Casualty Clearing Stations During WW1

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.

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(MEDICINE DURING THE FIRST WORLD WAR: CASUALTY CLEARING STATIONS (CO 3151) A panoramic photograph showing wounded British and German soldiers as they await treatment in the sunshine outside a Casualty Clearing Station (CCS) near Duisans, September 1918. On the left, a large tent can be seen and several huts are visible on the right. 

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(MEDICINE DURING THE FIRST WORLD WAR: CASUALTY CLEARING STATIONS (Q 10418) A typical motor ambulance scene. Wounded being delivered to No. 13 Casualty Clearing Station. (The number of Casualty Clearing Stations on the Western Front corresponded with the number of Divisions). 

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(THE OFFICIAL VISITS TO THE WESTERN FRONT, 1914-1918 (Q 978) King George V conversing with officers at a Casualty Clearing Station at Remy, 14th August 1916.)

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(MEDICINE DURING THE FIRST WORLD WAR: CASUALTY CLEARING STATIONS (E (AUS) 4623) A ward of the 2nd Australian Casualty Clearing Station at Steenwerke, November 1917.)

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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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14 thoughts on “Casualty Clearing Stations During WW1

  1. I found it really interesting to learn more about how the wounded were treated during World War I. I confess I don’t know a lot about the subject. From your article, it is clear that it was a big logistical exercise that required meticulous organisation. The dedication of the staff was incredible. I have a relative who was on one of the hospital trains sent back to England (records on FindMyPast). His injury was a cut knee! As you say, even a minor wound could become very serious if it became infected.

    Liked by 1 person

  2. Thank you. I had two great-uncles who died in WW1. One was killed in action, but the other died of wounds. He is buried in Etaples Military Cemetery near a large field hospital, and he died about three weeks after he received shrapnel injuries. He would have been through a casualty clearing station etc such as you describe.

    Liked by 1 person

    1. Thanks Margaret for sharing with me the stories about your great uncles. It must have been a horrendous time for those on the front line but I always think about the horrors that those treating the sick and wounded must have witnessed, unthinkable really.

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  3. I volunteer with the British Isles Family History Society of Greater Ottawa, a Canadian family history society. I would like to share a project that a group of volunteers have been working called No 1 CCCS. BIFHSGO volunteers have prepared biographies for 65% of the soldiers, indicated on the listing. Information from the No. 1 CCCS records was supplemented with other publicly available information. In some instances, volunteers have been able to connect with family members, who may have been able to provide more personal information and family pictures. There are over 400 biographies of Canadian soldiers available for viewing. You can find the list here https://bifhsgo.ca/cstm_cdnCasClrStn.php

    Thank you sharing this part of history.

    Liked by 1 person

    1. Hi Andrea thank you so much for sharing such a wonderful resource! This looks to be an incredible amount of work. If you have no objections can I write a short blog and share this on my site? It would be a great resource to publicise and share

      Liked by 1 person

      1. Hi Paul,

        Thank you for your reply. I love your blog, by the way, I am a faithful follower.

        The volunteer who is in charge of the project would be very happy to have you feature the No 1 CCCS, she would like me to let you know the following.

        The only little concern is that we need to make sure the details are correct. There are things like the fact that the diaries don’t cover the whole of the war and, in the diary that we have, there are missing dates. I don’t want people to think that we have information on all who died at No. 1 CCCS. Also the information provided varies from chaplain to chaplain.

        If you would like to get in touch with one of the volunteers for more information you can send an email to webmanager@bifhsgo.ca

        Thank you for all the work you do in the genealogy community, blogs and Twitter have been a great resource and time filler in these crazy times. Still in strict lockdown here in Ottawa so it is always lovely to have genealogy stories to share.

        Take care, stay well. Andrea

        Liked by 1 person

      2. Thank you so much for your kind words Andrea, it’s really nice to hear that people enjoy my blogs and what I write, I really appreciate that. I am pleased to hear that you are happy for me to include your volunteer project in one of my blogs. Of course we need to get the content right and explain clearly what’s available. I will send an email to one of the volunteers and we can go from there. Thanks again for your agreement and support with this and thanks for such a lovely response about my blogs, Take Care, stay safe Paul.

        Like

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