I often get asked how and why an individual man ended up in hospital many miles from home rather than a local unit, and here are a few reasons and pointers, though certainly not the complete picture
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It's highly unlikely that any decisions were made overseas about a patient's destination once back in the United Kingdom except perhaps for a few senior officers, nurses and other women who had special accommodation set aside in London.
The port of departure, and thus arrival in the UK, would depend on the position of the overseas Base Hospital, which in itself may have been a random choice initially. As the war progressed, specialist units were set up to treat various classes of illness and wounds, and that would have been a deciding factor in the fate of some men on arrival. There was also an enormous concentration of beds in London, Manchester and Birmingham and the chances of being treated in one of those areas was high. There was always a likelihood that men from London or Manchester would end up near home, just by chance.
Although I have read accounts of men being purposely sent away from home to prevent hospitals being over-run with visitors, it seems that this was never the intention. By September 1914 there were three main aims when men arrived back wounded in the UK – to give priority to those most seriously injured, to clear beds in the largest hospitals as quickly as possible to make room for new arrivals and to ensure that the men were transferred between medical facilities as few times as possible.
For men disembarking at Southampton, the most serious cases were transferred to the Royal Victoria Hospital, Netley and the Southampton War Hospital, the latter soon earning the reputation of being one of the busiest and 'heaviest' hospitals in the country. From Dover, the sickest men were found accommodation in London. Men needing specialist treatment were separated out and given some priority to admit them to a unit which suited their needs. Lightly wounded men and the walking wounded were often the ones chosen to do the longest journeys and therefore more likely to end up in cities such as Plymouth or Aberdeen.
Apart from the worst cases the men would be found a place on the next available train whatever its destination – there seemed to be little question of a Highlander turning down the 16.00 to Waterloo because he’d rather wait for the 19.30 to Glasgow. Because men were often wounded in large actions it follows that men of the same regiment would frequently be wounded, treated and evacuated together, and find their way back to England if not ‘en masse’ then certainly in tens, dozens and scores. So it was not surprising that, for instance, fifty Scots ended up in No. 2 Eastern General Hospital at Brighton and fifty Royal Sussex men in Manchester – often it was just the luck of the draw.
As the war progressed the pressure on beds became more severe and it was even more difficult to find accommodation than previously. However, as there were more trains there may have been several waiting at Southampton and Dover at any one time and always the chance of different outcomes, but it’s said that even the men themselves were often reluctant to make a decision about destination. Where was nearer, where was more exciting, where were their friends going; where would the soldier from Cornwall choose when he was in the West Yorkshire Regiment and most of his friends were going north? The vast majority of officer beds in the UK were in London, so an officer was very likely to be accommodated there, at least initially, wherever his home was. As the war progressed there were other important decisions to be made about special categories of patient.
Before the ‘average’ man could be moved, account had to be taken of mental patients, neurological patients, those with venereal disease, enteric fever and dysentery, serious orthopaedic cases, cardiac and rheumatic conditions, eye and facial injuries - an ever lengthening list. Canadians, Australians, New Zealanders and South Africans also had to be filtered off to their own hospitals and the movement of patients soon became a very intricate and complicated process which didn't always allow a free choice of destination. Where this was impossible, facilities were put in place for seriously ill men who were going to be in hospital for a long time to be moved nearer home when their condition was stable. If a man was expected to be in hospital for more than three months there was a high chance that arrangements would be made for him to be transferred to a hospital in his home area – these transfers were often long-distance, and carried out by fitting extra patients into existing ambulance train journeys.
Throughout the war the pressure on beds was always enormous and all Home Commands were instructed to expand their hospitals to the fullest limit. Of course this ‘fullest limit’ was never enough, and the number of beds was still increasing in October 1918. The expansion of the auxiliary hospitals and convalescent homes meant that most soldiers would eventually be transferred out of the main hospital, and this was most likely to be to a facility affiliated to that hospital, and therefore in the same locality. Initially he bed state nationally was being updated weekly and later on twice weekly but as the situation became critical it was done on a daily basis. At time of the Armistice available beds nationwide stood at approx 364,133 and included 18,378 for officers. Between autumn of 1917 and beginning of 1918 the usual daily occupancy was 317,000.
I'm sure there must have been many a bright young ‘walking wounded’ who, seeing more than one train drawn up in front of him, found some way of making a choice but it was really a question throughout of squeezing casualties in anywhere that had enough room to take them – choice would have put an impossible burden on a massively overstretched system.
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