Better fall back a few yards,’ said the officer, and even as we were doing so something jabbed my hand. It dropped down and blood spurted out. The others had gone. I was alone….From the pillbox, hidden somewhere about…a couple of bits of lead whistled. I crawled into an enormous shell hole and began to sink into mud. With the slime clinging to me I got away, through the bottom of a hedge which, by the grace of God, had remained there. No one to be seen now and my head facing I knew not where….Not far away a tank, half embedded, was getting it full tilt. The sweat stood on my dirty face. And then in that great expanse of mud and wire I spotted a little red cross on a little flag, sticking eighteen inches out of the ground. I felt safe again.’

Private Alfred Willcox, Royal Sussex Regiment, was just one of the 310,000 casualties sustained by the British Expeditionary Force (BEF) during the Third Battle of Ypres, a controversial campaign that dragged on from July 1917 until Passchendaele fell to the Allies in November. For Willcox and millions like him, the ‘little red cross on a little flag’ meant the difference between life and death. It was the emblem of the medical corps — the stretcher-bearers, orderlies, doctors, nurses and many others who often risked their own lives to care for the wounded.

Medical treatment for battle injuries is as old as warfare itself. It is discussed in ancient Egyptian surgical texts from 3000 bc. Greek physician Hippocrates (ca. 460-377 bc), for whom the doctor’s Hippocratic Oath is named, advised his disciples, ‘He who would become a surgeon, let him join an army and follow it.’

Humanitarian considerations aside, the need to conserve trained fighting men by caring for their wounds has made sense for millennia, but treating those casualties on the front lines is a relatively recent development. In the West, Queen Isabella is usually credited with the creation of field hospitals; during the reconquest of Spain from Muslim rule in the 1480s she provided medical tents for her wounded soldiers. (Given that Islamic medicine at the time was greatly advanced compared to that of Europe, some have suggested that Isabella got the idea from the Moors.) The use of military hospitals and even mobile field hospitals caught on slowly. The English, for example, did not establish field hospitals until King William III’s bloody trek through Ireland in 1690.

Modern military medical practice owes much to Napoleon Bonaparte’s chief surgeon, Dominique Jean Larrey. Larrey’s greatest contribution was the flying ambulance — a horse-drawn wagon that evacuated wounded from the battlefield, so that they could be tended to farther behind the lines. His use of triage — treating the wounded according to the severity of their injuries instead of by rank — was considered quite radical at the time; today it is standard operating procedure. Larrey was also a proponent of immediately amputating a damaged limb rather than waiting until it became gangrenous, at which point it was usually far too late to save the limb or the life.

Military medical care followed the same pattern for more than a century. Stretcher-bearers would remove the wounded from the field and take them to a dressing station located just out of range of enemy small-arms fire and equipped with the barest essentials. In the American Civil War, for example, that included bandages, chloroform (if it was available), morphine, opium and whiskey. The surgeon’s task was to stop the bleeding and prevent shock until the wounded troops could be moved farther behind the lines for treatment in a field hospital. Over time, this basic method of evacuating the wounded and providing care developed into a remarkably efficient system.

In the early 1900s, the Medical Department of the U.S. Army and the British army’s Royal Army Medical Corps (RAMC) were probably the best-prepared military medical outfits in the world. Both armies had learned harsh lessons about the importance of quality medical care during the Spanish-American and Anglo-Boer wars, in which the Americans and the British respectively lost more soldiers to typhoid than to combat. They entered the 20th century determined to attract quality medical professionals to military service and to enforce basic hygiene and other preventive measures among the troops. Nothing, however, could prepare them for the catastrophe that awaited as the world rushed headlong toward 1914.

World War I produced horrors the likes of which had never been seen. Some 65 million troops were mobilized by the Allies and Central Powers; more than 37 million — approximately 57 percent — were counted among the dead, wounded or missing at war’s end. Treating those casualties was a gargantuan task, and the work of the RAMC serves as a good example of life on the Western Front.

The RAMC established three working zones: the collecting zone (that closest to the battlefield where the wounded were taken first); the evacuating zone (located along lines of communication with vehicles to transport the wounded to the rear); and the distributing zone (the location of more permanent structures such as base hospitals).

The regimental medical officer (MO) was the first crucial link in this chain. His aid post was situated within yards of the main fighting trench, but if the fighting — or wound — was such that a soldier could not be moved, the MO attended casualties in the trench itself. Fighting trenches measured approximately 2 feet wide at the bottom, 4 feet wide at the top and 6 feet deep. Fire-steps were dug into trench walls about a foot off the ground where stretchers could be placed out of the way of fighting men. In waterlogged trenches, which were common, the fire-step also kept the wounded dry.

The cramped quarters made maneuvering stretchers difficult, to say the least; sometimes they had to be carried over open ground. Generally these removals took place under cover of darkness unless the nature of the wound was so critical that the soldier had to be moved under fire at whatever cost to the stretcher-bearers and the soldier himself. (Stretcher-bearers suffered extremely high casualty rates, and the RAMC is the only component in the British army to have had two members awarded double Victoria Crosses.)

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