The number of casualties during the First World War was unprecedented. Firstly there was the vast size of the armies – 10 million soldiers for the British Empire army alone – and secondly new types of weapons were causing mass and horrific injuries. The estimated wounding rate during the Great War was 50% for the French, 20% for the British (including 40% for the Australians) and 40% for the Germans. Some estimates put the total number of wounded during the First World War as 20 million! Add to this sickness and illness brought on by the harsh conditions in the trenches, the influenza epidemic, psychological damage, then the number of men requiring medical treatment was huge. The medical facilities required to treat the sick and wounded during the Great War therefore needed to be on a massive scale, and the process for treatment well defined and executed.
The medical services for the British Army in the First World War were provided by the Royal Army Medical Corps, with its base at Queen Alexandria’s Hospital in London. The RAMC was first set-up during the Boer War at the end of the 1890’s i.e. not a long preparation before the outbreak of the Great War. Around the same time in 1902 saw the formation of the Australian Army Medical Corps which in turn established the Australian Army Nursing Service Reserve. Approximately 2,300 Australian nurses (Australian Nurses in WW1) served in the First World War, most within the AANS with an additional 130 as part of the Queen Alexandria Imperial Military Nursing Service.
The chance of survival often depended upon how quickly the wound was treated, therefore the first point of medical treatment would be at the Regimental Aid Post situated in a dug-out or communication trench or even shell hole close to the front. The wounded would have preliminary first aid applied by the Medical Officer or stretcher bearers with a view to either patching up to go back into the line or for sending to the Advanced Dressing Station or Field Ambulance situated some 400 yards behind the line in tents or preferably in buildings. From the Field Ambulance (unit, not vehicle) those that required further treatment would be sent to the Casualty Clearing Stations situated far enough away from the front line and close to roads or railway stations to facilitate the transportation further to the rear. For non-battle injuries, minor battle injuries, exhaustion, and shell shock casualties were also sent to Rest Stations.
It was at the CCS’s where the first point of surgery could be performed, but the role of the CCS was as it states in its name, i.e. to facilitate the movement of the wounded from the battlefield to the hospitals. They had to be prepared to move at very short notice too, in case of a pending attack or to support an advance. Within the British Army it is estimated that there were over 70 CCS’s supporting the British sector including three which belonged to the Australian Army Medical Services. From the CCS the wounded would be transported to either a Stationary Hospital – although despite the name they could be moved – situated usually in a hospital in a town, or a General Hospital near a base such as Etaples or Le Havre and close to transportation links. Again the 70 plus General and Stationary Hospitals were often just temporary stays for the wounded who if needing specialist work or longer stays of treatment, or for the badly wounded being readied for discharge, would then be transported by railway to a nearby port then across the Channel by hospital ship and to England and one of the many hospitals waiting there.
The Australian Army Medical Corps in France
With the transfer of the first two divisions of the Australian Imperial Force from Egypt to France in March 1916, the 1st Australian General Hospital was also despatched to Europe, with its patients transferred to one of the Auxiliary Hospitals in Cairo. The 1st AGH departed Alexandria on 29th March and disembarked at Marseille on the 5th April before heading to Rouen. So began the formation of the Australian Army Medical Corps within Europe where it would remain, working within the structure of the British RAMC, until the end of the war.
Supporting the Battalion and Divisional medical staff who were at the forward positions in the RAP’s and Field Ambulances, the AAMC were primarily distributed in three Australian Casualty Clearing Station’s and three Australian General Hospital’s as described below.
No.1 Australian Casualty Clearing Station
With the Australian Imperial Force first assigned to the ‘nursey’ sector in the vicinity of Armentieres in French Flanders, No.1 CCS opened in May 1916 at Estaires within the command of the British Second Army. No.1 CCS opened with a nursing staff of 7, drawn from the staff of No.1 Australian General Hospital that had just arrived from Egypt. In May 1917, No.1 CCS moved slightly further north to Bailleul, where it had a busy time during the battle for Messines Ridge, and in July it moved again to Outtersteene, a site near the major railhead at Hazebrouck. Here the work was intense during the mustard gas attacks in the Armentieres sector. The CCS itself came under shell fire and on 26th September, a shell fell at the back of the Officers’ ward, but fortunately did not explode. The patients were evacuated and the nurses sent to No.2 CCS for the afternoon, but returned later. After this, a concrete dug-out was built in the nurse’s compound.
On 18th March 1918, No.1 CCS came under shell fire during the German Spring Offensive, and the heavy work continued from the first days of the Allied retreat until 28th March, when a removal was ordered owing to an expected enemy attack. The huts and tents were taken down under shelling and re-erected on a site further back Hondeghem. For several days the work was carried out at Hondeghem under great difficulties owing to rain, mud and the seriousness of the situation, until on the 12th April orders were again received to evacuate, as another enemy attack was expected. The nursing staff were transported in motor buses to No.10 Stationary Hospital (where they experienced an air-raid upon their arrival) and remained there until 17th April, when No.1 CCS opened up at Blendeques, a few miles out of St. Omer, with the nurses billeted in nearby houses.
During the summer of 1918 and with the war turning in the Allies favour No.1 CCS received casualties from the AIF 1st Division raids at Merris and Meteren. Working alongside No.2 CCS they dealt with some 8,000 casualties during June and July. At the beginning of September orders were received to move back to Hondeghem to support the advance of the British Fifth Army, and then again to the south of St.Omer at the St Venant Lunatic Asylum. With the fall of Lille at the end of October No.1 CCS moved again to Fretin, to Turnai and then the Convent School at Hal until March 1919.
No. 2 Australian Casualty Clearing Station
No.2 CCS worked in close conjunction with No.1 CCS supporting the British Second Army. Located at the rail-head at Trois Arbres within the town of Steenwerck in French Flanders and extremely close to the front in the Armentieres sector, it was based here from 29th June 1916 until the middle of March 1918 when it was forced to withdraw. No.2 CCS had a baptism of fire for the AAMC by taking in the wounded from the disastrous attack by the 5th Division at Fromelles. On the 20th July 1916, 2,357 patients had been evacuated through No.2 CCS and by the following day 3,984 had been cleared.
With the Allied offensive at Messines during the summer of 1917 the workload became heavier, and additional staff was sent up from No.2 Australian General Hospital, increasing the Nursing Staff to 14. In July, the Sister-in-Charge wrote that they had 3 operating tables in use throughout the day, and usually two at night. During July and August almost 2,000 operations were performed in this unit alone. It was in July that the No.2 CCS was bombed, and the four Sisters were awarded the Military Medal. Two patients and two orderlies were killed and many of the men in the ward were wounded. At this period also the CCS received many patients from the mustard gas attacks. The Sister-in-Charge wrote “Mustard oil shells are being used by the enemy, in consequence of which we receive many patients with burns therefrom, the eyes specially being much inflamed. At times, large blisters form on the body”. In September the CCS was under shell fire several times and once a large piece of shell pierced the roof of the theatre, and bent the operating table, but fortunately no one was operating at the time. Night bombing raids were also quite frequent. A bomb-proof shelter was built for the Sisters who slept there on moonlight nights. The heavy work continued up to the end of the year, and a great deal of night work was done, it being quite a usual thing for 2 or 3 surgical teams to work through the night.
On 11th March 1918 and in preparation for the German Spring Offensive hostile shelling was closer than usual, and orders were given for the unit to pack up in preparation for a move. All the patients were evacuated and the Nursing Staff left in motor ambulances for No.10 Stationary Hospital. On the 5th April the CCS was ordered to a new location at Hazebrouck and became operational on the 9th receiving over a 1,000 casualties but within three days orders were given to move again due to the German advance. Roads were very busy with military traffic and refugees heading west, but on 17th April No.2 CCS re-opened at Blendeques. As with No.1 CCS, the 2nd followed the advance of the British Fifth Army commencing 2nd September to Hondeghem, then to St.Venant,Nouveau-Monde, Tournai and finally Ath until the end of February 1919.
No.3 Australian Casualty Clearing Station
No.3 CCS was formed on 17th March 1916 from personnel of the 10th Australian Field Ambulance. The unit sailed from Port Melbourne on the S.S.Medic on 20th May 1916. After further training and provisioning in England, they reached Le Havre on 26th September 1916 where they spent two days in a rest camp, then left for Rouen. After five days in camp at Rouen they entrained for Gezaincourt in the Somme Valley near Doullens where they relieved No. 11 British Casualty Clearing Station. A few days later, seven nursing sisters under the charge of Head Sister Ida O’Dwyer completed the staff, and the CCS opened on 14th October 1916 to receive the first wounded of the newly formed British Fifth Army from Beaumont-Hamel and the Ancre. During this period the weather was terrible and the mud up near the line was so bad that many cases came in for treatment literally covered from head to foot. Sometimes three and four trains per day with loads of from 200 to 400 walking cases were admitted. The Operating Theatre with its three tables was kept active day and night.
The construction of huts began to replace the tents, and with the end of the Somme Offensive in November came winter and the influx of patients suffering from trench foot, rheumatism and pneumonia. On 9th February 1917 No.3 CCS received orders to move to Edgehill (Dernancourt) which was near the Town of Albert. Lorries were provided and the camp was soon ready for the reception of wounded. On the 7th April 1917 orders were received to move forward to Grevillers (photograph above) near Bapaume which had fallen to the Second Australian Division about three weeks before. The size of the camp was gradually extended to cope with the enormous number of wounded which were being received from Lagnicourt and Bullecourt. No.3 British CCS., and later on No.29 British CCS, joined the 3rd ACCS at Grevilliers.
On 21st July 1917 No.3 CCS transferred north with the AIF to Brandhoek which lay near Ypres. Towards the end of August the CCS was shelled out of Brandhoek several casualties being sustained amongst the medical personnel, relocating to the tented facility at Nine Elms close to Poperinghe, temporarily attached to No.10 British CCS while reorganizing. No.3 CCS remained at Poperinghe until April 1918 when they were forced by the German advance of the Spring Offensive to retreat to Esquelbecq some twenty miles further back. For the week prior to departure the German long range guns were dropping shells perilously close to the camp every day. No.3 CCS remained at Esquelbecq until September when it moved to Bandaghem closing up on 18th October 1918, then advancing with the British Second Army to Dadizeele, Oudenarde and finally Euskirchen where it took over from 1 Canadian CCS until 26th Aril 1919.
With the arrival of I Anzac Corps on the Somme in July 1916, the decision was made to establish a Corps Rest Station for minor injuries and exhaustion and so help alleviate the strain placed on the Casualty Clearing Stations from the expected high level of battlefield casualties. The initial rest station was created by the 2nd Field Ambulance in the fine grounds of Chateau Vadencourt (photograph right) near Contay, and then with the arrival of 7th Field Ambulance on the 27th July the Corps Rest Station was formed in a field nearby. Immediately it became evident that many of the men arriving at the rest station were suffering from shell shock, or neurasthenia as it was also known. During the period July 22nd-16th August, excluding 1,112 cases of sickness, 7,183 casualties passed through this unit. During the first five days 376 out of 1,824 from the Australian 1st Division were suffering from shell shock.
Following their withdrawal from the Somme frontline and move north to the quieter Ypres salient, the I Anzac Corps rest station was operated at the Divisional level. On return to the Somme in October 1916 a Corps Rest Station was re-established at Buire-sur-l’Ancre, but was quite unsuited for winter conditions, undrained, bare, and with inadequate facilities for comfort. Over 1,200 men at one time were here treated in small marquees without floorboards, many for the scourge during this time of trench foot. A new site was found at Bellevue Farm to the south east of Albert (location shown in map, left), where under the enthusiastic leadership of Lieut.-Colonel A. H. Moseley, 6th Field Ambulance, a commendable system of rest and relief was achieved. The Corps Rest Station concept died with the Somme campaign, reverting afterwards to Divisional control.
From the end of 1917 onwards and in order to minimise the loss from the Army zone of both non-battle and minor battle casualties, in particular from the effects of gassing, the Casualty Clearing Stations were increasingly exploited. Thus in the winter of 1917-18 both Nos. 1 and 3 ACCS were detailed to form Corps Rest Stations for I and II Anzac Corps respectively.
No.1 Australian General Hospital – Rouen
No.1 AGH with a nursing staff of 117 arrived at Marseille on 5th April 1916, and after a few days waiting for orders, proceeded by rail and arrived at Rouen on April 13th 1916 where the unit remained until after the end of hostilities when it was transferred to Sutton Veny near Warminster in England. Given its key location in the grand scheme of evacuation meant that No.1 AGH was just one of about 15 British hospitals in the town. The tented hospital, with beds at first to treat 750 patients, was located on the racecourse on the site vacated by No.12 Stationary Hospital and opened for the reception of patients from all countries within the British Army on April 29th 1916, some two months before the Somme offensive.
The severe winter of 1916-1917 was extremely tough for the medical staff in this tented environment with a number of the staff suffering from frost-bite. Many of the casualties from the Somme offensive of 1916 passed through Rouen, and later that year numerous cases of trench foot and pneumonia were treated. In mid-October 1917, days following the Broodseinde attack near Ypres, the number of patients treated at No.1 AGH was in excess of 1,000, many of whom were en-route to hospitals in England. In total No.1 AGH admitted 90,298 patients through the war – approximately half sick, half wounded – with an average of almost 3,000 per month.
A number of cemeteries are found in Rouen, but the majority of the dead from the hospitals were buried in the city cemetery of St. Sever which was extended in September 1916 as a result of the Somme campaign. St. Sever Cemetery contains 3,082 Commonwealth burials of the First World War, including 14 men from the 22nd Battalion.
No.2 Australian General Hospital – Wimereux
No.2 AGH arrived at Marseille from Egypt on the Braemar Castle on 1st April 1916 with a nursing staff of 115. Upon arrival they took over the local hospital at Moussot, where they were stationed and ready to treat soldiers with infectious diseases that had been identified on the inspections at sea following the soldiers embarkation from Egypt. The main body of the medical staff left on 29th June for Wimereux near Boulogne leaving a section to carry on at the hospital until 18th August 1916. The first contingent arrived 1st July 1916 (first day of the Somme offensive) on the site of partly completed 5th British Convalescent Depot on the road between Wimereux and Boulogne, which at the time was the most important base port of the B.E.F. and on the direct route of casualties from the Ypres Salient to the channel port. The tented hospital was ready for patients the next day, an in due course would be supplemented by 17 huts.
As with No.1 AGH, the severe winter of 1916-1917 caused hardships for both the medical staff and the patients. Water pipes would frequently freeze and there was a shortage of coal. The first major influx of patients occurred in April 1917 with the British and Canadian offensive at Vimy Ridge. Given its close proximity to the port of Boulogne and associated railway lines, the hospital was frequently bombed. The hospital at Wimereux, which came to specialize in fractures, closed on 7th February 1919, with instruction to return to Australia in March. Three soldiers from the 22nd Battalion are buried in the Boulogne Eastern Cemetery.
No.3 Australian General Hospital – Abbeville
No.3 AGH arrived in France on 27th April 1917 with a nursing staff of 91. They were temporarily accommodated in the Abbeville and Treport areas until the unit, which was opening on a new site at Abbeville to the northwest of Amiens was ready with its huts and tented accommodation to receive them. By the first week in June 1917 the Sisters’ quarters were completed, and the whole staff rejoined.
Abbeville was headquarters of the Commonwealth lines of communication and as a result a number of hospitals were located there including the South African General Hospital and the No.2 British Stationary Hospital. Most of the wounded arrived by train, but some of the more seriously wounded by barge. During its existence No.3 AGH admitted gassed patients and provided initial treatment before sending them to England.
During the last week in March 1918, as a result of the German Spring Offensive, the military situation was considered sufficiently critical to cause all hospitals in the Abbeville area to be reduced to a number of nursing staff sufficient for Casualty Clearing Station duties only. In the first few days of April 60 AANS Sisters were sent by passenger or Ambulance Train to Boulogne, so that by 4th April, the staff was reduced to just 26 trained Nurses, and 2 Red Cross workers. However Ambulance Trains were obliged to continue unloading at Abbeville and the convoys admitted to the Hospitals were very heavy ones, so that it was very shortly found necessary to increase the Staff. As the military situation improved, it was brought back to its full strength, incidentally at the time when gas attacks in the Australian held Amiens sector on the Somme were common. At the end of September 1918 there were over 1,600 patients in the hospital, many suffering from the influenza epidemic of that time. One soldier from the 22nd Battalion, Pte PB James, is buried in the Abbeville cemetery having died of illness after the end of the war in November 1918. No.3 AGH closed for admissions on 16th April 1919, and was instructed to be ready for withdrawal from France by May 20th.
For further information on the hospitals, and accounts from nurses based in France, visit Through These Lines – the published research from an original Australian play based on the letters and diaries of Australian army nurses serving in WWI.