July, 1916: Medical Shortcomings at the Somme

The 1st of July, 1916 marked the beginning of The Somme Offensive, one of the bloodiest battles in history. On the first day alone, 57,000 casualties were sustained by British Forces, a figure significantly higher than the predicted 10,000. Peter Barton, speaking in a recent documentary for the BBC (The Somme 1916- From Both Sides of The Wire), notes that it was this figure upon which the medical corps based all of their planning; ‘from hospitals, to bandages, to graves.’

As the actual number of casualties proved to be over five times greater, there were serious implications for the fate of those wounded. The catastrophic underestimation of medical requirements meant that resources were soon overwhelmed, and countless men died whose lives might otherwise have been saved. Barton stresses this point, suggesting that the prediction of 10,000 casualties was emblematic of the habitual underestimation of the German enemy.

Stewart Emmens however, writing in ‘Wounded: Conflict, Casualties and Care’, is rather more forgiving. ‘This was war on a vastly different scale,’ he writes, ‘a new kind of war that produced levels of wounding unparalleled in severity and casualty numbers.’ It was also a war fought in unimaginable conditions, within an environment that could be hugely detrimental to efforts to save the wounded. As such, a great many medical challenges arose from the carnage of the Somme, challenges which Emmens believes would later be countered by scientific, technical or strategic innovations.

One such example, offered by Emmens, is the pioneering use of blood transfusions in 1917. As although the procedure had been around prior to 1914, it was only later in the war, after the experiences of the Somme, that the technique was refined. The blood transfusion set represented a major advance in medical treatment which arrived late in the war, but within a very short period of time ‘proved the life-saving potential of what is now a standard procedure in emergency medicine.’ Ultimately, it has helped to save countless lives, both during the war and in the years since.

blood transfusion set, 1917 - science museum
Blood Transfusion Set (1917)

Yet, Emmens also writes that ‘it is not a simple case of “the triumph of medicine.”’ He asserts that the medical experience of 1914-1918, and the implications for the years that followed, forms ‘a vast and complex narrative.’ Therefore, while real medical innovation did arise- as new techniques and strategies were pioneered, rediscovered, or adapted and evolved through experience- many mistakes were also made. This was particularly apparent in the short-term as, ‘time and time again,’ medical services were simply overwhelmed by both the nature and the sheer scale of casualties.

Many who witnessed the effects of these shortages first-hand were the nurses, doctors and medics who served during the conflict. Sister Edith Appleton, a nurse who worked at General Hospital No. 1 during the Somme, kept a diary which reveals a harrowing change in tone during the first week of the battle. It makes for difficult reading.

Sunday, July 2, 1916

The last eight days the guns have been firing the whole time. Fine big ones they must be for us to hear them so distinctly. The Germans have been giving themselves up and coming across in dazed groups – which is fine.

How absolutely glorious if we knock them right out and level them flat, so our infantry and cavalry can have a walkover such as would make good reading in history.

Tuesday, July 4

Wounded! Hundreds upon hundreds on stretchers, being carried, walking – all covered from head to foot in well-caked mud. We had horribly bad wounds in numbers – some crawling with maggots, some stinking and tense with gangrene.

One poor lad had both eyes shot through and there they were, all smashed and mixed up with the eyelashes. He was quite calm, and very tired. He said, ‘Shall I need an operation? I can’t see anything.’ Poor boy, he never will.

Thursday, July 6

I give up trying to describe it – it beats me. In ordinary times we get a telegraph from Abbeville saying a train with so many on board has left and is coming to us.

Then they stopped giving numbers – just said “full train”. Not even a telegram comes – but the full trains do.

Yesterday, in addition to our 1,300 beds we took over the lounge of a large restaurant, the orderlies’ barracks, the ambulance garage, the Casino front and part of the officers’ mess, and all used except for the garage- which is ready for today. We were not able to send any on to England, as the boats were full, so if full trains continue to pour in today we shall have to start on private people’s houses.

(Quoted from: A Nurse at the Front: The First World War Diaries of Sister Edith Appleton)

Penny Starns, writing in Sisters of The Somme: True Stories from a First World War Field Hospital also offers an incredible insight into the difficulties of nursing in such extreme conditions, by examining official war diaries from the first week of the Somme, when medical supplies and resources were stretched to their absolute limits.

‘Casualty clearance stations were soon overwhelmed.’ She writes, ‘A basic triage system assessed the injured upon arrival, and many men were simply put to one side to die; others, unable to access medical assistance, died where they fell. Those who were fortunate enough to reach first-aid posts and advanced dressing stations were quickly treated with rudimentary dressings. As many of the injured as possible were placed on hospital trains and shipped back to England. Casualty numbers were so high that only the most seriously wounded could be kept in France.

‘By 3pm on 1 July news of the appallingly high casualty figures gradually filtered through to Sloggett [Director General of the Medical Services], and he called the rail transport office at Amiens to urgently order more hospital trains. By this time base hospitals were overrun with wounded. Every conceivable mode of transport had been commandeered to shift wounded men away from the battlefield toward some semblance of care, and medical personnel worked around the clock to help the injured.’

Dorothy Field was one of the many medical personnel to work ‘around the clock’ during the first week of the Somme. She was a member of the Voluntary Aid Detachments of the British Red Cross, working at General Hospital No. 10. In small pocket diaries, Dorothy recorded brief details of her wartime experience. For example the first convoy of 170 men who arrived at the hospital at 4am on the 2nd of July, described by Dorothy as the ‘going over the top result. Practically all surgicals.’ (Source). Over the next forty-eight hours, four convoys of wounded arrived, while two convoys of stabilised patients left for other hospitals in France or Britain. Such was the intensity of work at the hospital that it was not until the 13th of July that Dorothy had a rest from her duties.

Dorothy’s diary also manages to capture the horrors of war in one simple, epitomising sentence:  ‘Too awful for words.’

yorkshire regiment during battle of the somme
A Yorkshire regiment at the Somme
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