These notes are intended for those readers who wish to go beyond the main narrative of Wounded to connect directly with the primary sources and the context of their production. They give detailed references for each source and also provide a brief commentary on current academic analysis and historiography, with details of related secondary literature. They examine shifts in interpretation and, in places, suggest areas where further research is required.
Wounded does not have a conventional bibliography, but there are four key works of medical history that constitute an analytical framework for the book. Mark Harrison’s The Medical War: British Military Medicine in the First World War (Oxford University Press, 2010), Jeffrey Reznick’s Healing the Nation: Soldiers and the Culture of Caregiving in Britain during the Great War (Manchester University Press, 2004) and Christine Hallett’s Containing Trauma: Nursing Work in the First World War (Manchester University Press, 2009) are specialist academic histories that focus on a range of specific themes and contexts, including developments in public health, social and political attitudes to the care of the fighting soldier, and the skills and status of nurses in the period. Ian Whitehead’s Doctors in the Great War (Leo Cooper, 1999) remains the standard account of the war’s impact on the medical profession. These four works come with extensive bibliographies which, taken together, provide an almost definitive list of secondary sources for the study of medicine in the Great War. For a general overview, John Keegan’s The First Word War (Pimlico, 1999) sets the standard for efficient and clear military history.
In 1914, the Royal Army Medical Corps had 20,000 personnel of all ranks and 7,000 hospital beds. Although medics had information on casualty treatment during the Russo-Japanese War of 1904–5, it was not thought to be relevant, so the Boer War in South Africa remained the model for military medical services. Preparations were made on this basis, even though some senior medics, such as Sir Frederick Treves, feared they would be inadequate.1 Surgeons thought that gunshot casualties would have ‘in-and-out’ wounds, aseptic and sterile, needing nothing more than standard civilian antiseptic responses to heal without trouble. ‘Never was a teaching more false’, was the conclusion reached by two surgeons writing of their experiences stationed on both the Eastern and Western Fronts.2 In a report published after the war, the Medical Research Council noted that there had been very few doctors with the right kind of experience for the wounds of the Flanders casualty, complicated as they were by infection, gangrene, a variety of shock symptoms, cold, and the agonisingly slow evacuation procedures.3
It wasn’t just surgeons and doctors who lacked experience. The Voluntary Aid Detachment (VAD), which would send many of the nurses and orderlies to medical facilities in France, practised entraining and detraining casualties in elaborate exercises during 1913 and 1914. But these were primarily designed to attract recruits who were drawn more to the active nature of the events than to first aid courses and bandage-rolling in cold village halls.4 Some medical officers took unilateral action. Captain Somerville Hastings analysed papers from German and French military congresses and journals to see if they contained anything useful. He privately published his findings as First Aid for the Trenches, but they would not be available for his colleagues until 1916, when the book was given a wider audience through publication by John Murray.
By 1918, the RAMC comprised 13,000 officers and 154,000 other ranks, including bearers and orderlies. Over the course of the war, 2.5 million wounded were brought home to Britain in 63 hospital trains and 66 hospital ships. Overall, there were 364,000 hospital beds in Britain and France, and a similar number across the Empire, all of which would be used many times over. In Britain, the war caused 11 million casualties. Forty per cent of all those who served either ended up with a disability pension or their dependants were in receipt of a death pension.
The creation of such a huge new medical system was a remarkable achievement, and this was recognised at the time. Surgeon-General Anthony Bowlby, who had served at CCS No. 38 and operated on the Rev. Charles Doudney, favourably reviewed surgical provision in his report of 1917, ‘The Development of British Surgery at the Front’.5 The 1919 MRC report was one of the very first official sources to note the contributions of nurses to the process. But that same year senior medic Wilmot Heringham wrote a memoir, A Physician in France (Edward Arnold, 1919), which lamented the lack of recognition for the staff of the CCSs and showed concern that their extraordinary work with the wounded of the Western Front would be ignored. He was right. Over the next eighty years, records would disappear, memories would fade and the achievements of many of the medical trades involved in the care for the wounded would be marginalised. Medical histories of the war would become ‘increasingly fragmented … [with] few works of synthesis and comparison capable of providing a rounded view of what medicine meant to their contemporaries’.6 Wounded seeks to put medical history back at the heart of studies of the Great War and give credit and understanding where it is long overdue.
1 See Ian Whitehead, Doctors in the Great War (Leo Cooper, 1999), p. 170, and Mark Harrison, The Medical War: British Military Medicine in the First World War (Oxford University Press, 2010).
2 B. Hughes and H. S. Banks, War Surgery from Firing Line to Base (Bailliere, Tindall and Cox, 1918), p. 29.
3 See Cowell and Fraser, ‘A Clinical Study of the Blood Pressure in Wound Conditions’, MRS Special Report No. 25, 1919.
4 See Journal of the RAMC, vol, 32, no. 1, 14 January 1915, p. 63 on the VAD’s pre-war exercises.
5 British Medical Journal, 2 June 1917, pp. 705-12.
6 Harrison, The Medical War, p. 13.
Mickey Chater was wounded at Neuve Chapelle just as the military medical system on the Western Front disintegrated. Both the nature of his wounds and his only battle set a pattern for the remainder of the war. The trauma to Chater’s body was unprecedentedly severe and complex, brutally demonstrating the effect of the war’s new weapons. Bullets and fragments of shell had both primary and secondary wounding power within seconds of impact. In Chater’s case, whatever struck his face had enough force to cross from one cheekbone to the other. As it hit hard bone, its power was transmitted around Chater’s whole upper jaw, blowing it away and battering his nose into pieces.
Every bullet or shell fragment that hit a soldier on the Western Front had the same potential for destruction. In White Heat: The New War, 1914–1918 (Sidgwick & Jackson, 1982) John Terraine describes the technological developments that underpinned the conduct of the war. He argues that artillery significantly changed the battlefield: ‘Artillery was the battle-winner, artillery was what caused the greatest loss of life, the most dreadful wounds, the deepest fear.’ Terraine’s work is a careful analysis of how new weaponry and technology had primarily strategic and tactical but also physical consequences.
Chater’s archive at the Imperial War Museum (ref. 87/56/1) is rich and well organised. He had enthusiastically joined the war in 1914 and witnessed the Christmas Truce. After his wounding his memoirs focus on his injuries, their medical treatment and the commitment of his doctors as they struggled to restore him.
1 Papers of Marie Chisholm, archives of the IWM, 01/42/1.
2 A. E. Francis, History of the 2nd/3rd East Lancashire Field Ambulance (Francis Jackson, 1930), p. 133.
3 See Cyril Falls, The Gordon Highlanders in the First World War (University of Aberdeen Publications, 1974), p. 38.
4 2nd Lt C. G. Tennant, letter to his wife, 21 March 1915, archives of the IWM, 68/12/1.
5 See Geoff Bridger, The Battle of Neuve Chapelle (Leo Cooper, 2000), and John Keegan, The First World War (Pimlico, 1999).
6 John Terraine, White Heat: The New War, 1914–1918 (Sidgwick & Jackson, 1982), p. 146.
7 The new ammunition could have particularly devastating effects on the human face: ‘High velocity bullets at short range, traversing the face approximately from one malar region to another. Encountering hard bone on the way, its force is transmitted to the upper jaw, detaching it from its superior attachment. The whole support of the nose is also destroyed.’ Mickey Chater would experience a very similar wound to the one described here by Harold Gillies in Plastic Surgery of the Face (Frowde, 1920), p. 226.
8 2nd Lt C. G. Tennant, letter to his wife, 21 March 1915.
9 Very few of the medics and surgeons in France had any experience of severe facial wounds. They were not unprecedented, however: similar kinds of casualty had occurred during the American Civil War. One surgeon, Dr Gurdon Buck, who treated many such cases, photographed his patients for an illustrated textbook, Contributions to Reparative Surgery (New York, 1876). It had been available in Britain, but was considered to be so gruesome that it might put medics off war service. See A. J. Bollet, Civil War Medicine (Galen Press, 2002).
10 See the papers of Dorothy Seymour, archives of the IWM, 95/28/1, entry for 15 March 1915.
11 Francis, History, p. 133.
Joseph Gray, A Ration Party of the 4th Black Watch at the Battle of Neuve Chapelle, 1915; Gilbert Rogers, A British Red Cross Society and Order of St John of Jerusalem Motor Driver. Henry Tonks’s pastels of facial casualties illustrate similar injuries and surgical reconstructions to those suffered by Mickey Chater.
There was larksong just as the first barrage rang out at Neuve Chapelle, and the sound of birdsong on the battlefield always came as a surprise to the soldiers on the Western Front. See Isaac Rosenberg, ‘Returning, we hear the Larks’.
The creation of a stretcher-bearer corps was the first step in rebuilding the collapsed medical system on the Western Front in 1915, just as the bearers themselves were the first step on the journey of the wounded to safety and medical care. Stretcher bearers gave whatever treatment they could as soon as they found the casualty, trying to secure his immediate survival. They then carried him safely to a fixed site of medical provision, such as an aid post or the dugout of an RMO. This process – where treatment was given as close to the time and place of wounding as possible – transformed military medical provision on the Western Front and remains the standard in the twenty-first century.
Within a year, an entire service battalion was created almost from scratch, consisting of technically expert staff who were trained in both Britain and France. There were more bearers than any other medical trade in France, and they spent longer on the battlefield than anyone else, including soldiers. Like doctors, nurses and the wounded, bearers wrote their memoirs in the years immediately following the war. These included Pat McGill’s The Great Push, William St Clair’s The Road to St Julien, J. H. Newton’s A Stretcher Bearer’s Diary, Frank Dunham’s The Long Carry, and Stretcher Bearers … At the Double! by Frederick Walter Noyes, but most are out of print and none well known.
However, if there were policy or operational documents from the War Office or the Army Medical Services relating to the creation and administration of the stretcher-bearer corps, they have been lost. There are similarly no archives from the training facilities for bearers or from the publishers of their manuals. Perhaps because of this, the stretcher bearers are all but invisible in the Official Medical Histories of the war, where the only mention of the word ‘bearer’ in the index refers to porters in the campaign in Cameroon. It is an example of marginalisation and, in the words of Mark Harrison, of how ‘the medical world, which made such an impression on contemporaries has faded from view’.
But such marginalisation may also have another cause. Medical histories of the war analyse the impact of military service on the primary medical professions and their members: surgeons, doctors and nurses. There is almost no analysis for the auxiliary medical trades. Yet as we have seen, auxiliaries – and stretcher bearers in particular – were vital to the conduct of the medical war. Bearers were a separate, defined element of the medical organisation in France. They were specifically recruited for their post. They had codified education and training. They had considerable technical skill, such as the control of haemorrhages and the application of splints. They had their own manual, which was constantly updated to take into account new types of ammunition and improvements in treatment. The use of expert bearer teams became the standard in British military medicine.
Bearers were not the only auxiliary medical trade whose history should be analysed alongside those of surgeons, doctors and nurses: there were also orderlies, anaesthetists and X-ray technicians. A pioneering work in this respect is Jeffrey Reznick’s Healing the Nation, which among other topics discusses the work of physiotherapists at the Shepherd’s Bush Military Hospital. Reznick portrays physical and occupational therapy in its own right, rather than as an adjunct to orthopaedic surgery. A full medical history of the Great War must account for all the relevant personnel involved in saving and treating the wounded, whatever their status or skills.
As Wounded went to press, new research was being done by Dr Jessica Mayer, who leads the medical strand of Leeds University’s Legacies of War project. Her areas of analysis include the masculine identity of medical auxiliaries during the First World War, their status as non-combatant service personnel in a society engaged in total war, their dual position as uniformed members of the military and care-givers, and the relationship between RAMC auxiliaries and those serving with voluntary service units.
There is one place for researchers to go in order to (literally) hear the voices of the stretcher bearers of the Great War. The Imperial War Museum’s sound archive contains a number of testimonies given directly by bearers to its historians, and that of William Easton (no. 18277) has been used here. The IWM’s archives also hold the main textual sources for this chapter: the papers of Earnest Douglas (no. 6-9-1917) and William Young (no. PP/MER/90). In addition, the references below provide details of memoirs by RMOs and field ambulance personnel on which I have also drawn, to bring to life the Great War’s stretcher bearers and their work.
1 Tales of a Field Ambulance: Told by Personnel (Borough Publications, 1935), p. 68.
2 Pat McGill, The Great Push (Herbert Jenkins, 1916), p. 57.
3 A. E. Francis, History of the 2nd/3rd East Lancashire Field Ambulance (Francis Jackson, 1930), p. 87.
4 ‘Treatment of wounds from Fire Trench to Field Ambulance’, in Journal of the RAMC, vol. 27, 1916, pp. 230–40.
5 Richard Chapman, IWM sound archive, no. 8578.
6 Tales of a Field Ambulance, p. 19.
7 Bulletin of CCS 61, item 209, archives of the IWM, Misc. 10. See also the papers of Captain Angel, archives of the IWM, 88/46/1, for details of stretcher-bearer training, especially at the Cambridge Hospital.
8 Dr Georges Dupuy, The Stretcher Bearer (Hodder & Stoughton, 1915). The manuals continued to be published and updated throughout the war.
9 ‘The Whole Duty of an RAMC Officer’, Journal of the RAMC, vol. 32, 1916, p. 289.
10 RMO Charles McKerrow noted how bearer performance improved after every single lecture and he thoroughly approved of the new system. See the papers of Charles McKerrow, archives of the IWM, 93/20/1, entry for 30 August 1915.
11 J. H. Newton, A Stretcher Bearer’s Diary (Stockwell, 1932), pp. 29–30.
12 Tales of a Field Ambulance, p. 62.
13 See McGill, The Great Push, p. 207.
14 William St Clair, The Road to St Julien (Leo Cooper, 2004), p. 36.
15 The papers of William Harris, archives of the IWM, no. 6732/78/4/1, entry for 13 November 1916.
16 Wilfred Cook, ‘The Lengthened Shadow’, unpublished ms, archives of the IWM, 11/7(BY).
17 Eventually the training trenches at Étaples were filled in and a large cemetery took their place, which was painted by John Lavery in 1919.
18 Captain Angel also told of being trapped in a shell hole with his patient: see papers of Captain Angel, archives of the IWM, 88/46/1.
19 Tales of a Field Ambulance, p. 62.
20 See Newton, A Stretcher Bearer’s Diary, p. 22, entry for 22 July 1917. David Jones’s epic poem In Parenthesis, set in Mametz Wood, contained the line ‘But why dont [sic] the bastards come – / Bearers! – stret-cher bear—ers!’ The simple answer is that snipers and the destruction of the terrain made it almost impossible for them to move forward.
21 Cook, ‘The Lengthened Shadow’; McGill, The Great Push, p. 120. Walking on the dead is an experience described by Professor Drew Gilpin Faust in her American Civil War history, This Republic of Suffering: Death and the American Civil War (Vintage Civil War Library, 2009), pp. 51-8.
22 St Clair, The Road to St Julien, p. 76. Seeing bearers pass with loaded stretchers was an image that remained with Siegfried Sassoon, who wrote of it in his poem ‘Aftermath’ in 1919. See Brian Gardener (ed.), Up the Line to Death: The War Poets 1914–1918 (Methuen, 1964), p. 154.
23 R. H. Haigh and Philip Wilson Turner (eds), The Long Carry: The Journal of Stretcher Bearer Frank Dunham (Pergamon, 1976), p. 27.
24 McGill, The Great Push, p. 237.
25 Letters of a Canadian Stretcher Bearer (Little, Brown, 1918), p. 90.
26 See James Brady, sound archive in the IWM, 11387/2.
27 Papers of Captain Angel, entry for 29 September 1917.
28 Tales of a Field Ambulance, p. 49.
29 McGill, The Great Push, p. 145.
30 Tales of a Field Ambulance, p. 47. The papers of Private Herbert Empson, archive of the IWM, 02/12/1.
31 McGill, The Great Push, p. 143.
32 Newton, A Stretcher Bearer’s Diary, p. 24.
33 Harold Dearden, Medicine and Duty (Heinemann, 1928), p. 112.
34 See Tales of a Field Ambulance, p. 48.
35 See The Official History of the Medical Services of the Great War, vol. 3, General History, p. 166, and St Clair, The Road to St Julien, p. 59.
36 Tales of a Field Ambulance, p. 73.
37 Ibid., p. 52.
38 Newton, A Stretcher Bearer’s Diary, p. 74.
39 See Harold Plant, sound archive in the IWM, reel 3.
40 Joseph Yarwood, sound archive in the IWM, 12231.
41 Bernard Adams, Nothing of Importance (reprint; Donovan Press, 1988), p. 182.
42 St Clair, The Road to St Julien, p. 57. St Clair’s entire division and bearer corps was shattered at Loos.
43 The poet was Geoffrey Studdert Kennedy, otherwise known as ‘Woodbine Willie’, who won an MC at Messines Ridge. Two hugely popular collections of his poetry were published during and just after the war: Rough Rhymes of a Padre and More Rough Rhymes (Hodder & Stoughton, 1918, 1920).
Stretcher bearers and their work made a considerable impression on the artists of the Western Front, official or otherwise, who observed important details of the skill and dedication of bearers and regarded them as worthy of the highest standards of painterly representation. Gilbert Rogers produced a whole series of drawings: The Stretcher Bearers, A Royal Army Medical Corps Stretcher-Bearer, Fully Equipped, ‘Humanity’ Bearer Post, Cambrai section, August 1916: The First Field Ambulance, Stretcher Bearing in Difficulties, The Dead Stretcher Bearer and Ypres 1915. In addition we have Harold Williamson’s Removing the Wounded 60 yards from the Enemy, Charles McKay’s Portrait of a Stretcher Bearer on Water Duty, Christopher Nevinson’s The Harvest of Battle, P. Watkins’s An Ambulance Dressing Station on the Western Front and Hayden McKay’s Portrait of a BRCS and Order of St John Stretcher Bearer, An RAMC Squad with Infantry: Night at Nurlu, October 1918.
David Jones, In Parenthesis; Siegfried Sassoon, ‘Aftermath’; Isaac Rosenberg, ‘Dead Man’s Dump’; Robert Graves, ‘A Child’s Nightmare’.
Two academic works provide the background for this chapter. Mark Harrison’s The Medical War examines in detail RMOs’ responsibility for the public-health aspects of medical provision in the Great War. This included the maintenance of the overall health of their battalion, such as personal and dental hygiene, sewerage and water provision, and the treatment of general ailments. Harrison’s analysis links their work to broader themes of public health, military organisation and civilian expectations of medical provision for soldiers, which had evolved in the late nineteenth century. Ian Whitehead’s Doctors in the Great War looks at medical provision from the point of view of the medical profession itself. Whitehead describes the impact on both the profession and their patients of the removal of so many medics from civilian life. He also examines the differences between the career RAMC doctors and their civilian volunteer colleagues, as well as their recruitment and training. Both historians come to a similar conclusion: that, despite a lack of preparation and structure, medical provision during the Great War was a success.
In this chapter the work of RMOs is described primarily in terms of their care of wounded men. Emphasis is placed on the high level of independence given to each medical officer, so that he could make his own preparations and decisions on how best to treat the wounded. This meant not only choosing the location of his aid post, but also training his stretcher-bearer teams to the highest standard possible to support his efforts. RMOs were able to set up formal and informal networks, such as the Rouen Medical Society, which was created to share knowledge and provide support. In addition there were numerous local medical societies that regularly met close to the front. The Journal of the Royal Army Medical Corps was fundamental to the exchange of information and experience; much of its content from 1914 to 1918 remains to be explored and analysed by historians, as do the activities and output of the Western Front’s medical societies.
Although the RAMC’s service records for the war no longer exist, many medical officers wrote memoirs that provide insight into both personal experience and medical policy. This chapter draws on the memoirs and papers of four RMOs, who were either GPs or surgeons in civilian life: John Linnell (unpublished manuscript, private collection), Alfred Hardwick (IWM, no. 98/12/4) and Charles McKerrow (IWM, no. 93/20/1); my account of William Kelsey Fry draws on Harold Gillies’s Principles and Art of Plastic Surgery (Frowde, 1920), Siegfried Sassoon’s Memoirs of an Infantry Officer (Faber & Faber, 1937), Joseph Hone’s The Life of Henry Tonks (Heinemann, 1939) and obituaries of Kelsey Fry in the Lancet, The Times and the Supplement to the London Gazette.
1 Supplement to the London Gazette, 24 July 1915, p. 7281.
2 See www.1914–1918.net/Diaries/wardiary-2welsh.htm, accessed 6 November 2008.
3 Supplement to the London Gazette, 16 November 1915, p. 11426.
4 For a full discussion of this aspect of medical care in the Great War, see Mark Harrison, ‘War, Health and Citizenship: Preventative Medicine on the Western Front’, in The Medical War (Oxford University Press, 2010), pp. 123–70. RMOs were increasingly well trained and prepared for all aspects of service at the Officers’ School of Instruction run by the RAMC. Very few records of this institution remain; some of the most useful are the painted representations of John Hodgson Lobley. His work shows that RMOs were trained to build and operate incinerators and that the training camp in Blackpool was tented, so they were prepared for life under canvas in France. Lobley’s work is in the IWM art holdings, nos 3731, 3681, 3968.
5 See the papers of Major R. C. Ozanne, archives of the IWM, no. 91/23/1, entry for 21 September 1915. See also William G. MacPherson, in The Official History of the Medical Services of the Great War, vol. 1, General History, p. 150, cited in R. L. Atenstaedt, ‘The Organisation of the RAMC during the Great War’, in Journal of the RAMC, vol. 152, 2006, pp. 81–5.
6 See R. H. Haigh and Philip Wilson Turner (eds), The Long Carry: The Journal of Stretcher Bearer Frank Dunham (Pergamon, 1976), p. 140.
7 See Bernard Adams, Nothing of Importance (reprint; Donovan Press, 1988), p. 270. Bernard Adams served as an officer with the 12th and 1st Battalions of the Royal Welch Fusiliers during the First World War. The book was written as a description of his life as an infantryman whilst convalescing from wounds received during the battle of the Somme in 1916. He rejoined the 1st Battalion in February 1917 and was killed within three weeks.
8 Ibid., p. 272.
9 Supplement to the London Gazette, 11 March 1916, p. 2718.
10 See Siegfried Sassoon, Memoirs of an Infantry Officer (Faber & Faber, 1937), p. 330.
11 Ibid., pp. 376–7.
12 J. S. G. Blair, A Centenary History of the Royal Army Medical Corps (Lynx Publications, 2001), p. 148.
13 On the ‘Year of Battles’, see John Keegan, The First World War (Pimlico, 1999), pp. 277–331.
14 See the papers of Captain F. G. Chandler, archives of the IWM, 19 July 1916.
15 From 1917 onwards, some CCSs retained the ‘so-called shell shock cases … in [wards] especially organised for their treatment in as advanced a position as possible’. The Official History of the Medical Services of the Great War, vol. 3, General History, p. 119.
16 Ferret-keeping was enormously popular at the time. See the Rev. J. W. H. Heslop, ‘How to make a ferret court’, in The Boy’s Own Paper, 1916, p. 761.
17 ‘The Whole Duty of an RAMC Officer’, Journal of the RAMC, vol. 32, 1916, p. 289.
18 See Isaac Rosenberg, ‘Dead Man’s Dump’, in Andrew Motion (ed.), First World War Poems (Faber and Faber, 2003).
19 See Basil Peacock, The Royal Northumberland Fusiliers (Leo Cooper, 1970), and John Keegan, The First World War (Pimlico, 1999), pp. 318–19.
20 C. K. McKerrow, ‘Pyrexias of Doubtful Origin in an Infantry Battalion on Active Service’, Journal of the RAMC, vol. 30, 1918, pp. 175–85.
Haydn Reynolds McKay: The Main Dressing Station of a Field Ambulance, Templeux-la-Fosse, 18th September, 1918; Epehy: In a Sunken Roadway near the Regimental Aid Post of the 7th Battalion Royal Sussex Regiment; A British Red Cross Society and Order of St John of Jerusalem Officer in France; An Advanced Dressing Station for the 36th Field Ambulance at Lieramont; and An Advanced Dressing Station, France: Cars supplied by the British Red Cross.
Apart from shell shock, surgery is the most thoroughly researched subject in the medical history of the Great War. In the Official Histories, produced from 1922 onwards, surgery has two volumes to itself. Leading surgeons such as Harold Gillies wrote sections on their individual disciplines – in Gillies’s case, facial repair – summarising their work and achievements during the war. These sections aimed to educate civilian specialists, although no hospital department was likely to encounter injuries of similar severity or scale. The volumes also dealt with areas related to surgery, such as blood transfusions, anaesthesia (not yet anaesthesiology) and infections, and included long sections on the new weaponry and its wounding effects. There was a well-intentioned section that examined wounding by modern artillery (‘The Results of Projectile Action’) but for today’s reader the effect is undermined by the author’s use of examples from Big Game hunting to demonstrate wounding power.
Modern historians have also paid close attention to surgery in the Great War and have put it into the broader context of industrial society. Works such as Roger Cooter’s Surgery and Society in Peace and War (Palgrave Macmillan, 1993) compare the demands made on orthopaedic surgeons by the Great War with those of the industrial injuries generated by the building of the Manchester Ship Canal. In both cases surgeons used their much-increased caseloads to generate recognition for their specialisation and to consolidate their status. In a similar vein, Joel Howell, ‘Soldier’s Heart: The Redefinition of Heart Disease and Speciality Formation in Early Twentieth-Century Great Britain’, in Roger Cooter, Mark Harrison and Steve Sturdy (eds), War, Medicine and Modernity (Sutton, 1998), focuses on heart disease in Great War soldiers and its influence on the development of cardiology. The focus of these works is broad but primarily about surgeons and dedicated units based well to the rear or in Britain. Thus the war is seen as a contributing factor in the overall development of civilian medical practice, creating the modern disciplines we recognise today.
This chapter takes a different perspective on the surgical achievements during the Great War. Even if he was a specialist in civilian life, a surgeon at the Western Front was expected to perform all types of operations, usually on an emergency basis. During battle the surgeons at the CCSs worked in theatre all day and all night, performing everything from abdominal procedures, bone-setting and amputations to arterial repair, debridement and even some basic brain surgery. This was not the frenzied hacking practised in the surgical tents in the American Civil War; it was modern surgery, with antiseptic procedures, anaesthetics and post-operative care. This chapter therefore describes an unconventional yet crucial medical breakthrough: the discovery that surgery could be done in a forward medical unit close to the actual place of wounding, and that by doing so survival rates would be radically improved. Wounded shifts the attention back onto developments in military, rather than civilian medicine. What was created at the Western Front was nothing less than a new model for military surgery and military medical care.
The chapter uses three primary sources. Henry Souttar’s A Surgeon in Belgium (Edward Arnold, 1915) is one of the few memoirs to describe in detail the setting up of a forward surgical facility in the early months of the war. By the time Norman Pritchard wrote his diaries (IWM, no. 03/17/1) the CCS was established as the centrepiece of medical provision in France. John Hayward (www.firstworldwar.com/diaries/casualtyclearingstation.htm, accessed 27 October 2010) was a CCS surgeon in the last summer of the war, when the military medical facilities were at a high point in terms of numbers, skill and range of provision.
1 Hartnell Beavis and Henry Souttar, ‘A Field Hospital in Belgium’, British Medical Journal, 9 January 1915, p. 66.
2 Sir Henry Sessions Souttar features in the Oxford Dictionary of National Biography (Oxford University Press, 2004), entry no. 36303, written by Tom Treasure.
3 Sarah MacNaughtan, My War Experiences in Two Continents, ch. 11: ‘We Go to Furnes’ (BiblioBazaar reprint, 2009).
4 Beavis and Souttar, ‘A Field Hospital in Belgium’, pp. 64–6.
5 The nurse who couldn’t stand the pressure at No. 1 Belgian Field was May Sinclair. Her despair permeates her memoir of the place, A Journal of Impressions in Belgium (Hutchinson, 1915). She described the hospital as ‘a world apart, a world of insufferable space and agonizing time, ruled over by some inhuman mathematics and given over to pre-transcendent pain’ (p. 46).
6 See Baroness de T’Serclaes, Flanders and Other Fields (Harrap, 1964), p. 59.
7 For details of these techniques developed by nurses in all the CCSs, see Christine E. Hallett, Containing Trauma: Nursing Work in the First World War (Manchester University Press, 2009).
8 A War Nurse’s Diary (Macmillan, 1918), p. 63.
9 Elizabeth, Queen of the Belgians was profoundly interested in medicine – her German father preferring the profession of ophthalmologist to his ducal birthright. The queen drove provision for refugee Belgian servicemen almost single-handedly, raising funds, supervising building works and even nursing when necessary. See A. Nicholas, Elizabeth Queen of the Belgians: Her Life and Times (New Horizon, 1982), and Marie José, Albert et Élisabeth de Belgique: Mes Parents (Plon, 1971).
10 Both French and British medical radiology units had been dependent on German X-ray bulbs before the war, so it took some time for suppliers and manufacturers to catch up. See Medicine and Surgery in the Great War, catalogue of the exhibition held at the Wellcome Institute, 1968, and A War Nurse’s Diary, pp. 112, 113. For details of Curie’s work at the front, see Eve Curie, Madame Curie: A Biography (Da Capo Press, 2001), pp. 291–302.
11 Although Curie didn’t mind the tent, she was glad to be out of it. After Furnes, she went to a hospital in Poperinghe, from where she wrote to her daughter Irène that she had ‘a nice room and they gave me a fire in a stove at the side. I’m better off than at Furnes.’ Marie Curie to Irène Curie, from Correspondance (Les Editeurs français réunis, 1974), p. 158.
12 The story of Curie and her travelling radiographers is also covered in a recent work of fiction, Jeb Rubenfeld’s The Death Instinct (Headline Review, 2011).
13 On the development of the CCS between 1915 and 1917, see Mark Harrison, The Medical War: British Military Medicine in the First World War (Oxford University Press, 2010), pp. 34–8.
14 See ‘Treatment of Wounds in RAPs and FAs of the Second Army’, regulations from the ADMS, issued 6 June 1917: ‘Amputations should only be performed for completely shattered limbs’, section 5, p. 1 (author’s collection).
15 William G. MacPherson, Official History of the Medical Services of the Great War, vol. 3, General History, p. 177. Amputation rates in civilian practice had fallen significantly as conservative surgery became more effective. The volume and severity of femoral fractures caused by bullet and shell fragments was a challenge to this new methodology. Most surgeons amputated when confronted with a femoral fracture in the hospitals in France, which was felt to be the only solution to avoid death from gas gangrene or blood loss. In 1917 more effective splinting of compound fractures was introduced and amputation rates fell dramatically in the last year of the war. Stretcher bearers were trained to use the new Thomas Splint, which was simple and effective. In particular, the splint could be applied over uniform rags, so was quick and easy to use even under fire. Ironically, by 1918 many of the splints being used by bearer teams and MOs on the Western Front had been manufactured in occupational-health rehabilitation centres by disabled or amputee soldiers retraining for civilian life. See P. M. Robinson and M. J. O’Meara, ‘The Thomas Splint: Its Origins and Use in Trauma’, Journal of Bone and Joint Surgery, April 2009, vol. 91-B, pp. 540–54, and John Kirkup, A History of Limb Amputation (Springer, 2007), p. 92. For details of the occupational therapy that manufactured splints and other medical items, see Jeffrey S. Reznick, Healing the Nation: Soldiers and the Culture of Caregiving in Britain During the Great War (Manchester University Press, 2004), pp. 116–37.
16 See the papers of Captain Fred Chandler, archives of the IWM, 07/21/1, correspondence of 7 November 1917.
17 See Georges Duhamel, The New Book of Martyrs (William Heinemann, 1918) p. 58. For details of both the technical difficulties of early anaesthetics and an unusual female anaesthetist, see Hanine Fourie, ‘The Untold Story of a Great War Anaesthetist: Lady Helen D’Abernon’, unpublished research essay, May 2009, available in the Imperial College Library. See also Helen Venetia Vincent D’Abernon, ‘War Case-book, 1915–1918’, archives of the IWM, 92/22/1.
18 For the immediate results of the war experience on the surgical profession, see George H. Makins, ‘Introductory’, British Journal of Surgery (special issue), 1918, vol. VI, no. 21, pp. 1–11.
John Hodgson Lobley, The Operating Theatre, First Casualty Clearing Station; Christopher Nevinson, The Doctor and Night Arrival; John Singer Sargent, Gassed; Henry Tonks, An Advanced Dressing Station in France, An Underground Casualty Clearing Station, Arras and A Saline Infusion.
Wilfred Owen, ‘Conscious’; Vera Britten, ‘The German Ward’.
Bert Payne’s testimony was given directly to the IWM’s sound archive (no. 9894) and has been supplemented by information from his family. The main source for the material on the first day of the battle of the Somme is Martin Middlebrook’s The First Day of the Somme (Penguin, 2006). Detail on the nature and flavour of octanes and caffeine was supplied by students of the Imperial College Chemistry Department.
Henry Tonks’s collection of pastel drawings of facial casualties; John Hodgson Lobley’s Wounded Passing through Snow Hill Railway Station, Birmingham.
The history of nurses and nursing in the Great War, like that of surgeons and surgery, is a field that has generated interest and research continually since the end of the war. Historical studies of nursing in the twentieth century have focused on the influence of war on the development and status of the profession. These works also emphasise the broader social context of wartime nursing: suffragism, the campaigns for women’s rights and the changing expectations of the public role of women in the period. Some studies have looked at femininity in the context of industrialised warfare. In addition to these academic studies, nurses wrote some of the finest memoirs of the Great War. Vera Britten’s Testament of Youth is the most famous, but less well-known memoirs by Olive Dent and K. E. Luard also provide unique insight into life and service at the front and have been used in Wounded.
In the twenty-first century, historians have begun to take a different path by looking closely at the technical aspects of wartime nursing. Christine Hallett’s Containing Trauma is an entirely new representation of the work of nurses at the front and draws out subtle, essential detail about the precise nature of their achievements and skills. Hallett describes the complexity of nursing care: how technical medical knowledge was fused with attention to the whole patient who was recovering or beyond recovery. Moreover, she judges these skills in their own right, not as adjuncts to surgery, and reveals how nursing skills and experience facilitated the development of the CCS as a clinically capable forward medical facility. Hallett’s emphasis on the expertise of nurses at the CCSs in France matches the focus of Wounded.
Nurses’ memoirs are some of the most valuable testimonies of all the medical staff on the Western Front. Not only do they describe their work with the wounded, but they provide some of the most detailed descriptions of the CCSs themselves and what it was like to live and work immersed in the war. CCSs had no facilities to produce notes and reports or to store archive material, so there is very little information about individual units in the official records. Nurses’ memoirs fill in many of the gaps. We learn, for example, that most CCSs had a rich and varied social life that included concerts and fancy-dress competitions. The nurses’ frankness about how the war engulfed and threatened to overwhelm them, however, reveals the limits of even the most advanced military medical system.
In addition, these memoirs often hint at the psychological trauma suffered by medical personnel serving in the Great War. Nurses in particular needed periods of rest away from their post, which was provided by Queen Mary’s Army Auxiliary Corps Home for Convalescents in France and the Edith Cavell Homes in Britain. Some nurses recovering there had been so badly affected by their experiences that they never returned to the front. The toll that the war took on all ranks of medical personnel at the Western Front could be severe, but to date there is no body of research comparable to that on shell shock which investigates its consequences. Much more work is needed, and nurses’ memoirs would be an excellent place to start.
There are three primary sources for this section, all from the archives of the Imperial War Museum. Sister Jentie Patterson (ref. 90/10/1) describes how a CCS that dispensed hot drinks and fresh dressings to casualties was converted into a fully fledged forward hospital, while Winifred Kenyon (ref. 84/24/1) provides great insight into daily life at one of the new expert CCSs. Nurse Elizabeth Boon’s contribution is her letter to the family of Private Simpson (ref. Misc. 262/5562), which draws together many of the themes of this chapter about the unique contribution made by nurses to the medical care at the Western Front.
1 See H. S. Souttar, A Surgeon in Belgium (Edward Arnold, 1915) p. 18.
2 See the papers of No. 61 Casualty Clearing Station, archives of the IWM, Misc 10, item 209, 17/7/18.
3 Olive Dent, A VAD Nurse in France (Grant Richards, 1917), p. 263.
4 Ibid., p. 61.
5 K. E. Luard, Unknown Warrior (Chatto & Windus, 1930) p. 8.
6 See Bernard Adams, Nothing of Importance (reprint; Donovan Press, 1988).
7 Dent, A VAD Nurse in France, p. 47.
8 Ibid., p. 279.
9 Lady Helen D’Abernon, Red Cross and Berlin Embassy (John Murray, 1946), p. 32.
10 Dent, A VAD Nurse in France, p. 140.
11 Ibid., p. 329.
12 There were also convalescent homes in Britain for nurses who broke under the strain. The first Edith Cavell Home of Rest for Nurses was opened in November 1917, with Elizabeth, Queen of the Belgians as patron. Its aim was ‘the establishment of Homes of temporary rest for practising trained women, nurses and practitioners, who are or who have been employed in civil or military hospitals or in connection with the war or in any other capacity whatever and have become temporarily in need of mental of physical rest’. See Christine E. Hallett, Containing Trauma: Nursing Work in the First World War (Manchester University Press, 2009), p. 215; see also papers relating to The Nation’s Fund for Nurses in the archives of the Wellcome Trust, SA/NFN/C/1.2.
13 Dent, A VAD Nurse in France, p. 333.
14 See Susan Richmond, ‘Little Short of a Miracle’, History Today, July 2006, pp. 12–21.
15 Alexandrina Marsden, Resistance Nurse (Odhams Press, 1961), p. 48.
16 See D’Abernon, Red Cross and Berlin Embassy, p. 27.
17 Dent, A VAD Nurse in France, p. 270.
18 Ibid., p. 313.
19 A War Nurse’s Diary (Macmillan, 1918), p. 109.
20 Dent, A VAD Nurse in France, p. 150.
21 See the papers of F. Davison, archives of the IWM, no. 03/15/1.
22 Luard, Unknown Warrior, p. 68.
23 Dent, A VAD Nurse in France, p. 201.
24 Luard, Unknown Warrior, p. 163.
25 This wasn’t just kindness on the nurses’ part. The system was felt to be so effective that keeping a ward notebook became official RAMC policy: ‘Special care should be taken to safeguard the belongings of dying patients. Messages and wishes should be carefully recorded and a special book kept for this purpose.’ See ‘The Casualty Clearing Station as a Working Unit in the Field’, Journal of the RAMC, vol. 32, 1916, p. 45.
26 Dent, A VAD Nurse in France, p. 284.
John Lavery, Portrait of Nurse Billam and Sister Currier and The Queen Mary Army Auxiliary Corps Convalescent Home, Le Touquet; William Hatherell, Nurse, Wounded Soldier and Child; John Lavery, German Wounded at Etaples; John Hodgson Lobley, The Camp of the 42nd Casualty Clearing Station, Douai; William Hatherall, The Last Message; Martin Edwin, The Second Casualty Clearing Station, Douai.
Anonymous, ‘To Little Sister, No. 16’; Siegfried Sassoon, ‘Died of Wounds’ and ‘The Deathbed’; Wilfred Gibson, ‘Mark Anderson’; Wilfred Owen, ‘The Dead-Beat’.
Orderlies provide further evidence for the high levels of skill and training given to the auxiliary medical trades at the Western Front. Like the stretcher bearers, their history has also faded from the record.
Two testimonies have been selected from the archives of the IWM: those of Alfred Arnold (ref. no. 9691) and Harold Foakes (ref. no. 99/54/1).
1 See the papers of Private Herbert Empson of 2nd/5th Field Ambulance, 180 Infantry Brigade, in the archives of the IWM, 02/12/1.
2 See John Keegan, The First World War (Pimlico, 1999), pp. 350–3, for an account of the battle of Arras and its aftermath.
John Hodgson Lobley, Reception for the Wounded at the First Casualty Clearing Station, Le Chateau, during the British Advance in October 1918.
John Glubb was a prolific writer and his memoirs, produced after his retirement from the Arab Legion, were extremely popular with the public. While he appeared to have suffered little psychological trauma from his experiences in France, he spares no detail in his account of his long and often difficult recovery. Into Battle (Cassell, 1977) covers the period of his injury and treatment; additional details were supplied by Trevor Royle’s biography, Glubb Pasha.
1 Trevor Royle, Glubb Pasha (Little, Brown, 1992), p. 59.
2 Ibid., p. 60.
3 Head injuries were upsetting for everyone in the wards. They were almost always fatal and patients were noisy, incoherent, vomited frequently and had to be subdued with knockout doses of morphine. See John Laffin, Surgeons in the Field (Dent, 1970), p. 225.
4 See Royle, Glubb Pasha, p. 61.
5 Ibid., p. 62.
Wilfred Gibson, ‘In the Ambulance’.
Throughout the twentieth century the history of military chaplaincy was dominated by the issue of denomination. Historians explored the distinctions between Catholic, Anglican and Nonconformist clergy in their attitudes towards the war and the military, and have focused on the differences in their recruitment of battalion padres. In addition, Robert Graves’s Goodbye to All That (Jonathan Cape, 1929) has had a lasting influence on our understanding of chaplaincy during the Great War. In the earliest editions of the book, chaplains across the board come in for criticism, but in later revisions Graves depicts all Anglican chaplains as cowardly fools and all Roman Catholic padres as absurdly brave and inspiring.
In recent years, however, historians have sought to broaden the focus of their research beyond issues of denomination and they have questioned the accuracy of Graves’s characterisations. Drawing on clerical records and both chaplains’ and soldiers’ memoirs, Edward Madigan’s study Faith under Fire: Anglican Clergy and the Great War (Palgrave Macmillan, 2011) shows that bravery and cowardice were ecumenical. Clergymen of all types could be found both on the battlefield and hiding in a tent to the rear; courage was a question of character, not denomination. Moreover, the work of Michael Snape has introduced a new analytical framework to the history of military chaplaincy. In God and the British Soldier (Routledge, 2005) and Clergy under Fire (Boydell Press, 2007), Snape has looked at the state of religion in modern Britain and how different forms of religiosity affected the morale of soldiers. He has also studied in detail the work of the Royal Army Chaplains Department and its educational facilities. Both Madigan and Snape have provided a new and invigorating basis for future work in the field.
This new work emphasises the responsibility that chaplains took for caring for the dead, particularly in ensuring that burials were proper and prompt. There is less focus on the relationships that they had with the world of the wounded. Linda Parker’s The Whole Armour of God (Helion & Company, 2013) contains a chapter on chaplains and doctors but concentrates on the religious context of their work and provides very little medical detail. Wounded, by contrast, focuses on chaplains who worked in medical facilities and engaged closely with both patients and medics in a personal redefinition of their ministry. Catholic monk, Anglican vicar or Nonconformist minister, they all made the same choice: it was at aid posts, CCSs and base hospitals that their presence was most needed.
In common with all the section titles in Wounded, this chapter heading is deliberately simple. It gives only the names of the men whose memoirs have been studied, not their denomination or clerical rank. Here and elsewhere in the book, commitment to the care of the wounded is the primary concern, beyond details of rank, education, professional status or recruitment type. Each chaplain, regardless of his background, was determined to find a place at the Western Front where he could best serve the soldiers. Each found his way to a medical facility, whether it was a front-line aid post, a casualty clearing station or a base hospital to the rear.
Chaplain memoirs are a particularly rich historical source. In addition to their being educated men and used to writing, there were few others who observed the system of medical care in all its forms and details. Chaplains worked everywhere. They could be found in hospital mail rooms, operating theatres or lonely outposts in no-man’s-land. They stayed for long periods in their postings and watched the medical services around them evolving, noting the changes in their diaries. They tell us about laboratories, post-operative wards and medical provision for POWs. They observe how self-sufficient and multi-disciplinary their units became, and how expert their staff. It is a chaplain who tells us of the new mental wards in CCSs, providing evidence for a network of provision for shell shock and other psychological conditions at the front. While the history of shell shock, which dominates so much of the medical history of the war, focuses primarily on treatment in Britain, such facilities in a forward position remain under-researched. Perhaps typically, the chaplain’s description of the mental wards is coloured by his concern that he is failing to give comfort to the patients he finds there. Although many padres felt that they weren’t doing enough, the moral authority that accrued to them among the medical staff in France indicates otherwise.
This chapter draws primarily on personal memoirs. Wilfred Abbott’s story is told in John Linnell’s unpublished memoir of the battle of Neuve Chapelle (private collection). Ernest Crosse’s extensive personal archive is in the Imperial War Museum, where it is much used by curators (ref. 80/22/1). Charles Doudney’s life is accounted for in a biography by his descendants, The Best of Good Fellows (Jonathan Home Publications, 1995). John Murray’s archive is at the IWM (ref. 77/106/1) and additional material on him can be found in the Museum of Army Chaplaincy at Amport House. Cyril Horsley-Smith’s and Montagu Bere’s papers are also in the IWM (96/38/1 and 66/96/1 respectively). John Lane Fox left no personal papers, but his service is recorded in Pat MacGill’s The Great Push (Herbert Jenkins, 1916) and in the memories of his colleagues and relatives. I have also drawn on Owen Spencer Watkins’s With French in France and Flanders (Kelly, 1915). This was one of the first books published by a serving chaplain and is mostly about the RAMC and the stretcher-bearer corps, both of which Spencer Watkins admired greatly. The Crockford’s Clerical Directory (Church House Publishing, annually and online) provided details of the pre- and post-war lives of the chaplains in this chapter.
1 See Journal of the RAMC, vol. 32, 1916 p. 289.
2 Owen Spencer Watkins, With French in France and Flanders (Kelly, 1915), p. 79. See also Michael Snape, Clergy under Fire (Boydell Press, 2008), pp. 190, 204 and 247. Snape also provides details of the organisation and administration of the Army Chaplains Department.
3 See Spencer Watkins, With French in France and Flanders, p. 79.
4 ‘Pending the arrival of a Medical Officer, the Reverend E. Manning will take command of the stretcher bearers, having volunteered to do so’: papers of the Rev. Manning, archives of the IWM, 78/7/1/, Army Book 152, Field Despatch from Hollingsworth to DDHQ, 27 September 1917.
5 See the papers of the Rev. Mellish, archives of the IWM, PP/MCR/269. Padre Mellish won a VC at St Éloi in March 1916. See also Max Arthur’s history and directory, Symbol of Courage: A Complete History of the Victoria Cross (Sidgwick & Jackson, 2004), p. 239.
6 Spencer Watkins, With French in France and Flanders, pp. 47–8, and the papers of the Very Rev. E. Milner-White, archives of the IWM, 96/38/1.
7 Ibid., p. 6, entry for 4 June 1916.
8 Ibid., p. 14.
9 Letter from Mrs Doudney to St Luke’s parish magazine, Bath, May 1915. He was given donations by his parishioners for equipment that he might need in France, including a set of private Communion vessels.
10 St Luke’s parish magazine, September 1908, p. 2.
11 It is perhaps not surprising that Doudney took this view of his service in France. The living at St Luke’s was in the gift of the Simeon Trust, based on the teachings of the Rev. Charles Simeon, a nineteenth-century evangelical. Although Simeon believed that conversion was at the heart of ministry, he espoused a gentler form than many of his peers, and Simeon Trust clergymen emphasised the Christian duty for social action and responsibility for one’s fellow man. See the website of St Luke’s Church, Wellsway, Bath, www.stlukesbath.com, accessed 20 April 2011.
12 See the papers of the Rev. L. L. Jeeves, archives of the IWM, 80/22/1. Jeeves was also mistaken for the doctor at his CCS.
13 See the papers of Canon Rogers, archives of the IWM, 77/107/1, entry for 10 March 1916. See also papers of the Rev. Dr T. H. Davies, archives of the IWM, 03/30/1, entry for 3 December 1916.
14 The papers of the Very Rev. Milner White, archives of the IWM, 96/38/1.
15 St Luke’s parish newsletter, letter from Mrs Doudney, October 1915. She wrote that the vicar was having ‘A nerve-shaking time – frequently up to the firing line – hiding in dug-outs to take funerals’.
16 ‘The Death of Charles Doudney’, obituary in St Luke’s parish magazine, with details from a letter by the officer commanding the 18th Field Ambulance.
17 For the ‘relentless self-criticism’ of some padres, see Edward Madigan’s Faith under Fire: Anglican Army Chaplains and the Great War (Palgrave Macmillan, 2009). Madigan cites examples of chaplains who were ‘painfully aware’ of the limitations of their ministry and their own shortcomings as messengers for Christ, whether they worked in a medical setting or elsewhere at the front. Madigan thinks that one particularly interesting feature of the personal narratives produced by Anglican chaplains during the war was their honesty about the difficulties inherent in their ministry; author’s email exchange with Dr Madigan, 22 August 2011.
18 For details of the work on these new mental wards offering ‘Forward Psychiatry’, see Edgar Jones, Adam Thomas and Stephen Ironside, ‘Shell Shock: an outcome study of a First World War PIE unit’, Psychological Medicine, 2007, vol. 37, pp. 215–23.
19 See ‘Question XXVIII: Of Joy’, in Thomas Aquinas, Aquinas Ethicus: or, the Moral Teaching of St Thomas, vol. 1 (Summa Theologica – Prima Secundae, Secunda Secundae Pt. 1), 1274. I am grateful to Father Timothy Radcliffe for this reference.
20 Papers of Canon F. H. Drinkwater, archives of the IWM, 99/54/1, entry for 29 August 1915: ‘Those brown blankets – they will always remind me of wounds and death.’
21 The papers of Rev. Smithwick, diary entry for 25 September 1916, archives of the IWM, 01/59/1.
22 Papers of Canon F. H. Drinkwater, diary entry for 1 July 1916.
23 See The Official Medical History of the Great War (HMSO, 1924), vol. 3, p. 163.
24 The papers of the Reverend Wilkinson, archives of the IWM, 67/22/1.
25 Another chaplain showed an early insight into the diagnosis of shell shock that was becoming increasingly familiar: ‘I am certain the shell shock was caused not just by the explosion of a shell near by but by the sights and smell and horror of the battlefield in general.’ See the papers of Rev. D. Railton, archives of the IWM, 80/22/1, entry for 24 September 1916.
26 From David Blake, ‘Chaplaincy Training during the First World War’, Journal of the RACD, 2007, vol. 46, pp. 41–2.
27 For details of the ‘pointless’ battle of Loos, see John Keegan, The First World War (Pimlico, 1999), pp. 217–19.
28 Father John Lane Fox to Robin Baird-Smith, private correspondence, 12 April 1969. Father John was eighty-nine years old at the time of writing. In The Great Push (New York: George Doran, 1916) Pat McGill describes his grave-digging: ‘Often at night the sentry on watch can see a dark form between the lines working with a shovel and spade, burying the dead. The bullets whist by, hissing of death and terror; now and then a bomb whirls in the air and bursts loudly … but indifferent to the clamour and tumult, the solitary digger bends over his work burying the dead.’
John Hodgson Lobley, The RAMC in Training, Blackpool: The Church of England Tent and The Church of England Tent, 39th Stationary Hospital, Ascq, September 1919; William Orpen, German Sick: Captured at Messines, in a Canadian Hospital.
Edmund Blunden, ‘Vlamertinghe, Passing the Chateau, July 1917’.
J. H. Plumridge’s Hospital Ships and Ambulance Trains, (Seeley, Service & Co., 1975) is the main secondary source for details of this component of the military medical system. Plumridge describes the facilities on board the trains and how they were continually upgraded as the war went on. By 1917 the medical provision on ambulance trains, which included pharmacies, operating tables and sterilisation units, was comparable to that of CCSs. Treating ambulance trains as medical entities in their own right, rather than simply as links in a chain, would be a valuable approach in future research on the subject.
From the personal testimonies of ambulance-train staff we learn that the authority structure was minimal, with individual members taking a great deal of responsibility for the care of their patients. Unlike the nurses at the CCSs, those on ambulance trains were not able to develop specific technical skills beyond their general nursing training, but their work required considerable adaptation. Ambulance trains were often delayed and the wounded had to be kept calm and, if possible, happy. Staff and patients sat together for hours, and nurses devised ways of alleviating boredom and frustration. Staff came to identify closely with the train and their fellow crew members, and rich social lives developed. It does not appear that the train drivers and engineers were part of this social life, however, and further research would be needed to establish the reasons for this.
Leonard Horner’s memoir is of particular value as it gives us insight into the world of the Friends’ Ambulance Unit, a volunteer group formed by the pacifist Quakers. The Quaker movement’s decision to offer their service of love in wartime is more complicated than it might seem. There were absolutists among them who refused to have anything to do with the war; they sought unconditional exemptions from mass conscription after 1916, and many of them went to prison. But the absolutists were in the minority: most Quakers worked from the very first days of the war to help its victims in Britain. Quaker organisations were among the first (and best organised) to offer aid to destitute refugees and enemy aliens. Later in the war they worked to help their fellow conscientious objectors, who often found themselves and their families in penury as a result of their principles. Other Quakers, such as Leonard Horner, were able to reconcile their pacifism with service at the front itself. Quakers joined non-combat units, such as the despatch riders, and medical services. In the process they saw the very worst of the war, up close and under fire.
Beyond his religious convictions, Horner may also be seen as representing a group of men and women who served in the war, but struggled to reconcile their principles with their work. Both at the front and back in Britain, medics questioned not only the war itself, but the role of medicine in furthering its aims and means. It was not just Quakers who had to make difficult decisions about their role in the war.
This chapter is based on the following primary sources: Miss Bickmore’s ‘Life on an Ambulance Train’ (archives of the IWM, ref. 85/51/1); the personal archive of Nurse Morgan on No. 3 Train (IWM, ref. 06/100/1); the papers of Nurse Margaret Brander (IWM, ref. 05/06/1); and the papers of Leonard Horner (IWM, ref. GM62). The Quaker archives at Friends House in Euston Road, London are well organised and include both an excellent history of the FAU in The Friends’ Ambulance Unit: A Record and a collection of No. 16’s newsletters in A Train Errant. The archives contain many other personal memoirs of FAU members, which are yet to be explored.
1 See the papers of Captain H. E. Meysey-Thompson, archives of the IWM, 92/19/1, entry for 21 September 1917.
2 See Catherine E. Hallett, Containing Trauma: Nursing in the First World War (Manchester University Press, 2009), p. 167.
3 See Captain H. C. Meysey-Thompson, archives of the IWM, 92/19/1.
4 See M. Tatham and J. E. Miles (eds), The Friends’ Ambulance Unit: A Record (Strathmore Press, 1920), p. 149.
5 See John McCanley, ‘A Manx Soldier’s War Diary’, for details of travel on the ambulance trains; McCanley papers in the archives of the IWM, 97/10/1. For McCanley, the journey had been tedious and painful.
6 See J. H. Plumridge, Hospital Ships and Ambulance Trains. (Seeley, Service & Co., 1975).
7 Tatham and Miles, The Friends’ Ambulance Unit, p. 136.
8 See the collection of No. 16’s newsletters in A Train Errant (Simpson & Co, 1919). Newsletters and magazines written in hospitals and medical facilities were not limited to the front: see Jeffrey Reznick’s Healing the Nation: Soldiers and the Culture of Caregiving in Britain during the Great War (Manchester University Press, 2004), pp. 65–98. There was greater censorship of magazines written and produced in hospitals in Britain, but the sense of humour was the same.
John Lavery, The Wounded at Dover; Cecil Lawson, Railway Station, Arras; John Hodgson Lobley, Loading Wounded at Boulogne; Harold Septimus Power, A Red Cross Train, France.
May Wedderburn Cannan, ‘Rouen’; Wilfred Owen, ‘The Send-Off’.
Studies of voluntarism and voluntary aid form a strong new historiographical strand in the history of the Great War. Works such as Jeffrey Reznick’s Healing the Nation describe the range of voluntarist groups and their work with wounded soldiers, both in Britain and behind the front. Similarly, the work of the YMCA is described by Michael Snape in ‘The Back Parts of War: The YMCA Memoirs and Letters of Barclay Baron, 1915 to 1919’, Church of England Record Society, vol. 16, 2009. The YMCA also identified gaps in the evacuation system for the wounded in France. They put up a hut at Poperinghe Station, gave out hot drinks and food, and helped the men to write postcards home. They also installed teams at Le Havre, providing food, water and basic medical attention when the ambulance trains arriving from the Somme abandoned thousands of men on the platforms and docksides.
Sarah MacNaughtan’s work is part of this voluntarist tradition, but with one important distinction. She worked as an individual and was not part of any group, relying on no resources but her own. Such individuals could be found up and down the front, trying to find solutions for problems they had identified. They had certain features in common: they were usually rich enough to pay their own bills, of sufficient social and professional status to contemplate ignoring the authorities, and driven by an absolute commitment to their cause. Numerous such individuals contributed to the medical war. The dental surgeon Charles Valadier worked on Mickey Chater’s facial injuries in a reconstructive unit that he had paid for himself. Elsie Knocker and Marie Chisholm, in their cellar house at Pervyse, ran their own aid post, without interference, until the building was destroyed by enemy shelling. Even so, MacNaughtan’s story seems unique. The military authorities never interfered with her work at the railway station. She was able to take advantage of whatever part of the official military and medical infrastructure suited her: she was allowed to use the Red Cross delivery service to bring the supplies she had paid for across the Channel, even though she was not part of the Red Cross itself. She was not required to report to a male authority figure, in either the military or medical sphere. In short, she was given as much space as she needed and left to get on with it. It was only the failure of her own health that brought her work to an end.
The main source for Sarah MacNaughtan’s work at Furnes Railway Station is her own memoir, My War Experience on Two Continents, which is available online or in printed form from Bibliobazaar. She also has an entry in the Oxford Dictionary of National Biography, by Harriet Blodgett, www.oxforddnb.com/view/article/59332/, accessed 17 August 2007. Her initiative and self-reliance were observed by others working at No. 1 Belgian Field, including Nurse Cora Mayne (archives of the IWM, no. 82/26/1).
Christopher Nevinson, La Patrie.
Joseph Pickard’s testimony is drawn from his sound archive at the IWM (no. 8946). Details on the House of Hardy in the Great War are drawn from James Leighton Hardy’s The House the Hardy Brothers Built (Medlar Press, 2006).
1 A ‘monkey jacket’ was the equivalent of today’s bomber jacket: a short jacket with elasticated cuffs and no collar, usually issued to Navy personnel. Pickard’s would have come from a Red Cross store and was probably second-hand.
The final chapter is drawn entirely from Claire Tisdall’s ‘Memoir of the London Ambulance Column’ (C. E. Tisdall, 1976; archives of the IWM, no. 42 TIS). But for this memoir, the history of the LAC would have faded away entirely, and this absence would have greatly diminished our understanding of the home front. All the Dent family papers were destroyed in the Second World War and there is no mention of them in the Red Cross archive. There is a brief reference in L/Cpl Ward Muir’s Observations of an Orderly at an English War Hospital (Simpkin, Marshall, Hamilton & Kent, 1917) to ‘that indefatigable body, the London Ambulance Column’. Muir’s memoirs are analysed in Jeffrey Reznick’s Healing the Nation, in the chapter ‘Havens for Heroes’.
1 There is some confusion as to the names of Mr and Mrs Dent. Miss Tisdall remembered the husband as Lancelot, but Mr Dent’s school records have him as Lesley. As the archive of the Dent family business was destroyed, it has not been possible to be precise.
2 See The Nation’s Fund for Nurses, archives of the Wellcome Trust, SA/NFN/C.1.2, p. 11.
William Hatherell, The Funeral Service of Edith Cavell at Westminster Abbey, 15 May 1919; Cecil Lawson, Victory Parade; John Hodgson Lobley, Outside Charing Cross Station, July 1916: Casualties from the Battle of the Somme Arriving in London and Charing Cross Station: Detraining Wounded by the British Red Cross Society and the Order of St John.
Wilfred Gibson, ‘Bacchanal’; Robert Graves, ‘Armistice Day’; Ivor Gurney, ‘The Day of Victory’.
1 See Michael Chater, Family Business: A History of Grosvenor Chater, 1690–1977 (Grosvenor Chater & Co., 1977).
2 See the papers of Alfred Chater, archives of the IWM, 87/56/1, including ‘A Harrow Memoir’.
3 See Charles Valadier, ‘A Few Suggestions for the Treatment of Fractured Jaws’, British Journal of Surgery, 1916, vol. IV, no. 13, pp. 64–73.
4 From conversations with the family of Bert Payne, in particular his granddaughter, the artist Sarah Pickstone, who won the 2013 John Moores Prize for painting.
5 Details of all post-war medical careers were sourced from The Medical Register, copies covering the period from 1914 to 1965, consulted in the library of the Royal College of Surgeons.
6 Harold Gillies, The Principles and Art of Plastic Surgery (Butterworth, 1957), p. 23.
7 For details of William Kelsey Fry’s work at Sidcup, see ibid. For Tonks’s friendship with Kelsey Fry, see Joseph Hone, The Life of Henry Tonks (Heinemann, 1939), p. 130: ‘In Kelsey Fry, the dental surgeon, one of Sir Harold’s chief collaborators, Tonks also found a man of kindred tastes. To him he gave a gift of two small but accomplished works; in the first drawing, a piece of five figures, Sir Harold is seen operating, in the second (which is of considerable medical interest) a patient in the sitting position receives a general anaesthetic.’
8 The obituary of William Kelsey Fry in The Lancet, 2 November 1963, p. 954.
9 For the history of the Royal Victoria Hospital at Netley, see Philip Hoare, Spike Island (reissue; Fourth Estate, 2010).
10 Canon Ernest Crosse, sermon at Marlborough College, 25 May 1919, final page of transcript.
11 For details of all post-war ministries, see Crockford’s Clerical Directory. Copy consulted in the Lambeth Palace Library, volumes for the period 1912 to 1970.
12 See The War Letters of General Cyril Pereira to Henrietta Pereira, 1914–16, vol. 1, entries for 4 March–1 October 1916. Both volumes are in the family’s private collection, as is Father John’s chalice.
13 Author’s conversations with Father Timothy Radcliffe and Robin Baird-Smith, and private correspondence between Father John and Robin Baird-Smith, 12 April 1969.