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MEDICAL UNITS
IN THE
FIRST WORLD WAR

By

David Langrish 

By kind permission of

THE NATIONAL ARCHIVE

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This year, the focus of The National Archives’ First World War Centenary programme shifts to the use and development of technology. Medicine is one of the areas that we will be exploring and so today’s post is designed to give a brief overview of the route which wounded or sick soldiers would have taken when receiving treatment.


Having been injured, wounded or taken sick on the Western Front, British and Commonwealth soldiers would have received their initial medical treatment at a Field Ambulance unit, from where they would either be returned to their unit or sent further back to a Casualty Clearing Station for further care.


From a Casualty Clearing Station the injured would be moved back further towards a Base Hospital before potential transportation home to a British military or civilian hospital. This journey would come to see a wide variety of transportation methods utilised, ranging from stretcher bearers, horse-drawn carriages, motorised vehicles, barges and ships of various shapes and sizes.

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From a research perspective, discovering the medical units or hospitals that your ancestor may have been treated at can be quite difficult. A service record, if it survives, may contain details of medical units which treated a wounded or sick soldier. Alternatively, if you know the Division that your person of interest was serving with, this can help identify the three Field Ambulance units attached to that formation. I would also recommend consulting the ‘Location of Medical Units’ found within WO 95/5494. This folder details the various medical units and hospitals in numeric sequence by hospital type. In some cases the Division attached to, location, and relevant dates are recorded.

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In terms of records of these various medical units and hospitals, our First World War unit war diaries clearly show the demanding, hectic and dangerous day-to-day work carried out by these units. For example, the diary of the 14 Field Ambulance on 10 September 1914 describes how the stretcher bearers came under enemy artillery fire on the road leading to the dressing station at Passy.

 

Later that same day the bearers returned to the front lines to collect the fallen and entitle them to a dignified burial. The entry for 15 September reveals the discovery and use of ‘an excellent room for operations’. Crucially, the ‘light was good; acetylene gas was installed so that we can work by day and night’. Perhaps we neglect the basic challenge of maintaining light or heat at advanced positioned medical units during the early stages of the conflict. 

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HISTORY OF THE ROYAL ARMY MEDICAL CORPS

By Kind Permission

Of

The Museum Of Military Medicine

ORIGINS

 

RAMC Crest Medical organisation within the British Army can trace its formal origins back to 1660 and the formation of the Standing Regular Army, when each regiment of infantry and cavalry had a Regimental Surgeon and his assistant. In the reign of Queen Anne (1702-1714), the Duke of Marlborough introduced ‘Marching’ or ‘Flying Hospitals’ which accompanied his armies, but it was not until the Peninsular Wars of 1808-1814 that the medical services of the army were organised on a more formal basis.

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PENINSULAR AND NAPOLEONIC WARS

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Following the Battle of Waterloo in 1815, the Army Medical Department underwent a major reorganisation under Sir James McGrigor, who himself had introduced significant changes to the army medical services during the Napoleonic Wars. He established a well-planned system of casualty evacuation, arranged for pre-fabricated huts to be sent from England, instituted large convalescent depots, which kept thousands of trained men in the field, introduced a system of registering casualties, which forms the basis of medical statistical returns in use today, and also set up a Benevolent Fund and Widows and Orphans Fund. Sir James McGrigor was Director General for 36 years but it would be forty years before the British Army was called on again to fight a war of such a large scale and by then the lessons learnt from Waterloo had been forgotten.

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CRIMEAN WAR

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Following the Battle of Waterloo, officers in the British Army enjoyed a relatively long period of stability and had the opportunity to enjoy the social benefits of life as an Army officer.

 

When the Crimean War began in 1854, the medical and logistical support was organised by civilian departments, which often held meetings without any consultation with the army. The consequences were disastrous.

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Medical organisation was largely based on a peacetime arrangement of regimental hospitals. Although the medical officer was commissioned and wore the uniform of his regiment, he held no military rank and was entirely under the command of the Colonel of his Regiment. He had no trained staff, just a few men detailed to him from the Regiment, who had no medical knowledge or training but received instructions as he could give them. The recent invention of the telegraph meant that the scandal of inadequate medical provision reached the shores of Britain relatively quickly. There was national outrage as the public read about the suffering of soldiers, dying of disease in the Crimea.

 

The Director General, Sir Andrew Smith, urged the necessity of a medical corps and the War Office responded by collecting together 300 old army pensioners to form an ambulance corps. Shortly before their departure to the Crimea, Smith declared they could hardly carry themselves let alone care for the sick and wounded. Sadly, he was proved correct when many of them died of cholera and others turned to the consolation of alcohol. Finally, in 1855 the Medical Staff Corps was formed, composed of ‘Men able to read and write, of regular steady habits and good temper and of a kindly disposition’.

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FORMATION OF THE ROYAL ARMY MEDICAL CORPS (RAMC)

 

In 1857 the Medical Staff Corps was reorganised into the Army Hospital Corps, although it reverted back to its former name in 1884 and by 1898 there were two distinct organisations within the Army Medical Services, the Medical Staff Corps and the Medical Staff (i.e. the officers). These two separate organisations were reorganised into one Corps, the Royal Army Medical Corps, by Royal Warrant on 23rd June 1898. With the formation of the RAMC medical officers were granted the same rank structure as the rest of the British Army and assumed full executive and administrative responsibility. Three months later RAMC personnel were serving in the Sudan and only one year after its formation the RAMC was fully committed in the Anglo-Boer War.

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BOER WAR 1899-1902

 

The Boer War highlighted the importance of medical care for the army; the medical services treated 22,000 wounded and a staggering 74,000 for dysentery and typhoid fever alone. The advice of the new hygiene officers was ignored and as a result consequences were fatal; water purification was defective, sanitation deplorable and rations inadequate.

 

However, the Professor of Pathology, Sir Almroth Wright, along with Captain Leishman (later Lt-General Sir William Leishman Director General Army Medical Services 1923-26) was working on an anti-typhoid vaccine. As a result of their work typhoid fever, which killed 8,000 soldiers during the Boer War, was reduced to negligible proportions during the two world wars.

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WORLD WAR ONE, 1914-1919

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Lessons learnt during the Boer War were not forgotten and the efficiency of the army medical services in the build-up to World War One was largely due to Lt-General Sir Alfred Keogh (Director General 1904-1910 and 1914-1918). His foresight and planning ensured that the medical services were recognised as an essential part of the British Army.

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At the outbreak of war in 1914 the majority of transport was horse-drawn and organisation for casualty evacuation was based on a ‘chain of evacuation’ in which the sick and wounded were moved backwards by a series of posts; the regimental aid post, the collecting post, the advanced and main dressing station, the casualty clearing station and finally the general hospital either in France or England via hospital ship. At an early stage in the war, Casualty Clearing Stations were expanded into forward areas and in some cases could take up to 1,000 patients.

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The RAMC expanded rapidly during World War One; on mobilization the Corps consisted of approximately 9,000 other ranks, by 1918 there were 13,000 RAMC Officers and 154,000 other ranks. The RAMC served across the globe in France, Belgium, Macedonia, Italy, Palestine, South Russia and Mesopotamia.

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WORLD WAR TWO, 1939-1945

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During World War Two technology enabled the RAMC greater access to mechanised land and air transport, allowing specialists and operating teams to get right to the front-line in an increasingly mobile war.

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There were major medical developments pioneered by the army, such as the use of penicillin for the first time in the North African campaign and also the development of blood transfusion, which was so crucial in wartime.

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Many medical personnel were taken prisoner during the war, as they often remained with the wounded. In the Far East many British and Australian medical personnel were amongst those taken prisoner at the Fall of Singapore in 1941.

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1945 ONWARDS

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The end of World War Two saw the start of the Cold War. British troops were needed worldwide, and National Service lasted from 1948 to 1962.

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Many National Servicemen served in Korea and Malaya, East Africa, Borneo and Cyprus, as well as the Suez operation of 1956.

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The British Army have been committed to Northern Ireland since 1969, the Falklands War of 1982, the Gulf War 1990-1991, Bosnia and Yugoslavia and more recently Afghanistan and Iraq, as well as numerous other peacekeeping and humanitarian operations across the globe. In each instance, the Army has been supported by medical personnel from the RAMC.

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THE VICTORIA CROSS

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Since the Victoria Cross was instituted in 1856 there have been 29 Victoria Crosses and two bars awarded to medical personnel. A bar, indicating a subsequent award, has only been awarded on three separate occasions.

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Twenty-three of these Victoria Crosses are on display in the museum and details of the awards can be found in the Museum publication The Medical Victoria Crosses
 

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WO 95/1540/3: War diary of 14 Field Ambulance showing the use of acetylene gas to provide lighting

Field Ambulance war diaries can also highlight the pressing need for improved and disciplined sanitary conditions, to reduce the spread of disease or infection. The 24 Field Ambulance, for example, improvised the re-use of biscuit tin boxes to create better latrines for the patients and staff, as demonstrated by diagrams in their July 1915 war diary (WO 95/1703/1). This example points to the fact that improved equipment or conditions for troops, the wounded, sick and medical staff, did not always require a technological first or new invention. Simple improvisations combined with a bit of imagination could help improve local conditions for troops, which in this case may have limited the threat of disease or illness.


Our MH 106 collection consists of a representative sample of First World War medical papers, including admission and discharge registers to selected Field Ambulance units, Casualty Clearing Stations, Base and Home Hospitals. Although only a 2-3% sample, these registers record each patient who was admitted during the period covered by each volume, noting the name of the soldier, nurse or civilian admitted; unit; squadron, battery or company; regimental number; rank; age; years of service; type of wound or disease; religion; and dates of discharge, transfer or death.


As well as the battlefield wounds suffered by soldiers, with the horrific nature evident on a classification sheet at the start of each register, the spread and impact of different illnesses or diseases amongst troops is also notable. With these records being a selective sample from across the various theatres of war, as well as the various nationalities forming the Allied fighting force, the registers may indicate possible patterns in the contracting of and spread of certain infections.

WO 95/1703/1: 24 Field Ambulance war diary, July 1915. Sketches showing how to turn biscuit boxes in

The hygienic discipline expected of the troops began at the front lines rather than in medical units, however, with a perfect example found in the war diary of the Adjutant and Quartermaster General, Salonkia.

 

A copy of instructions to troops on tackling malaria provides tips on how to identify the more dangerous ‘anopheles’ mosquito which had spotted wings. The use of a mosquito net, taking a dose of quinine ‘regularly as ordered’ and by rubbing ’the exposed surface of the body with a strong smelling substance which will be issued’, were also recommended to troops

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MH 106/279: Admission and discharge registers of selected First World War medical units.

In medical terms, technological advances, such as new medicines and equipment would have a very significant impact on the care, treatment and rehabilitation of wounded during and after the conflict. We hope to explore some of these advances in greater detail throughout our series of blog posts, so do watch out for the next one in February from my colleague, Vicky. What is evident when researching the experiences of various medical units, however is that disciplined sanitary practices and the innovative yet simple use of materials could lead to improved conditions for the wounded and sick during their journey through the various stages of medical care.

WO 95/4765: War diary of the Adjutant and Quartermaster General, Salonika, April 1917. Instructions
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SEEKING PROTECTION
FROM GAS WARFARE
IN 1915

By David Langrish

By kind permission of

THE NATIONAL ARCHIVE

‘Complexion here was an ashed blueish grey, the expression most anxious and distressed with the eye-balls staring, and the lids half closed. Respiration was extremely laboured and noisy with frequent efforts to expel copious amounts of tenacious yellowish green frothy fluid which threatened to drown them, and through which they inhaled and exhaled air into and out of their lungs with a gurgling noise.’ 1


This distressing statement comes from Captain Edward L Reid of the Royal Army Medical Corps, serving with No. 7 Field Ambulance in May 1916. Reid is describing just some of the horrific sufferings experienced by soldiers with gas poisoning during the First World War. As part of our ongoing medical technology series of blogs, today’s post will examine some of the earliest developments made by the British Army in 1915 to try and combat the dangers posed by this new weapon.

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Opening paragraph from The Use of Poisonous Gases in War report made by the Royal Army Medical College in June 1915 (catalogue reference: WO 142/183)

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Within the Chemical Warfare Department series in WO 142, you can find a sub-series of papers titled Anti-Gas files. Within file 4, there’s a report titled ‘The Use of Poisonous Gases in War’ from June 1915. The report describes five essential requirements of any gas protection device for troops:

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‘1. Protect the respiratory passages from incapacitating amounts of gas inhaled in moderate concentration for moderate length periods.

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2. Protect the eyes from disabling irritation.

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3. Be capable of rapid and secure adjustment by unintelligent men.

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4. Afford minimum interference with fighting capacity by obstruction of respiration, vision or hearing.

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5. Be of a type sufficiently simple to be made cheaply, rapidly and in large numbers by unskilled labour.’

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One of the early pad type gas masks issued to British troops in May 1915.

© IWM (EQU 3906)

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Developments led initially to a face mask made of textile with a fitted pad opposite the mouth. Celluloid eye pieces were incorporated with purse string elastic to provide adjustment over the forehead and under the chin, with an elastic band to fit over the back of one’s head. This face mask idea quickly moved towards a full helmet based respirator design, which was introduced in May 1915. The RAMC report continues:

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‘The helmet consisted of textile, the two or later three pieces of which were securely sewn together by a single seam of cotton thread, a celluloid window being inserted in the situation of the eyes. It was large enough to fit over the service cap and come well down over the shoulders, the skirt being tucked beneath the collar of the tunic or shirt which is then buttoned over it. The external surface was 3¼ square feet.’

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Essential requirements of new gas protection devices stated in the June report (catalogue reference: WO 142/183)

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The initial respiratory protection is described quite plainly as ‘a pad of cotton waste wrapped in black veiling’ which was ‘approximately the size of a hand’. Folds were included so to offer protection of the eyes, as were anti-gas goggles. This pad was to be dipped in a solution that would absorb the gas being used by the enemy (chlorine). Unfortunately, it was found that when using this pad, men were ‘incapacitated’ within five minutes by respiratory and eye irritation, at a time when the Army Medical Service was seeking protection for at least 20 minutes. Consequently, the report confirms that the cotton pad failed to comply with the first four of the above essential requirements. 2

EYE WITNESS REPORT

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The War To End All Wars

 

GAS!
    
At Vimy there was a gas attack and this bloke who’d been gassed came to talk to me.  He knew we were hungry and he gave me his bread and said

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“Take that, I’m going where there’s plenty”.  

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And his face lit up and he was blind with gas and I thought to myself how he’d suffered and he was so glad to get away even though he didn’t know if he’d recover his sight.  

 

I don’t know how powerful that particular gas was but there thirty of them all in a line each holding each other’s tunic tails as they came down the trench.  

 

All bandaged, all making their way to the dressing station for treatment.  

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This lad I was talking to before they moved off seemed quite jolly

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“I’m going to where I’ll get plenty of bread.  I’m finished with this lot”.  

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Four months later the war was finished.

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   James Bennett b. 1898    
 

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