During World War I, the Australian Imperial Force (AIF) suffered 58,339 deaths and 151,948 wounded. To help deal with so many injured and sick soldiers, the Australian Army Medical Corps was expanded. By 1918, the Australian medical units included many specialist units, such as sanitary sections. Medical staff served wherever Australian soldiers served. They also worked in Australian hospitals for returned soldiers.
Regimental aid posts
A regimental aid post was the first step in the medical evacuation chain. The post was usually located about 700 yards (640m) behind the front.
A Regimental Medical Officer and five other ranks from the Australian Army Medical Corps staffed most posts. Infantry battalions assigned at least 16 soldiers to act as stretcher-bearers.
The regimental aid post was a vital point of liaison with the field ambulance units set up further behind the front. The post controlled everything in front of its position. Field ambulances controlled the medical evacuation chain behind the post.
Medical officers tried to set up regimental aid posts in the most suitable places. This wasn't always possible.
Major Keith Doig, the Regimental Medical Officer for 60th Battalion, noted in his diary on 26 November 1916 that his:
[Regimental Aid Post was] a deep German dug-out but unfortunately [it was] right in middle of barrage line and machine gunning.
Field and Light Horse field ambulances
Field ambulances were attached to each of the AIF brigades. A field ambulance was a military unit, not a vehicle. The field ambulances played a vital role in triage.
Transport
Transport attached to a field ambulance included:
- three horse-drawn ambulance wagons
- seven motorised ambulances
- 10 general service wagons
- three water carts
- one motorcycle
- one bicycle
- one small two-wheeled Maltese cart
Staff responsibilities
Each infantry division had three field ambulance units with 10 officers and 182 other ranks from the Australian Army Medical Corps.
Staff in each ambulance unit gave immediate care to wounded soldiers. They were responsible for managing:
- advanced dressing stations
- main dressing stations
- walking wounded dressing stations
Field ambulance staff moved the wounded from the regimental aid post (just behind the front lines) to an advanced dressing station. The trip was about 1 to 3 miles (1.6 to 4.8km) and took around 6 hours to complete.
Stretcher-bearers worked in relays. At least 36 stretcher-bearers handled each patient along the way.
The main dressing station was another 3 to 8 miles (4.8 to 12.9km) beyond the advanced dressing station.
Read about triage of sick and wounded soldiers
Experience of the wounded
Sergeant William Peach of the 7th Battalion AIF described the process of the medical evacuation chain in a diary entry on 15 May 1918 after being wounded:
Fritz got a shell right on to us about 8 am. Several killed and number wounded. House collapsed and we were buried in debris. My wounds not serious but numerous. Got it in head, hands, right shoulder, back hip, legs, knees and ankles. Managed to pull myself out from rubbish, and after getting first aid from SBs [stretcher bearers] walked to Advanced Dressing Station at Bourne (Jimmy Donnet assisted me down). Had wound redressed and then taken to Main Dressing Station in ambulance. Particulars etc. taken there, inoculated with anti-tetanus and taken on to C.C.S. [Casualty Clearing Station] […] at Ebblingham in Ambulance Car. Put on table at C.C.S. and went under operation. Got an injection of morphia and had a bit of a sleep. Put on Ambulance train at 8 pm. Fritz bombing close to station so had to move out in quick time. Had a very tedious and rough journey to Base. Suffering a lot with pain in stomach. Unable to sleep. Doctor gave me a drug but even that was no good.
Casualty clearing stations
A casualty clearing station was a small hospital generally located around a vital communication hub, such as a railway junction that received wounded from the field ambulances.
Casualty clearing stations were typically 10 to 20 miles beyond the main dressing station. A trip from the front to a casualty clearing station would have taken about 8 to 10 hours.
Each station acted as:
- a hospital
- an evacuation centre
- a 'sieve' that helped soldiers with minor wounds return to duty quickly
Each station had operating surgeries and wards, where wounded soldiers could be treated before being moved to the next phase of the medical evacuation chain.
Staff responsibilities
A casualty clearing station typically had:
- 8 officers and 78 other ranks from the Australian Army Medical Corps
- 5 to 15 nurses from the Australian Army Nursing Service
By 1918, specialist surgical teams served at casualty clearing stations as needed.
Important work at casualty clearing stations included:
- performing triage on patients to assess the severity of their wounds
- performing resuscitation, operations and after-treatment care for patients with severe wounds before they were moved further down the medical evacuation chain
- giving interim treatment for patients with minor wounds or those afflicted by the use of gas
- treating patients with minor wounds so they returned to duty as quickly as possible
Staff at casualty clearing stations supported base hospital staff by the diagnosis and early treatment of soldiers with mental illness. 'NYDN' meant 'not yet diagnosed nervous'. The term was applied to patients with suspected psychological conditions related to the war.
Base hospitals
Next in the medical evacuation chain was the base hospital, which was located within the line of communication area.
Base hospitals could be either:
- general hospitals, or
- stationary hospitals
General hospitals
During World War I, Australia raised 16 general hospitals. Several general hospitals served overseas. The rest were in Australia.
No 1, No 2 and No 3 Australian General Hospitals served on the Western Front.
No 14 Australian General Hospital served in the Middle East.
In 1916, No 10 Australian General Hospital was broken up in the United Kingdom (UK) to provide staff for the new Australian Auxiliary Hospitals.
Hospitals in Australia typically dealt with:
- training-related injuries and illnesses
- veterans who had been invalided home and required further medical care
Each general hospital had about:
- 1040 beds
- staff of 34 officers, 73 nurses and 203 other ranks of the medical service
By late 1918, No 3 Australian General Hospital had 28 officers with another eight attached for various duties, 82 nurses and 233 other ranks.
The work of the Australian general hospitals reflected the British Army system. As the commander of No 1 Australian General Hospital, Colonel Sir Trent de Crespigny noted in a 1917 memorandum:
No Australian General Hospital or Casualty Clearing Station in France is exclusively devoted to the treatment of Australians. Such selection and segregation would be difficult and inadvisable. We admit sick and wounded in precisely the same way that our British and American neighbours do, so that in the same ward one may see English, Scots, Irish, Canadians, Australians, New Zealanders, South Africans, Newfoundlanders, British West Indians and members of other overseas units. It is a most striking example of the Empire's 'far flung battle line'. The contact that exists between hospital patients offers an admirable opportunity for men of various dominions and the mother country to know and understand each other.
As Sergeant William Peach recalled in a diary entry on 16 May 1918, this process worked both ways, with Australians often treated at hospitals run by other Allied nations:
Arrived at Boulogne about 6 am. Admitted to No 13 General Hospital (American). Out in ward B3. Lovely big building on sea coast. Originally a casino. Had my wounds dressed and got settled down in bed. Doctor gave me a bit of hurry up for 10 minutes or so. Unable to eat or sleep. Very painful.
Base hospitals
Main functions of base hospitals were to:
- admit and treat the wounded who'd been transported down the medical evacuation chain
- evacuate patients for further treatment
- return service personnel either back to their units or to the UK
Base hospitals did an enormous amount of work. For example, during 1918, No 3 Australian General Hospital treated 29,061 medical cases and performed surgical work.
Stationary hospitals
Two stationary hospitals were set up as small hospitals in forward areas during World War I.
No 1 Australian Stationary Hospital served on Gallipoli and became No 3 Australian Auxiliary Hospital in 1916. No 2 Australian Stationary Hospital served in Palestine.
After the base hospital, a patient would either continue their journey along the medical evacuation chain or return to their unit.
Auxiliary hospitals
If a soldier suffered a 'blighty' wound, this meant that after treatment at a base hospital, he would be transported back to the UK by a hospital ship.
Australian troops typically embarked in France at the ports of Rouen and Le Havre and arrived at Southampton. They returned to France through Le Havre.
In the UK, the wounded men received further care. During World War I, around 250,000 Australian troops were treated at a hospital in the UK.
When Mary Ann Pocock became Matron at No 3 Australian Auxiliary Hospital in early 1918, she noted that the hospital had around 1150 patients.
To support the British effort, in 1916, the AIF created several auxiliary hospitals to give medical care to their troops.
After being transported to a British hospital in the UK, patients were transferred to an Australian auxiliary hospital as the final part of their treatment before moving to a command depot.
As soldiers entered the auxiliary hospital system, they received their initial classification. This decided if they would be returned to duty or invalided home. Three broad classifications were applied to soldiers by a Medical Board:
- Class A - fit for general service
- Class B - temporarily unfit for service
- Class C - permanently unfit for service
Other classifications existed within each of these categories. It was not unusual for someone's classification to be changed as they recovered.
Staff at auxiliary hospitals focused on the movement and treatment of the wounded.
No 1 and No 3 Australian Auxiliary Hospitals dealt with those soldiers deemed able to return to duty. Staff undertook surgical work linked to getting soldiers back to the front.
Medical work at these facilities also focused on preventative measures against disease so that soldiers were returned to their units.
As Matron Pocock recorded in her diary on 4 January 1918 shortly after she arrived at No 3 Australian Auxiliary Hospital:
Went all round wards - know the bad cases now - very few - all convalescent nearly. Sisters very good and thoughtful- feel I shall like it and be happy and feel that I shall only be here a very little while - I don't know why - the same feeling I had at Cobham Hall.
Staff at No 2 Australian Auxiliary Hospital focused on work to ensure patients could be transported back to Australia. As part of this, No 2 Australian Auxiliary Hospital specialised in fitting artificial limbs.
Work in the UK was also risky. As Matron Pocock noted in her diary on 28 January 1918:
Much shells, anti aircraft fighting and guns - Germans must be over. Fancy I heard some bombs explode - great noise and much search lights etc. Ceased about 10pm for a while - can hear the engines quite well - men say our planes - but I think German.
Back in Australia, during the war, No 13 and No 24 Australian Auxiliary Hospitals specialised in providing care for returned soldiers with psychological disorders.
Command depots
The command and convalescent depots were the final stages in the return of a wounded soldier either to front-line duty or being invalided back to Australia.
Depots undertook an enormous amount of work. For example, 134,104 soldiers passed through Australian command depots in the UK over a 16-month period from July 1917 to November 1918. Many (46,871) were invalided back to Australia.
When command depots in the UK received Australian soldiers from the Australian auxiliary hospitals, the staff tried to move the soldiers from being convalescents to be 'effective'. Once soldiers were 'hardened', they went to the Australian Overseas Training Brigade. Soldiers eventually returned to the front in France.
No 1, No 3 and no 4 Australian Command Depots dealt with the soldiers deemed able to return to duty. No 2 Australian Command Depot managed those who were to be invalided back to Australia.
As a development of the command depot system in the UK, in 1918, a convalescent depot was established in France. This helped to speed up the process of returning wounded soldiers to duty who were deemed fit for front-line duty.
Convalescent depots
In part, this was a reaction to the German Spring Offensives of 1918 and the growing need for manpower. The creation of No 1 Australian Convalescent Depot in France allowed for 'hardening' to take place sooner. The depot had 2000 soldiers split into two camps or 'divisions'. Each camp was then further divided into four companies.
Under these companies, soldiers were treated, trained and classified. Classification within the convalescent depot differed from those in the UK:
- Class A still applied to the considered fit for duty - these soldiers were transferred to base depots as soon as possible
- Class B men were fit for physical training and route marching
- Class C men were only fit for light fatigue duties and physical training
- Class D men were considered unfit for any duty
As in the UK, personnel were constantly reclassified. Those not fit within 2 months went to the base depot for appropriate treatment.
From its formation to February 2019, 14,734 wounded passed through No 1 Australian Convalescent Depot. Most (12,349) were classified 'A' and eventually returned to service.
Australian Flying Corps Hospital
For much of World War I, the medical arrangements of the Australian Flying Corps were administered by the British Royal Flying Corps. This was because Australian Flying Corps squadrons operated as part of the Royal Flying Corps.
In 1918, created a dedicated medical service to make the Australian Flying Corps more self-sufficient.
The Australian Flying Corps Hospital in Tetbury, UK, was close to the Headquarters of the Australian Flying Corps Training Wing and its nearby training squadrons.
The hospital mainly dealt with accidents related to training. Its staff included one Medical Officer, four nurses and two Australian Army Medical Corps orderlies.
Sanitary sections
While casualties are often associated with those who received wounds due to combat, a key challenge for all militaries has been the maintenance of clean operating conditions and the prevention of disease amongst troops. The spread of disease has often been a significant factor in limiting the effectiveness of military forces.
During the Gallipoli Campaign, sanitation and hygiene had been a significant factor in spreading diseases and led to a large number of non-battle casualties. In May 1915, No 1 Sanitary Company was established.
Continuing issues surrounding sanitation and hygiene led to the creation of sanitary sections for each of the AIF divisions.
Sanitary sections helped the front line units by:
- working with them to combat infectious disease
- performing disinfection and disinfestation
- taking direct action against gastrointestinal infections
Symptoms of stomach infections included diarrhoea, vomiting and abdominal pain.
Sanitary sections were staffed by one officer, five non-commissioned officers (NCOs) and 20 privates.
Views of the effectiveness of these units varied. The commander of No 3 Sanitary Section recorded in a memorandum that:
[t]he only usefulness of sanitary sections for front line or support line is to make latrine boxes, and get them taken up at night. […] The limit forward of usefulness is at about reserve Coy. cookhouses, where grease traps, latrines, F.P. food boxes and water supply can be gone into. The most useful work is in camps and villages where troops are camped or billeted in large numbers.
Dermatological Hospital
Dealing with infectious diseases, including sexually transmitted diseases, was a large challenge for the military.
Sexually transmitted disease was called 'venereal disease'. Sometimes it was more politely referred to as 'rheumatism' because it held a social stigma. In the British military, soldiers infected with a venereal disease often faced punishment.
As the Australian official history of the Australian Medical Services reflected:
[t]he history of the [Australian Dermatological Hospital reflected] the banal tragedy and social cruelty that surrounds venereal disease.
No 1 Australian Dermatological Hospital was established in 1915 and eventually transferred to Bulford in the UK. By 1917, No 1 Australian Dermatological Hospital was the size of a general hospital with 1040 beds.
Three sections of the hospital dealt with:
- cases of acute gonorrhoea, syphilis and scabies
- complicated cases of gonorrhoea
- cases of chancroid and all cases of disciplinary detention
The AIF tried to control cases of venereal disease by:
- punishing anyone found to have venereal disease by stopping their pay during their period of absence due to the illness
- teaching personnel to understand the issues surrounding the illness.
These efforts rarely changed the behaviour of Australian soldiers.
In France, Australian soldiers suffered from higher rates of venereal disease when compared to the British and French soldiers. Cases of venereal disease were treated by No 39 British General Hospital in Le Havre. By 1918, Australian medical personnel staffed a wing of this hospital to help deal with cases emerging from AIF troops in France.
Glossary
- casualty
- embark