soldier could expect to become a casualty, with physical injuries ranging in severity from light wounds to permanent, life-changing disabilities.’   And yet, she continues, ‘in the historical record of the First World War, the wounded and the men and women who cared for them are an undiscovered, somehow silenced group.’

It is those other journeys – of the wounded bodies and the woundscapes through which they moved – that are the central focus of my research on the First World War.  And, as regular readers will know, I extend that analysis to the deserts of North Africa in the Second World War, to Vietnam, and to Afghanistan, Gaza and Syria in our own troubled present.  Later modern war is far from disembodied.