J R Army Med Corps: first published as 10.1136/jramc-43-01-13 on 1 July 1924. Downloaded from 71 \ . .' ~. HISTORY OF' THE GREAT WAR. 'MEDICAL SERVICES. GENERAL HISTORY. Vol. Ill." THE. MEDICAL SERVICESI DURING THE. OPERATIONS 'ON THE WESTERN FRONT IN 1916, 1917 AND ] 918; IN ITALY, EGYPT AND PALESTINE. By Major-General Sir W. G. Macpherson, KC.M;.G., C.B., . F.R.S., L:L.D. Obtainaole through any bookseller or directly from His Majesty's Stationery Office, Imperial House, Kingsway, London, W.C.2. 1924. Price,£lls. ' The Medical History of the Great War on the Western Front is com- o pleted jn this voluine, and the campaigns in Italy, Egypt and Palestine are described. '. The(preface states that limitations of time and space have been imposed upon the historian,.but we hope that a'description of the medical 'services in Gallipoli, 'Salonika and German East' Africa may yet be publislied. The corps is deeply indebted to' Gerieral Sir W. G. Macpherson for th,ese works of which tl1e educational value is exceptionally great. Protected by copyright. The sketch m~ps, charts and diagrams are excellent, and the carefully comp'iled appendices will repay close study. Chapters I' to XVIII cover the Western Front operations from February, '1916, to the_end of December, 1918, and. account for three-quarters of the book. The~Somme battles are fully described~ 'but the advance to victory has had to be somewhat compressed. This is unfortunate as much could have been learned of the tactical handling of medical units in a rapid advance, from a more detailed account . Chapters XVIII to XXII deal with the medical servjces 9f our forces in Italy, Egypt and Palestine. http://militaryhealth.bmj.com/ ;' The actions of the Bluff; St. Eloi Craters; the German attack on the Vimy· Ridge; the ba.ttle of Mount Sorrel and the engagement at Fromelle .: are described in Chapter i. The succeeding fotty-three 'pages forming 'Chapter II describe the medical'arrangemen~s for the battle' of the Samme. ' Fifty-six infantry and six cavalry divisions Itook, part at different periods in this stupendous struggle which 'lasted nearly five ,months .. The main part of the :fighting fell 'to the 4th Army whicp ha.~ five corps on a front' of about twelve miles. A study of App~ndix "B" together with 'page' 50 'enables the arduous' wQrk of the medical services to. be appreciated; on October 1, 2021 by guest. 310,073 wounded wer~ admitted to field ambulances, 6f whom 304,285 were subsequently evacuated to the, base from casualty clearing stations. In: addition some thousands of sick cases had to be prov:ided for.'. That 26,675 wounded .could be collected by field aQ1bulances in tlie first twenty-four hours ,of a battle would have1;>e'en considered imposflble in' 1914.. Th~ price paid ·in casualties. among the medical ~ervices ,is· shown on p. 53.' .t . \ /' J R Army Med Corps: first published as 10.1136/jramc-43-01-13 on 1 July 1924. Downloaded from 72 Reviews The lessons contai~ed in these pages are chIefly:- (1) The rapidity with which casualties reach the clearing stations in the first twenty-four hours of a m'odern-battle necessitates an ,accurate and timely, appreciation of ambulance train requirements in order to avoid congestion of the wounded. This point is well brought out in a memorandum of the -Director General, -Medical Sel'vices, on p. 47. (2) The constant changes of divisions justify the temporary detachment of samtary sections for area work in order that a continuity of sanitar.y efficiency of a high' standard may be maintained. (3) The .need for the allotment of clearing stat-ions for treatment of special cases, sick, etc. , . (4) The' general scheme of the medical arrangements evolved as the result of previous experience in the tactical handling of field ambulances and the strategical, grouping of casualty clearing stations proved adequate . even when subjected to such a severe test. Chapter III 'describes the advance to the Hindenburg line in 1917. Protected by copyright. The chief anxiety at this time, from the medical point of view, was to 'ensure an adequate number of vacant hospital beds for reception of the estimated battle casualties. Lack of available medical personnel rendered the formation of ne'Y hospitals impossible, but 36,000 beds were provided by increased evacuation of 'patients to Engiand. In thesE') operations collection and removal of casualties from the forward area was rendered more difficult owing to the destruction 'Of roads and bridges by the retreating .enemy. The medical arrangements for the battle of Arras] 917 are contained in Chapter IV. The pooling of the divisional ambulance cars with the motor ambulance convoys is ,described on pp. 77 'aud 78, and th€l special http://militaryhealth.bmj.com/ orders for the clerical-work at casualty clearing stations on p. 79. These innovations did not fulfil expectations as the later. stages of the battle clearly proved. ' . The cavalry advance to Monchy-Ie-Preux is of great interest as it records' the medical arrangen;lents for amounted force in an advance. The Assistant Director of MedIcal Services of the Cavalry Division had taken over . immediate control of his field ambulances except the pack mounted sections which were commanded by the field ambulance commanders in person.' These sections /failed in their function and it would appear that their value is doubtful. There was loss of close touch between regimental ,medical on October 1, 2021 by guest. officers and field ambulances which cau~ed confusiQn and regrettable delay in the evacuation of casualties. , . The nex;t c,hapter gives the medical arrangements for the·battle-of Vimy Ridge which worked-smoothly and well. , Chapter VI outlines the.Fland~rs_ offensives in 1917 in which mustard gas was first use~ by the enemy.' Special arrangements to deal with this were introduced in forward areas and at casualty clearing stations. The ..... J R Army Med Corps: first published as 10.1136/jramc-43-01-13 on 1 July 1924. Downloaded from Reviews 73 surgical cleansing of wounds before evacuation became the rule, and tbe 5th Army adopted tbeprinciple of retaining for treatment so' called sbel1- shock cases in a specially organized casualty clearing station sited in an advanced position as possible. _ The next chapter describes tbe medical arrangements for tbj battle of Messines wbich worked well. The spberes, of responsibility were clearly defined, and trencb tramways Were fully utilized from regimental aid posts to advanced dressing stations. A good specimen of corps i:nedical orders is given on pp. 125-6-7. Tbe first instance of tbe formation of an advanced convalescent' depot for 1,000 patients likely to be fit for duty in four to five days, QCcurs in tbe preparations for this battle. The diagram facing page 134 is worthy of close attention as it outlines the evacuation from the line to casualty clearing station. Chapter VIII is tbe story of the battle of Ypres, 1917, wbicb lasted nearly four montbs and resembled the Somme ba~tles, in that various divisions were engaged at difierent'times. The attack on November 6 was made by tbe 3rd and 4tb Canadian Divisions with the 1st British Division. The Somme Redoubt Advanced Dressing Station was shared by a Canadian and British division. Protected by copyright. The hand-carry of 5,000 yards to this advance 1 dressing station was a severe strai!l on the field ambulance bearers. The tracks were Qver sbell­ pitted ground which the rains had turned into a quagmire. Enemy s'belling a~d'bombing of medical units during tbese battles were specially noticeable. The siting of casualty clearing stations too far forward was brougbt to notice by the pirector General, Medical Services. The medical arrangements of tbe 5th Army were voluminous and contained much detail. Many returns . were demanded from divisional assistant directors of medical services, wbo were often only a few days in the same corps. High-explosive shell wounds predominated amdl1g tbe 10,789 wounded evacuated. Sick cases http://militaryhealth.bmj.com/ were in the proportion of 1 to 2'3 wounded among officers, and 1 to 2'46_. wounded among otber ranks'. Chapter IX gives a brief account of the battle of Hill 70, while in . Chapter X the Dunkirk Nieuport area if;! described. The sketcb opposite 'page 177' was apparently drawn after July 10, ~s previously two regimental aid posts in the support trenc? across t,he Yser of the L'eft Sector provided medical aid for the two battalions holaing tbe line. dost Dunk"erke Bains w\tS the headquarters of a field ambulan~e and had considerable accom­ mQdation for casualties. The advanced dressing station of this sector in Nieuport Bains communicated :with a covered boyau running along tbe sea on October 1, 2021 by guest. wall. It was sited in the cellars of two houses and was specially notable for the artistic talent displayed on tbe walls by its previous French, occupants, " Th,e medical arrl,Lngements for ,combined naval and military operations are outlined, on p. 181. 'Jt, was in tbis camp that tpe 1st Division in­ augurated its 'own d~ntal service wbi,ch functioned Eluccessfully up to the Armistice and saved mqch ~voidable sick w,astage. J R Army Med Corps: first published as 10.1136/jramc-43-01-13 on 1 July 1924. Downloaded from 74 Reviews· , Chapter XI is of exceptional interest owing to the necessity for extreme secrecy in the preparations 0'£ .casualty 'clearing stations for the Cambrai b!tttle' of 1917. 1 , That t,he medical arrangements worked.