Getting The Wounded Out Of The Trenches

World War 1 saw great advances in the care of the wounded.  Significantly that was probably because there were more wounded rather than slowly dying to  take care of.  That was because transportation advances, specifically the development of automobiles and trucks that could be reliable enough to stand up to military requirements enabled the wounded to get to treatment faster and thus survive.

During the war the system of evacuating the wounded progressed from a hodgepodge of people and vehicles jumping in to get the job done to a well run system of men and vehicles working to get wounded evacuated to the appropriate medical care as soon as possible.  Here’s a schematic of how the system worked for the AEF.  I suspect that the systems for the French Army and the British expeditionary forces were essentially the same from what I’ve seen in pictures.  The British don’t seem to have as many motor vehicles in their evacuation chain as the French and the AEF.  The reasons for that is that the  French and the AEF had the advantage of volunteers who set up the Ambulance corps as outlined below.  I don’t know about the Central powers evacuation organization or the Russians and I imagine that the details were different due to the lack of automotive ambulances.

Click to access British%20Red%20Cross%20transport%20during%20the%20First%20World%20War.pdf

The first step in the evacuation path was the stretcher bearers and medics.

Click to access woundedchapter2.pdf

These men would collect men from assaults or from the trenches and evacuate them to the battalion aid stations in the second line trenched typically. Or directly to a dressing station.  Walking wounded got care at the battalion aid and then walked to the dressing station.

From there the wounded would be evacuated by ambulance or trench railway to the field hospitals. Some videos

British ambulance pics from the British Library.

The Maharaja of Barwani with ambulance cars [Merville, France]. Photographer: H. D. Girdwood.

Casualty arriving at a Field Ambulance [La Gorgue, France]. Photographer: H. D. Girdwood.

Casualty leaving field ambulance for clearing station [La Gorgue, France]. Photographer: H. D. Girdwood.

Casualty leaving field ambulance for clearing station [La Gorgue, France]. Photographer: H. D. Girdwood.

Surprisingly many of the ambulance drivers were women and Americans volunteered long before the US entered the war.  I suspect that the reason for women drivers and the willing acceptance of volunteers was due to the fact that driving was not a universal skill in the early 20th Century, especially in Europe.  In the US, Henry Ford and the Model’s influence was having an effect on creating ever more people familiar with the automobile and able to drive.   The chaos of war and the fact that nobody really knew in 1914 just what the needs of the war and what the potential of the automobile would be didn’t help things in the beginning.  Which leads to this interesting article about how the American Ambulance Service became the primary ambulance service for the French army.

“Who knows?” Piatt Andrew wrote Isabella Stewart Gardner from shipboard on Christmas night of 1914, “we may spend the winter carting the groceries from Paris to Neuilly.” He had volunteered to drive an ambulance for the American Hospital in France, but beyond that his prospects were utterly uncertain. Yet within months he was to organize and direct an ambulance service that would serve virtually the entire French army until after America’s entry into World War I .

“Who knows?” Piatt Andrew wrote Isabella Stewart Gardner from shipboard on Christmas night of 1914, “we may spend the winter carting the groceries from Paris to Neuilly.” He had volunteered to drive an ambulance for the American Hospital in France, but beyond that his prospects were utterly uncertain. Yet within months he was to organize and direct an ambulance service that would serve virtually the entire French army until after America’s entry into World War I

Inevitably the doctors running the American Hospital regarded ambulance work as ancillary to their main purpose. The American ambassador, William Sharp, the consul general, Frank Mason, and other leading members of the American community in Paris sensed that the work could be of immense significance, but there was no agreement as to how it should be organized. Its management had been placed in the hands of a transportation committee of the hospital, chaired by an expatriate engineer named Laurence Benet. He had appointed an executive secretary, who in turn delegated most of the operating decisions to an amateur military historian, appropriately named A. W. Kipling. This gentleman adopted the title “Captain of Automobiles.” All three were ensconced in large groundfloor offices in the main building of the Lycée Pasteur and rarely soiled their hands with axle grease.

Before he could reasonably attempt to do something about this state of affairs, Andrew first had to prove his worth as a driver. “I spend most of my days kneeling in the mud in the freezing rain, practising the business of painter, carpenter, chauffeur and washer in turn,” he noted in his journal. “My section is made up of a fine lot of fellows; two or three were artists in peace time, one an architect in New York; some are students just out of college; some, like Regis Post, are millionaires, some paupers. There is even one ex-Assistant Secretary of the Treasury. We are like les cadets de Gascogne .” After two weeks of bureaucratic delay Andrew’s section was finally sent off to Dunkirk, where he was immediately put to work on the night shift, meeting trainfuls of wounded men and driving them to neighboring hospitals or to the docks, whence hospital ships took them to Boulogne or Brest.

“Five to eight trains arrive sometime during every twenty-four hours,” he wrote, and out of these trains hobble or are carried the grist of the war in our vicinity, from four to six hundred men daily—men with their eyes or heads or chins heavily bandaged, men with their arms or legs in slings, men shot through the shoulder or hips or stomach, men with frozen feet, men weakened by typhoid or pneumonia, men broken down and scarcely able to stand from months of exposure and anxiety in the trenches, men pale and yellow with sickness and unshaven for weeks. The French soldiers wear the long blue coats and red trousers made familiar to us in the pictures by Détaille and de Neuville of the soldiers of 1870, and with their untrimmed beards they seem very like the soldiers of our own Civil War. War has its picturesque sides, but it is a sad business. There are said to be more than six hundred thousand wounded today in the hospitals of France. All over the country, from the Channel to the Mediterranean, schools, colleges, churches, hotels, museums, town halls, and every available sort of building have been made over into hospitals. The doctors tell me that more than seventy thousand wounded and sick have passed through Dunkirk alone since the war began. There are twelve to fifteen thousand here now.

But meeting trainfuls of wounded, though incontestably useful, did not save many lives. The real challenge lay in timely transportation of freshly wounded men from the trenches to the dressing stations, usually located in or near towns close behind the lines. A severely wounded man’s chance for survival generally depended on the speed (and comfort) with which he could be conveyed from a first-aid shelter in the trenches to a station where immediate surgery or other emergency measures could be undertaken. For this reason ambulance work was inherently a transportation problem, not a medical matter. Horse-drawn ambulances in previous wars had traditionally been part and parcel of an army’s medical service, with treatment necessarily administered during the lengthy period the patient was rattling along en route. The French army had instantly grasped that the availability of motor vehicles, with their vastly greater speed and range, made it advisable to break with this tradition by subordinating their ambulance drivers to the transportation service. From the French point of view it was as unreasonable to expect doctors to organize and manage such a service as it was to require transportation experts to undertake surgical work in dressing stations. While this was also immediately obvious to Andrew, it was but dimly perceived, if at all, by those in charge of the service at the American Hospital in Neuilly. Each fighting division of the French army sorely needed a squad of ambulances, well serviced and manned by disciplined drivers, yet American volunteers eager to perform such a function were obliged to putter around in a haphazard collection of jalopies in the rear of the Allied armies.

Piatt Andrew had been driving his Model T ambulance at Dunkirk for nearly two months when Robert Bacon acted to end this impasse. Early in March Andrew was summoned back to Neuilly and offered the position of inspector general of the nascent ambulance service. This was a flossy title, but it carried little weight within the hospital hierarchy. While final authority resided with Bacon, he had to be highly circumspect in wielding it, and the chief surgeon at the hospital, Dr. Edmond Gros, regarded Andrew as little more than an annoyance. The members of the transportation committee, even less enchanted at Bacon’s intervention, were disinclined to surrender management prerogatives without stubborn resistance. “I am to go up and down the land,” Andrew observed, “inspecting and advising and making myself generally obnoxious to our several équipes .”…

More than a half century later Dallas McGrew still vividly recalled those April days in the Vosges, when this tiny group of volunteer drivers astonished the French transport personnel with its discipline and élan. Conveying freshly wounded men from the front throughout the frosty nights and along slippery mountain roads without lights was only part of their accomplishment. For sheer military bravura McGrew remembered how they invariably had their little Ford ambulances punctiliously lined up and polished every morning at six o’clock, radiators and tanks filled, for inspection by a French officer. When this officer appeared, he invariably found the drivers standing at attention next to their cars, one foot placed on the crank protruding from the radiator. At a signal from the section chief the drivers would stamp heavily on the cranks and ten motors would spring to life simultaneously. The French had never seen anything like it. Ecstatic reports went back to Vittel and from there to Chantilly. And the American Field Service was in business.

Andrew’s next problems were equipment and money. The American automobile industry was highly fragmented in those days, and many manufacturers would have been pleased to equip ambulance sections with free samples of their products for advertising purposes. Tempting as it was to accept such offers, Andrew knew that interchangeability of spare parts was vital for his service—to accept a mixed bag of Hupmobiles, Whites, Pierce Arrows, and other makes would be fatal to this requirement. The optimum benefactor for the service was Henry Ford, whose interest Andrew tried repeatedly to enlist. But Ford, as Andrew put it, “had his own peculiar sense of philanthropy,” which left no room for donations to any organization functioning on a battlefield in any capacity whatsoever. Yet his Model T, magnificently durable, well sprung, and uniformly manufactured, was clearly more suitable than any other vehicle for ambulance work. Andrew was thus obliged to acquire Fords at retail prices and modify them into the standard ambulance that proved superior to any other in use on the battlefields of the war.

Meanwhile French military authorities had begun to work closely with Andrew. Together with Doumenc he was able to hammer out an agreement whereby American ambulance units would be attached to line divisions of the French army, and the signing of this agreement at Marshal Joffre’s headquarters in mid-1915 marked the first formal recognition of the ambulance service as a quasi-independent organization. This agreement also brought Andrew a pleasant surprise: When I went to the automobile bureau in Paris from which I get my passes, the captain in charge informed me he had received word from the Grand Quartier Général that an officer was to be attached to me. He apologized for not having a lieutenant available but said he would give me a Maréchal de Logis, more or less the equivalent of a sergeant. I was not sure by any means that I wanted to have a strange and possibly uncongenial person tied to me, but there was no way out, and presently a tall, distinguished-looking soldier, who might have been a Russian general from his appearance, presented himself in broken English as my future aide. I expressed appropriate polite satisfaction, and asked him his name. He murmured four or five syllables which I did not quite catch, and I offered him my card, the one embellished with several rows of titles as is supposedly necessary here in France, and he presented me his. It read simply “Le Duc de Clermont-Tonnerre.” So the Duke now travels with us as my aide.

Two factors finally persuaded Mrs. Vanderbilt and Bacon to give Andrew the independence he wanted. In the first place, the performance of the ambulance service during the first phase of the Battle of Verdun, between February and June, 1916, was beyond praise. Scraping together every car and driver he could obtain, Andrew threw five ambulance sections into this maelstrom. On and around the voie sacrée , by day and night, these men performed with heroic endurance. “Our sections,” Andrew wrote, are ranged all along the Verdun front, from Mort Homme to the Fort de Tavannes—the most serious work that any of our sections have ever done—work which only begins at dusk, and which ends at dawn, driving without lights of any kind over shell-pitted roads often cluttered with trucks, or horse-drawn artillery, or marching troops, avoiding here a wrecked machine, there a dead horse, the sky flashing incessantly as with heat lightning, the air vibrating with the roar of thousands of cannon, shells whistling by overhead and arriving in the neighboring fields, all the time signal rockets shooting into the sky and leaving now three red stars, now five green stars, or perhaps a trail of twenty stars sent up from the Observatory posts to tell the artillerymen further back how to direct their fire. The visits to the dressing stations—sometimes in farm houses half in ruins, sometimes in tunneled holts in the ground in the open fields—wounded soldiers, shot in the stomach, the head, the arms, the legs, sometimes whispering their experiences, sometimes inert and silent, I can’t describe them—but I can never forget. Verdun is written forever in the world’s history, but for the boys of our service it is written deep in their hearts. I think of a sunny morning in Dugny, about three miles from Verdun, an improvised tent in a dewy field with benches and a table—our boys coming in to breakfast telling gaily of the night’s work and excitements…—a few yards away a row of six dead soldiers lying on the grass carefully arranged, their overcoats over their faces—in a neighboring tent thirty or so other soldiers coughing and racking from an attack with gas. I think of a visit to the improvised hospital at Vadelaincourt. Outside rows and rows and rows of little wooden crosses—some 1800 of them marking the graves of those who have died in the hospital since it opened its doors four months ago. Inside rows and rows of cots with pale unshaven faces, tired eyes, bloody bandages—those who are too severely wounded to be carried further back from the lines. I think of Victor Chapman of the Lafayette Escadrille—smiling, modest, attractive, whom I saw only a few days before he went tumbling from the sky to his death in the German lines. He was a great friend of our boys of Section 2 and with them the night before he died. How like an old Roman his father, who cabled back “Today France is fighting for the rest of the world, and all who died in her cause are blest!” These are little personal threads in the great tapestry of Verdun which begins to unfurl thirty miles away in the clouds of dust that float above roads over which 12,000 motor trucks are moving to and from the city. It stretches to the hills on the horizon north and east and west of the city, where columns of smoke are continually rising from the hail of shells that fall day in and day out, night and day, along a front of at least twenty-five miles. It includes the blue sky with its dozens of “saucisses”—observation balloons—with little birdlike aeroplanes forever coming and going, often surrounded by puffs of white smoke from the land guns attacking them. It covers miles and miles of wooded hills crammed with soldiers’ huts, with artillery, with all the paraphernalia of war, and sheltered villages where thousands of horses are camped, as if hundreds of circuses were congregating there. But above all, it includes an unforgettable picture of the soldiers of France pouring in and out of every doorway and village street, trailing over every road. We stopped to snap a detachment passing through the town of Dugny the other day on the way to the front and one of them called out gaily, “That’s right—take a photograph of the dead.”

At least the article explains why most of the WW1 ambulance pictures I’ve found are Model T’s.

The next step in the evacuation was from the field hospital to a hospital train.  The British developed specialized hospital trains just before the war and transported them to France as the war went on.  They augmented the trains with converted barges as well.

The final stop before evacuation for home or return to service was the base hospital.

Of course the way things were done changed as the availability of transportation and facilities changed on the various fronts.

Here’s a pic of a train in use by the Australians somewhere in Asia

An Ambulance train

And some horse drawn ambulances.

Australian Field Ambulance - First World War 1914 - 1918

The fact is that with the knowledge germ theory and antiseptics the wounded in WW1 had far better chances of survival once they were off the field.  The advent of the automobile and mobile field hospitals meant that those inflicted with the traumas of war or the diseases that inflict soldiers stuck in hellholes for long periods of time could be treated and return to some semblance of an ordinary life.

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