Casualties

Martin Pegler

Private stretcher-bearer, 2nd Bn. Seaforth Highlanders; 4th Division, 1 July 1916

Britain began the war with a small but relatively well-equipped medical service, and the system of aid posts, dressing stations, field hospitals and base hospitals served the army quite well at the outset. However, as the size of field armies increased, so did the numbers involved in battles, and the campaigns of 1915 such as Neuve Chapelle and Loos saw numbers of wounded arriving at the aid stations far beyond those contemplated in 1914.

The system of dealing with casualties relied on a network of treatment centres – Regimental Aid Posts behind the reserve trenches, casualty clearing stations behind them, field hospitals and base hospitals behind those.

The medical services had considerable experience of dealing with high-velocity gunshot wounds, based on earlier colonial campaigns. For the ordinary soldiers, exposure to the effects of such injuries was unsettling to say the least. Many men wrote home about the effects of ‘explosive bullets' fired by the Germans: in fact the energy contained within a standard .303in. or 7.92mm bullet was awesome. At close range (200–300m) such a projectile would punch clean through a man's torso with little loss of power, creating exit wounds that were several inches across. Men hit in the head rarely survived, regardless of the range, as shock caused massive internal damage. Even slight wounds could be complex, as bullets often travelled along bones. One man struck in the right wrist by a bullet had it travel up his arm, deflect off his collarbone, and exit from the top of the opposite shoulder. Wounds from shells were invariably worse, with razor-sharp, jagged chunks of steel flying hundreds of yards, and lead shrapnel balls peppering the ground like giant shotgun blasts.

Principal Matron, Territorial Force Nursing Service

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Lightly wounded men were expected to make their own way to aid posts, whilst the more serious cases waited to be collected by the stretcher bearers, who did heroic work in trying to reach the wounded, despite being frustrated both by enemy fire and the sheer numbers involved. In the first 24 days of the Somme battle, 136,000 men became casualties, 59,000 on the first day alone, overwhelming the medical service. Clarrie Jarman was one of them:

‘We went over the top at Carnoy… I had a bad gunshot wound in my right leg and was lucky to fall into a deep shellhole. The ground was covered with lads in khaki, dead, dying and wounded, and was being spattered with shrapnel, high explosive and bullets. I lay where I had fallen all day – about 14 hours. Again, I was lucky as a lad from the RAMC happened to come my way looking for wounded … with the aid of a comrade they carried me back to the front line. After several hours I was placed on a stretcher and carried into the field dressing station, where my leg was dressed. Then I was sent to Amiens , but there were no beds, so I spent five days on the stretcher. I then went on a barge down the Somme River to Abbeville, where we got clean clothes before going by train to Boulogne. The hospital ships were full. At 3am on the 11th I arrived at Aberdeen.' By that time, Clarrie's leg had been infected by gangrene and had to be amputated.

For an army that lived in the open, there were comparatively few minor ailments, such as colds. Fred Dixon commented that 'considering we were mainly volunteers, and not hardened to an outdoor life, we were all very healthy. If you got a cold it was gone in a couple of days.' More problematic were illnesses such as trench foot, cuts which invariably turned septic because of infection, and sheer exhaustion from lack of sleep.

Poor diet also resulted in boils and constipation, which was also, curiously, a common side effect of being under shellfire for any period of time. A form of trench fever also manifested itself sometimes, with flu-like symptoms. Most of these ailments were treated with a few days in a field hospital followed by ‘light duty' for a week or so. Bad stomach problems were common, generally caused by drinking polluted water from shellholes. Water was always in short supply, and any source was welcome, the general assumption being that if boiled it would be alright. Pvt. Wells, living in a trench near Delville Wood, wrote: 'all things considered I am fine. We have been taking our water from a shellhole behind, and were surprised to find that the boot sticking out of it was still attached to a German. We are using a new hole now, but I don't suppose it makes much difference.' The problem of ‘trench foot' was a serious one, being a form of gangrene brought about by having constantly wet feet exacerbated by poor circulation. It was actually considered a crime to contract it, and an afflicted soldier could be punished. Various remedies were tried, including issuing whale oil, which was to be rubbed into the feet on a daily basis. The best solution was dry footwear, and removal of boots and puttees whenever possible, to relieve pressure on swollen feet and legs. In mud-clogged trenches, this was easier said than done, as Pvt. Wells recalled:

‘In Ypres, I never took my boots off for two weeks. When we came out of the line I had to cut my laces with a clasp knife, and when I got them [the boots] off the socks had rotted and my toes were black. I reported sick but I never lost any toes because the nurses were so good.'

The problem eased with the more widespread issue of waders, and more stringent checks by medical officers, but was never entirely eradicated.

Another persistent problem was that of venereal disease, and medical officers could do little to prevent wholesale infection. Affected men were sent back to base hospital for treatment but even placing notorious red-light areas out of bounds could not stop the problem. On average 800 men a month were admitted to hospital with one or other form of the disease. Lectures on hygiene were given noting simple precautions that could be taken to reduce risk, most of which were met with a barrage of ribald comments, to the discomfort of the lecturer, and amusement of the men.

A problem that the army took some time to come to terms with was shellshock. In the early days of the war victims were treated as cowards, and many were severely punished, even to the extent of being executed. However, as the frontiers of medical knowledge moved forwards, so did the acceptance that exposure to severe concussion did cause mental instability ranging from headaches and shaking to complete mental breakdown. Treating such cases was another matter, with therapy ranging from electric shocks to cold baths. Then, as now, recuperation tended to be very much dependent on the individual, with some men making a total recovery whilst others never did. George Wells was badly shellshocked and remained affected all his life, flinching uncontrollably at loud noises and suffering poor hearing and stuttering.

There was little that could be done for the dead except to give them a decent burial where time and circumstances permitted. Most regiments tried to ensure this was done where possible, and bodies were wrapped in groundsheets or blankets, then placed behind the parados to await removal to one of the small cemeteries that sprang up behind the lines. Burials were often attended by the dead man's comrades and presided over by the padre. Personal effects were gathered to be returned home, but useful items were usually shared out amongst friends. After Pvt. Dawson was killed, his friend, Pvt. Setchell, wrote a letter of condolence to the bereaved mother starting off: ‘I am sorry about what happened as I was his friend. I have got his pocket knife'!

Thousands lay where they fell, to be buried later, or were hastily placed in shallow graves marked with a rifle and steel helmet, their sites lost in later fighting. Many were simply never found. Buried in dugouts, or vaporised by high explosive, they merely became names added to the growing list of ‘missing presumed killed'. The many monuments to the missing which dot the countryside in France and Flanders are mute testament to them.

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