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During World War I, the scientist invented a mobile x-ray unit, called a "Little Curie," and trained 150 women to operate it

smithsonianmag.com

Ask people to name the most famous historical woman of science and their answer will likely be: Madame Marie Curie. Push further and ask what she did, and they might say it was something related to radioactivity. (She actually discovered the radioisotopes radium and polonium.) Some might also know that she was the first woman to win a Nobel Prize. (She actually won two.)

But few will know she was also a major hero of World War I. In fact, a visitor to her Paris laboratory in October of 1917 - 100 years ago this month - would not have found either her or her radium on the premises. Her radium was in hiding and she was at war.

For Curie, the war started in early 1914, as German troops headed toward her hometown of Paris. She knew her scientific research needed to be put on hold. So she gathered her entire stock of radium, put it in a lead-lined container, transported it by train to Bordeaux - 375 miles away from Paris - and left it in a safety deposit box at a local bank. She then returned to Paris, confident that she would reclaim her radium after France had won the war.

With the subject of her life's work hidden far away, she now needed something else to do. Rather than flee the turmoil, she decided to join in the fight. But just how could a middle-aged woman do that? She decided to redirect her scientific skills toward the war effort; not to make weapons, but to save lives.

X-rays enlisted in the war effort

X-rays, a type of electromagnetic radiation, had been discovered in 1895 by Curie's fellow Nobel laureate, Wilhelm Roentgen. As I describe in my book "Strange Glow: The Story of Radiation," almost immediately after their discovery, physicians began using X-rays to image patients' bones and find foreign objects - like bullets.

But at the start of the war, X-ray machines were still found only in city hospitals, far from the battlefields where wounded troops were being treated. Curie's solution was to invent the first "radiological car" - a vehicle containing an X-ray machine and photographic darkroom equipment - which could be driven right up to the battlefield where army surgeons could use X-rays to guide their surgeries.

One major obstacle was the need for electrical power to produce the X-rays. Curie solved that problem by incorporating a dynamo - a type of electrical generator - into the car's design. The petroleum-powered car engine could thus provide the required electricity.

Frustrated by delays in getting funding from the French military, Curie approached the Union of Women of France. This philanthropic organization gave her the money needed to produce the first car, which ended up playing an important role in treating the wounded at the Battle of Marne in 1914 - a major Allied victory that kept the Germans from entering Paris.

More radiological cars were needed. So Curie exploited her scientific clout to ask wealthy Parisian women to donate vehicles. Soon she had 20, which she outfitted with X-ray equipment. But the cars were useless without trained X-ray operators, so Curie started to train women volunteers. She recruited 20 women for the first training course, which she taught along with her daughter Irene, a future Nobel Prize winner herself.

The curriculum included theoretical instruction about the physics of electricity and X-rays as well as practical lessons in anatomy and photographic processing. When that group had finished its training, it left for the front, and Curie then trained more women. In the end, a total of 150 women received X-ray training from Curie.

Not content just to send out her trainees to the battlefront, Curie herself had her own "little Curie" - as the radiological cars were nicknamed - that she took to the front. This required her to learn to drive, change flat tires and even master some rudimentary auto mechanics, like cleaning carburetors. And she also had to deal with car accidents. When her driver careened into a ditch and overturned the vehicle, they righted the car, fixed the damaged equipment as best they could and got back to work.

In addition to the mobile little Curies that traveled around the battlefront, Curie also oversaw the construction of 200 radiological rooms at various fixed field hospitals behind the battle lines.

Although few, if any, of the women X-ray workers were injured as a consequence of combat, they were not without their casualties. Many suffered burns from overexposure to X-rays. Curie knew that such high exposures posed future health risks, such as cancer in later life. But there had been no time to perfect X-ray safety practices for the field, so many X-ray workers were overexposed. She worried much about this, and later wrote a book about X-ray safety drawn from her war experiences.

Curie survived the war but was concerned that her intense X-ray work would ultimately cause her demise. Years later, she did contract aplastic anemia, a blood disorder sometimes produced by high radiation exposure.

Many assumed that her illness was the result of her decades of radium work - it's well-established that internalized radium is lethal. But Curie was dismissive of that idea. She had always protected herself from ingesting any radium. Rather, she attributed her illness to the high X-ray exposures she had received during the war. (We will likely never know whether the wartime X-rays contributed to her death in 1934, but a sampling of her remains in 1995 showed her body was indeed free of radium.)

As science's first woman celebrity, Marie Curie can hardly be called an unsung hero. But the common depiction of her as a one-dimensional person, slaving away in her laboratory with the single-minded purpose of advancing science for science's sake, is far from the truth.

Marie Curie was a multidimensional person, who worked doggedly as both a scientist and a humanitarian. She was a strong patriot of her adopted homeland, having immigrated to France from Poland. And she leveraged her scientific fame for the benefit of her country's war effort - using the winnings from her second Nobel Prize to buy war bonds and even trying to melt down her Nobel medals to convert them to cash to buy more.

She didn't allow her gender to hamper her in a male-dominated world. Instead, she mobilized a small army of women in an effort to reduce human suffering and win World War I. Through her efforts, it is estimated that the total number of wounded soldiers receiving X-ray exams during the war exceeded one million.
Timothy J. Jorgensen, Director of the Health Physics and Radiation Protection Graduate Program and Associate Professor of Radiation Medicine, Georgetown University

This article was originally published on The Conversation.

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How Marie Curie Brought X-Ray Machines To the Battlefield

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smithsonianmag.com Ask people to name the most famous historical woman of science and their answer will likely be: Madame Marie Curie. Push further and ask what she did, and they might say it was something related to radioactivity. (She actually discovered the radioisotopes radium and polonium.)

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How three men saved countless lives: blood transfusion in the First World War

If we are in an accident or have an operation and lose blood, we take it for granted that we will be given a transfusion. Not only that, but it will be matched to our blood type, will have been stored in the correct conditions and will be delivered using sterilised equipment to avoid infection.

At the start of the First World War blood transfusion technology was largely untested and not widely accepted. Blood types had first been identified at the turn of the century, but where transfusions were carried out surgeons did not test the blood for compatibility. This could be fatal where the patient's immune system attacked the new blood cells.

Transfusions were 'direct' using a tube to carry blood from an artery in the donor to a vein in the patient - this carried the risk that blood would clot and block the tubes. As is so often the case in war, new techniques were advanced in the urgency of the battlefield, and in this case, a Canadian, an American and an Englishman all played vital roles.

The Canadian was Lawrence Bruce Robertson. Of Scottish background, Robertson was born in 1885 in Toronto. He joined the Canadian Expeditionary Force and was posted to the Canadian Army Medical Corps' No. 2 Casualty Clearing Station. He persuaded the British surgeons at the casualty clearing stations to practice 'indirect' blood transfusions, where blood was transferred using syringes and canulae to overcome problems of clotting - a technique he had used at Toronto's Hospital for Sick Children.

Robertson set up the first blood transfusion equipment at a casualty clearing station on the Western Front in Spring 1917 and began to record the results of the transfusions he performed. In an article in The Lancet published on 24 November 1917, Robertson described 36 cases where he had used the indirect transfusion method. He wrote that 'In the cases of severe primary haemorrhage accompanied by shock, blood transfusion frequently produces an immediate and almost incredible improvement. The change from a pallid, sometimes semi-conscious patient with a rapid flickering pulse to a comparatively healthy looking conscious and comfortable patient with a slower and fuller pulse is dramatic evidence of the value of the transfused blood.'

Robertson's article in the Lancet was printed with a note by Colonel Charles Gordon Watson, the consulting surgeon to the British Expeditionary Force, which said 'During the past year I have had the opportunity of observing the technique and the results of blood transfusions by Major Bruce Robertson and other workers. Without doubt transfusion of blood after primary haemorrhage is a life saving device of the greatest value and enables urgent operations to be successfully performed under conditions otherwise hopeless.'

Another Robertson, this time an American by the name of Oswald Hope, played an equally important role in developing blood transfusion technology. Oswald Robertson was born in England in 1886 but emigrated to America as a child. He qualified as a doctor in 1915 and joined the Western Front as a volunteer with the United States Army, attached to the 48th casualty clearing station. He built the world's first blood bank - storing blood mixed with a citrate and dextrose solution in glass bottles kept on ice. The blood could be kept for up to 26 days and moved to casualty clearing stations ready to be used in transfusions to patients.

In an article in The Lancet published on 22 June 1918, Robertson described the technique and equipment to be used in storing blood safely for later use. He discussed the results of blood transfusions using stored blood saying that 'The effect of transfusion with preserved blood was fully as striking as that observed after the giving of freshly drawn blood. There was the same marked improvement in colour, the pulse became slower and stronger, and the blood pressure showed an increase of 20 to 40 points'.

During heavy fighting a casualty clearing station received many seriously wounded men at once. The less seriously wounded, who would normally have been able to donate blood, were not taken to the casualty clearing stations. This meant that having a stock of stored blood allowed the medical services to give transfusions quickly and easily. Robertson was awarded the Distinguished Service Order by the British Government in recognition of the lives his techniques had saved.

Another aspect of blood transfusion technology was developed by an Englishman, Geoffrey Keynes. Born in 1887, Keynes qualified as a surgeon with the Royal College of Surgeons in London and in 1917 he married Margaret Darwin - granddaughter of Charles Darwin.

Like many other doctors, Keynes was granted a temporary commission with the Royal Army Medical Corps. His medal card ( WO 372/11/152014) shows he was attached to the 4th General Hospital. Service records for RAMC officers who received a permanent commission are at The National Archives in WO 339, but service records of officers with a temporary commission for the duration of the war were destroyed after 1920. War diaries of hospitals and ambulance trains in WO 95 can sometimes mention officers by name and illustrate the day to day experiences of those who served with the RAMC.

Keynes developed equipment that enabled blood transfusions to be carried out away from established medical facilities. Where there was no refrigeration available to store blood, the best hope a patient had was to get a transfusion there and then from another person. Keynes' equipment enabled 'indirect' transfusions by regulating the flow of blood between the donor and the patient.

It's difficult to imagine how many men must have owed their lives to the techniques developed by these three men. Thanks to their skills and inventiveness, blood transfusion became accepted practice within the Royal Army Medical Corps which later declared it the most important medical advance of the war.

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How three men saved countless lives: blood transfusion in the First World War | The National Archives blog

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How three men saved countless lives: blood transfusion in the First World War If we are in an accident or have an operation and lose blood, we take it for granted that we will be given a transfusion.

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Presented by Dr Saleyha Ahsan Doctor & ex-Army officer

Presented by Dr Saleyha Ahsan Doctor & ex-Army officer

World War One was fought on a scale that had never been experienced before.

At the Battle of Waterloo in 1815, the main infantry weapon was the muzzle-loading musket, which fired up to four shots a minute. At the Battle of the Somme, just over a century later, machine gunners could fire off 600 rounds a minute. High velocity rounds wreaked havoc in the body, twisting tissue and splintering bone. Fighting on farmland fertilised by manure meant that wounds quickly became infected; gangrene was rife.

Faced with this challenge, new equipment and techniques were invented that, across four years of fighting, would end up saving thousands of lives.

This journey would have been familiar to many wounded soldiers, though the actual route taken would have varied. In quiet periods, a wounded soldier could be evacuated from battlefield to base hospital in less than 24 hours.

The wounds inflicted on millions of soldiers drove the development of new medical techniques and inventions.

The British Army began the routine use of blood transfusion in treating wounded soldiers. Blood was transferred directly from one person to another. But it was a US Army doctor, Captain Oswald Robertson, who realised the need to stockpile blood before casualties arrived. He established the first blood bank on the Western Front in 1917, using sodium citrate to prevent the blood from coagulating and becoming unusable. Blood was kept on ice for up to 28 days and then transported to casualty clearing stations for use in life-saving surgery where it was needed most.

Innovations developed in the First World War had a massive impact on survival rates - such as the Thomas splint, named after pioneering Welsh surgeon Hugh Owen Thomas, which secured a broken leg. At the beginning of the war 80% of all soldiers with a broken femur died. By 1916, 80 % of soldiers with this injury survived.

From January 1915 the British military medical machine moved closer to the front line. Casualty clearing stations were now better equipped and, crucially, more surgeons were closer to the battlefield. There were now fewer delays in administering potentially life-saving treatment. Soldiers with wounds that would have been fatal were now more likely to survive.

What does modern treatment owe to the First World War? Professor Christine Hallett of the University of Manchester explains how modern medicine continues to be influenced by advancements made during World War One.

Blood is now routinely used in hospitals throughout the world, with stockpiles that can be called upon when required. In the military, the Medical Emergency Response Team is able to give wounded soldiers blood on the ground, helping to prevent deaths from shock. Developments in wound shock treatment in the First World War - from the use of saline, through direct donor-to-patient blood transfusion and the development of techniques to store blood - have helped shape much of modern practise.

Today, heavily infected wounds are rarely seen thanks to the discovery of antibiotics in 1928 and their widespread adoption throughout the 1940s. However, our understanding of the treatment of wounds owes much to the experimentation with antiseptics seen in the First World War. The Carrel-Dakin technique, which delivered sodium hypochlorite directly to damaged tissue in deep wound-beds, came to be viewed as best-practice. A British version of Dakin's Solution, known as EUSOL (Edinburgh University Solution of Lime) continued to be used to treat wounds until the late twentieth century.

Cleanliness and hygiene are key weapons in preventing the spread of infection in both army accommodation and military hospitals. Soldiers living in the squalid conditions of the First World War trenches were susceptible to a range of infections, including typhus fever carried by lice. The treatment of so-called trench fever extended our understanding of how to break the spread of such infections, with the more hygienic practises adopted in First World War base hospitals helping to structure modern approaches.

The modern military has a much more detailed knowledge of psychological trauma, or Post-Traumatic Stress Disorder. Patients benefit from a wide range of approaches, including Cognitive Behavioural Therapy (CBT). During World War One, some thought 'shell-shock' was a physical condition, caused by the percussion of shell-blast on the brain tissue; others saw it as essentially an acute form of psychological distress. These controversies fed into the work of the psychoanalytic movement in the early twentieth century, which can be viewed as the forerunner of CBT.

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How did WW1 change the way we treat war injuries today?

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Presented by Dr Saleyha Ahsan Doctor & ex-Army officer Presented by Dr Saleyha Ahsan Doctor & ex-Army officer World War One was fought on a scale that had never been experienced before. At the Battle of Waterloo in 1815, the main infantry weapon was the muzzle-loading musket, which fired up to four shots a minute.

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Presented by Michael Mosley Broadcaster and doctor

Presented by Michael Mosley Broadcaster and doctor

A million British soldiers died in World War One, and double that amount came home injured. For many of those lucky enough to return, the wounds they had suffered in Europe would leave them permanently disfigured.

The trenches protected the bodies of soldiers, but in doing so it left their heads vulnerable to enemy fire. Soldiers would frequently stick their heads up above the trenches, exposing them to all manner of weapons.

At the start of the war, little consideration was given to the trauma of facial injuries. It came as something of a surprise that so many victims survived to the point of treatment. Escaping the war with your life was seen as reward enough. The advent of plastic surgery would radically change that perception.

Lieutenant William Spreckley, above, was one of Harold Gillies' biggest successes. To fashion him a new nose, Gillies hit the books and came across an old Indian idea known as the 'forehead flap'. He took a section of rib cartilage and implanted it in Spreckley's forehead. It stayed there for six months before it could be swung down and used to construct the nose. From start to finish, the process took over three years. Spreckley was admitted to hospital in January 1917 at the age of 33 and discharged in October 1920.

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How do you fix a face that's been blown off by shrapnel?

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Presented by Michael Mosley Broadcaster and doctor Presented by Michael Mosley Broadcaster and doctor A million British soldiers died in World War One, and double that amount came home injured. For many of those lucky enough to return, the wounds they had suffered in Europe would leave them permanently disfigured.

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Medicine and care had to develop very quickly during the war to deal with different types of injuries and casualties. Improvements in transport were a big help.

Scientists and doctors found it was important for injured soldiers to be treated within an hour. New, motorised ambulances and trains helped to make getting to the injured easier and mobile X-ray units improved the level of care that could be provided.

These X-ray units could be taken to the soldiers. They told doctors where in soldiers' bodies any bullets or pieces of shrapnel were. The fact that skilled nurses were allowed closer to the front line than in other wars was also very helpful.

With the development of X-ray technology, surgeons were able to detect where a bullet had penetrated. Many operations were successfully performed during the war thanks to this advancement in medicine.

Nurses still only had salt water to clean wounds. Soldiers did not always realise that open wounds were more likely to get infected.

Blood was first stored successfully during World War One. This meant doctors could now give blood transfusions to soldiers when they had lost blood. This was a process where they transferred blood taken from a healthy person, to someone who had lost a lot of blood. Blood transfusions prevented many deaths. In previous wars, soldiers with severe burns, tissue damage and contagious diseases would have usually died.

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Medicine and care had to develop very quickly during the war to deal with different types of injuries and casualties. Improvements in transport were a big help. Scientists and doctors found it was important for injured soldiers to be treated within an hour.

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In 1918, towards the end of the war, the biggest illness of all began to spread around the world.

Spanish Influenza (flu) was first reported in March 1918 and quickly became a pandemic (an illness that spreads around the world).

It became known as Spanish Flu because Spain was one of the earliest countries to be hit hard by the disease. By June 1918, it had spread around the world.

It was called "the greatest enemy of all" because it infected about half of the world's population. 40-50 million people died of this illness - many more people than the war itself.
What was to blame?
At the time, people were not sure what had caused the outbreak of the flu. Some thought it might be caused by poison gas. Today we know it developed in animals and birds then spread to people. Influenza spread all around the world on ships trading goods with other countries. The war helped it to spread because more people than usual were travelling. Soldiers also lived very closely together in camps and trenches and this helped the influenza to spread more easily.
Spread of the flu
Spanish Influenza seemed just like an ordinary cold when a person first got it. It developed quickly and sometimes people died just a few hours after they realised that they had the illness.

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In 1918, towards the end of the war, the biggest illness of all began to spread around the world. Spanish Influenza (flu) was first reported in March 1918 and quickly became a pandemic (an illness that spreads around the world).

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Shell Shock - The Psychological Scars of World War 1 I THE GREAT WAR Special

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Conditions in Trenches - Dan Snow's Battle of the Somme

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During World War One, soldiers suffered not only from injuries in battle but also from illnesses and diseases caused by the dreadful conditions in the trenches.

Poisonous gas was used as a weapon for the first time in World War One.

Some gas was intended to only cause noses to run and eyes to water. Others were far more dangerous.

When gas was first used, doctors and nurses did not know how to treat even simple symptoms. Gas could affect someone seeing and breathing in just a few minutes so protective masks were given to all soldiers. Some fumes stayed on clothes causing blisters and sores. Bathing and washing would have solved the problem but this was not possible in the trenches. Many soldiers suffered from the effects of gas attacks for the rest of their lives.

Some soldiers suffered from a condition called trench foot.

This was caused by standing in water and mud for a long time and losing blood circulation. In some cases, soldiers' socks started to grow on to their feet. In severe cases, soldiers had to have their feet or legs amputated (cut off).

Trench fever was an unpleasant disease caused by body lice during World War One.

The fever was easily passed between soldiers, causing them to suffer from high fever, headaches, aching muscles and sores on the skin. It was painful and took around twelve weeks to get better from. For many soldiers, it was an illness that struck them more than once.

Shell shock was another new illness during World War One.

It was not a physical illness, but a mental one. The constant noise of explosions and guns, along with the smell and danger of the trenches made many soldiers very scared and uncomfortable. Shell shock caused soldiers to act strangely. They found life on the front line very hard to deal with and would stop being able to follow commands and do their duties properly.

To begin with, officers and doctors did not understand the illness and thought the soldiers were weak. Some were sent to special hospitals to recover. Others had to carry on fighting.

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During World War One, soldiers suffered not only from injuries in battle but also from illnesses and diseases caused by the dreadful conditions in the trenches. Poisonous gas was used as a weapon for the first time in World War One. Some gas was intended to only cause noses to run and eyes to water.

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FANY (PRVC) - Princess Royal's Volunteer Corps

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http://fany.org.uk/public/FANY_WW1_Overview_Pdf.pdf | WWI | FANY (PRVC) - Princess Royal's Volunteer Corps

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RAMC - The Royal Army Medical Corps in WW1

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The RAMC - the Royal Army Medical Corps, formed in 1989 was formed for the management of care and welfare for the sick and the wounded during World War 1

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Injured and sick soldiers needed to be treated quickly so they could go back to fighting as soon as possible.

The Royal Army Medical Corps (RAMC) was set up to care for British troops. It used a special system called 'triage' where sick soldiers were put into one of three possible groups:

1. Slightly injured - Soldiers who did not need much care. They were quickly given treatment wherever they were and then carried on fighting.

2. Need hospital - Soldiers who needed to be transported by ambulance to a hospital for treatment. They were taken in motorised or horse-driven ambulances to the nearest hospital base.

3. Beyond help - Soldiers who did not have much chance of getting better. They were made comfortable but little treatment was given as priority was given to others.

Casualty clearing stations were set up close to the battlefields, some by the Red Cross. After being treated in the trenches, wounded soldiers would be taken first to a clearing station then moved on to a general hospital if they needed more treatment.

Women on the front line

Female volunteers who wanted to help were allowed to work as nurses at casualty clearing stations. Some drove ambulances. This was usually the closest they were allowed to get to the front line but it was still close enough that they might be hit by enemy fire. Most worked 14-hour days and sometimes even longer when there were lots of injured soldiers. The soldiers liked having women around because they reminded them of their mothers, wives and sisters.

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Injured and sick soldiers needed to be treated quickly so they could go back to fighting as soon as possible. The Royal Army Medical Corps (RAMC) was set up to care for British troops. It used a special system called 'triage' where sick soldiers were put into one of three possible groups: Slightly injured - Soldiers who did not need much care.

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This page describes the main medical functions in a complex chain that processed the casualty from the front line back to hospitals at home. It is in a simplified format. Many men missed stages altogether, and of course many wounded soldiers were in no condition to know which of these units was caring for them.

Aid and Bearer Relay Posts

The casualty is likely to have received first medical attention at aid posts situated in or close behind the front line position. Units in the trenches provided such posts and generally had a Medical Officer, orderlies and men trained as stretcher bearers who would provide this support. The Field Ambulance (see below) would provide relays of stretcher bearers and men skilled in first aid, at a series of "bearer posts" along the route of evacuation from the trenches. All involved were well within the zone where they could be under fire.
Stretcher-bearers carrying an injured man on a stretcher down a twisting trench in Salonika. Imperial War Museum copyright image Q31794. Note also the walking wounded following them. These men have clearly already received some rudimentary medical assistance in the trenches.
Field Ambulance

This was a mobile medical unit, not a vehicle. Each British division had three such units, as well as a specialist medical sanitary unit. The Field Ambulances provided the bearer posts but also estabished Main and Advanced (that is, forward) Dressing Stations where a casualty could receive further treatment and be got into a condition where he could be evacuated to a Casualty Clearing Station. Men who were ill or injured would also be sent to the Dressing Stations and in many cases returned to their unit after first aid or some primary care.
This diagram from a Canadian history shows the locations and types of aid posts and dressing stations that supported the 1st Canadian Division during the opening of the Second Battle of Ypres. There are six regimental aid posts behind the front line, two Advanced and two Main Dressing Stations.
There was no hard and fast rule regarding the location of a Dressing Station: existing buildings and underground dug-outs and bunkers were most common, simply because they afforded some protection from enemy shell fire and aerial attack. The Dressing Stations were generally manned by the Field Ambulances of the Royal Army Medical Corps.
An Australian Medical Officer attends a wounded man at an Advanced Dressing Station during the Third Battle of Ypres in 1917. Imperial War Museum copyright image E(AUS)714.
Once treated at a Dressing Station, casualties would be moved rearward several miles to the Casualty Clearing Station. This might be on foot; or on a horse drawn wagon or motor ambulance or lorry; or in some cases by light railway. It is helpful to consult the war diary of the Assistant Director of Medical Services of the Division relevant to the man's unit, for they usually have very detailed reports on the locations of the bearer and dressing stations at the time that the man was being evacuated.
A Field Ambulance wagon passing over muddy ground near Ovillers, Somme, in September 1916. Imperial War Museum copyright image Q1098. This may be on its way from a Dressing Station to a Casualty Clearing Station. Imagine what wounded men suffered when moving over such ground on this type of transport.
The next three images are from the war diary of 76 Field Ambulance, a unit under command of 25th Division, and relate to its time in the Ypres area during the Third Battle of Ypres offensive in August 1917. The diary reference is WO95/2239 and the images are Crown Copyright.

Click on the image for a full scale view. Note the bearer posts and relay stations linking back from the units at the front to a Dressing Station at (or perhaps more accurately, given this sketch, near) the ruined site of Hooge Chateau.

Click on the image for a full scale view. This is a circuit for horse drawn ambulance transport, picking up casualties at the Hooge Chateau Advanced Dressing Station (in square 15) and taking them out of the battlfield past Dickebusch. A typical onward route from there would be to the group of CCSs at Remy Farm (Lijssenthoek).

The Hooge Chateau Advanced Dressing Station dealt with 3395 casualties in the period 1 to 14 August 1917, of which just under 1000 were on 10-11 August alone. About a third were stretecher cases and the rest were able to move, to some extent, on their own. These figures and proportions were not untypical for a unit involved in a major action.
Wounded British troops arriving at 43 Casualty Clearing Station, Frevent, 8 April 1918. Imperial War Museum copyright image Q334.
Casualty Clearing Station

The CCS was the first large, well-equipped and static medical facility that the wounded man would visit. Its role was to retain all serious cases that were unfit for further travel; to treat and return slight cases to their unit; and evacuate all others to Base Hospitals. It was often a tented camp, although when possible the accommodation would be in huts. CCS's were often grouped into clusters of two or three in a small area, usually a few miles behind the lines and on a railway line. A typical CCS could hold 1,000 casualties at any time, and each would admit 15-300 cases, in rotation. At peak times of battle, even the CCS's were overflowing. Serious operations such as limb amputations were carried out here. Some CCS's were specialist unit, for nervous disorders, skin diseases, infectious diseases, certain types of wounds, etc. CCS's did not move location very often, and the transport infrastructure of railways usually dictated their location. Most evacuated casualties came away from the CCS by rail, although motor ambulances and canal barges also carried casualties to Base Hospitals, or directly to a port of embarkation if the man had been identified as a "Blighty" case. (In 1916, 734,000 wounded men were evacuated from CCS's by train and another 17,000 by barge, on the Western Front alone. There were 4 ambulance trains in 1914 and 28 by July 1916). The serious nature of many wounds defied the medical facilities and skills of a CCS, and many CCS positions are today marked by large military cemeteries. CCS's also catered for sick men. Generally, considering the conditions, the troops were kept in good health. Great care was taken in reporting sickness and infection, and early preventive measures were taken. The largest percentage of sick men were venereal disease cases at 18.1 per 1000 casualties; trench foot was next with 12.7. Until mid 1915, the CCS was known as a Clearing Hospital. Generally there was one provided for each Division. From the CCS, the casualty would be evacuated to a Base Hospital.
A ward of the 2nd Australian Casualty Clearing Station at Steenwerke, November 1917. Imperial War Museum copyright image E(AUS)4293. The locations of the CCS's in France, Belgium and (later) Germany
This map of May 1918 gives an impression of the great extent of the CCS's established at Remy Farm, Lijssenthoek, in the rear areas of the Ypres sector. The blue rectangles are huts and buildings of the CCS's. Note the railway line passing through the camp. The inevitable cemetery at Remy Farm became one of the largest on the Western Front and now has an interpretive visitor centre next door - well worth seeing for an understanding of how a CCS functioned.
Wounded British troops outside a Casualty Clearing Station at Heilly, Somme, September 1916. Imperial War Museum copyright image Q1255. Note the train in the distance, left. These men are likely to be waiting for a move to a Base Hospital.
Ambulance Trains and Barges

Casualties would normally be moved from the CCS to a Base Hospital,by specially-fitted ambulance train or in some circumstances by barge along a canal.

Base Hospital

Once admitted to a Base Hospital, the soldier stood a reasonable chance of survival. More than half were evacuated from a General or Stationary Hospital for further treatment or convalescence in the United Kingdom. The Stationary Hospitals, two per Division, could hold 400 casualties each. The General Hospital could hold 1040 patients. They were located near the army's principal bases at Boulogne, Le Havre, Rouen, Le Touquet and Etaples. The establishment of a General Hospital included 32 Medical Officers of the RAMC, 3 Chaplains, 73 female Nurses and 206 RAMC troops acting as orderlies, etc. The hospitals were enlarged in 1917, to as many as 2,500 beds.
The locations of the Base Hospitals in France
Home hospital

Existing military hospitals were expanded; many civilian hospitals were turned over in full or part to military use; many auxiliary units opened in large houses or public buildings; and many private hospitals also operated.
The locations of the many of the principal hospitals at home Transfers to Military Convalescent Hospitals
Command Depot

Once discharged from hospital men were sent to various locations for convalsecence, depending on their circumstances. Many went to the military Command Depots:
List of the Command Depots
Links
A soldier's life Classification of wounds

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The evacuation chain for wounded and sick soldiers

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This page describes the main medical functions in a complex chain that processed the casualty from the front line back to hospitals at home. It is in a simplified format. Many men missed stages altogether, and of course many wounded soldiers were in no condition to know which of these units was caring for them.

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Ambulances On The Salonika Front - Moving Wounded Soldiers On Sleeve As Ambalances (1916)

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First World War - Battle of the Somme and experiences of trench warfare

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The third of four videos detailing the experience of the First World War. The first half of this film looks at the Battle of the Somme (including the use of aircraft in warfare). It then goes on to look at trench warfare tactics including artillery and gas, and describes the extent of the injuries they caused and how the wounded were treated.

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Battle of Ypres WW1  -Blood mud and rain

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Why Trenches? - WW1 Uncut: Dan Snow - BBC

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Second Battle of Ypres - The Dawn of Chemical Warfare

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Life in a Trench | World War I | History