Historic battlefields.

Arras April 1917- Continued operations

The results of 9 April 1917 were to be overshadowed by the attritional nature of the rest of the battle, as the offensive continued due to the demands of coalition warfare. As with most logistical or combat support elements, the work of the RAMC continued. Whether the “routine” casualties of trench holding or the peaks following attacks [or counter-attacks], the main burden continued to fall on the bearer companies. Whilst within a division it was sometimes possible to rotate brigades out of the line, with the bearer divisions of the three field ambulances effectively merged an equivalent relief was impossible. The process of evacuation was only able to continue as the structure of a field ambulance allowed an internal rotation of suitable men within units without any disruption of command and control.[1] 

 

As the fighting continued the various units of the BEF rotated in and out of the line. As their divisions heading to the rear areas, for many a period of rest beckoned, but a field ambulance had to continue providing medical support to its division. In the operation orders relating to moves out of the line, we see the field ambulances being temporarily affiliated back to brigades for administrative purposes, but also being ordered to set up Divisional Rest Stations. Through this facility, men could recover from minor wounds or illness, but stay within the division, desirable both for elements of esprit de corps but also for maintaining the strength of the division.[2]

 

The larger distances between the frontline and Arras gave more tactical freedom in the placement of medical posts, more of the general principles expressed in RAMC 1911 could be followed; posts appear in hollows, adjacent to roads, but the slow extension of the chain of evacuation required more collecting and relay posts, eventually supplemented with vehicle loading posts.[3]As the offensive stalled these posts took on an air of permanence, the location of many now being marked with Commonwealth War Graves Commission [CWGC] cemeteries.[4] In these the periods of occupancy can be clearly identified by the burials,[5] the association of cemeteries with medical facilities is an unfortunately obvious one,[6] but this is more commonly associated with dressing stations and CCSs.  At these forward posts staff applied a triage sieve preventing casualties unlikely to survive passing further down the chain. This was made easier as the various collecting and relay posts sat outside the regimental family and could make a less emotional, more realistic appreciation of the casualty’s chances.[7]

 

Whilst not always completed immediately an admission and discharge book [A&D book] was kept for each field ambulance, showing the nature [and numbers] of casualties passing though the unit.[8] The A&D book of the 51^st Field Ambulance still exists, it shows a surprising amount of men attending the ADS sick, with most being evacuated. Concern to keep the ADS clear dictated the swift evacuation of the sick, but was reliant on a vigorous filtration at unit level by the RMO. The A&D book covering 24-25 April 1917 has 90 admissions. Of these 12 were sick, all of whom are evacuated. A further two had suffered soft tissue injuries and were also evacuated, in this case to the Corps Rest Station.  Of the 76 injured most [61] were gunshot wounds, the majority [26] being to the limbs.[9]In this period there were four deaths in the ADS; two from abdominal injuries, a situation the field ambulance was not adequately equipped for; one a double traumatic amputation; the last being shrapnel wounds to the thigh. The field ambulance's pragmatic approach to triage and casualty assessment at forward posts coupled with the careful work to counter shock had resulted in a low mortality rate at medical facilities.

 

A record of operations carried out at No 19 CCS allows for an examination of the type of casualty making it through the whole chain of evacuation to surgery. On 11 April 1917 Captain Donaldson performed 18 operations, all gunshot wounds; 15 leg, 1 shoulder and 1 buttock injury.[10]All of these were evacuated before the end of the day. Faced with the high number of casualties of an offensive the finite resources of the AMS had to be directed towards those with most chance of success. This principle was applied from the first field ambulance post through to the CCS.

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[1]For example, men of the 2/2 London Field Ambulance tent divisions were sent forward as reinforcements and replacements of the bearer company, TNA: WO 95/2944 entry for 14 April 1917

[2]In the post war Babtie Committee this was deemed to be one of the great successes of the field ambulance, TNA: WO 32/11395.

[3]Vehicle loading posts were originally staffed by a RAMC NCO purely responsible for the loading of the ambulance cars and accounting for the equipment. By 28 April 1917 both the 14^th and 56^th Divisions have more substantial posts.

[4]The Great War Digital product “Linesman” provides translation from contemporary trench maps to modern day IGN maps. Allowing for the inherent inaccuracy of mapping it is possible to identify the approximate position of wartime locations.

[5]Within the area of this study, Happy Valley cemetery is approx 50 yards away from a relay post, identified casualties from the 12 Division can be found buried here from a period when 37^th Field Ambulance was running the post. The Rookery cemetery is about 40 yards from the position of a 18^th Division collecting post, Tigris Lane cemetery is approx. 25 yards from the site of a 56^th Division Vehicle loading post,

[6]A number of cemeteries are named after dressing stations. St Mary’s ADS near Loos is but one example, with cemetery registers often identify nearby medical facilities.

[7] An order is issued in October 1917 that “Moribund Cases are not to be moved from Field Ambulance.” The definition of these cases seems to have been left to the reader. Standing Orders of ADMS 56^th Division in TNA: WO 95/2038.

[8]Most of these have been destroyed, the following is taken from examination of part of a small sample kept within TNA: MH106.

[9]This incidence of injury to the limbs is slightly higher than the 40% suggested in Major T. Mitchell, Medical Services, Casualties and Medical Services of the Great War (London: Imperial War Museum, 1997) p. 279

[10]TNA: WO 95/414 No 19 CCS.

The first battle of the Scarpe 9 April 1917- New army division

On the opposite side of the Arras-Cambrai road the 12^th Division were to attack from the eastern edges of Arras toward a line between Feuchy and Monchy. This new army division had already experience much hard fighting since its arrival in early 1915 and all elements of the division had learnt from their time on the Somme.

 

In his instructions sent out to RMOs and his field ambulances, the ADMS noted:

“Medical Officers should consult with CO's as to the distribution of Regimental Stretcher Bearers, but judging from past experience it is advisable only to send over 8 bearers and 8 reserve with the Companies keeping the other 8 bearers and 8 reserve in reserve till the MO calls for them.”[1]  

In common with the other divisions, having reinforced and re-supplied the RAPs of the attacking battalions,[2] the OC Bearers established dumps of stretchers and similar stores on the likely routes of evacuation, before allocated the remaining men of the pooled bearers to clear the frontline. When the attack began the bearers at the RAP would take over the vacated aid posts and use them as bearer posts as the advance continued.[3] Sites for up to four ADSs had been prepared in the streets of Arras, the main two being located in a factory adjacent to the Arras-Cambrai road, the second in a nearby abattoir.[4]

 

Once the attack began the division advanced despite resistance from defensive works forward of Observation Ridge, only a few lying cases arriving at the ADSs in the morning. During this stage of the fighting two RMOs became casualties,[5] replacements quickly being found from officers of the field ambulances. The close relationship between RAP and field ambulance enabled swift replace of MO casualties with doctors experienced in the realities of trench warfare.[6] Maintaining touch with the advancing troops the bearers moved forward. As the advance ground to a halt near Feuchy chapel they set up an aid post in a recently abandoned German dressing station.[7] From here casualties were evacuated directly down the Arras-Cambrai road, with ambulances coming as far forward as Tilloy.[8]With the zone between frontline and Arras being covered by the one unit, ease of internal communications allowed flexibility of deployment for the medical posts. With RAPs in particular being sited as the situation dictated, returning bearers, via OC Bearers provided updates on locations and casualties, these being fed back to both field ambulance and Infantry Brigade headquarters.

 

As evening approached, the ADMS noted a build up of casualties around the ADSs. This is likely to have had a number of causes; one RAP [no 3] had received many more casualties than others,[9] causing an imbalance and congestion in the chain; as the front advanced the movement of casualties became easier within a, relatively, safe zone leading to a sudden influx; the extraction of casualties from the captured positions could only be done after some degree of defensive re-organisation again causing a rush of casualties. Movement had been inhibited by the explosion of an ammunition dump near to the railway bridge adjacent to No 1 ADS and the advance of cavalry units hindering the work of 15 Motor Ambulance Convoy.

 

To clear his ADSs the ADMS called for a concentrated effort from 15 Motor Ambulance Convoy, a 15-car convoy being sent to the division. Having cleared the ADSs, by midnight they were again full with 180 lying cases,[10] a further 14 car convoy being required, the ADSs eventually being clear of all casualties by 8 am on 10 April. With the largest advance of a single division in this study, the 12^th Division settled down to hold its gains,[11] its chain of evacuation forming around posts along the Arras-Cambrai road. This route provided good communications from the frontline to the rear, but with ambulance cars not able to proceed past Tilloy the hand carriage of casualties, necessarily slow, continued. By the early hours of 10 April 37 officers and 1009 men had been treated and evacuated,[12] on 11 April 8 officers and 383 men had been admitted but 20 men hadn't been evacuated immediately. The evacuation chain had begun to falter.

 

The absence of MDSs made the field ambulance cars somewhat redundant,[13] by pooling them under the command of 15 Motor Ambulance Convoy they had been fully employed during the early part of the offensive and the large deployments needed to clear the dressing stations during the night 9/10 April had been possible. But as the units advanced, with new posts appearing, control of the cars became too remote. Feeling the moment had come, perhaps a few hours too late, DDMS Thompson released the ambulance cars back to their parent units, but the process wasn't completed smoothly.

 

This, the only significant breakdown in the evacuation chain, had not been caused by the field ambulances but by the removal of its assets. The idea of employing the otherwise idle ambulance cars elsewhere in the chain was sound, but didn't require their removal from their parent units, the field ambulance. If left under their own OC's control the inherent flexibility of the field ambulance would have enabled the cars to switch focus as required.

 

Across the front many critically injured men had received, basic, but sufficient treatment of their wounds. Their comfort had been given every possible priority,[14]partly to raise the individual’s morale but more clinically to ward off shock. Often rising their own lives, the men of the field ambulance had successfully ensured the rapid removal of the wounded, some reaching a CCS within two hours.

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[1]TNA: WO 95/1834 ADMS war diary Medical Arrangements dated 3 April 1917

[2]Each RAP received 1 officer, 1 NCO and 18 men from the field ambulances in the 72 hours before the attack. The field ambulances supplied each RAP with 50 tins of water, candles, 60 stretchers, 80 blankets, 20 waterproof sheets [for protection of the blankets] dressings, rations [both for medics and casualties] and splints, possibly including three Thomas splints

[3]Strictly speaking this didn't occur until the RMO had left the aid post, it does however seem that most RMOs moved out into no mans land quite early

[4]For a short period in the afternoon all four ADS did open but the two above provided the bulk of the care. Their positions on a main road allowed easy access and a maximum distance RAP to ADS of 1.1 miles.

[5]Captain Prentice, RMO 5^th Royal Berkshires, was wounded and Captain Edey 6^th Buffs sprained his ankle.

[6] By October 1917 at the latest this practice had become formalised. In Standing orders the ADMS of 56^th Division requires all doctors to be trained ready to take over as RMO,   to do so they must have completed a month at the field ambulance including five days attachment to the sanitary section and ten days to a functioning RAP. TNA: WO 95/ 2938.

[7] This allowed the post to “open” rapidly. The combined artillery related  problems of the entrances facing the “wrong” way and the Germans knowing the exact location seemed to have been often accepted in return for the degree of shelter given.

[8]The aid post at Feuchy Chapel was quickly converted into a British ADS, this was a bound forward of 3.01 miles, measured in a straight line using Linesman.

[9]Someone had placed a red flag on the roof of this RAP, attracting casualties from across the division's front. some stray casualties from the nearby 15^th Division also made it to this aid post

[10]Many of these were German prisoners of war. As all casualties were to be treated equally this may be due to a clearance of the captured positions. TNA: WO 95/1834 “Report on Operations from 5.30 am 9^th April to 6 pm 11^th April 1917 by the ADMS dated 11 April

[11]The 37^th Division was expected to pass through and seize Monchy. Bearers of the 12^th Division's field ambulances would be required to remove 37^th Division's casualties, and those of 3^rd Cavalry Division from in front of Monchy.

[12]TNA: WO 95/1843 36^th & 37^th Field Ambulance

[13]Field Ambulance cars would normally be held at or around the MDS and be used to collect casualties from the ADS. If the situation allowed they might be used to clear posts further forward ie RAPs.

[14]RAMC units aimed to provide hot drinks to those passing through the chain, this extended to setting up at least one refreshment stall on the route of the walking wounded.

The first battle of the Scarpe 9 April 1917- Regular Division

Further north the 3^rd Division was in the line in the southeastern suburbs of Arras. The front for the attack was particularly narrow, the frontage slightly extending on the objective.

The division had been in position for some time before the attack and much of March had been spent labouring in improving its posts. The 3^rd Division medical facilities were centred on two ADSs, one in the buildings of a Girl's School, the other in Thompson's Cave. Most of the physical labour of preparing these, and other, posts fell to the men of the RAMC, particularly the bearers, with only specialist help on matters such as lighting.[1]

 

With the strong German position known as the Harp close to its narrow jumping off position, the 3^rd Division ADMS heavily reinforced the regimental medical elements, deployed the bearers of one field ambulance [7^th] into the RAPs and nearby trenches to advance with the attack. The tent sub divisions of this field ambulance formed the Cave and Girl's School ADSs. A second field ambulance [8^th] was in reserve packed ready to advance,[2] with all necessary equipment broken down into sandbags to allow “hand carriage”. This ability to project itself forward, without the reliance on external support, was essential to maintaining the connections of the chain of evacuation. The Division's third field ambulance [142^nd] was held further back at Hauteville packed with its wagons ready for the advance. The ADMS was obviously concerned by this apparent return to the affiliation of the field ambulances to Brigades as in his final draft of medical arrangements issued to RMOs he states:

 

“M.O's i/c of Battalion must remember that Field Ambulances do not belong to Brigades, but are Divisional troops....In action, and indeed at all times, the Field Ambulances of a Division work directly under the control of the A.D.M.S.”[3]

 

With the initial success of the attack, casualties were rapidly removed, the first arriving at the Girl's School ADS within 50 minutes of zero hour. As the day progressed the two ADSs alternated in receiving casualties, this simple expedient and the work of the Motor Ambulance Convoy, which initially experienced little traffic congestion, prevented any accumulation of casualties at any of the division’s medical posts.

 

At 2 pm the 8^th Field Ambulance received its order to move, heading towards Tilloy to open an ADS, this it achieved by 4.30 pm, with it's bearers moving forward to maintain touch with aid posts of the 8^th Brigade. This forward position did experience difficulties with traffic, casualties being evacuated by hand towards the original ADSs.  The common practice of using German prisoners of war as bearers helped clear the casualties, but by completing a single “one way” leg this caused minor difficulties in the necessary return of stretchers.[4] The bearers of the two field ambulances working the forward area successfully maintained touch with the RAPs, preventing these becoming overwhelmed and providing a rapid transit to the ADSs, always important but becoming critical as the climate deteriorated, with snow falling and a “piercing gale of wind”.[5]

 

As evening came on the Girl's school ADS was closed, having seen 160 casualties pass through since the beginning of the attack. By the early hours of 10 April 1917 the 3^rd Division's ADSs had treated a total of 291 cases.

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[1]The efforts seem to have passed muster, as part of the continuous round of inspections and visits the DMS Third Army and DDMS VI Corps visited the ADSs on 30 March 1917, “The Surgeon General expressed his intense satisfaction with the preparations made at the Rue du Temple & the cave ADS (known as Thompson's Cave).” TNA: PRO W0 95/1396

[2]The 8^th field ambulance had two of its tent sub divisions detached to 19 CCS before the attack started

[3]TNA: PRO WO 95/1396 Medical Arrangements dated 6 April 1917 paragraph 6; the ADMS also urges RMOs to avoid “panicky” messages about numbers of casualties and reminds that there are only 300 field ambulance bearers in the whole division

[4]Some units retained German prisoners of war, almost as extra staff, see Rorie, A Medico's Luck in the War, pp 125-27. In his rather long anecdote Rorie confers the title “auxiliary loader” onto the prisoners who are kept in the ADS.

[5]TNA: WO 95/1396 ADMS 3^rd Division.

First Battle of the Scarpe 9 April 1917- Territorial Force

The German retreat to the Hindenburg line had the most effect in the southern region of the proposed attack. The 56^th (London) Division's attack was on a limited front, centred on the fortified village of Neuville Vitasse. The division's medical assets were orientated around its ADS at Achicourt, with a series of bearer posts [Agny then Beaurains] to the front line.[1] As with all attacking divisions, the field ambulances had reinforced the RAPs, placing 8 bearers forward to each attacking battalion. In keeping with most divisions on 9 April, the 56^th Division had pooled all its remaining bearers under the command of an officer of one field ambulance.[2] This role, that of Officer Commanding Bearers [OC Bearers] was an attempt to correct problems from the Somme;

“The previous medical arrangements..., where a shifting personnel and a divided jurisdiction of field ambulance commanders had been somewhat confusing, were now changed; and a forward evacuation officer was appointed, whose duty it was throughout the battle to contrive and supervise the evacuation of all wounded from the RAPs to the main dressing station and walking wounded collecting station,”[3]

The tented sub-divisions formed the aforementioned ADS, using the cellars of a row of shops in the village square. The central nature of this location [the square] meant it was shared with both an ammunition dump and a vehicle park and frequently became congested.

“Our Field Ambulance arrived at the village of Achicourt near Arras, and set up its HQ as a MDS [sic] in a disused cafe, with cellars under, which joined up with those of the adjoining shops and buildings, adjacent to which was the narrow bridge over the stream by which all traffic had to enter the village and led to the square, only a short distance away.”[4]

This choke point was an obvious target for the German retaliatory shelling, an infantry platoon being wiped out in an adjacent building and the building containing the ADS itself was hit, the only casualties being the Sergeant's kit bags.[5]

At zero hour the assaulting units, whilst experiencing resistance, successfully entered the German trenches. As the attack progressed the RAMC pushed forward to maintain touch with the aid posts being established within the ruins of Neuville Vitasse. Casualties began arriving rapidly at the various posts, typically the lightly wounded first. The OC Bearers successfully managed his new responsibilities and maintained the critical junction between the regimental aid posts and the field ambulance throughout the day, all casualties moving rapidly down the evacuation chain.

Having survived the initial insult of injury, the cold, shocked casualty became a passive load in the gruelling journey “down the line”.

“...the bearers moved up from Agny. They passed through the shattered Beaurains, where a post had been established, and occupied a series of relays between that village and Neuville Vitasse, which had fallen in the morning's attack. By now the weather was very cold, sleet was falling at intervals, and the carrying across the scarred fields was made harder by the accumulating mud. Stretcher bearing went on intermittently through the night, but on the whole casualties were not heavy.”[6]

With the OC Bearers acting as one centralised, advanced, point of control the bearer division was able to react to movement and varying demands across their front. The pooled manpower also allowed for a reserve to be held, but under forward control, which in turn allowed for some relief of individual bearers. But if the opportunity for rest was more frequent the work was still hard and dangerous:

“They talk about a soldier going out + fetching a comrade in under shell fire-and he gets the MM or DCM, we are always under shell fire, I can't dump our stretcher + run for it to a soft spot, we have to plod on, up past the knees in mud- balancing on the edge of shell craters slipping + sliding, shells bursting above + in the earth quite all around us, its Gods mercy that we get thro but we have the patient to think of, + quickness probably means saving his life, so we go right thro it, not caring a damn + somehow when you get to the sap-head + safety, you laugh and joke at the capers.”[7] [underlining in original]

The existing records of the actual number of casualties passing through the 56^th Division's chain seem somewhat confused. The ADMS, in his war diary, records 11 officers and 211 other ranks till the early hours of 10 April. The war diary of the unit running the ADS at Achicourt states 329 total.[8]It is difficult to reconcile this difference as the ADS were under instruction to wire the ADMS every 12 hours with the number of casualties treated. The most likely explanation is the ADS number includes men from other units and possibly prisoners of war, as these would be passed down the same evacuation chain.

The successful advance of the division required the aid posts to move forward. In the traditional, caterpillar like movement, the bearers vacated the cellars for an ADP to be set up early during 10 April, this in turn was replaced by an ADS on 13 April. Having taken over the cellars of a small house, the capacity of the ADS was very limited, only able to hold four patients at a time, this seems to have been an acceptable compromise against the benefits of the location.[9] In the first hours following it's opening, 30 casualties passed through, testimony to the efficiency of the evacuation chain at this point.[10] Further, ultimately unsuccessful, attacks were carried out by the division during 14-15 April, approximately 200 casualties being treated in this cellar on each day.[11] The evacuation of these casualties was conducted by hand back over the newly won ground. To keep the ADS clear and to minimise the casualty's exposure to the harsh environment it was no longer possible to follow the doctrine of evacuation under the cover of darkness, so until communications trenches were established it was the demands of a carry over the top.

Due to the relatively confined area of operations, the influence of the centralised control of the bearer officer and comparatively light casualties the 56^th Division's chain of evacuation had held. The pooling of all bearers under one point of command and control had given a new flexibility to the RAMC's forward assets, allowing a rapid advance of medical facilities in support of the attack. Each unit in the chain had managed to maintain touch with the post to its front, ensuring re-supply of materials and a fluid passage through the extended chain of evacuation back to Achicourt.[12]

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[1]On 5 April 1917 a last minute change of the allocation of personnel was forced by the absence of reinforcement by 100 [most likely non RAMC] bearers. Priority was given to the forward posts, but no post seems to have been shut.

[2] OC

[3]D. Rorie, A Medico's Luck in the War (Aberdeen: Milne & Hutchinson, 1929)

[4]A. Atkinson, 2/3^rd City of London Field Ambulance. London Soldiers-Unarmed Comrades (London,: Elsdale & Martin, 1969), p. 42

[5]The casualties from this shelling, mostly members of the 13th Battalion London Regiment, would have been received straight into the nearby ADS, demonstrating the flexibility of the chain. A similar direct access was often used for units to the rear of the front line such as artillery brigades.

[6]Anon, The Second-Seconds in France (London: Spottiswoode, 1920),  p 41

[7]IWM 7997 98/28/1 A E Douglas

[8]TNA: WO 95/2944 2/3 London Field Ambulance. War diary summary by compliers of official medical history. TNA: WO 95/814 DDMS VI Corps gives a total of 13 officers and 277 other ranks till 6 pm 9 April 1917, a further 13 officers and 295 men by 6 am 10 April 1917.The official history gives the total figure of casualties into field ambulances between 9am 9 April to 9 am 10 April as 26 officers and 522 men for the 56^th Division. The “extra” casualties must have found their way into the facilities of nearby divisions, a relatively common occurrence.

[9]The position chosen was/is on a junction of the few roads at the north side of Neuville Vitasse. As such it had good access and egress, is relatively sheltered from view [and hostile fire], would have been easy for men of the division to locate and fairly central on the axis of the division's advance.

[10]The ADS was open at midday, these casualties passed through by 6 pm. There is no way to tell of the chronological distribution within this period.

[11]TNA: PRO WO 95/2944 2/3 London Field Ambulance.  14^th “about 200 wounded” 15^th 234. In both cases this represents the holding capacity of the ADS x 50

[12]The initial distance from the front RAMC posts to the ADS at Achicourt had been 2.57 miles, by last light on the 10 April it was at least 3.7 miles. These measurements are taken “as the crow flies” but via the appropriate posts in the chain of evacuation.

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.

Finally finished

I have now officially been told my dissertation has passed, and therefore I have successfully completed my MA in British First World War Studies!

I might look at carving my dissertation up and posting it at some point in the future, but my basic findings were flavourable towards the field ambulances. The structure and role developed after the South Africa war was suitable, [though stretched, tested and sometimes creaking] for the field ambulance's role of bridging the gap between point of wounding and surgery.

When does an idea become a theory?

Looking at the cemeteries of the Commonwealth War Graves Commission, it is obvious that some are associated with medical facilities, St Mary's ADS near Loos is an easy example.

But my studies on Arras have put an idea in my mind, that earlier RAMC posts were applying a vigorous form of triage as casualties were passed down the evacuation chain. This all stems from looking at the positioning of medical units as outlined in various ADMS war diaries and then converting those, via Linesman, to modern map references. A few examples:

Looking south of the River Scarpe and east of Arras, Happy Valley is on the site of a post manned [in late April 1917] by elements of the 12th Division's 37th Field Ambulance.

The Rookery is adjacent to a collecting post manned by the medics of the 18th Division, again at the end of April into early May.�

Tigris Lane is metres away from a vehicle loading post of the 56th Division, a 100 metres or so from the 14th Division's equivilent [from later April 1917] and a number of 14th Division RAPs and relay posts from earlier in April.

In each of the above cases within the cemetery are buried men from the respective divisions during the dates of occupancy by the medics. Obviously men may die in transit, but the frequency and numbers involved suggest something further. The re-assessment at each post may have lead to the removal of those with a low expectation of survivial, aiming to avoid clogging up the casualty evacuation chain.

But when does an idea move�become a theory?

So why write about the RAMC at Arras?

The battlefield responses of the British Expeditionary Force [BEF] to the demands of the western front have been studied since shortly after the first shot was fired. In more recent works the actions and effectiveness of the various combat arms have been evaluated at all formation levels. Always present but virtually ignored were the soldiers and units of the Royal Army Medical Corps [RAMC].

 

This dissertation is to be a study of the work of the RAMC field ambulances in the forward areas during offensive operations. More specifically it is a case study of the RAMC response to the demands of the

Arras

offensive in April and May 1917. This period has been chosen as the first full opportunity for the RAMC to apply any lessons from the bloody classroom of the

Somme

in 1916. The role of the

Somme offensive as a catalyst for change has been proven beyond reasonable doubt for the “fighting” elements of the BEF,[1] but there has been little study of the combat support elements.

 

To provide a tight focus the dissertation will follow three divisions through the planning for, and fighting of, the offensive. Those selected cover the three armies within an army; the 12^th (Eastern) Division, formed by war raised service battalions; the 3^rd Division, a regular formation; the 56^th (

London

) Division, a territorial force unit. All three divisions were deployed south of the River Scarpe, with the 12^th (Eastern) and 3^rd divisions straddling the Arras-Cambrai road.

 

With the benefit of hindsight it can be seen that the fighting around

Arras

would also be the RAMC’s harshest trial on the western front, with a daily casualty rate exceeding that of other campaigns.[2] The British initial assault was against prepared defensive positions with initial plans for the offensive being dislocated by the German withdraw to the Hindenburg positions in early 1917. The battle of

Arras

in 1917 lends itself to a case study as it provides a “potted” version of the whole war; set piece offensives against prepared positions; piecemeal attacks at short notice; prolonged action requiring stamina and logistical support, with occasional glimpses of a war of movement.[3] Despite this it is overshadowed, both in history and historiography, by the

Somme

and Third Ypres.[4]

 

No part of the landscape of

Northern France

can be considered to be particularly mountainous, but the area around the River Scarpe includes many features that would hamper the movement of casualties, or severely tax the resources of the RAMC in effecting the same. From a medical point of view the RAMC’s task was further complicated by the weather conditions, soldiers found themselves attacking on 9 April 1917 in snowstorms and for many of them the climate was to add to the discomforts of their wounds.[5]

 

A successful performance despite the above factors would be a vindication of the field ambulance. But how can we measure the performance of a field ambulance? The Army Medical Services [AMS] have a multifunctional role, to prevent disease; to treat illness and injury. This is all directed towards its prime aim, the preservation of the fighting strength. The RAMC sanitary section and the Regimental Medical Officer [RMO] had taken on the main weight of the first of these roles, allowing the field ambulances and Casualty Clearing Stations [CCS] to concentrate on the latter.

 

The field ambulance was born out of the experiences of the

South Africa

war.[6] By the issue of the RAMC training manual of 1911, the role and responsibilities of the field ambulance had been defined. It was to relieve the Regimental Aid Post [RAP] of its casualties and care for them enroute to the appropriate hospital facilities. The field ambulance was considered to be a divisional unit, the above manual giving specific advice on the field ambulance’s duties in supporting a division in offensives, static periods and retirements.

 

Designed for the highly mobile warfare of the last war and anticipated next, the field ambulance generally performed poorly, or at best ineffectively, during the initial mobile phases of 1914. Unable to move casualties swiftly down an evacuation chain, the field ambulances often became overwhelmed by the numbers of severely injured. Early attempts at surgery within the field ambulance occurred more by accident than design.[7] As with many arms the frequent movement of units dislocated the RAMC’s unit hierarchy, in this case negating the principle of units removing the casualties of the unit in front. The RAMC had no real opportunity to effect a change to its ways or structure before the circumstances of the battlefield changed, the stalemate of trench warfare appeared requiring further adaptation. The resulting static nature of this siege warfare, allowed the chain of evacuation to re-form. This in turn allowed for an increased surgical responsibility for the Casualty Clearing Station [CCS]. For the best possible outcome in surgery the casualty needed rapid transportation from the point of wounding to the surgeon’s table.[8] With a CCS [or in later stages a group of them] typically comprising of a tented city near a railhead, a gulf existed between definitive surgical care at the CCS and the point of wounding near the mobile, lightly equipped, regimental aid post. It was in bridging this gap the field ambulance was to re-establish its role.[9]

 

Ian Whitehead’s work has shown the extent to which many within the higher echelons of the RAMC felt the Field Ambulance wasn’t an effective part of the chain of evacuation. Some felt it actually hindered the care of the casualty.[10] Even as late as 1917 Sir Almroth Wright believed the Field Ambulance had three fundamental flaws; its basic scaling of equipment limited it’s ability to provide “immediate surgical treatments”; the use of doctors in non-medical roles was inefficient; the rotation of Field Ambulances into rest with their divisions was “wasteful”.[11]

 

The last statement clearly ignores the critical work of Field Ambulances in the treatment of the sick, an ongoing commitment, and the injured of training. A Field Ambulance at “rest” might find itself running a divisional rest camp, or a bathhouse. The ability to keep soldiers “on strength” of a division, whilst still giving them access to suitable medical facilities was to be judged one of the successes of the Field Ambulance post war.[12]

 

The use of doctors for non-medical work was to be debated into the inter-war period. Sufficient momentum was gained by campaigners to force a reduction in the scaling of doctors within field ambulances during the war, roles such as that of transport or bearer officer being filled by non-medical officers. This decision was reversed in the findings of the Babtie committee, medical knowledge being deemed “of benefit to the wounded soldier”.[13]

 

A field ambulance was not designed to hold casualties during a pro-longed period of recovery, it was therefore clearly not the place for complicated surgery. Its equipment scaling reflected this and it was a constant process to maintain the delicate balance between holding sufficient equipment to function without restricting the unit’s mobility.[14]

 

The sources

 

Since the writing of the medical volumes of the official history there has been little study of the RAMC’s work. A number of contemporary magazine articles describe various aspect of the RAMC at work but these and more modern writing has tended to focus on the work of Doctors and advances in medical treatment.[15] Studies of the mechanics of the evacuation are thin on the ground, therefore this dissertation will rely heavily on unit war diaries. These are a valuable primary source, but have been found to be quite variable. Putting aside the differences in individual’s writers’ interpretation of their documentary role, the diaries found at different levels vary enormously, but consistently by formation level.

 

The war diaries of field ambulances are good for detail of individuals’ movements in and out of the unit,[16] but frequently do not record the details of the deployment of its personnel for operational purposes. A few copies of orders from higher formations survive, but these are the exception not the rule. On the plus side, these diaries often record the number of patients moving through the unit’s facilities allowing for an estimate of the “workload” of the units. The issue of casualty statistics is always difficult but it is impossible to gauge the effectiveness of the field ambulance without consideration of the numbers passing through its chain of evacuation.[17]

 

An unexpected bonus in the war diary of the 56th Field Ambulance of the 18^th (Eastern) Division is the inclusion in the July 1917 folio of a set of standing orders for medical officers. Standing orders being the “instructions” of military function, this gives a benchmark against which to measure performance and an insight into the “corporate thinking” of the time. It has so far been impossible to locate any earlier versions. The timing of the issue tantalises whether standing orders may have been amended after the experience of the fighting around

Arras

.[18]

 The respective war diaries of the Assistant Director Medical Services [ADMS] of the divisions have so far proved to be the most useful level. Generally consisting of a log of the ADMS’s daily activities, operational orders and commonly maps, these diaries give a detailed account of both life within the division but also the diverse demands upon the medical services.

 

The Corps level war diaries give a broader picture with general orders, the finer detail being left to the ADMS as the “Johnny on the spot”.[19] The Deputy Director Medical Services brings the resources together but does seem to be something of a post box once units have been allocated responsibility. The war diaries for the Director Medical services at both Third Army and General Headquarters [GHQ] have an understandably wide-ranging scope. That of the medical advisor to GHQ in March and April 1917 makes little direct reference to operations at

Arras

, but covers subjects as diverse as opium and treacle mixture for Indian troops and considering permission for medical officer’s articles to be passed for publication.

 

Recent studies have argued that some of the BEF’s assets were best managed at Corps level but the RAMC’s operations in early 1917 were centred on the division.[20] Having begun the war firmly associated to Brigades, the sheer numbers of casualties and the accompanying logistical difficulties forced a change. By 1917, whilst still affiliated to brigades, the field ambulances are deployed as divisional assets.[21]

As the lead medical figure within the division the ADMS was the command and control centre of the medical resources. Responsible for the extraction and further dissemination of operational orders, the detail in the ADMS’s war diaries gives a clear picture of the medical deployment.

 

The ADMS’s operational orders to his field ambulances often give precise locations for the chain of evacuation. Using contemporary trench maps and the modern Linesman mapping system it has been possible to plot these facilities allowing an examination of the chain of evacuation. In many of the ADMS’s diaries specific routes for “up” and “down” traffic are designated. During the

Somme operations the evacuation of casualties was often delayed due to congestion in the trenches or on the obvious routes of vehicles.[22] The use of the products mentioned above has enabled measurement of these routes. The sheer physical effort and resulting time delay in the casualty’s transit are difficult to comprehend in modern society. During September 1916 the New Zealand Medical Services found hand carries of 3000 yards frequently necessary, with a “round trip” time to the bearers of 4 to 5 hours.[23]

 

Due to Linesman containing the modern day mapping of the area, it has become apparent that many Commonwealth War Graves Commission [CWGC] cemeteries are adjacent to medical posts from 1917.[24] The CWGC website contains descriptions of it’s cemeteries and it is common to find reference to CCS’s establishing cemeteries, but it is likely that an aggressive, or more pragmatic, form of triage was being practiced further forward.[25]

 

A small selection of Admission and Discharge books of medical units have been kept at the National Archives, those of the 51^st Field Ambulance [17^th Division] are extant and give a fascinating insight into the range of conditions treated.[26] Whilst a narrow sample, this has produced a surprising low level of soldiers being treated and then returned to duty. This may be due to the RMO’s work but soldiers with sprained ankles and pyrexia of unknown origin [PUO] find themselves being evacuated along with victims of gunshot wounds [GSW]. The dressing stations, both advanced and main, do seemed to have fulfilled a function of filtering these towards appropriate facilities.

 

Oblique references can be found in the war diaries to analysis and conclusions from previous operations,[27] but there is no apparent recording of lessons learnt as often found in infantry war diaries. It is only be comparing the approach of the same units across a period of time that changes can be found.

 

Ian Whitehead has provided a valuable account of the work of Doctors in the BEF. He argues that the Regimental Medical Officer [RMO] provided both a regimental face to the AMS, but also an important medical function in the initial treatment and preparation for evacuation of casualties. This argument should rightly be extended to the doctors within the Field Ambulance. It was whilst in the care of this unit that the casualty was to experience the rigours of the evacuation chain and the most critical time for treatment would pass.

 

Ian Whitehead’s work gives a succinct view of the arguments of the employment of doctors within the British Army, with both civilian and military authorities feeling a shortage of medical staff. Within the AMS this lead to campaigns to rationalise the use of doctors. One school of thought was to replace RMO’s with senior Non Commissioned Officers from the RAMC; this overlooks the wide-ranging work health role and morale effect of the doctor’s presence. In post war reflection it was decided that the post of RMO must be occupied by a doctor.[28] The Field Ambulance was to experience the cuts, one, then two medical officers being removed from the infantry divisions establishment. The lack of understanding, even amongst high ranking members of the RAMC, of the role of the Field Ambulance made it a prime target for economies in strength. Non-medical officers replaced doctors in the administration roles within the field ambulance, this decision was also criticised post war.

 

The structure of the dissertation

 

It is proposed that the dissertation will consist of an introduction, three chapters, and a conclusion with appendixes as required.[29]

 

The introduction will outline the research question, the need for it to be studied and the state of current and contemporary writings on the topic. As detailed above current research has produced more of the latter.

 

Chapter 1 is to cover pre-battle issues. It will examine the structure of the Field Ambulance as a unit and its role on the battlefield. The arguments on the value of the field ambulance will be included. Recent work by Andy Simpson has shown that many of the BEF’s resources, especially artillery, were best controlled from Corps level. The question of where the field units of the RAMC received their directions is to be addressed in this chapter. The preparations and logistics up to the eve of battle will also be considered, with some reflection on the question of “learning” from the fighting around the

Somme in 1916.

 Chapter 2 is to focus on the First Battle of the Scarpe, 9-11 April 1917. All divisions in the initial attack have been considered but the work of the three selected divisions is to be studied in detail. An examination of the flow of casualties down the evacuation chain from RAP to CCS will be used as one tool to gauge the effectiveness of the various field ambulances. The ability of the medical chain to stretch itself forward during the successful attacks will be appraised, it will also be examined to see how flexible to the tactical situation the field ambulance and its chain of evacuation could be.

 

Chapter 3 will look at the work of the nominated units during the continued fighting into May 1917. As divisions rotated in and out of the line, each of the chosen divisions returned to the fray. The response to the attritional nature of the continued offensive must be examined, with comparison to the pre-war establishment and the initial [9 April] structure.

 

The conclusion will summarise the argument of this dissertation: whether the RAMC field ambulance was “fit for purpose”.

---

[1] J. Lee, ‘Some Lessons of the Somme: The British Infantry in 1917’ in Bond, B. et al., ‘Look to Your Front’: Studies in the First World War (Staplehurst: Spellmount, 1999), p.81

 

[2]

Arras

created an average casualty rate of approximately 4000 per day, whilst it was less costly in absolute terms that the

Somme

or Third Ypres, it was the numbers repeatedly passing through the medical chain per day which is of consequence for this study.

3] The advance of the 9^th & 4^th divisions made a record of the time at 4 miles.

[4] The Canadians and Vimy ridge have caused a growing mountain of literature, an almost solitary British viewpoint is given by Jonathan Nichols highly anecdotal Cheerful Sacrifice.

[5] This is the conventional idea, based on the recommendation that the casualty should be kept warm, still taught in first aid today. Following the

Falklands

war of 1982 there has been some discussion on the benefits of hypothermia in trauma victims. The argument runs that due to the high level of troop fitness combined with the effects of hypothermia, casualties’ survived potential fatal injuries and delayed evacuation. The lack of aggressive fluid resuscitation didn’t counter this response, in contrast with the American experience of

Vietnam

casualties; hyperthermic, fluids pushed in and rapid evacuation to medical facilities, often by air. Some hospitals, both in the

UK

and

USA

, have been performing operations in a deliberately chilled environment.

[6] The general impression that the separate Bearer companies and Field hospital structure were no longer appropriate seems to have been quite wide spread, it was however surprisingly left to a Territorial Force Staff Sergeant to suggest the solution. See lecture by Staff Sergeant Stapleton in Journal of the Royal United Services Institute, 46 (1902).

[7] Delays or inability to evacuate demanded that surgery be carried out further forward than had been anticipated.

[8] This is still considered to be true of most trauma cases, medical staff talking of the “golden hour” as an outer limit of time from injury to definitive care. There have been efforts to support this with the “platinum ten minutes”, this is aimed at pre-hospital staff and is defined as the time span from time of injury to evacuation from the scene.

[9] The field ambulance has only recently been removed from the British army’s lexicon in favour of the Medical Regiment. It still has effectively the same internal structure.

[10] See I. Whitehead, Doctors in the Great War (Barnsley: Pen & Sword 1999) page 189- 196

[11] Quoted in Whitehead, Doctors in the Great War, page 190

[12] WO 32/11395 Report of Babtie Committee page 8, paragraph 44

[13] WO 32/11395 Report of Babtie Committee page 9, paragraph 49

[14] The war diaries of the 56^th (

London

) Division’s field ambulances and ADMS contain correspondence and orders relating to alterations in equipment scales. Additional numbers of stretchers and Thomas splints [a traction device for leg injuries such as a fractured femur] are frequently included, but the “thinning out” of unnecessary equipment is common.

[15] Ian Whitehead’s work is considered below, but for surgery see Geoffrey Noon’s ‘ The Treatment of Casualties’, in Paddy Griffith (ed), British Fighting Methods During the Great War (London: Frank Cass, 1996)

[16] This is possibly due to the lower turn over in personnel and smaller numbers involved. The field ambulance war diaries often mention other ranks being brought on to strength or sent on detachment. A frequent occurrence is the mention of individuals who have been noted for good work, whether officially recognised by gallantry awards or otherwise.

[17] It has been argued that the rapid passage of casualties through the Field ambulances contributed to the overwhelming of Casualty Clearing station on the Somme in July 1916, see N Cherry ‘The RAMC on the Somme 1916’, Stand To! The Journal of the Western Front Association, 64

[18] The BEF was capable of absorbing lessons and issuing its conclusions quite promptly. Guidance drawn from lessons on the

Somme

in July 1916 may have been issued before the month was out.

[19] This is very much in keeping with a general concept within the British army of the day. For the argument on the application of this principle from Field Service regulations see Andy Simpson Directing Operations.

[20] See Andy Simpson Directing Operations

[21] By the period in question, the only frequent incidence of field ambulances being associated with “their” brigades seems to be for unit moves into rest.

[22] Famously during the 1 July 1916 attack on Beaumont Hamel, the 1 Essex and Newfoundland Regiment couldn’t advance through trenches due to congestion. The New Zealand Medical Services experienced similar difficulties during operations  near Flers in September 1916, see The New Zealand Medical Services in the Great War, page 201-204

[23] The New Zealand Medical Services in the Great War, page 210 + 211, The RAMC manual of 1911 gives an estimate of a hour.

[24] Cemetery outside Achicourt is on location of 56^th division ADS, Cherisy Road East and Cuckoo Passage both seem to be on the location of collecting posts used by the 18^th division in May 1917.

[25] As the first medical staff, also being outside the regimental family, it may have been somewhat easier for the staff of the field ambulance’s post to make a realistic appreciation of a casualty’s chances. A number of cemeteries are named after dressing stations, but some are on the location of earlier medical posts.

[26] The National Archives (TNA):Public Record Office (PRO) MH106/91-95

[27] In an operational order dated 3 April 1917 within WO 95/1834 ADMS 12^th (Eastern) Division it is noted “from past experience it is advisable only to send over 8 bearers and 8 reserve with the companies”

[28] WO 32/11395 Report of Babtie Committee page 6, paragraph 25

[29] It is planned to outline the order of battle and the RAMC chain of evacuation as a minimum. A log of the locations of the studies units may also prove to be useful.

Another part of the onion

Being male I have a weakness for gadgets. This is good, as technology evolves it directly effects our day to day lives and the world around us, but as a history geek as well as a gadget one I was amazed when a friend showed me Linesman.

This programme gives access to somewhere in the region of 750 First World War trench maps, good in itself, but allows data to be combined with the modern day French IGN mapping. A wealth of other options allow for a contoured view of the landscape, a fly through view and exporting data to GPS/GPS enabled PDAs.

So now, with a bit of work,  you can stand on the (military) spot of your choice, find trenches etc. But I've been having a lot of fun with laying my own tracks.

Using the grid references from the Assistant Director Medical Services (ADMS) war diaries from various divisions, I've been plotting the casualty evacuation routes of field ambulances at Arras, Ypres and Cambrai from 1917. This could be an extreme example of a geneologist trying to track "Uncle Albert's" war, but in my case it is an attempt to understand the casevac chainas part of my dissertation research. I'd started doing this on paper, but the ease with which Linesman allows this is amazing. By tracing the route of a trench the distance is measured, but the contoured/3d view helps get an appreciation of the ground, something which becomes paramount when carrying a stretcher.

I'm not claiming that I now understand all that was happening, I've just added another layer to the onion.

RAMC sources

Well, I've been amazed at the possibilities I've managed to uncover without really trying. Firstly the curator of the AMS Museum Peter Starling, has been both helpful but also encouraging. The later is much in need at the moment.

Secondly, a search of the Imperial War museum's on-line database of its collections has thrown up a shortlist of 21 records to follow up. A quick phone call later and I'm off to the reading room soon to check the full(er) catalogue and see what else turns up.

Then the Journal of the Royal United Services Institute has been of great use. It has also been a great waste of time. Not because of any lack of information or accessibility but due to me getting distracted into reading articles on the British invasion of Tobago and the like.