The Casualty Clearing Station

There is little written about Casualty Clearing Stations during the Great War. What is written is often, as in Chinese Whispers, an interpretation of something taken from an already inaccurate account found on a web site, or glossed up magazine article based on the diary of a nursing nobody. What I find particularly distressing is the suggestion that a Casualty Clearing Station was a temporary collection of ramshackle tents, or, worse still, a dug-out under the Somme's chalk battlefield, or scraped into the Flanders mud.
The following page is a great example of appalling inaccuracy, with no easy way to contact the author to report their trial and execution (by ME!).
http://www.oucs.ox.ac.uk/ltg/projects/jtap/dce/ritchie/ClearingStations.html

[unfortunately, since writing this entry, the page at the other end of this link has been removed - obviously took fright at the thought of being hung, drawn and quartered]

It talks of the 'largely filthy conditions' of the CCS in which 'septicaemia and gangrene quickly set in' and that many operations were carried out in the 'primitive conditions' that existed there. We are also informed that 'many of the nurses were VADs' (Never, ever, did VADs work in CCSs) and more surprisingly, that they were joined by members of the First Aid Nursing Yeomanry (Give me strength!). Rather unfortunately, an internet search pushes this model of rubbish right up to the top of the pile, resulting in few readers going elsewhere. Of course, if they do go further, the situation does not necessarily improve, and if a picture tells a thousand stories, then this one is a rather unfortunate example:
http://www.chavasse.u-net.com/ccs.html
[Link now removed]

Entitled 'A Casualty Clearing Station at Trones Wood, August 1916' the photo is obviously genuine, but is not a Casualty Clearing Station, but some sort of medical facility right on the front line - an advanced dressing station, or regimental aid post. The amount of incorrect information is prodigious, but even reputable sites don't get it right - they have a go, but seem to be working from documents that simply don't reflect what was actually happening on the ground at the time.
The Western Front Association tell us that a CCS had 'a nominal capacity of 150' while the Victoria and Albert Museum describe them as 'small mobile hospitals' and a recent edition of The National Archives magazine 'Ancestors' carried a wonderfully illustrated article on the life and work of VADs in Casualty Clearing Stations on the Western Front. Just to emphasise the point, VADs were never allowed to be employed in any CCS. Never, ever. I did write to TNA just to let them know that their lead article was just not right, but unfortunately they neither replied to me, nor did they publish a correction.
In the autumn of 1914, when the war became static, Casualty Clearing Stations shed their extreme mobility and started to spring up in more fixed form, near enough to the front line to be easily accessible, but out of range of most of the German artillery. They were, wherever possible, established in buildings; convents, schools, factories and existing hospitals, often expanding into huts and tents to provide more accommodation. Later on, many became predominately tented and hutted, but only in the absence of suitable permanent accommodation. Trained nurses were posted to CCSs from October 1914, and to certain Field Ambulances from the autumn of 1915. Only the most experienced nursing staff were sent, and were immediately replaced if they proved lacking in the many qualities needed. In the early days, four nurses were considered adequate in addition to the RAMC staff, but by August 1916 some CCSs had nursing staffs of 25 to cope with the enormous casualties of the battles of the Somme.
At present I'm transcribing the official war diary of the Matron-in-Chief with the British Expeditionary Force in France and Flanders during the Great War. It runs to more than 4,000 pages, and hopefully it will provide enough material of interest to enable it to be published, albeit in much edited form. But just for the sake of waving the flags of both the Casualty Clearing Station, and it's smaller brother the Field Ambulance, here are some extracts taken at random from the diary, during the spring and summer of 1916. These are just a few of thousands of similar entries, but hopefully will provide an accurate snapshot of the set-up and conditions at CCSs and FAs at that time, as viewed through the eyes of the Matron-in-Chief, Maud McCarthy, on her visits of inspection. Although I have removed some of the diary entries not relevant to Casualty Clearing Stations, I have left the remaining text as originally written, and without correction or editing. I will let them stand alone, without further comment.

26.04.16

Left for 3^rd Army 9.30am. To 12 Stationary Hospital, just taken over from the French, a new Hospital built entirely on English lines, with various improvements. Most perfect in all respects. Hutted accommodation for all, including M.O.s, Nursing Staff and personnel. Every possible convenience, the position an excellent one. From there to DMS 3rd Army at St. Pol, where I had lunch and where the DMS told me of certain units shortly to open.

Visited 30 and 43 C.C. Stations, now both at Aubigny, the latter having just arrived from Lucheux. Both in house and a Hospice which is set apart for officers only. 30 C.C. Station running smoothly and well. Staff satisfactory, first rate operating theatres just completed. 43 C.C.S. run on same lines and is side by side with 30 C.C.S., the Hospice being at some distance, and in these grounds the Nursing Staff of 42 C.C.S. are accommodated under canvas.

From there to Chateau Habarcq where an emergency Hospital is about to be established, and where DDMS asked me to inspect with a view to another Staff being established there. The O.C. Major Carruthers took me round. A beautiful building with spacious accommodation, which will lend itself admirably for the purpose. Ample accommodation, also for the Nursing Staff on the top floor. Already in the grounds are several Huts and Marques for the reception of severe cases. From there to Avesnes – 37 C.C. Station. All going well. Then to Frevent – 43 C.C. Station, just established in French huts, and a school (where officers will be nursed). A great many badly wounded there – a great deal of work has already been done at all these Stations, the Nursing Staff are suitably accommodated and the reports of the work and behaviour of the Nursing Staff entirely satisfactory.

28.04.16

Left 9.30am for 4^th Army, having already rang DMS to let him know I was coming. Went first to St. Ouen, 3 C.C. Station, where I found the C.C. Station was about to move to Puchevillers. After lunch went to Heilly to 36 C.C. Station, which has just opened. Is entirely at present under canvas, but operating theatres and sterilising rooms are being built. Both O.S. and Sister in Charge spoke of the shortage of orderlies, and those entirely untrained.

From there to Warloy – 92 Field Ambulance, where 4 Nurses have just joined, Miss Whyte being in charge, established in a well built French Hospital with every convenience, and beautiful beds of flowers, forget-me-nots and pansies in the front - on their Staff among the Company are 2 Sandringham gardeners. Staff billetted in a little house opposite. Everything most comfortable, and the Nurses spoke of the welcome they had received from everyone, and the nice tea which was awaiting them. This Field Ambulance is not far from Albert.

From there to Gezaincourt to inspect the Chateau which is about to be opened for officers, and a Staff being required of 6. 60 officers can comfortably be put up here. Beautiful building situated in beautiful grounds. Was taken round by Captain, as the O.C. was on leave here, gone off suddenly to Dublin in consequence of the Riots, as he was anxious about the safety of his wife.

02.06.16

Left for 3^rd Army. Visited: 39 C.C. Station at Frevent, only recently established and which had just received orders to pack up, to make room for 6 Stationary Hospital which is on its way up. This will be a hutted unit, handed over from the French. The Officers Hospital accommodation for 30 is in part of a school at some distance from the rest of the unit, and which should I think have its own separate Staff. These can be billeted near their work and the remainder will have to be under canvas in their own compound when the new tent arrives. I have arranged to make use of the present Staff until 39 C.C.S. re-opens, as the O.C. reports that his Staff was most satisfactory and adaptable in every way. The unit looks entirely satisfactory, and the patients on the stretchers were made as comfortable as possible. It was evident on all sides that the very best that could be done was being done for these men.

To Headquarters where I had lunch with the DMS, Surgeon General Murray Irwin, and where I was able to discuss certain matters with him, and mainly with the nursing arrangements in the units in his area, and the suggestion of having a certain number of Nurses ear-marked at 12 Stationary for emergency work at the C.C.S.’s in his area in times of stress, and also I told him of the fresh rules which were being circulated for the Sisters in Charge assistance and guidance while working at the Front, with which I heard that many at present were in doubt.

After lunch to Aubigny. 30 C.C. Station since my last visit has vastly improved and everything is working smoothly and well. The Sister in Charge Miss Cameron TFNS is an able manager. Miss Warrack TFNS unfortunately has asked for a transfer Home, which has been granted. She is an admirable Theatre Sister, and has done great work in equipping her theatre in an admirable manner. Now that the transfer is permitted, she is wishing she could remain till her time at the front has expired, but this unfortunately cannot be arranged. So many of these girls really do not know their own minds. The Staff is comfortably and suitably accommodated.

42 C.C. Station which is next to 30 C.C. Station is not by any means so satisfactory, it’s dirty, ill managed and a lack of interest and management everywhere. This I told the O.C. and said that I was not satisfied with the Nursing arrangements, and after reporting the matter to the DMS I would make certain changes which I hope may improve matters at any rate in my department I hope.

At Harbarcq I visited 14 Field Ambulance, where 4 Nursing Sisters under Miss Wood QA are working in a Chateau which is being set apart for seriously wounded men and officers, and where French women and children are also admitted sometimes. At the time of my visit there was a little French girl who was being nursed in one of the rooms near the Nurses quarters. She was doing well, and also a poor Sergeant who it was reported had been picked up in the trenches where he had been for 10 days without anything to eat. He had been in 2 days and was better, but still in a very serious condition. This unit should be a very good one later, at present only in the making. The accommodation for the Nursing Staff is good and the Staff keen and I think good Managers.

At Avesnes – 36 C.C.S. all was going smoothly and is much as it was the last time I visited it. All these units are very near the firing line. The sound of bombardment was incessant and one could see Taubes in the air. The C.O. here is a difficult and not an able one I should say.

At Le Quesnil 43 Field Ambulance, Isolation Hospital. This unit is situated in the most glorious park. The Chateau has been converted into a Hospital for the serious cases. Here we have 3 Nurses, Miss Baird in charge, accommodated in one of the wings. This is a beautiful unit, in beautiful surroundings, lovely tapestries and pieces of lovely furniture which is still left here and there. All these things leave a feeling of sadness, and thoughts for the poor owners. The avenues of wonderful trees are particularly beautiful here, and I was told that it is feared many of the trees are permanently damaged by the French Cavalry which have been recently quartered here since the beginning of the war until they recently moved their line. One cannot help devoutly hoping this is not the case – for the moment they are quite wonderful. The lavatory accommodation here as in most French buildings is the one difficulty here. Returned to Abbeville 8.30pm. After dinner went to office where much correspondence was awaiting me.

18.06.16

Left for 4th Army 8am, arrived at HQ 10am. Passed thousands of troops marching forward, each battalion with its band, all wearing masks. DMS very busy, many Clearing Stations opening and needing Staffs. Visited them all that I could in the time.

Heilly 34 and 36 C.C.S., both very busy, needing more help. Accommodation for Staff good.
Warloy 92 Field Ambulance. More help, only Staff of 4 and they had been working day and night.
Puchevillers 3 and 44 C.C. Station busy opening up under canvas. They are side by side, quite close to a railway side and both Staff will Mess together. Arrangements very good.
Authie South Midland Field Ambulance, in a Chateau, Staff not yet arrived, but everything being got into order, and good accommodation for Staff ready. Some very badly wounded there, who were being cared for devotedly by the orderlies – even flowers by their sides.
Doullens The Citadelle – a wonderful historic fort, inside which 35 C.C. Station is being established. Wonderful buildings, a Chateau, Barracks, etc., built 1618. Anxiously waiting for Staff which should arrive tonight.

On to GHQ with my particulars of staff with covering letter with which Colonel Morgan was quite satisfied. He said he had already applied officially for the Nurses, but he doubted whether we should get them. Well, if they don’t come, one must just carry on, but one can’t do impossibilities, and these people who work so hard, I am so sorry for them. However, they will not fail us I am sure, and leave will have to be stopped till more help comes. Got back to Abbeville 9pm.

24.06.16

Left 8am for 4^th Army, arrived Vequemont 10am. Visited 34 and 45 C.C. Station opening up side by side under canvas, near railway siding, everything getting in readiness for the coming push. Nursing Staff in both units increased to 10, accommodated in huts and to Mess together. Both units capable of taking 1000 each, and everything in readiness.

Then to DMS 4^th Army, where I learnt what was being arranged for the coming work, and he was extremely pleased how I had been able to supply all with nurses to the extent I had done. From there to Heilly to see 38 C.C. Station which was now working. Raining heavily, things going smoothly. This unit also under canvas, except operation hut, large enough for 4 tables to be working easily at once. Had lunch with Sisters 36 C.C. Station. All well settled in and glad of extra help in readiness for coming work.

On to Authie to South Midland Field Ambulance. 4 Sisters had arrived and were getting Chateau clean and workable. One of the dirtiest places I have seen and the difference since last Sunday quite remarkable. Unfortunately have not yet met O.C. – out each time I have been.

On to Doullens to Citadelle, where 35 and 11 C.C. Stations are now opening. Miss Toller and 6 others have only arrived so far. Have arranged for Miss Toller to be in charge of both, with a Staff of 14. A great deal had been done since I was there last Sunday. From there I went to Frevent, where 6 Stationary Hospital is just opening, and where the Staff is not sufficient, but where I am unable to send any more until the accommodation for them is available. This I am told will be ready in a few days

16.07.16

Left early for 4^th Army. To Headquarters first, where I saw DDMS Col. Fawcus, and from there Heilly, to 36 and 38 C.C. Stations, where I spend a long time. These units were extremely heavy, crowded with most dreadfully wounded men, many many who can never leave. The operating theatres with 4 tables in each are going day and night, and the work of everyone is continuous, heavy and sad. Everyone doing splendid work. Finding in both these stations that the Nursing Staff is not sufficient. I arranged to increase both Staff by 2, giving them each 14. Here an extra C.C.S. for walking cases has been established, not requiring Sisters.

From there to Vecquemont, 34 and 35 C.C. Stations. These like the 2 previous are under canvas, and near the railway line. Both these units had just evacuated and everything was satisfactory. An extra C.C.S. for walking cases here also.

17.07.16

Reserve Army - Where I saw the DMS, Surgeon General Nichols, and who will communicate with me direct always in connection with anything to do with the Nursing Staff, and I arranged to keep him informed of all matters needing his attention when visiting the C.C.S.s in his areas.

To Puchevillers to see 3 and 44 C.C. Stations, now much quieter, and where I found I was now able to take 2 Nurses from each to Warloy, where the Field Ambulances were just changing. The Hospital crowded with serious abdominal cases, a Staff of 8 not sufficient. Arranged to send another Sister at once, experienced in operating theatre work.
(Welsh F.A.) To Authie to Field Ambulance also just arriving, the predecessor just transferred to Warloy. Here the work had diminished considerably, and I found I was able to move 4 Nurses.
To Doullens to Citadelle, 11 and 35 C.C. Station. This place in the short time has become a most magnificent unit, more like a General Hospital than a C.C. Station in every respect. Miss Toller who is in charge of both units is managing most excellently. In all instances I saw the O.C.s who expressed entire satisfaction with the Nursing arrangements in all units.

Unable to get accommodation in any Hotel, so went to 19 C.C. Station where I had dinner and where they found me a billet where I was more than comfortable in a charming room, and a nice old French lady, the owner, was most kind and welcoming.