At the outbreak of WW1, there was an ongoing debate about the best way to treat casualties from the front line. Opinion was divided, should you treat the casualty as close to the front line as possible, getting the wounded and injured men to surgery in the fastest possible time, whilst accepting that the operating conditions and facilities might not be the same as you would find at a Hospital; or are you better having the operating theatres and facilities as far away as possible from the front line, but with the best treatment available at that time and accepting that the wounded would take longer to arrive.
Field Marshal Sir Douglas Haig decided that it would save more lives if Soldiers were treated as near to the front as possible and it was for this reason that there was a large increase in the number of Casualty Clearing Stations. By the end of the war, there were well over 50 Casualty Clearing Stations established, sadly over time, these would be flanked by Cemeteries established to bury the fallen men from the Western Front.
A Casualty Clearing Station (referred to as CCS) was almost like a small village and mobile hospital combined and formed part of a chain of stations designed to get medical treatment to those that needed it the most, in the quickest possible time. They covered a large area, up to one square mile and consisted of huts, stores, semi-permanent buildings and tents. They were generally close to railway lines, for obvious reasons, to help facilitate the removal of casualties to and from the front line or to and from a Hospital.
A CCS was commanded by a Senior ranking Army officer, typically a Lieutenant Colonel from the Royal Army Medical Corp, serving under him would be anything up to 12 senior medical officers, typically Majors that had specialist surgical skills. There would be several chaplains covering different religions, plus somewhere in the region of another 100 soldiers of different ranks including NCO’s, Warrant Officers, Sergeants and Privates. This was also the most advanced point that a female Nurse would be allowed. A CCS could have on average 50 beds with room for a further 150 stretchers and could treat around 200 wounded and sick Soldiers at a time.
Some of the CCS specialised in the treatment of specific types of injuries, for example, shrapnel, but most covered anything and everything that was thrown at them. The facilities that would be typically available would be X-Rays, Blood transfusions, dressing of wounds, theatres that included amputations and much more. Despite what you might think, the survival rate was high, but obviously, there were still a large number of the injured and wounded that never made it, hence why you typically find cemeteries located close by. If a wounded Soldier made it back to the CCS the most likely cause of death would be an infection. With no antibiotics back then and despite the best efforts to clean and re-dress wounds, once infection took hold in many cases that signalled that the war was over for that particular Soldier. Sadly sometimes the least significant wounds could still result in infection and death.
Diseases such as mumps, dysentery, typhus, and cholera were very common and the occurrence of such illnesses was exacerbated by poor sanitation in the trenches. Many soldiers became victims of trench foot, caused by prolonged exposure to wet and unsanitary conditions. Their feet would become numb, turn red and swell, often developing blisters and open sores. If left untreated trench foot usually resulted in gangrene, which required amputation. In an attempt to minimise trench foot soldiers were paired together, each soldier responsible for his partner’s feet, ensuring that wet socks were removed at the end of each day and dried.
Respiratory diseases such as influenza, tuberculosis, pleurisy and pneumonia were rife, as were scabies, lice and other parasites. Body lice caused trench fever, resulting in headaches, aching muscles, skin sores and a high fever.
For a Soldier to arrive at a CCS, he would have already been through a series of dressing stations where immediate wounds would be assessed and patched up. It was during WW1 that the first attempts at Triage were carried out whereby Soldiers injuries were immediately assessed in the field and those that had a realistic chance of survival were given a priority and moved first.
Before arriving at a CCS, a Soldier would have been given initial emergency first aid treatment and assessment at a Regimental Aid Post (RAP) and these were located as close to the front line as possible, typically 20-30 ft behind the front line. This could be either a dugout, old shell hole or communication trench and the priority was preserving life and preventing shock. Cold, hungry, wet and barely alive from horrific injuries, the physical and mental scars for both the patients and those tending to the sick and injured would stay with these men for life. It’s hard to comprehend what this must have been like, the horrors seen on a daily basis were enough to break some men.
Every battalion would have a Regimental Medical Officer (RMO) who would be assisted by a number of stretcher bearers whose responsibility it would be to set up the Regimental Aid Post. This RAP was designed to give first and immediate aid only and had no facility to hold any patients, it was from here that a casualty was either sent for further treatment at the Advanced Dressing Station (ADS) or was patched up and sent back to the front line. Because the casualties numbers from the Great War were so large, interim posts known as Collecting Posts and Relay Posts were required to avoid a backlog and build-up of casualties. The casualties could be moved between these various positions via several different means, but the thought of carrying a stretcher for several mils across muddy shell-shocked ground doesn’t bear thinking about. Transportation included motor vehicles, horses, carriages and of course physically carrying a wounded Soldier by stretcher. For obvious reasons, stretcher bearers suffered extremely high casualty rates and the Royal Army Medical Corp is the only unit within the British Army to have two Soldiers receive double Victoria Crosses.
After treatment at the CCS, a Soldier was either sent back to the front line or sent to a Military Hospital for further treatment. The Military Hospital was further away from the main front line in a safer location and was typically a larger building in the Town, a Hotel for example that had been commandeered for use as a Hospital.
The key part between the main hospital, CSS ADS and RAP was the transportation between these various locations and these transport networks, whether road or rail, were vital in helping to save as many lives as possible.
The full horrors of war would have been a part of every day life for those that served in the various rolls within the RAMC.
The following images of WW1 casualty Clearing Stations are supplied courtesy of the Imperial War Museum.
I hope this gives you some insight into the role of a Casualty Clearing Station and the associated dressing stations that ferried the sick, dying and wounded back from the frontline. Without these men receiving immediate first aid treatment, many more soldiers would never have survived. Many advances in the field of medical science were first pioneered during WW1 and some of those techniques are still principally used today.
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