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.

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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]

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.

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.

A heavy reckoning

Emily Mayhew‘s Wounded was one of the catalysts for my present research project on medical care and casualty evacuation in war zones.  The original idea was to complete four case studies – the Western Front in the First World War, the deserts of North Africa in the Second, Vietnam and Afghanistan – but since then it has expanded to include a detailed analysis of attacks on hospitals and healthcare in Syria and elsewhere.  But running throughout these investigations is an interest in what Emily called ‘precarious journeys‘ – and a determination to break away from the usual academic voice (see here) –  so an announcement of her new book is extremely welcome.

It’s due from Profile in May:

What happens when you reach the threshold of life and death – and come back? As long as humans have lived together on the planet, there have been wars, and injured soldiers and civilians. But today, as we engage in wars across the globe with increasingly sophisticated technology, we are able to bring people back from ever closer encounters with death. But how do we do it, and what happens next? Here, historian Emily Mayhew explores the modern reality of medicine and injury in wartime, from the trenches of World War One to the dusty plains of Afghanistan and the rehabilitation wards of Headley Court in Surrey. Mixing vivid and compelling stories of unexpected survival and giving astonishing insights into the frontline of medicine, A Heavy Reckoning is a book about how far we have come in saving, healing and restoring the human body. But what are the costs involved in this hardest of journeys back from the brink? From the plastic surgeon battling to restore function to a blasted hand to the double amputee learning to walk again on prosthetic legs, Mayhew gives us a new understanding of the limits of human life and the extraordinary costs paid both physically and mentally by casualties all over the world in the twenty-first century.

The book is published in conjunction with the Wellcome Collection, and I should note that Emily has also co-curated the current exhibition Wounded: Conflict, Casualties and Care at London’s Science Museum (more information here and here).  I spent a fascinated couple of hours there when I was in London last month – it is well worth a visit, though the parallels it draws between the Western Front and Afghanistan were too abbreviated for me.

‘Dearer to the Vultures’

Over at the Paris Review Scott Beauchamp has a beautiful short essay that complements my own reading of Harry Parker‘s Anatomy of a Soldier: ‘Dearer to the Vultures‘.

Here’s how it begins:

My memories of war are fractured: faces disappear like smoke while literal plumes of smoke, their specific shapes and forms, linger on vividly for years. I remember the mesh netting, concrete, and dust smell of tower guard, but the events of entire months are completely gone. I remember the sound of a kid’s voice, but not anything he actually said. I guess that’s what Tim O’Brien meant when he wrote about Vietnam, “What sticks to memory, often, are those odd little fragments that have no beginning or end.”

Parker Anatomy of a soldierMemories of people, too complex to carry through the years, fall apart. It’s easier to find purchase on memories of objects. The weapon I was assigned on my first deployment to Iraq was an M249 SAW, or what we would colloquially and inaccurately refer to as the “Squad Assault Weapon.” I remember the way it felt to disassemble—the slight give of the heat-shield assembly, its tiny metal pincers clinging to the barrel. I remember the sound of the feed tray snapping shut on a belt of ammunition. And I remember the tiny rust deposits on the legs of my weapon’s bipod, which would never go away, no matter how hard I scrubbed with CLP (Cleaner, Lubricant, and Protectant oil). I remember my SAW’s voice and the things it said.

During my second deployment, I served as the gunner in a Bradley Fighting Vehicle. We ran over two Soviet-era landmines that had been stacked on top of each other. Besides a few bruises and perforated eardrums, everyone in the crew was fine. When I would try to tell people the story back home, civilians would get caught up on the descriptions of objects they had never heard of, objects that were integral to understanding my experience of the event. “Were you hurt?” Not really, I’d say, but my head slammed against the ISU, and since we had the BFT mounted in a weird place, that sort of got in the way. “What’s an ISU and a BFT?”

I came to realize that the barrier in explaining my injuries to civilians wasn’t quite phenomenological so much as it was ontological. Everyone has experienced pain, fear, and frustration, but not everyone knows what an Integrated Sight Unit is or has had their face slammed into one. Even in just trying to narrate the events to family members, it seemed like any understanding of my trauma would have to come through a knowledge of the materials around me that made the trauma possible: the ISU, the Bradley Fighting Vehicle, the way the tracks moved, the type of soil underneath the tracks, how the mine mechanism worked, the radios we used to call in the explosion to base.

Harry Parker, a former British Army Captain, recently published Anatomy of a Soldier, a novel that puts forward an object-oriented ontology of war: an assertion that the material objects sharing the battleground with humans play an equal role in the composition of reality itself.

And the rest is equally worth reading, including some interesting reflections on ‘the rush from the intimate to the inanimate’ –and its limitations.

I first wrote about Anatomy of a Soldier here, followed it up with a notice of an interview with Harry Parker at the Imperial War Museum here (where I’m currently working, deep in the Research Room), and finally summarised my conference presentation on the book and its implications in San Francisco here (‘Object Lessons’: the presentation slides are available under the DOWNLOADS tab).

Wounded

Somme medical dispositions.001

This summer London’s Science Museum is staging an exhibition that is of direct relevance to my current research on casualty evacuation from war zones over the last hundred years:  Wounded: Conflict, Casualties and Care.  It opens on 29 June and is designed to commemorate the centenary of the Battle of the Somme:

57,000 casualties were sustained by British Forces on 1 July 1916, the first day of the Battle of the Somme, creating huge and unprecedented medical challenges. Wounded: Conflict, Casualties and Care, a new exhibition opening at the Science Museum on 29 June, will commemorate the 100th anniversary of this battle and the remarkable innovations in medical practices and technologies that developed as a result of this new kind of industrialised warfare.

During the First World War ten million combatants were killed, but double that number were wounded and millions were left disabled, disfigured or traumatised by their experiences. The challenges were immense. For medical personnel near the front line treating blood loss and infection was the immediate priority in order to save lives. However medics also encountered new forms of physical and mental wounding on a scale that had never been seen before, creating huge numbers of veterans returning home with serious long term care needs.

At the centre of the exhibition will be a remarkable collection of historic objects from the Science Museum’s First World War medical collections, illustrating the stories of the wounded and those who cared for them. From stretchers adapted for use in narrow trenches to made-to-measure artificial arms fitted back in British hospitals, medical technologies, techniques and strategies were pioneered or adapted throughout the war to help the wounded along each stage of rescue and treatment. Visitors will also see unique lucky charms and improvised personal protective items carried by soldiers on the frontline alongside examples of official frontline medical equipment.

I’m looking forward to seeing this over the summer.  The organisers note that:

 Warfare has changed dramatically over the last one hundred years, but similarities remain with the military medical challenges faced today, both through the experiences of the wounded and in their treatment and care. The Wounded exhibition team has worked closely with two UK charities that were formed during the First World War, Combat Stress and Blind Veterans UK, to draw out these parallels and share the personal experiences of soldiers wounded in more recent conflicts.

You can find some of my preliminary thoughts on casualty evacuation from the Western Front here and here, and on twenty-first century casualty evacuation in Afghanistan here and here.  Some of the differences between the two systems are summarised in this slide from a presentation on the project I gave in 2014.

WOUNDS OF WAR Vancouver Jan 2014.001

Much  more to come!

Divisions of Life

Journeys from No Man's Land.001

My main presentation at the AAG in Chicago was part of a session organised by Noam Leshem and Alasdair Pinkerton on Remnants of No Man’s Land: history, theory and excess (more on their larger project here).  Here is an extended summary of what I had to say, together with some of my slides, but bear in mind that this all had to be done in 20 minutes so there wasn’t much room for nuance.  Neither was there time to discuss civilian entanglements, both volunteers and victims, nor the sick: the presentation focuses on the wounded, even though the problems of trench foot, ‘trench flu’, and a host of other diseases were also extremely important.  They do all receive attention in the larger project from which this is extracted.  One last, geographical qualification: my discussion is limited to the evacuation of British and imperial troops from the Western Front.

My starting-point was the strange disappearance of the wounded from the field of battle.  As John Keegan wrote in The Face of Battle, in most histories the ‘wounded apparently dematerialize as soon as they are struck down’; he was writing specifically about General Sir William Napier’s account of the battle of Albuera in 1811, but the point is a sharp one that can be enlisted as part of a more general critique of military history.

In the case of the First World War, the emphasis on those who lost their lives – on the dead not the wounded – derives not only from the sheer scale of the slaughter but also from the enduring landscape of memorialisation and commemoration.  When John McCrae‘s elegaic poem ‘In Flanders Fields’ is recited every Remembrance Day – ‘In Flanders fields the poppies grow, between the crosses, row on row’ – it is all too easy to forget that he wrote those lines not only to commemorate the death of a close friend but that he did so at Essex Farm Advanced Dressing Station:

Journeys from No Man's Land.003

Journeys from No Man's Land.004

What lies behind those haunting lines – and that medical outpost – is a vast canvas of wounded men, which Christopher Nevinson captured as ‘The Harvest of Battle’ (below).  The dead occupy the foreground, but behind them is the endless, moving panorama of the wounded whose precarious journeys took most of them far beyond ‘No Man’s Land’.

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

In fact, as Emily Mayhew reminds us, ‘being wounded was one of the most common experiences of the Great War’: on the Western Front, she writes, ‘almost every other British soldier could expect to become a casualty’.

But, perhaps not surprisingly, for the first six months of the war the British Expeditionary Force was unprepared for the scale of casualties, and even with the help of civilian volunteers and aid societies – Nevinson briefly served as a medical orderly with the Friends Ambulance Unit, for example – the remarkably long time it took to evacuate the wounded combined with the perilous nature of their improvised journeys to increase the mortality rate.

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And so what Mark Harrison called the military-medical machine had to be speeded up – and moved closer to the field of battle.

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Before every major offensive elaborate plans for medical support were prepared: casualties were ‘cleared’ down the line as far and as fast as possible to make room for the newly injured, casualty clearing hospitals moved closer to the line, ambulances and stretcher-bearers made ready, and ‘down’ trenches designated for the efficient removal of the wounded (below).

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Soldiers wounded in ‘No Man’s Land’ – a term never recognised by the British General Staff, who insisted that they controlled the field of battle right up to the enemy front lines – were often immobilised and disoriented; some crawled into shell holes, seeking refuge below the field of fire, but it could take hours, even days before they were discovered and rescued (I’ll devote a later post to a detailed discussion of some of those cases).

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Sometimes their mates came to their rescue, sometimes the regimental stretcher bearers.  But they too had to find their way through a dangerous and devastated terrain, often with no landmarks to guide them and on occasion made virtually impassable by the thick, cloying mud that was always –  disconcertingly – much more than mud.

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By now, they were in the care of the Royal Army Medical Corps’s Field Ambulance, and their first objective was an Advanced Dressing Station.  

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Treatment at ADS 1917

Those that needed anything beyond simple treatment or emergency surgery were sent on by horse or motor ambulance to a Casualty Clearing Station (a field hospital).

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It was usually here that their first surgeries took place.  The journalist Philip Gibb was shown around a CCS at Corbie and the experience haunted him for years:

After a visit there I had to wipe cold sweat from my forehead, and found myself trembling in a queer way. It was the medical officer—a colonel—who called it that name. “This is our Butcher’s Shop,” he said, cheerily. “Come and have a look at my cases. They’re the worst possible; stomach wounds, compound fractures, and all that. We lop off limbs here all day long, and all night. You’ve no idea!”

CCS Corbie

I had no idea, but I did not wish to see its reality. The M.O. could not understand my reluctance to see his show. He put it down to my desire to save his time—and explained that he was going the rounds and would take it as a favor if I would walk with him. I yielded weakly, and cursed myself for not taking to flight. Yet, I argued, what men are brave enough to suffer I ought to have the courage to see… I saw and sickened. These were the victims of “Victory” and the red fruit of war’s harvest-fields. A new batch of “cases” had just arrived. More were being brought in on stretchers. They were laid down in rows on the floor-boards. The colonel bent down to some of them and drew their blankets back, and now and then felt a man’s pulse. Most of them were unconscious, breathing with the hard snuffle of dying men. Their skin was already darkening to the death-tint, which is not white. They were all plastered with a gray clay and this mud on their faces was, in some cases, mixed with thick clots of blood, making a hard incrustation from scalp to chin. “That fellow won’t last long,” said the M. O., rising from a stretcher. “Hardly a heart-beat left in him. Sure to die on the operating-table if he gets as far as that… Step back against the wall a minute, will you?” We flattened ourselves against the passage wall while ambulance-men brought in a line of stretchers. No sound came from most of those bundles under the blankets, but from one came a long, agonizing wail, the cry of an animal in torture. “Come through the wards,” said the colonel. “They’re pretty bright, though we could do with more space and light.” In one long, narrow room there were about thirty beds, and in each bed lay a young British soldier, or part of a young British soldier. There was not much left of one of them. Both his legs had been amputated to the thigh, and both his arms to the shoulder-blades. “Remarkable man, that,” said the colonel. “Simply refuses to die. His vitality is so tremendous that it is putting up a terrific fight against mortality… There’s another case of the same kind; one leg gone and the other going, and one arm. Deliberate refusal to give in. ‘You’re not going to kill me, doctor,’ he said. ‘I’m going to stick it through.’ What spirit, eh?”…

“Bound to come off,” said the doctor as we passed to another bed. “Gas gangrene. That’s the thing that does us down.” In bed after bed I saw men of ours, very young men, who had been lopped of limbs a few hours ago or a few minutes, some of them unconscious, some of them strangely and terribly conscious, with a look in their eyes as though staring at the death which sat near to them, and edged nearer. “Yes,” said the M. O., “they look bad, some of ’em, but youth is on their side. I dare say seventy-five per cent. will get through. If it wasn’t for gas gangrene—“

He jerked his head to a boy sitting up in bed, smiling at the nurse who felt his pulse. “Looks fairly fit after the knife, doesn’t he? But we shall have to cut higher up. The gas again. I’m afraid he’ll be dead before to-morrow. Come into the operating-theater. It’s very well equipped.”

By now the bureaucratic machine had been activated: labels had been attached to the wounded and field medical cards (‘tickets’) completed; telegrams had been sent to advise families, and nurses had often written letters home on their patients’ behalf.

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The next stage for the most seriously wounded was evacuation by ambulance train to  a base hospital on the French coast.  There was a considerable bureaucracy involved in planning these movements, but for all the neatness and symmetry of the organisational diagrams – part of Clausewitz‘s ‘paper war’ – there were all sorts of delays.

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Priority was given to trains rushing reinforcements, supplies and ammunition to the front, and ambulance trains were frequently marooned in sidings waiting for them to pass so that journeys that might have taken hours could take days.  It was not uncommon for an ambulance train to arrive at a base hospital to find that there was little or no room for new patients and all but the most grievous cases had to travel on to the next.

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Many patients were treated at the base hospitals, but those with more serious wounds were evacuated by hospital ship to Britain.  This stage of the journey was no less dangerous than the previous one: as the war continued, there was an increasing danger of mines and submarines in the Channel.

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A distinctive  geography of the wounded emerged.  If they arrived at Southampton, the most critical cases were taken by train straight to the Royal Victoria Military Hospital at Netley, which treated as many as 50,000 patients during the war.  According to Lyn McDonald,

 ‘Those who could not be accommodated, and those who were seriously wounded but likely to survive a longer journey, were sent on by train to Birmingham, Bristol, Exeter, Leicester, Norwich and Plymouth.  But seven out of every ten hospital trains were directed to London, and during the first days of the Somme they rolled in almost every hour to Charing Cross and Paddington stations.’

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This is, of course, a highly abbreviated account of the casualty evacuation chain, and in the larger project from which this is derived I provide many more details.  But I think I’ve said enough to show that the chain was, in effect, a production line with an elaborate division of labour (again, in the larger study I show how class – or more accurately, rank – gender and race segmented the chain in various ways).  Indeed, in The Politics of Wounds Ana Carden-Coyne argues that what she calls ‘the Taylorist approach in modern war’ – and remember that this was industrial war on the grand (guignol) scale – ‘was particularly evident in the assembly-line style of evacuation and triage.’

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This prompts two concluding observations.

First, what was the instrumental logic that animated the evacuation chain?  After all, it was an expensive undertaking, as Arthur Empey (himself wounded on the Western Front) realised in this re-calculation of the chain:

It may sound heartless and inhuman, but it is a fact, nevertheless, that from a military stand-point it is better for a man to be killed than wounded.

EmpeyIf a man is killed he is buried, and the responsibility of the government ceases, excepting for the fact that his people receive a pension. But if a man is wounded it takes three men from the firing line, the wounded man and two men to carry him to the rear to the advanced first-aid post. Here he is attended by a doctor, perhaps assisted by two R.A.M.C. men. Then he is put into a motor ambulance, manned by a crew of two or three. At the field hospital, where he generally goes under an anaesthetic, either to have his wounds cleaned or to be operated on, he requires the services of about three to five persons. From this point another ambulance ride impresses more men in his service, and then at the ambulance train, another corps of doctors, R.A.M.C. men, Red Cross nurses, and the train’s crew. From the train he enters the base hospital or Casualty Clearing Station, where a good-sized corps of doctors, nurses, etc., are kept busy. Another ambulance journey is next in order — this time to the hospital ship. He crosses the Channel, arrives in Blighty — more ambulances and perhaps a ride for five hours on an English Red Cross train with its crew of Red Cross workers, and at last he reaches the hospital. Generally he stays from two to six months, or longer, in this hospital. From here he is sent to a convalescent home for six weeks.

If by wounds he is unfitted for further service, he is discharged, given a pension, or committed to a Soldiers’ Home for the rest of his life, — and still the expense piles up. When you realize that all the ambulances, trains, and ships, not to mention the man-power, used in transporting a wounded man, could be used for supplies, ammunition, and reinforcements for the troops at the front, it will not appear strange that from a strictly military standpoint, a dead man is sometimes better than a live one (if wounded).

Hence, for example, the orders recorded by A.M. Burrage:

The instructions given to stretcher-bearers are rather harsh. “ If you find two men wounded, and can take only one away, take away the one more likely to make a fit soldier again.” Therefore the one more urgently in need of attention must be left to die, because he would walk with a limp and would never again be able to carry a pack. Sound business, of course, but just a little hard.

Kate Luard captured another dimension of this when she wrote in January 1915:

‘The ambulance trains do so much bringing the British Army from the field that I hope some other  trains are busy bringing the British Army to the field, or there can’t be many left in the field…’

And Emily Mayhew provides this bleak vignette from a medical orderly that captures the seemingly insatiable drive of industrial war:

An ordinary train, similar to the one that had brought him to the front, was at one end unloading reinforcements, while at the other end it was filling up with wounded men.

The logic, then, was one of ‘salvage’; four out of every five men wounded on the Western Front were returned to the fighting, which was the over-riding objective of the military-medical machine.

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Second, the division of labour was also a division of life: the dead from the wounded, the dying from the ‘salvageable’, and the wounded from the unwounded or yet-to-be-wounded.  The last was not the least.  For breaching that separation could have the most unsettling consequences of all:

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 ***

What started me on this journey was Emily Mayhew‘s brilliantly conceived Wounded and an excellent series of articles by Martin Bricknell in the Journal of the Royal Army Medical Corps: see in particular here.

You can also find more on the casualty evacuation chain from the Western Front at Beyond the Trenches here and here, the Long, Long Trail here, the Medical Front here, and the Royal Army Medical Corps site here.

My larger project examines the evacuation of casualties, combatant and civilian, from four combat zones 1914-2014: the Western Front during the First World War, the deserts of North Africa during the Second World War, Vietnam, and Afghanistan.