The VAD and the Casualty Clearing Station

     I'm always complaining about errors made in placing VADs in Casualty Clearing Stations during the First World War.  Writers of fiction, newspapers, the BBC, the world and his wife, all love to see them in the thick of it with bombs falling and shrapnel whizzing past the poor VAD on her way to the bin with an amputated leg.  It's fair to say that the senior medical staff in France and Flanders would have agreed to them being there, but the Matron-in-Chief was adamant that only the best and most experienced trained nurses were good enough to be working at the sharpest of ends and it was she who won that battle.  Of course if you look hard enough it's often possible to find an exception to any rule and during a long and varied war there was at least one VAD who managed to buck the trend.

     Alice Batt was born in Oxfordshire in 1890, the daughter of Charles Dorrington Batt, a doctor, and his wife Isabel (née Wake). By the outbreak of war Charles Batt and several of his children were involved with local Voluntary Aid Detachments, his son John, also a doctor, becoming resident medical officer during wartime at the large auxiliary hospital at Ampton Hall, Bury St. Edmunds. Alice Batt first worked as a VAD in London at the Officers' Hospital, 6 Bruton Street - the heart of Mayfair and in March 1916 she signed for overseas service and was sent to No.9 British Red Cross Hospital, the 'Duchess of Sutherland's,' at that time in Calais.

Operating theatre staff No.9 BRCS Hospital (Duchess of Sutherland's) in July 1917  [IWM Q2615]

     During the final weeks of the war as the British army advanced, the hospital moved further forward to Hazebrouck by which time Alice Batt was working as an operating theatre orderly. Although this was not a role undertaken by VADs in British military hospitals, it was found acceptable in units run under the control of the Joint War Committee of the BRCS and Order of St. John. By the beginning of October 1918 although Britain seemed to be winning the war, casualties were great and all medical units were working under extreme pressure.

     Three Casualty Clearing Stations working side by side at Rousbrugge [Roesbrugge], Nos.11, 36 and 44, were in danger of being overwhelmed with casualties and a request had been made for extra staff which could not be fulfilled at the time by other British units under War Office control.  The principal need was for 'surgical teams' which were mobile groups used to fill urgent gaps, and each team  was made up of one surgeon, one anaesthetist, a trained theatre sister and one or two theatre orderlies.  Appeals were made both to Canadian and American units who were able to send some reinforcements but the three CCSs at Rousbrugge were still understaffed.  At that point two surgical teams were offered by No.9 British Red Cross Hospital, an offer which was gratefully accepted and probably the only time during the war that this happened.  Theatre orderly Alice Batt was part of one of those teams and she joined the staff of No.36 Casualty Clearing Station. Within a few days she was at the centre of a drama for which she was later awarded the Albert Medal for her actions. The citation published in the London Gazette 25th April 1919, gives the details:

The KING has been pleased to award the Albert Medal in recognition of gallantry displayed in saving life: —
Miss -Alice Batt, Voluntary Aid Detachment
On the 1st October, 1918, a fire broke out at No. 36, Casualty Clearing Station at Rousbrugge, Belgium, and quickly reached the operating theatre, where the surgeon, was performing an abdominal operation. The light went out, and the theatre was quickly filled with-smoke and flames, but the operation was continued by the light of an electric torch, Miss Batt continuing her work of handing instruments and threading needles with steadfast calmness, thereby enabling the surgeon to complete the operation. Miss Batt afterwards did splendid work in helping to carry men from the burning wards to places of safety.

     As the staff of the Duchess of Sutherland's Hospital were predominately female, it's possible that Alice Batt was not the only VAD employed at a British CCSs during that hectic period, but the award of her Albert Medal makes her the only one to be positively identified.  Full details of Alice Batt's wartime service are included on the BRCS website here:

Original card that shows work in London

Later card for overseas service

*****

Evacuation from Dunkirk

Geoffrey Moulson, who appears in the previous post, served for nearly forty years as a medical officer in the Royal Army Medical Corps. During the First World War he initially worked in Mesopotamia and later in India, a place he knew well from his childhood. During the inter-war years he rose rapidly through the ranks and on the outbreak of war in 1939 he was posted to France as Commanding Officer of both No.4 Casualty Clearing Station and No.203 Field Ambulance - the 'sharp end.' Following the German invasion of the Low Countries in May 1940 his medical unit was one of many that had to take action to avoid the enemy advance, and eventually make their way back to the United Kingdom through the Channel ports.  After the evacuation was complete and all the nursing staff safely home, the Matron-in-Chief, Katharine Jones, asked some nursing sisters to write accounts of their experiences of the evacuation and two were submitted by staff of No.4 CCS of which Geoffrey Moulson was Commanding Officer. The following was written by Sister Annie Trethewey* Territorial Army Nursing Service, to Geraldine Ball** Principal Matron at the War Office.

*****

No.4 CASUALTY CLEARING STATION

Sisters’ Quarters,
Military Hospital,
Holywood,
Co. Down.
20th January, 1941.

Dear Miss Ball,
Your letter of the 11th instant just to hand and I am pleased to accede to Miss Jones’ request and give you an account of my very interesting, if not always useful experiences with the B.E.F. after the invasion of the Low Countries. How well I remember the news at midnight on the 9th May of the invasion. I was on night duty at the time and our Colonel brought me the news, after listening to the announcement, with the remark as he retired for the night “I shall probably see you again before morning”.

May 10th – 5 a.m.
Our first “alert” since the previous October. Our C.C.S. was in a Chateau with a basement for the evacuation of walking patients, but our stretcher patients had to remain in their beds which we pulled into the middle of the wards away from windows, and during the remainder of our stay there I marvelled at the calm with which the men, mostly Air Force, behaved during “alerts”.

May 11th
The “Dawn Patrol” becoming a daily habit and our C.C.S. becoming very busy with air casualties.

May 12th
We evacuated 115 patients at 1.30 a.m.

May 13th
Much confusion in the town of Epernay with constant alerts and continual streams of refugees, such pathetic sights, while convoys of French Troops were going through the town and up the line.

May 14th
The Hospital getting busier every hour – such fine men to nurse – I have remarked in my diary “Makes one proud to be British”.

May 15th
Rumours of our evacuating the Hospital, so I get my packing done before going to bed. By this time I had given up hoping for much sleep but I usually managed to stay in my bed and rest unless there was too much activity overhead. When I arrived on duty at 8 p.m. all patients were on stretchers ready for the evacuation and we were supposed to be 'closed' to admissions, notwithstanding we admitted patients all night and the Theatre was busy the whole time. There was a very anxious night ahead of us; the Red X train, which was due at 1 a.m. got delayed owing to enemy action further along the line; at 5 a.m. the Colonel decided to let the patients travel all the way to the Base by ambulance so arrangements were made accordingly and by 8 a.m. the Convoy was ready for a start when the news that a train would soon be through to take them arrived, cancelling the road transport (many of the patients were too ill for a long journey by road).

IWM H1642

May 16th

Eventually the train arrived at midday and the Sisters and half of the R.A.M.C. Personnel also went on the train for a journey of about 20 miles to the town of Chateau Thierry where we said 'Goodbye' to our patients while they went on to the Base and safety, we hoped. Here we found a curious reception, the French were rather afraid to let us stay in the town as up to then they had not had any raids, so our Officer who was in charge decided with the aid of the Interpreter to find us billets in the village of Chiery, two miles away, and how we welcomed the peace after our recent experiences; but alas, it was not for long and on...

May 17th
… the Enemy reached that spot.

May 18th
After 36 hours of fairly heavy raiding and wondering where the other half of our Unit was, it was a great relief when the Colonel arrived to take us to our new home and so we hoped Hospital. We had a long and chequered journey through convoys of refugees going in the same direction as ourselves, with convoys of French troops coming in the opposite direction, but fortunately it was peaceful from the air. We reached our destination – Ville Neuve – to find we were going to live in a cottage attached to the Chateau which was to be our Hospital and delightfully situated in the woods. Alas our Hospital did not materialize and although we all appreciated the quiet and rest at first, we soon began to wonder what was happening to our wounded and feeling rather useless. For some days we stayed there and I am afraid found it very difficult to believe 'They also serve who only stand and wait'. We were finding it most trying not to be up and doing, knowing that so many of our own men must be wanting attention.

June 2nd
Various signs that we were on the move again.

June 3rd
Up at 5 a.m., breakfast and packing done, ready for a start at 7 a.m. It was a lovely day and the Motor Ambulance Column had provided most comfortable transport for our 150 miles drive; our destination was once more a chateau with a view to making it into a hospital, in a small village near Bauge, but not only was the chateau inadequate, the grounds were unsuitable for tented extension.

June 5th
We move again, this time by ambulance and reach our new home, which is to be tented in some very nice grounds near Chateau du Loir. For a week we lived in tents at this delightful spot and our wards were being got ready for occupation, but, alas, on …

June 13th
… we packed once more and left on …

June 14th
… travelling in convoy by ambulance to Nantes, and spending the night in our ambulance, too near a munition dump for our popularity with the French Authorities.

June 15th
We were up early, waiting for orders which we received from an unexpected quarter; the French Authorities having given the order for us to move out of the field. As our Colonel is away on business, there is no alternative for the Second-in-Command but to have the convoy draw out on to the roadside and await the return of the Commanding Officer. At 1 p.m. the order came through for the Sisters from Nantes to go to La Baule to join the Staff there. It was with great regret we left our Unit and travelled the remainder of the journey in one ambulance. We were received by the Matron of No.4 General Hospital and given accommodation for the night.

HMHS 'Somersetshire' from IWM FL19182

June 16th
A long day of waiting and at 4 p.m. left La Baule on the hospital train for embarkation at St. Nazaire; a raid was in progress during the journey and for some hours while the Hospital Ship “Somersetshire” was being loaded at the port, but we got safely away at 4.30 a.m. on …

June 17th
During the homeward journey we once more had a visit from the enemy and two bombs were dropped close enough to shake the ship from end to end, but we reached Southampton safely on the evening of June 18th. Although during the whole of our journeying we had quite a fair amount of aerial activity to contend with, we travelled very comfortably and I realize only too acutely that after the invasion of the Low Countries, when we had hoped to be useful to our Unit, it was quite the reverse and we were an additional responsibility.

*****

* Annie Mary Trethewey was born in Cornwall at the turn of the century. She trained as a nurse at the Royal Cornwall Infirmary, Truro, completing her training in 1925. 

** Geraldine Catherine Ball trained at the West London Hospital, Hammersmith between 1909 and 1912 and served with QAIMNS Reserve during FWW, later joining the permanent service.

Account taken from documents at The National Archives, WO222/2143

Unknown Warriors

     When Diary of a Nursing Sister on the Western Front* was published by William Blackwood in 1915, the author, Kate (Evelyn) Luard, had to remain anonymous.  As a member of Queen Alexandra’s Imperial Military Nursing Service Reserve it was not acceptable for her to comment publicly on her work with the British Expeditionary Force in France. As a result, the book shed its copyright restraints some time ago, allowing thousands of readers to enjoy one of the few accurate accounts of the work of a trained military nurse during the Great War.  In 1930 Kate Luard published her second book, Unknown Warriors, under her own name, picking up where she left off in 1915 and completing her wartime story.  That book only appeared in one edition and over time has become a rare entity, difficult to track down and increasingly costly to buy.  In this Great War Centenary year, members of the author’s family decided to take up the challenge and re-publish Unknown Warriors and by doing so bring joy to many people who have so far been denied the pleasure of this further account.

     The typesetting of the new edition matches the original and gives it an old-fashioned authenticity, but there are also many additions which offer extra detail and information. A new introduction by Professor Christine Hallett and Tim Luard explains the background to the author’s personal and working life and also to her family connections in Essex. An index and bibliography have been added together with photographs and a glossary of terms which may otherwise be unfamiliar to readers.

     The book is composed of letters sent by Kate Luard to her family in Essex, recounting her life and experiences during wartime on the Western Front. She was an exemplary nurse, admired and appreciated by her colleagues and with the resilience to cope with everything that war threw up. Although there are now a number of diaries and accounts available written by the untrained nurse – the ‘VAD’ – those of trained military nurses are rare and must be valued. This book describes in plain terms the difficulties of both nurses and patients, the desperate conditions, and also the periods of rest and pleasure. Much of her wartime service was in Casualty Clearing Stations including the Advanced Abdominal Centre (No.32 CCS) at Brandhoek during the Third Battle of Ypres in 1917, working in both the busiest and most dangerous conditions that a nurse could encounter.  Her words are never exaggerated or overblown, nor do they underplay the personal and professional difficulties that she faced. It is perhaps one of the very best examples among First World War nursing  accounts of ‘How it  really was.’

     The final ‘Postscript’ chapter is a wonderful extra and includes previously unpublished letters both from the author to family members and also from her close relatives in reply which provide a keen insight into how the war was viewed in rural England. On one occasion her brother Percy wrote, ‘Your letters continue to be thrilling …’ and suggests they would make an excellent book, and later, ‘Your letters are absolutely IT … and they fill me with awe and wonder and admiration and joy …’.

I have to agree with him!

*****

Unknown Warriors: The Letters of Kate Luard, RRC and Bar, Nursing Sister in France 1914-1918
Caroline and John Stevens (Editors)
The History Press, August 2014
ISBN-10: 0750959223
ISBN-13: 978-0750959223

*Diary of a Nursing Sister on the Western Front 1914-1915
If you've never read it, then probably a good idea to start at the beginning with this first book, available in many inexpensive printed editions and also as a free download on the web via the link.

The Intelligence Officer

This is part of an account written by Sister Catherine Black while working at a Casualty Clearing Station in 1916. Born in Ireland and trained at The London Hospital, Whitechapel, she was later the private nurse to King George V until his death in 1936.

Catherine Black - 'Blackie'

*****

     The German wounded had exactly the same treatment as our own, except that they were not allowed to speak to one another, and we were always ordered to place them in beds as far apart as possible. I can only remember one departure from this rule, and that was at a C.C.S. just behind the lines. A German prisoner, an officer of high rank, was brought in slightly wounded, and given a bed in the corner of my ward. On the day following his admission the British medical officer in charge of the station sent for me and told me that he had some instructions of the utmost importance for me. A patient, who would appear to be a German officer, would be brought to my ward later that day and I was for once to reverse all previous orders and put him in the bed next to the prisoner. He would in reality be an officer from the British Intelligence Department seeking certain valuable information, but I must be most careful to keep up the illusion. Although he would not, of course, be wounded, I must nurse him in the usual way and allow him every opportunity for getting acquainted with the German in the next bed. The Sister on night duty was to be given the same instructions as I. No one else in the station was to know anything, for the entire success of the plan depended on its secrecy.

     Late that afternoon another convoy came in and among them was a German officer.  His uniform was torn and covered with mud, and when he was carried in by two ambulance men he seemed so obviously ill and in great pain that I thought at first sight he could not possibly be the one for whose arrival I was prepared. Then he gave me the signal that I had been told to look for, and I ordered the stretcher-bearers to put him into the empty bed next to the German prisoner who had been admitted the day before.  Then began an elaborate game of make-believe. Never on any stage have I seen such an actor as that Intelligence Officer! His part was carried out to perfection. Not only did he completely deceive the German next to him as to his credentials, but he even hoodwinked the nurses and orderlies into believing him a badly wounded man. The Night Sister and I backed him up for all we were worth. At the proper times we put screens round his bed, carefully dressed and re-bandgaged his imaginary wounds to the most realistic exclamations of pain and protests in broken English. When he appeared to be suffering very much we carried out the pretence of giving him injections. Every day the whole performance of nursing him was carried out with scrupulous care, the only difference between him and the other patients being that no orderlies were allowed to attend him; Sister and I did everything for him ourselves. To avoid creating suspicion, we carried out exactly the same procedure in the case of the bona fide German officer. Very soon there were whispered conversations between the two beds, but we took good care to be out of earshot when that happened.

     On the fourth day the German officer was transferred to a prison camp, and our mysterious patient was 'evacuated.' We never knew his destination, but a week or two later I received unofficial information that the plan had been a great success. Somehow or other I linked this up with the news that our troops had taken an important German position.

King's Nurse, Beggar's Nurse, Catherine Black, published by Hurst and Blackett, London, 1939

Bravery - It Started with a Tweet

 

I've always had quite strong views on Great War nurses being described as angels and heroines, and the assertion that they were all  'brave.'So I was interested in a thread on Twitter which went as follows:

Tweeter A.  Army Nurse Corps took hot water bottles to bed with them then made tea with that hot water next morning!*
Tweeter B.  Some WW stories would be amazing to collate a brave history that we are loosing [sic] day by day
Tweeter C.  Perhaps bravery comes behind professionalism, stoicism, dertermination and skill
Tweeter A.  Bravery, the right choice under terrible circumstances, against all odds.

Obviously A. felt that 'brave' was the best word to describe these military nurses but it made me think again about war, nurses, and bravery. The early 20th century was a time when British nurses were fighting to have their qualifications officially recognised through a process of registration, to ensure that poorly trained and inexperienced women could no longer pass themselves off as fully-trained nurses. Many of them relished the chance that war gave them - to know that they would at last have a platform to show off their skills in a public and wide-ranging manner - the eyes of the nation and the wider world were on them as they were released from the anonynimity of their peacetime role.

I doubt if they were thinking about being brave when they first put on their new uniform and entered the doors of a military hospital. More likely they were thinking about being tested in a strange environment; about what skills they would need; how this new experience would give them an advantage in years to come as they climbed the nursing ladder. They must have wondered who would be working alongside them? Would there be any familiar faces from their training days? Would their pay and conditions be comparable to what they were already getting and would Army discipline defeat them? And when a few months later they added their names to the list of those wishing to go on active service overseas, did they do it because they were brave? I suggest that most of them were desperate to get nearer the action; to feel closer to their brothers, fathers and friends who were already abroad; to grasp the opportunity to visit places and see things they had never contemplated before. Nursing in France had an urgency and importance about it which was lacking in home hospitals - it made them special. And they wanted to be seen as being special.

They knew how hard the work could be - the rushes, the pushes, the pauses; the long hours and early mornings; the boring patches and the restrictions.  They knew that if they asked to be considered for duty nearer the front, at a casualty clearing station, they were nearer the guns, nearer danger, nearer the most badly wounded men. Did they go because they wanted to be brave?  My view is they went because they wanted to make a difference, and to be seen as making a difference.

One of the few nurses who died as a result of enemy action is universally described as 'brave.'  Nellie Spindler died in her bed, while sleeping, the result of a shrapnel wound during an enemy bombing raid on her casualty clearing station. Can 'brave' be the best word to describe her? Unlucky, certainly, but hardly brave.

There were nurses of all sorts, good, indifferent, and some very bad - bad behaviour, poor nursing skills, lack of tact, no sense of discipline. They were not all heroines, and of course, none of them were angels. Angels don't actually exist and trained nurses are very much of the real world. While there were undoubtedly individual acts of bravery by nurses during the war, it was not the lot of the majority. When they were in dangerous and difficult situations, being bombed or shelled or retreating with the enemy at their heels, they relied on their long experience, their skill, their confidence, determination, dedication and fortitude, and on an instant learnt response to emergencies. I would still say that all these came before bravery.

* This surely cannot be true. I have heard of nurses using the water for washing the following morning, but never for tea!

On This Day - May 26th 1940

I have copies here of many accounts by members of the military nursing services who were serving in France between the outbreak of war and mid-June 1940. The originals are held at The National Archives, ref. WO222/2143.  This one is the last part of a descriptive and atmospheric account by Sister Gretchen Leyland of No.6 Casualty Clearing Station. An experienced nurse, she trained at Guy's Hospital between 1930 and 1933.

***

Sunday 26th May 1940

A pump had been started for water and a dynamo to supply electric light in a wider part of the abri, where a Theatre for minor cases had been improvised. We had one or two dressing stations set up and were in a position to function as a C.C.S. in a small way.  I was sent to attend to twenty German prisoners who were in the former strong rooms. Pte. Sunderland gathered some equipment and came with me. In spite of the language difficulty we set two of the unwounded ones to the task of tidying up and cleaning the dishes with paper and we set about dressing the wounds of the others and prepared two for operation.  After a time Pte. Sunderland went off in search of food and water and I found it rather eerie to be alone with the German prisoners, except for the sentry outside, in a silence which was only broken by the sound of artillery coming nearer and nearer beyond the ridge behind the hospital.

The news came that the Sisters were to be evacuated along with the German prisoners and the last of the wounded.  In the morning one of the Nuns had asked me if the rumour was true that the British would not be able to hold back the Germans. This idea had not occurred to me and I had told her that of course they would be held back. Even now we assumed that we were being sent to work in a base hospital simply because a C.C.S. could not function very well in these conditions.  We left a unit that seemed to be downhearted at our going and made our last journey by ambulance through a desolation which included a field full of dead horses.

As we came into Dunkerque we saw a heavy roll of black smoke pouring across the sky. It was the ending of the burning Oil Dumps.  We realised that we were en-route for England but not that the whole of the B.E.F. was being evacuated, in spite of a continuous marching up of small companies of men beside the long queue of ambulances.  The hospital ship was crammed with twice the number it was meant to take and I renewed dressings which had not been touched since the field ambulance until 3.30 a.m. when I went up on deck.  My last memory, like my first of this period of the war, is of Calais, for I watched it now a high blaze, climbing into the air and shining far on the dark water.

Dead Man's Land - Robert Ryan

I'm a great reader of crime fiction, often to the exclusion of doing other, more important things.  On the whole I stick to British authors, like complex plots, skip over too much gratuitous violence, and prefer to arrive at the end actually understanding what's gone on in the middle. So about eighteen months ago I was intrigued and rather flattered to be asked by Robert Ryan if we could meet up to discuss a new book he was working on (these days a bit of flattery is so very welcome).  He intended to include 'some plucky VADs' and wanted to make sure that they would be appearing all present and correct.

Over the next months I was kept up to date with the progress of the book and then asked to check the first draft to see how the VADs were doing.  Anyone who has read this blog on a regular basis will know that of all the bees that float around my bonnet, the indiscriminate placement of VADs in Casualty Clearing Stations on the Western Front is the one that stings hardest, and in this book their inclusion in very forward areas was going to be essential to the plot. If I have learned one lesson from the exercise, it’s this.  If you’re a writer of fiction and make fundamental errors because of inadequate research and blissful ignorance, the wrath of pedants will be unleashed upon you.  On the other hand, if you include factual inaccuracies and weave them in an intelligent way, in full knowledge of your sins, you will always be forgiven (fingers crossed).

Dead Man’s Land was published at the beginning of this month with the full approval of the Conan Doyle estate. It follows Dr. John Watson’s travels around the Western Front during the Great War, and where Dr. Watson goes, death and intrigue are right on his heels. By most estimations he must be getting on a bit in age, but his physical limitations are highlighted, not glossed over, and his place as an elderly medical practitioner in wartime never seems extraordinary. The military setting is sound, and the depiction of hospitals and casualty clearing stations in wartime is thorough. The VADs are skilfully introduced into a place where they would never actually have been, with the difficulties and regulations surrounding their employment made clear. Even I was heard to clap. The story is unusual and absorbing, it has complexity, but with enough clarity to prevent it becoming confusing, especially for those who don’t usually dabble in ‘war,’ and it should appeal to everyone who enjoys crime fiction of any era, but perhaps especially to devotees of Sherlock Holmes.  Yes, of course he’s there as well.

And my thanks to Rob for his kind words in the acknowledgements where he accepts all errors as his own.  May I take this opportunity to clear my conscience and admit that there might just be one that’s mine!