The RAMC deployment at Arras prior to 9 April 1917

Recent debate has looked at the effective levels of command and control of the various assets of the BEF.[1]From the medical point of view, with a chain of evacuation stretching back to the United Kingdom, the RAMC needed representation at all levels of command, but on the western front the RAMC functioned due to Corps and Divisional level command. The former allocated resources and controlled rearward assets, such as CCS and Motor Ambulance Convoys [MAC], whilst the latter planned and directed the physical deployment of the forward units.

 

The war diary of the Director Medical Services at GHQ shows the diverse range of issues of concern to the office; censorship/publication of medical articles, procurement of medical equipment and the allocation of resources amongst the Armies.[2]The latter was a constant struggle in prioritisation difficult to appreciate to minds now conditioned to think in terms of individual set piece battles.

 

A concern from the battle of Loos, starkly highlighted by the recent Somme fighting was the issue of ambulance trains. On 31 March 1917 an estimate was made of possible casualties of the forthcoming offensives and the required number of trains.

24 hour periods	Number of casualties (expected)	Number of trains required
1st	8000	18
2nd	8000	18
3rd	8000	18
4th	8000	18
5th	5000	11
6th	4000	9
7th	3000	7

 

This allocation was made on the assumption that 50% of casualties during the first three periods would be transported by road.[3] Across the BEF the routine daily ambulance train capacity at this period was 9000 [3000 to Boulogne and Rouen, 2000 to Havre and 1000 to Calais].[4] To meet the perceived extra needs, the Third Army Directorate of railway transport garaged eight ambulance trains and three temporary ambulance trains near the CCSs before the attack.

 

Third Army’s Director Medical Services [Surgeon General J.M. Irwin] was responsible for the placement of the CCSs as army level assets. Due to the closeness of much of the frontline to the town of Arras, Main Dressings Stations [MDS] were left out of the chain of evacuation.[5] Casualties would be transported, by Motor Ambulance Convoy - a Corps level asset, direct from an ADS to a CCS. Irwin placed these in three main groups; three at Warlincourt Halte in the VII Corps area,[6] three at Agnez-les-Duisans in the VI Corps area and four at Aubigny for XVII Corps.[7] The group at Warlincourt Halte were approximately 18 miles from the British front line, but any suitable closer sites were within range of the German guns. After the German withdraw to the Hindenburg Line this threat was removed but there was insufficient time to relocate this group of CCSs. The CCS stayed in position throughout the battle but an advanced operating centre was deployed forward into Arras during the latter part of April.

 

The Agnez-les-Duisans group was about 11,000 yards from the VI Corps front line placing them within shell range but despite the surrounding areas being hit the group of CCS remained untouched, the risk was accepted due to the favourable position of the site on a broad gauge railway line. The largest group at Aubigny, out of shell range was again near a railway line. Additional CCS were allocated for dealing with Third Army’s sick, slightly wounded and local [behind the lines] casualties. On 5 April 1917 the CCSs received reinforcement by surgical teams from Fifth Army and Second Army.[8] Determined to avoid the previous year’s problems at CCSs, the DMS of Third Army further reinforced his CCS by ordering his ADsMS to provide each CCS with 3 officers 3 NCO and 24 other ranks from their field ambulances. Initially given a variety of roles, from burial parties to unloading ambulances, many of these men were replaced by non-medical reinforcements,[9] most eventually being employed on clerical or proper medical duties.

 

Within the Corps the respective DDsMS began to co-ordinate the actions of their units. Despite having lost men in the reinforcement of the CCSs, the personnel for all medical and sanitation posts being established were to be found from the division’s field ambulances. The DDMS of VI Corps, Colonel Thompson, was to have the biggest effect on the medical arrangements at Arras, and to a degree the future workings of field ambulances. Thompson realised that as his sector was directly in front of Arras all movement would be limited to, at best, a couple of roads. As traffic associated with the attack would take priority over medical evacuation he planned for his units to “hold” their casualties for up to 36 hours.[10] Thompson achieved much of this by effectively turning his ADSs into MDSs, his main site being set up in a cave 800 yards from the front line.[11]Whilst still primarily designed to treat and evacuate, the ADS, especially Thompson’s Cave, developed a capacity for emergency cases including surgery. Thompson’s most striking innovation was to reduce the paperwork required in the forward units. He used the men detached from his field ambulances to CCSs as clerical staff and gave the order that no Admission and Discharge books were to be completed in the field ambulances during the offensive. Simple casualty cards were completed on each man as he moved down the chain,[12] systems being developed to note basic treatment given and advice for the next station in the chain. The systems were simple but also flexible, in the case of a soldier receiving anti-tetanus serum:

 

“In addition to entering this on the Field Medical Card, a “T” in blue indelible pencil should be inscribed on the back of the left wrist. If the left wrist is wanting, then on the right wrist.”[13]

 

All relevant entries were later transcribed by the attached clerks at the CCS into the respective field ambulance Admission and Discharge books at leisure. Only a small sample of these still exist but these and some surgical logs from the CCSs give some indication of the type of injuries making it this far down the chain.[14]

 

To aid the rapid transit of the critical injured each Corps' also set up it’s own Walking Wounded Collecting Post [WWCP] to remove the lesser cases to a parallel chain of evacuation, with a clearly signposted route for the wounded to follow. VII Corps' at Agny was under the control of the OC 43^rd Field Ambulance of the 14^th Division, VI Corps' at the Bastion in the Western suburbs of Arras was fairly typical. It was equipped to receive, record, feed and dress up to 450 casualties at a time.

 

Across the battle area the men of the various field ambulances manned bearer relay posts, collecting posts, advanced dressing posts, advanced dressing stations, main dressing stations, walking wounded collecting posts and reinforced both RAPs and the CCSs. Having laboured to move themselves, medical supplies and stores into position they waited,[15] all was ready for the attack.

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[1]For example, Andy Simpson, Directing Operations: British Corps Command on the Western Front 1914-18.

[2]TNA: WO 95/46-50 GHQ DMS includes frequent cases of clearance for articles being sought, outsourcing of refilling of oxygen cylinders, which had previously been returned to the UK, discussion on “opium mixture” for Indian troops and a running tally of cases evacuated due to Venereal Disease and Trench foot, 900 & 200 cases per week respectively.

[3]Therefore the estimate of casualties for the first 24 hours was 16,000. The actual number was 11,520.

[4]TNA: WO 95/46-50

[5]This attempt to minimise the number of stages in the evacuation chain was in keeping with RAMC 1911. The VII Corps was the exception to this rule. Due to the Corps’ extended chain of evacuation the 2/2 London Field Ambulance of the 56^th (London) Division operated a CMDS with accommodation for 2000 patients in Gouy-en-Artois. TNA: WO 95/814 Summary of War Diaries April-May 1917

[6]No.s 20, 43 + 32

[7]Agnez-les-Duisans No.s 19, 41 + 8; Aubigny No.s 30, 42,

[8]Six teams arrived from Second Army, four from Second Army.

[9]TNA: WO 95/414 NO 19 CCS. On 14 April received men of the Middlesex Regiment and the Somerset Light Infantry to act as stretcher bearers. On 15 April men of the Devons and 12th Black Watch were released from grave digging.

[10]TNA: WO 95/790 DDMS VI Corps War Diary, this priority of forward movement over rearwards was as per 1911 manual, but is also found in other ADMS war diaries, see 51^st Div

[11]This facility was to become known as “Thompson Cave”, it was in a cave system originally excavated in the 16^th century. Equipped for standard and surgical care, accommodation for up to 700 casualties was planned. It was staffed by two tent sub-division of the 7^th Field Ambulance of the 3^rd Division. The site is near to the recently opened Wellington Cave system and is under a busy road junction and housing estate.

[12]These cards, AFW xxxx already existed, but the sole reliance on them to document casualty care was the innovation.

[13]TNA: WO 95/790 DDMS VI Corps Medical Appreciation on Proposed Operation dated 1 March 1917, repeated in WO 95/1396 ADMS 3^rd Division RAMC Operation Order 41 paragraph 15; further examples common to the units of the attack were; an “O” = no need to redress the injury before the CCS; “M” on forehead= a dose of morphia had been administered.

[14]The Admission and Discharge book for the 51^st Field Ambulance, part of the 17^th Division is contained in TNA: MH106, TNA WO 95/342 the war diary of 8 CCS contains at log of surgery carried out during the month of April. As well as giving detail on injury and treatment it is also possible to calculate the number of operations carried out by individual surgeons thereby giving an indication of the high workload experienced.

[15]The situation of infantry troops being tired by fatigues and working parties is familiar, but much time and effort seems to have been expended by RAMC personnel in establishing their posts. As a possibly low priority for RE assistance men were frequently tasked to work on making and/or improving positions. Vast amounts of stores were required, a RAP typically receiving [from the field ambulances] an extra 50 stretchers, 50 blankets and 50 water tins in addition to true medical supplies such as dressings.