Weapons used during trench warfare created terrible injuries that required complex medical treatment. The British forces developed a triage to prioritise the treatment of wounded soldiers. Australian medical and nursing units cared for the sick and wounded wherever the men served.
Illnesses and devastating injuries
The Australian Government recorded 215,585 casualties during the war. Over 80% of those casualties occurred on the Western Front, in Belgium and France.
The weapons used in trench warfare created horrendous injuries for both sides in the war. In the Australian Imperial Force (AIF), for example, most wounds were the result of flying metal.
During their service, many of the 331,781 AIF troops and medical staff were injured more than once:
- over 50% were hit by shell fragments or shrapnel bullets from artillery fire
- 40% were hit by high-velocity bullets from rifles or machine guns
- 12% were affected by chlorine or mustard gas
- 2% were hit by bombs or grenades
- only 0.3% suffered bayonet wounds
Many health risks also developed into large-scale problems on the front.
Those who served lived and work in crowded spaces, which helped to spread bacterial, viral and parasitic infections. Unhealthy living conditions for soldiers (and sailors) included:
- poor diet
- lack of sleep
- exposure to cold
- contact with mice, rats, fleas, lice and other parasites
When accessing a person's war service records, you can usually see how many times they were treated in a medical facility.
Triage for the wounded
As the war progressed, the British Army devised a complex triage.
Triage is the practice of sorting casualties (sick and wounded people) into categories of priority for treatment, and it's still used in hospitals today.
This new transport and assessment system meant that soldiers could be treated by medical staff as fast as possible.
The wounded were sorted and moved along a medical chain via a transport network that included:
- stretcher bearers
- horse-drawn wagons
- motorised ambulances
- ambulance trains
- canal barges
- hospital ships
Stretcher bearers, from the Australian Army Medical Corps or the battalion, collected seriously injured men.
Under appalling conditions on battlefields, stretcher bearers would:
- bandage wounds as part of first aid
- move the wounded away from the front
- deliver the wounded to an ambulance or a Regimental Aid Post
Protected only by their 'SB' armbands, these unarmed men often braved artillery and machine-gun fire to get their patients to safety. The troops greatly admired their courage.
Sometimes German prisoners of war carried stretchers for the Allies.
The 'walking wounded' would make their own way back to a regimental aid post.
Regimental aid posts
Usually located in rear trenches, the battalion's medical officer and other medical staff would:
- assess the wounded soldiers
- change bandages
- give morphine as a painkiller
Then a doctor would:
- classify the patients according to the type of care needed
- send them on further behind the line for more treatment
During a gas attack, the men lowered blankets over the regimental aid post to prevent gas from seeping into it.
Private Sir Albert Coates was an Australian medical orderly who served on the Western Front. He worked tirelessly to save the wounded amongst the horrors and filth of the trenches.
After the war, Coates became a surgeon and devoted his life to helping the sick. When Coates served again in World War II, he was captured by the Japanese and sent to work on the Burma-Thailand Railway. In the labour camps, he provided vital medical care to the other prisoners.
Advanced dressing stations
These stations were sometimes dug into a slope a few kilometres from the front.
Doctors in field ambulance units would:
- give anti-tetanus injections
- treat wounded men for shock
- perform urgent operations
Soldiers who needed more treatment were transported by ambulance or a 'GS' (General Service) wagon to either:
- a Main Dressing Station, or
- a Casualty Clearing Station
The walking wounded could receive treatment at an Advanced Dressing Station.
Main dressing stations
One of these stations would receive wounded men from several nearby advanced dressing stations.
Medical officers at these stations would:
- resuscitate severely wounded soldiers
- treat soldiers affected by chlorine or mustard gas
Most of the wounded men were passed onto casualty clearing stations.
Casualty clearing stations
Patients who survived and arrived at a Casualty Clearing Station needed surgery and nursing care. These stations were located as close as possible behind the lines.
Nurses of the Australian Army Nursing Service would attend to the incoming patients.
Surgeons operated on the men if they could.
[In the operating theatre] there were twelve operating surgeons, with theatre teams, working on six tables continuously for twenty four hours. The theatre staff worked the longest hours; the routine was sixteen hours on and eight off duty.
[Sister Mabel (May) Tilton in The Grey Battalion
Recovering patients were transported to Australian military hospitals, in Cairo, France or England.
In France, patients were often carried by hospital train.
Wounded men were transported to military hospitals, where doctors and nurses would care for around 1000 patients at a time. Men remained in hospital until they could be returned to their unit or evacuated to Britain.
Most seriously wounded soldiers were evacuated by hospital ship to England. They could undergo months of treatment and recovery. Some would return to the battlefield.
Hospitals in Britain
Hospitals in England were important for both the medical treatment of troops and the communities they fostered. The AIF's No. 1 Auxiliary Hospital, set up in the stately Harefield House, brimmed with life amongst the bodies devastated by war.
Invalided and recuperating patients at Harefield Hospital:
- established a vibrant hospital community
- were welcomed into the local community
- enjoyed amateur theatrics and sports competitions
- published their own newspaper, The Harefield Park Boomerang
General William Birdwood, the Australians' Commander, visited Harefield in 1916 with his wife and family. In the same style that endeared him to the troops at Gallipoli, he visited every Australian patient to ask how they were. His visit lifted the 'diggers' spirits immensely.
Outcomes for patients
Some wounded men were:
- returned to their units in the fields when they recovered
- sent to a convalescent depot for further recovery
- transported to hospitals in Britain for specialised care
- repatriated home to Australia if they were not fit to serve
Men who were missing arms or legs, blinded or maimed, or badly shell-shocked eventually returned to Australia. They were discharged from military service after they got home. Most were entitled to a pension and other benefits as veterans.
Many patients did not recover from injuries or sickness received on the battlefield. Sadly, they died - on the battlefield, during transport or during treatment - far from home.
Egypt at the start of the war
When the AIF arrived in Egypt in December 1914, it brought five complete units of the Australian Army Medical Corps, fully equipped. These facilities supplemented:
- two British Army hospitals - at the Citadel in Cairo and at Ras-el-Tin in Alexandria
- three East Lancashire field ambulances
- two British Indian general hospitals and extra field ambulances
- New Zealand Imperial Force medical units
The AIF established No. 1 Australian General Hospital at the Heliopolis Palace Hotel in Cairo on 25 January 1915. The hospital's capacity quickly increased from 200 beds to 1000.
During the Gallipoli Campaign, the hospital commandeered neighbouring buildings to make over 6000 beds available.
Lemnos during the Gallipoli Campaign
On the Greek Island of Lemnos, a small medical facility at West Mudrous took light casualty cases from Gallipoli.
From the August Offensive onwards, the medical staff were flooded with causalities. The centre was scaled up as an intermediate military medical base, including:
- No. 3 Australian General Hospital
- No. 2 Australian Stationary Hospital
- British and Canadian medical units
A rest camp at Sarpi - across from the hospitals - became a convalescent depot in September 1915. The first intake of Australian troops took 2 months to become fit enough to return to the battlefields, instead of the anticipated 2 weeks.
Insects as a source of disease
The Anzacs arrived at Gallipoli in the northern spring of 1915. Open pit toilets, animal manure and unburied bodies created an ideal breeding ground for flies. By summer, flies were breeding in their millions.
The flies quickly spread diseases like dysentery and enteric fever. Many sick men had to be evacuated. Some died.
By June 1915, more men were being evacuated from Gallipoli because of illness than because of enemy action.
- mustard gas