In order better to understand the work of a medical service on the Western front, and more fully to appreciate the problems met by the army medical corps, it is important to have some knowledge of military formations.

The unit of military calculation is the division, and upon it is built the whole structure of army organization. It is a self-contained and mobile force, and is styled a division of all arms as distinct from a cavalry division, which is a very different thing. The composition of this army prototype is interesting, and its main features may at first be more easily grasped by reference to a rough diagram (Fig. I), which illustrates the prominent factors in the organization of any fighting force.

The first group contains the immediate striking strength, as here exemplified by infantry, artillery and engineers. As such a body must be supplied with ammunition, equipment, food and other necessaries, full provision for carriage by motor lorry and horse transport, arranged under column, train and sub park, is made and forms the second group. The need that sick and wounded be promptly removed is almost as urgent as the need of supplies 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

​

 

 

 

 

 

 

 

 

 

or ammunition, so that the means whereby the lines are kept clear of casualties by field ambulances and other medical arrangements form the third group. In order to control, coordinate and guide the various groups of this military scheme there is a divisional headquarters that issues its orders to the lesser headquarters of their several members, while itself receiving instructions from the higher. headquarters of the corps.
 

The first group should be closely associated in the mind with the present work in the trenches, or near them, and for this purpose certain facts (illustrated in Fig. 2) must be remembered. The frontline or fire trench is seen to connect at frequent intervals with the support line by means of communication trenches. As these communication trenches are followed back, many are found to coalesce and so become greatly reduced in number by the time the reserve trench is reached, while between it and the third line of defence they usually disappear. From the fire trench saps run out into No Man's Land and are used for snipers or listening posts. A tambour is also shown. It is merely a trench curving forward in front of the fire trench, and is generally inhabited by snipers. In the early days of the war it was often used for trench mortars, which had not then much range, but is now chiefly in teresting as being a bad place to get in to. The support trench is placed 100 or 200 yards behind the front, and with it forms the first line of defence. The reserve trench, from 600 to 1200 yards behind the support, is the second line of defence. Along it are scattered strong points or redoubts, which are spots selected on account of some natural strength.

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

 

 

 

 

 

They are fortified and have in many cases a concrete machine-gun emplacement. The third line of defence, also known as the second reserve line, is placed about one or two miles. to the rear of the reserve trench. It is well constructed and ·has many strong points, in carefully chosen positions, but is not held until an enemy offensive may render it necessary to do so. The trench tramway is used to. transport materials and rations to the lines, and, on occasion, bring back the wounded. In favorable situations its track may be extended as far as the support line. At the end of each branch there is an engineers' dump of trench materials. 

Such being the conventional arrangement of the  ground occupied by the striking force of a division, the distribution and employment of its different arms may be followed. holding the various lines, is divided into three brigades. A brigade is composed of 4 battalions, a machine-gun company, a light trench motor battery and a headquarters. 

The battalions represent the attacking power of the brigade, and it is therefore of some importance to remember their approximate strength. Nominally, each has 1030 men, but the actual fighting strength consists of 4 companies of about 210 men, together with a machine-gun section of 8 guns and 40 men. The remainder are employed on various duties necessary to maintain or conserve the fighting power of the others, as those of transport, kitchens, sanitation, etc. 

The machine-gun company is a defensive unit, usually selecting positions in support and reserve·lines which give a good field of fire, and thus the likelihood of stopping an advancing enemy.

 

Like some other military units whose larger sphere lies in defensive measures, it also assumes the offensive, and its chief occupation during periods of trench warfare is indirect fire on communication trenches and roads used by the enemy. During a push forward it moves with each advance and takes up a new defensive position, then picks out centers of activity behind the enemy lines, which might be benefited by indirect machine-gun fire. It has 16 guns and about 200 men.

The light trench mortar battery, also known as the Stokes' gun battery, has positions for its guns in or near the support line, from which it fires on enemy trenches and assists in forming a barrage for the infantry attack. During an offensive it moves forward as soon as possible after an advance, in order to be in a suitable position to cover the infantry and take part in further developments. 

Following the general rule of battery strength it may be said to have 6 guns. The brigade headquarters is an epitome of the divisional headquarters, but is responsible in more detail for the active policy and work of the troops concerned, while receiving instructions in regard to the larger issues from the division.

THE ARTILLERY is made up of 2 field artillery brigades, a medium trench mortar battery, a heavy trench mortar battery, the ammunition column and a headquarters.

The field artillery brigade usually.has its positions some distance behind the reserve line, and is composed of 4 batteries; 3 of these have 18-pounder guns, which are used against the enemy trenches and on enemy infantry when caught in the open.

The fourth has howitzers, which also do trench work, but in addition are frequently engaged in counter-battery fire. The medium trench mortar battery, which joins the light in the support line, takes part in the beginning of an offensive, and makes an attempt to follow it. If the advance is held up for a day or two it tries to get into position in order to have an opportunity of knocking out enemy strong points. The heavy trench mortar battery, placed only a few hundred yards behind the medium and light, is essentially a trench warfare unit. It takes part in preparation for an offensive, but as soon as a first advance is accomplished it ceases to play an active part, which is only resumed when trench warfare is again established and these heavy guns can be moved forward.

​

The ammunition column, although belonging to the artillery, also carries ammunition to the infantry and comes under the further description of the second group.

The artillery headquarters is again a step in authority and guidance transmitted downward to it from the division and from it to each artillery brigade headquarters and the trench mortar batteries. 

THE ENGINEERS are composed of 3 field companies and a headquarters. Each company has an approximate strength of 230 men. During trench warfare they supervise and assist in such work as the construction of dugouts and trenches in the line, together with bridges, huts, etc., in the area behind it. During an offensive they bridge trenches, streams and other obstacles and make "strong points"· in the captured ground.

With this group must be associated the pioneer battalion. It has the same organization as an ordinary infantry battalion, even to its machine gun section. Its transport is, however, larger, as a certain amount of technical equipment is carried.

A fair proportion of its men are also trained artificers. During trench warfare they are responsible for the construction and upkeep of the second line of defence, while they also do work similar to the engineers in the trenches. During an offensive they repair roads, dig communication trenches behind the line and jumping-off trenches in front of it.

From all this it will be seen that the duties of the pioneers are very similar to those of the engineers, and they might indeed be called amateur engineers. In addition to this they also act as a reserve battalion, and the general officer commanding the division may call upon them at any time in the event of heavy casualties occurring.

This completes the more detailed account of the group closely engaged in the business of fighting the enemy.. From such description it is further evident that the divisional headquarters, having direction of all, must constantly be kept in touch with the work in hand. The signal company,
responsible for the establishment of communication by telephone between divisional, brigade and other headquarters, must therefore be added. This company is also in charge of the routine letter service between divisional units, and between division and corps. I t is divided in to 4 sections, one being for divisional headquarters and one for each brigade.

The group engaged in the transportation of ammunition and supplies is shown in Fig. 3. Its members appear at first sight a little difficult to understand, but a glance at the conditions to be met quickly affords an explanation. Supplies are usually put down at the most convenient railway station or siding, which is therefore called rail head by the particular division concerned. These supplies are then conveyed by motor lorry to a point as near the division as good roads and safety will
 

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​
 

​

​

​

​

​

​

​

​

​

​

​

​

​

​

allow. Such a place is termed the refilling point, and from it only horse transport can well be used. General service wagons, therefore, carry the supplies to various units for which they are severally responsible, the horse lines of such units being the designated place where delivery is made.

To perform this work there are the divisional supply column with its motor lorries and the army service corps supply train with general service wagons. The former carries from rail head to refilling point and the latter from refilling point to various units of the division. The divisional supply column having hauled from rail head to refilling point, the stores are unloaded and a dump formed beside the road. If such a dump were inspected it would be found that all the bread for the division was in one pile, all the bacon in another, all the fresh meat in a third and so on until hay and oats completed the line. The wagons of the supply train pass along the dump and receive from each pile the proportion required by the units for which they are responsible. The train is divided into 4 companies, I company being responsible for the artillery and various other divisional units, while 3 look after the infantry brigades. 

An exception to the usual arrangement of motor transport to refilling point must be noted in cases where the rail head happens to be close to the division. In this case the supply train frequently draws the supplies direct, thus freeing the column lorries to do other divisional work.

​

In addition to the supplies mentioned there is certain equipment stored for use of the division.

​

This is conveyed entirely by the supply column to the ordnance depot, which is placed at a convenient point. The supplies being duly delivered to the horse lines. of the receiving unit may be traced a little farther. From the artillery horse lines the rations are taken to the batteries with the ammunition at night; from the infantry horse lines, in limbers, to the head of the communication trenches. Here the fresh meat is cooked and an attempt is made to have stew taken to men in the trenches each day  at noon and hot tea at night. The dry rations are taken by trench tramway, also under darkness. 

The transport of ammunition is now more easily understood. Two means of conveyance are likewise necessary, the one by motor lorry, which is called the ammunition sub park, the other by horse wagon, which is the division ammunition column, and has  already been mentioned as belonging to the artillery.

For convenience, ammunition is sometimes stored in a corps ammunition dump instead of at rail head, but wherever it may .be it is the duty of the  ammunition sub park to convey it to the refilling point, or, if established, to a divisional dump.

From either place it is then transported by the divisional ammunition column to the horse lines of artillery and infantry brigades, from which it is moved forward by night to the guns in the first case and the communication trenches in the other. 

​

The foregoing account of a division and its machinery clears the way for the remaining group, which is concerned with the disposal of wastage as represented by sick and wounded. It also gives some conception of the varied dientele, numbering from 20,000 to 30,000, who, even while at rest, and therefore free from ordinary war casualties, require continued care and supervision. Under all conditions, whether during rest, in the trenches, or at battle, the field ambulances, of which there are 3 to a division, play the most spectacular and probably the most important medical role, yet for their success are largely dependent upon the efficiency of the regimental medical officers and their aid posts. The motor ambulance convoy, which also greatly assists by its cooperation in the rapid evacuation of wounded from field ambulance to casualty clearing station, must be included as a member of this group. As the subject of medical arrangements fitted to meet the difficult tasks imposed upon them in the division is the purpose of this book it is unnecessary to give further details here.

With the object of making the foregoing description more definite, Fig. 4 represents an area occupied by a division during a period of trench warfare. Under the conditions which now exist on the Western front, the distinction between trench warfare and an offensive must be clearly recognized, as not only divisional, but also medical arrangements alter very considerably when one changes to the other. Ordinary trench warfare, when the line is held and the day's work varied only by raids and so forth, is frequently called peace warfare, or inactive warfare, whereas an offensive is battle or active warfare.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In peace warfare a division generally occupies a three-brigade front, while during an offensive there are either two brigades in front with one in the support line, or one in the front, one in the support, and one in the reserve line.

The diagram illustrates a division occupying a three-brigade front and shows the relative position of its units. For the purpose of description the area is divided into zones, the reference numerals being placed at the side of the map.

The first zone comprises the front line and its support. These are held by 2 battalions of each brigade, each battalion having 2 of its companies in the fire trench and 2 in the support, while its machine-gun section is divided between them. In the support line, or immediately behind it, are the light, medium and heavy mortars. 

The second zone consists of the reserve line, composed largely of strong points, and is held by 3 battalions, I from each brigade, together with the 3 machine-gun companies, collected mainly at these points.

The third zone includes the area immediately behind the trenches, and in it the field arti11ery have their gun positions. The advance dressing stations of the field ambulances are frequently found here,and there is sometimes a bath-house for troops in the reserve line. 

The fourth zone has the third line of defence, which it will be noted does not follow the salients of the front but is constructed along a selected defensive position. As before stated it is not held until necessary.

The fifth zone is occupied by the engineers and pioneers, who live in hutments and go up to the trenches daily as working parties. Here also are artillery headquarters as well as the remaining 3 battalions in rest from the brigades.

The sixth zone contains the divisional headquarters, the field ambulances, ordnance, and the horse lines of the various units of the divisions.

The seventh zone holds the supply column and train, together with the divisional ammunition column.

​

The ammunition sub park is usually a mile or two behind the area shown. Rail head may also be situated in this zone.

THE REGIMENTAL MEDICAL OFFICER.

THE regimental medical officer is a person of protean pursuits. His interests reach from the cleanliness of the cook's hands to the care of wounded under fire. He legislates equally on water chlorination or trench fever. He replies to queries ranging from "How many men with itch reported at sick parade?" to "Considering the number of gas shells that fell around trench 3 this morning, is it safe to relieve the company tonight?"
 

On analysis his duties, like all medical activities, fall under either of two headings, the one preventive, the other curative. In the first category are such important subjects as water supply; food and kitchen arrangements; conservancy, with sanitation of camps or billets; the general comfort and cleanliness of the men.

​

In the second are proper attention to sick and wounded, including such matters as careful selection of the regimental aid post; instruction and control of stretcher-bearers and medical orderlies; the conduct of the morning sick parade, with thoroughness and acumen. Involving these, and at times of paramount importance, is the duty on the part of every medical officer to further the unhampered action of the fighting force by keeping its lines clear of sick and wounded through rapid evacuation of casualties to the rear.

In the performance of his duties the regimental medical officer has the assistance of certain non-commissioned officers and men detailed to such employment from the battalion and under his authority. From above he receives help and instruction from two sources: the assistant director of
medical services, who is the senior medical authority of the division, and the commanding officer of his battalion. This dual control is baffling only in such exceptional cases as those in which the medical officer has a difficult officer commanding or where he himself is perverse or tactless. Its necessity and obligations arise from the fact that the regimental medical officer, although with the battalion, is in a sense not of it.

​

He is a professional expert lent, or what is technically known as "attached," by the army medical corps. Being so attached he naturally comes under the authority of the officer commanding in all matters relating to military discipline, while on the professional side he looks to his immediate medical superior, who is the assistant director concerned, for guidance. As the officer commanding is responsible for the welfare of his unit, all matters of any importance in regard to preventive medicine must be brought to his attention in order that action may be taken. From knowledge of military conditions which this officer possesses, he may not consider it expedient to adopt certain recommendations made by his medical officer, but in the neglect of such he becomes accountable for any evil consequences that may occur. In carrying out the curative part of his duties, involving the use of his art in the treatment of sick and wounded, the medical officer cannot be interfered with and is alone responsible.

The selection of an aid post is a matter over which some divergence of opinion may possibly arise. At the beginning of an offensive, for instance, the assistant director of medical services may instruct the regimental medical officer to locate somewhere in a small area denoted by a numbered square on the map. With an advance it may be necessary to establish it farther forward, and with the consent of the' officer commanding the medical officer makes the move, but must duly notify his assistant director of same. At times these authorities do not agree as to the best site, in which case the medical officer must obey the written instructions of the assistant director and leave him to fight it out with the officer commanding. Another occasional cause of discord between the assistant director and commanding officers is that the latter, if at all fussy, are anxious to have the medical officer frequently in the front line, whereas the assistant director must conserve his medical men, in the fire trench instead of attending to casualties as they arrive at the aid post. The regimental aid post is the doctor's office to the little community of which he is medical officer. In it is held the morning sick parade, when patients are given advice and medicine and minor dressings are done.

​

They are paraded according to company, and any who are found to be at all seriously ill are at once transferred to the field ambulance for further treatment; others may be returned to full or light duty or instructed to report back for dressings, while occasionally one or two may be held at the post for observation. During a period of active operations, dental, eye and skin cases are not dealt with, but other sick are seen in the ordinary way, except on the day or days of an attack, when only those seriously ill are supposed to be sent for treatment.

Here, too, the wounded come, or are carried by the regimental stretcher-bearers, for attention before being evacuated by way of the field ambulance stretcher-bearers to the nearest advance dressing station. The position of the aid post must therefore be carefully chosen, with a view to convenience and as much safety as possible, both for casualties coming in and those being sent to the rear. It is frequently situated off a communication trench, but may be in the support or reserve line.

A good idea of such an outpost will be gained from the accompanying drawings. Fig. 5 illustrates a dugout beside a communication trench and its cross-section. The roof is constructed of elephant frames of corrugated iron, while the walls are built up by sand-bags held in
 

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​
 

​

​

​
 

​

​

 

​

 

 

place by stakes driven into the ground. Racks to hold six stretchers are made, together with a pair of trestles to support the stretcher while the patient is being attended to. A table for dressings and instruments, a primus or other stove, and, if there be room, a bench for walking wounded, complete the furniture.

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

 

 

 

 

 

 

This type of shallow dugout is probably the safest and most comfortable that can be had, its only disadvantage being that it is very narrow.

Fig. 6 shows a deep dugout with its entrance in the support or reserve line and its exit into a communication trench. The exit and entrance shafts as seen in the cross-section are protected by gas curtains. The advantage of such a dugout is that, for all practical purposes, it is shell-proof, and even though small, when once constructed it can be enlarged by digging a tunnel at right angles to the length.

Established in a stretcher-bearer post near the aid post are bearers from the field ambulance, who convey the casualties from such post to the advance dressing station. In these posts there are racks for stretchers, which allow of casualties being held until they can be carried back with some safety. 

Their close proximity to the regimental aid post is shown in Fig. 7 . From the cross-section an idea of the arrangement is obtained. Each is protected by gas curtains and holds six stretchers. The great advantage of these posts is that they are small and consequently but seldom hit; their disadvantage is that practically no arrangement can be made for heating them.

Having duly established his regimental aid post the medical officer has the help of two medical orderlies, one a non-commissioned officer, either sergeant. or corporal, the other a private. They assist him in attending to the sick and wounded, are responsible to him for the care and cleanliness of the post and have charge of his medical stores. In addition, 16 men, with a corporal, act as regimental stretcher-bearers. When the battalion is in rest these usually form the band; when in the trenches they live with the companies from which they are detailed for duty.

​

They work in pairs with their own companies, render first aid to the wounded, and guide or carry them to the aid post. During an offensive, so long as the wounded continue to arrive in fairly large numbers, the medical officer remains at the aid post to deal with them; but should he have reason to think conditions are becoming unsatisfactory, either from the reports of bearers, or judging from the smaller number of wounded arriving, he must investigate the situation.

The questions which he asks himself, and to which he must find the answer, are:

1. Have nearly all the wounded been brought in?
 

2. Have the stretcher-bearers, as the result of a successful attack, to carry the casualties too far?

3. Has it been an unsuccessful attack, and in consequence are the bearers unable to reach the wounded?

​

He endeavors to obtain information from his regimental headquarters as to the position resulting from the attack; also through the companies, particularly in case of an unsuccessful attack, and by personal reconnaissance, he must learn if wounded are lying out in No Man's Land.