The R.A.M.C. in Desert Warfare

It has been said that no adequate account of the work done by the Royal Army Medical Corps in Egypt can be given without touching almost at all points on the general history of the War in this part of the arena. This necessity becomes all the more obvious now that we have to deal with events following the evacuation of the Gallipoli Peninsula. 

As to the wisdom or unwisdom of that step, it is no part of the present writer’s business to inquire. It seems to have been largely a question of choice between two policies having a common main object. That object, supreme in its importance to the Empire, was the preservation of the integrity of Egypt, which at bottom meant the protection of the Suez Canal – the great artery through which the best of the life’s blood of our Empire flows. No doubt the simplest and surest means of attaining this end would have been a direct blow aimed at Constantinople, such as was at first attempted by what seemed the most likely method – the forcing of the Dardanelles. Even when matters had reached such a desperate deadlock on the Peninsula, it was still a question whether, by holding the main Turkish army before us in that far-off region, we were not serving our principal object, the preservation of the Suez Canal, if not in the best conceivable, at least in the best possible way. But, rightly or wrongly the opposite decision was taken.  Our army was withdrawn from the Dardanelles, and the greater part of it transported to Egypt, there to be reorganised under a new command for the same task but under very different conditions. 

Perhaps in all the thirty-five years of our occupation of that country no more interesting, indeed fascinating, problem has ever faced our military chiefs than that which confronted Sir Archibald Murray at the beginning of the year 1916. The original Turkish plans as regards Egypt were well known. There was to be a simultaneous invasion of the country across the Desert from the east and from the west, culminating in a grand central rendezvous of Moslemism at Cairo, the conquest of which place was to mark the final expulsion of the Christian and the termination of his power in Egypt. The Turkish army was to traverse the Sinai Desert, and force a crossing of the Suez Canal; while the Bedouin tribes, owning allegiance to El Sennussi, the chief Sheik and paramount influence in the Western Desert, were to combine under that leader assisted by Turkish officers, and so effect the invasion of Egypt from the west.

The situation which faced Sir Archibald Murray on his appointment as Commander-in-Chief of the British Forces in Egypt early in 1916, was one of considerable gravity.

Though the first Turkish attack upon the Suez Canal in the early part of the previous year had resulted in disaster to the invading host and its more or less complete disintegration as an army, it had not destroyed the Turkish power for mischief in this quarter. Considerable bodies of the enemy remained in the Desert east of the Canal wherever water was available; and throughout the following spring and summer made frequent raids on the shipway, their twofold object being to retain as large a number of our troops as possible in the Canal zone, and, if practicable, to lay mines in the Canal and thus put it out of use by sinking a big ship in the fairway.

Obviously, such a risk to the Canal was to be avoided at all costs, and we were compelled to maintain a large force in the area, constantly patrolling the Canal banks with a view to detecting and beating off the raiding parties that continually menaced its safety. It became evident, however, as time went on, that such half-measures might soon prove wholly in-adequate for their object. So long as the enemy retained a footing in the Desert within striking distance of the Canal, the uninterrupted traffic of this great highway of the world could never be ensured, and might, indeed, be rendered at any time absolutely impossible. Such a danger to the main communication of the Empire was clearly no longer to be tolerated. The great scheme, therefore, of the defence of the Suez Canal “in depth” – that is to say, by the creation of a defensive line throughout its whole length, some miles eastward out on the Desert – was immediately set on foot. Simultaneously with this new Canal defence scheme the inception of which, it is only right to say, was due to the late Lord Kitchener – preparations were begun for an eastward advance in force, having for its initial object the expulsion of the Turks from the Sinai Peninsula, and for its ultimate object, as all the world knows to-day, the invasion, conjointly with other Allied Forces, of the Ottoman Empire. At the same time an expedition was organised against the revolted Bedouin tribes in the Western Desert, which will be dealt with in its place. 

Before embarking on a narrative of the services and achievements of the Royal Army Medical Corps in these Eastern and Western campaigns, it will be useful to give an account, as briefly and concisely as may be, of the general organisation of the Corps and its procedure during the time of active service, par-ticularly of the various modifications of its systems brought about by the peculiar conditions of Desert warfare.

Practically none of the R.A.M.C. units in Egypt had had any previous experience of active service under Desert conditions. The experience gained on the Peninsula had been of very little preparatory value, except as regards general endurance of hardship and the perils of war. Our men had, therefore, all to learn in the new life that was now to begin for them, and this was especially true in the case of the officers, both commanding and executive, whom devolved the responsibility for the work of the Corps.

The functions of the R.A.M.C. in war-time are many and onerous. Foremost among these stands the preservation of the health of the troops. The paramount object towards which the Army Medical Service directs all its energy and knowledge is the maintenance of fighting efficiency; and this can only be assured by a high standard of physical fitness throughout all ranks. The work of preservation of bodily health among the individuals collectively forming an army has endless ramifications. The physical training of the men must be systematically looked after. Food must be of the right constituents, quality, and quantity. There must be a constant and sufficient supply of potable water. Clothing of the troops must be adapted to the exigencies of the climate of the country wherein operations are proceeding. Camp-life must be rigorously supervised, the choice of camping-sites carefully made, the disposal of excrement of men and animals, as also of all camp refuse, systematically carried out. All this falls within the province of the Medical Service.

In addition to the above, there are the collection, treatment, and evacuation of wounded and sick from the theatre of war, their care in the base hospitals, and their subsequent treatment as convalescents or, in the case of permanent ineffectives, their convey- ance homeward. Moreover, the R.A.M.C. is responsible for the provision of all medical and surgical equipment and material needed by the expeditionary force from first to last. 

During war-time the system on R.A.M.C. normally works is as follows:

An Army is composed of a number of Divisions, each Division consisting of three Brigades, and each Brigade being again subdivided into four Infantry Battalions. Each Brigade, in addition to its headquarters section, has also detachments of mounted troops, Field Artillery, Engineers, and a complete Field Ambulance of the R.A.M.C. The Brigade, in fact, is a little Army complete in itself. 

Each of the four Battalions composing a Brigade has its own attached Medical Officer, who is a member of the R.A.M.C. The duties of an attached M.O. are among the most exacting that can devolve upon a doctor in the Army. He is not only general physician to all the men in his battalion during the intervals of a campaign when there is no fighting on, but the whole work of first-aid to the wounded falls upon him during every action. This, however, by no means represents the entire scope of his activities. A good M.O. is nearly as much a moral force with his men as their medical factotum. By keeping close to them in all engagements and sharing all their dangers, with the single object of being instantly on hand when his services are required, he radiates confidence among the men in the battalion to an extent not to be easily over-estimated. In injuries where a major blood-vessel is involved, life itself often depends on the promptness with which skilled assistance can be obtained, and well the men know it. The proximity of the Medical Aid Post to the firing-line is a source of real comfort to the troops engaged, for it gives them that sporting chance at a crisis beloved of all British soldiers. 

The work of the Field Ambulance which is attached to each Brigade begins at the Medical Aid Posts. The Ambulance is divided into two sub- sections -a Tent Sub-section, and a Bearer Sub-sec- tion. The Tent Subsection mans the Advanced Dressing Station, which is situated in some convenient spot in the rear of the firing-line. It also Staffs the Main Dressing Station, which is established still farther in the rear. The Bearer Sub-section divides its strength between the four Battalion “Aid Posts”, and it is its duty to receive the wounded from the Medical Officer attached to Regimental units, and to convey them to the Advanced Dressing Station, the bearers journeying to and fro between these two points so long as the action lasts or there are injured men to be brought in. 

At the Advanced Dressing Station the wounded receive any further treatment which may be necessary but which has been impracticable amidst the stress and hurry of the Aid Post. They are then passed on by ambulance wagon, or other available means of transit, to the Main Dressing Station, which is, or should be, at such a distance from the firing-line as to be in a comparatively safe situation. 

These Main Dressing Stations, of which there is one to each Brigade, evacuate the wounded to the Casualty Clearing Station of the Division. The Casualty Clearing Station is the rearmost medical unit of the fighting army, and is established at the head of the Line of Communications, this being usually the nearest point on a railway. These Divisional Casualty Clearing Stations pass the injured down the line by hospital-train to the Stationary Hospital, which in turn evacuates to the General Hospital at the Base. Each Stationary Hospital will receive wounded from one or two or even more Casualty Clearing Stations, and each Base Hospital will be fed by probably several Stationary Hospitals. 

The system, in its entirety, may be likened to a series of sieves with progressively diminishing meshes, by which the various degrees in gravity of wounds or sickness are automatically separated. Very slight cases get no farther than the Dressing Stations, or even the Aid Post, whence after treatment they may be summarily returned to duty. Minor injuries and simple cases of indisposition likely to recover in a short time are intercepted by  the Casualty Clearing Stations, being thence re-turned straight to their units when sufficiently well. The Stationary Hospitals retain all cases which, though serious, will need no prolonged period for recovery. The General Hospital at the Base receives all gravely injured men and those suffering from prime disorders, Here all necessary medical and surgical treatment takes place, those cases making a good recovery being in due course transported to convalescent depots, thereafter eventually finding their way back to their units; while those who are permanently incapacitated from military duty are invalided home in hospital ships. 

The system briefly described above was – with certain important modifications dictated by local conditions – the one actually followed by the Royal Army Medical Corps throughout the greater part of the time occupied by the Egyptian Campaign and its subsequent developments. At an early stage in the hostilities, however, certain experimental changes were made. It was realised that as operations were to be carried out in a terrain consisting, for the most part, of nothing but trackless desert sand, the ordinary methods of transport by ambulance wagon or motor would be out of the question. Beyond the rail – head – which throughout these operations has necessarily been far in the rear – the wounded and sick unable to walk could only be conveyed on the backs of camels or in light ambulance-carts with wheels specially devised for travelling over sand. 

In respect of the camels, several kinds of litter were designed to accommodate lying-down cases. Each camel carried a pair of these pannier-fashion, the most convenient pattern being that which consisted of a padded metal frame, fitting over the animal’s back, to which the already loaded stretcher could be clipped or bolted. These litters, or cacolets, were also made in seat-form, to take patients whose injuries allowed them to travel in the sitting posture. The Desert ambulance carts, now for the first time brought into use, may be best described as large, double wire-spring mattresses under canvas canopies, running on a pair of wheels with very wide tyres, which rode over, rather than ploughed through, the loose, shifting sand. These wheels were boxed in on both sides, so that they had the appearance of revolving wooden drums rather than wheels. The carts were drawn commonly by a quartette of mules or horses, but draught-camels were also employed on occasion.

At one time it seemed likely that a sand-sleigh drawn by two mules or horses and accommodating one stretcher, would be a valuable and feasible method of transport for sick and wounded over the Desert ; and almost every Field Ambulance had a sledge of its own manufacture. But officially the sledge idea never came to much, the article eventually supplied by Ordnance proving in practice too heavy and cumbersome for routine work over long stretches of sand. The only units which made extensive use of the ambulance sledge were the Australian and other Mounted Field Ambulances. 

The early experimental modifications in the R.A.M.C. system for collecting and evacuating wounded in battle involved certain fundamental changes. In the operations on the Desert, large bodies of our troops in the form of a mobile column were often thrown rapidly forward in advance of the main force, and it was considered that a Field Ambulance, even with special Desert transport equipment on the lines indicated above, was too bulky and ponderous a unit to move as a whole with such a mobile column. 

For a time, therefore, instead of the Field Ambulances working in sections in the old way, each ambulance was divided into what were called a “Mobile Section,” two “Ambulance Convoys,” and a “Non-Mobile Section” which had all the heavy tentage and paraphernalia of the unit, and went by train. The Mobile Section was a section with a special cut-down equipment, the object being, while retaining the maximum efficiency, to give the transport camels as little weight as possible to carry. This Mobile Section was provided with camels for cacolets both lying and sitting, for carrying stores, and for conveying water in fantasses – light oblong metal cases. A fleet of sand-carts was also provided. The equipment of the Mobile Section enabled it to establish a Dressing Station, and to collect wounded from the Brigade with which it was working. Evacuation from this Dressing Station was effected by the two Ambulance Convoys, which also each possessed their equipment of sand-carts, camels for lying and sitting cacolets, and camels for carrying water and stores. 

These Convoys formed the connecting link between the Mobile Section and the so-called Non-Mobile Section – the more heavily accoutred part of the Field Ambulance situated in the rear – which moved only by train. The intention underlying the provision of two separate Convoys was that, where the interval between the fighting troops and the main portion of the Ambulance became unduly lengthened owing to the advance of the force engaged, the two Convoys could operate in relay, one behind the other, and thus prevent the gap from becoming unworkably large.

In practice, however, this organisation developed serious defects. It was too inelastic to fit the varying needs of Desert warfare. It was therefore soon given up, and a return made to the original tri-sectional formation, but with special modifications indicated by local needs. The Sections of each Field Ambulance officially designated A, B, and C were still divided into Bearer and Tent Subdivisions as heretofore, but with modified equipment. And two of the Sections, B and C, were rendered specially mobile, the Tent Subdivision of the A, or Headquarters’ Section, taking the surplus equipment, thus being only semi-mobile and still dependent on the railway. Despite this partial return to old and tried methods, however, something very like a revolution took place in the composition of the Field Ambulance, So far as its equipment for transport was concerned. The old Field Ambulance possessed : 

10 Ambulance Wagons. 6 G. S. Wagons. 4 Limbered G. S. Wagons. 3 Water Carts. 1 Maltese Cart  104 horses and mules. 

The Ambulance as modified for Desert warfare possessed much greater equipment. 

These innovations, though time was destined thoroughly to prove their worth, were at first not unattended by difficulties. Some of the early arrangements proved faulty in practice. At first the camels were not permanently stationed with the Ambulances, but had to be fetched from the Camel Transport Corps when needed. An Ambulance under orders to mobilise for action would send to the C.T.C. for the necessary animals. These would eventually arrive in a long string, possibly only a few hours before the Ambulance was required to march with the fighting column. Before a move could be made, however, the cacolet saddles had to be fitted to the camels’ backs. 

Now, whereas these saddles were made all to one rigid standard size and pattern by a decree seemingly as unalterable as the laws of the Medes and Persians, an unkind Providence had so ordained things that no two camels’ backs were of the same shape or dimensions. Some were narrow and others broad : some had their humps steeply and sharply pyramidal, many were of the flat tableland formation. But the camels had all to be saddled somehow in spite of these deterrents, though the process often necessitated hours of anxious contriving. Moreover, the camel train frequently arrived very late. On one occasion which came under the notice of the writer, the fighting column was due to move off at three o’clock on a pitch-dark morning, but the camels for the Ambulance did not put in an appearance until half an hour before. Obviously it was impossible for the Ambulance Transport to be ready in time. 

This camel difficulty was, however, soon removed by permanently allotting to each Ambulance its own special animals for the cacolet work. The requisite number of camels, with their native drivers, were parked with or near the Field Ambulance constantly; and the care and upkeep of the cacolets were made part of the general duty of the camel-men. This not only lightened the work of the R.A.M.C. orderlies, but it gave them a chance of learning to direct native labour and to pick up a knowledge of Arabic – acquirements which proved of no little service during the subsequent campaign. 

For the rest, there was a great deal to learn, even in the case of the most experienced R.A.M.C. man, in the treatment of the sick and wounded under the novel and trying conditions of the Desert. The faculty of ready adaptation to environment, for which the British soldier is famous, was now to prove doubly a necessity with the British Field Ambulance man. The Turks were not the only foes that opposed us on the Sinai Peninsula. Heat, dust, vermin, blinding suffocating sandstorms, the terrible Khamsin – which is a red-hot hurricane seemingly straight from the throttle of Hades.want of water and everything else needed to support life, the miles of daily march over an eternal sameness of shifting sand – all combined to make up a life that called for stoutness of heart, even more, perhaps, than of shoe-leather. That our Ambulance-men “made good” through it all, in the fullest sense of that expressive gutter-snipe among popular phrases, it will now be our business Ito demonstrate, by following the course of the campaign.

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