De l'Enfer au Paradis, les hôpitaux de l'arrière en 1916

On 21st February 1916, German artillery fire, the "Trommelfeuer ", starts the 300-day battle of Verdun (1). The toll for all nations would be 300,000 dead and missing and 400,000 wounded. Until December, from the craters in the ground, the shell holes and the pathways, could be heard the screams of the wounded, who could only be evacuated at night. And thus, for the luckiest ones, began the long journey to hospital. Men fell in their hundreds and thousands. Once night fell, hospital porters and the less seriously injured, carrying their comrades on their backs, would stumble and sink in the mud to reach the front line aid stations (2). This was where rudimentary first aid was dispensed, along with a drink of stagnant water, drawn from holes in the ground and contaminated by the corpses and the gases. The young assistant major doctors and nurses did the best they could. The porters, often religious figures, would have to suddenly become priests again in order to administer the last rites to those who would go no further (3). They had to wait for night again to get to a regimental or divisional aid station. At a divisional aid station, the wounded were carried on stretcher barrows to the head of the queue of health section vehicles that approached as far as they could despite the risks (4). The wounded were driven as quickly as possible to relay stage hospitals (HOEs), where they were operated upon before being evacuated behind the lines in health service trains or towards "surgical ambulances" and frontline hospital units. This task was carried out by the army's mobile health divisions and also by American mobile health divisions, volunteers from the American Field Service, including the future writer Julien Green, who, lying about his age in July 1916, became one of the drivers of 33 section at Clermont-en-Argonne, just behind the front lines at Verdun. Vehicles were constantly on the move between the aid stations, large triage posts and the evacuation hospitals 15 to 20 km behind the lines. In the front-line surgical teams - such as Brocourt, Baleycourt, Bevaux and Dugny - and the HOEs in the front line - such as Queue-de-Mala, Froidos and Fleury-sur-Aire - there were surgeons working day and night, like Georges Duhamel, the author of Vie des Martyrs (1917), who operated in the sheds of the HOE at Baleycourt. These housed 350 beds, 6 km from Verdun, near the fort de Regret. This hospital, allocated to the 29th and 67th ID and the three divisions of the 30th army corps, received between 1,500 and 2,000 wounded per day. From there, once treated, they could hope to be evacuated to one of the HOE of the second line, such as Bar-le-Duc (1,000 beds) or Revigny (500 beds) or to an HOE of a controlling station such as Saint-Dizier. The wounded thus left the front for the salvation of the rear lines, except for those who could not be transported or whose injuries were not considered serious enough.

At each controlling station, often flimsy health trains would each carry 96 wounded or sick lying down and 200 seated soldiers, mainly cared for by nurses from the Red Cross, who could often only look after the wounded in the stations, as 112 trains out of 168 had no connecting corridors. The wounded and sick were transported by train to hospitals in regions on the domestic front. For Bar-le-Duc, the distribution stations were Cravant, which served the 8th region (Bourges, Nevers), Limoges for the 12th region, Moulins for the 13th and Lyon for the 14th. It was a constant job. Between the 22nd and the 29th February 1916, the HOE at Clermont-en-Argonne received 6,107 wounded and judged 5,545 of them fit to be transported towards units on the domestic front on 21 health trains, at a rate of 2 to 4 trains per day. In his book (5) Le service de santé pendant la Guerre 1914-1918, Inspector General Doctor Mignon emphasised the seriousness of the injuries: 28 % head injuries, 6 % to the thorax, 2 % to the abdomen, 27 % to upper limbs and 33 % lower limbs. The Battle of Verdun was responsible for 1,000 wounded or sick per day; the military hospitals and annexes had too few beds and staff behind the lines. Faced with drastic shortages, extra hospitals had been created since 1914, mainly on the 'initiative of the Church and charitable organisations (6), who provided civilian staff and religious nursing sisters, under the responsibility of Justin Godart, a lawyer and member of parliament who had become the first under secretary of state for health.

The French Red Cross brought together three organisations with nursing skills: the Société de secours aux blessés militaires (Aid to wounded soldiers society) (SSBM), the Association des Dames françaises (Association of French Ladies)(ADF) of the Catholic faith and the Union des femmes de France (Union of the women of France) (UFF) of the protestant faith. All kinds of premises were used: schools and colleges, convents, châteaux, hotels and casinos. In Paris, to supplement the military hospitals at Val-de-Grâce and Villemin, every opportunity was taken: the American hospital at Neuilly, the college at Janson-de-Sailly and premises belonging to the elite school of higher education. About 300 buildings flew the flag of the Red Cross: the Rollin and Chaptal colleges, the Higher Business School, the hall of the baron de Rothschild, the PLM railway administration building, the hall of the Union chamber of stockbrokers, some of the large stores and hotels, museums, such as the Grand Palais, administration offices and convents etc. (7)On the côte d'Azur, large hotels and villas were made available to the Red Cross. All the large towns behind the front lines followed Paris' example. Holiday resorts, from Berck to Biarritz, opened their hotels and casinos, converting them into temporary hospitals, which were always full. Mountain resorts and spa towns did the same. Despite the occupation of the northern part of the country, 549,390 beds were available by the 1st July 1916 (8). At the beginning of 1916, the Société de secours aux blessés militaires alone had 773 auxiliary hospitals with 70,000 beds. A whole host of doctors, surgeons, chaplains and administrators ran the organisation, with 12,000 qualified nurses administering treatment and 10,000 auxiliary nurses who were trained up as quickly as possible (9). For its part, the Union des femmes de France had 353 auxiliary hospitals spread across the country, with 20,000 beds and 9,749 qualified nurses, assisted by 18,700 nursing assistants. Lastly, the Association des Dames françaises had 350, with 22,000 beds, 6,000 qualified nurses and about 10,000 nursing assistants. These ladies in white constituted an indispensable "army", sometimes criticised but almost always idolised by the wounded and sick soldiers.

These endeavours deserved the tribute paid by Justin Godart at the end of the battle of Verdun to the doctors who had used "science, ingenuity and application (...) to save our troops from contagion, to heal wounds, repair fractures and return staff to the army and send back to civilian life citizens as capable as possible of working", to the nurses who "had been repulsed by nothing (...) not the months upon months, nor the horror of the wounds, nor the humble nature of their duties" as well as "to the organisations of the Red Cross, ready since the mobilisation, and who continue without wavering in their valuable support to the State" (10).

Lastly, how could we not mention those who "suffered as they fought", in every hospital, maintaining a "fighting spirit": "the wounded are silent like soldiers. Not because they are overcome by pain, but so many mental images come to them and occupy them, images of fighting, of extreme tiredness, of blood and mud, images of the past and the future, of going home as an invalid, a home that may be in mourning tomorrow"(11).

Receiving the wounded

To cope with the influx of wounded, numerous private and public buildings were converted into hospitals. This was the case in Chambéry in the Savoie, for the boys' school (supplementary military hospital no. 4 with 50 beds), the young girls' school (auxiliary hospital no. 103 of the Union des femmes de France with 240 beds), the Jeanne d'Arc school(auxiliary hospital no. 9 of the Société de secours aux blessés militaires with 120 beds) and buildings of the Sacré-Coeur (temporary hospital with 400 beds for those with contagious diseases). In Brittany, Vannes, which was one of the destination stations of the health trains, did the same. The municipal Jules Simon college became temporary hospital no. 7, with 350 beds until May 1919. Temporary hospital no. 33 occupied the former religious college with about 500 beds. The teacher training school held temporary hospital no. 1, with more than 210 beds. The convalescence transfer hospital no. 5, with 300 beds, operated in a retirement home and the small religious college, with 200 beds, where the wounded and amputees arriving for physiotherapy in June 1916 were rehabilitated. On the north coast, Berck-Plage opened all the town's hospital facilities to receive the injured. The public aid maritime hospital made 300 beds available for the wounded, under the name of temporary hospital no. 21 B, with an additional 50 beds at the villa de la santé (temporary hospital no. 23 B) and 40 beds at Bourville hospital (temporary hospital no. 29 B), all managed by Doctor Victor Menard. "Bandaging and plasters" and "orthopaedics and preventive surgery" were taught there. In addition to the opening of a physiotherapy centre with 120 beds, temporary hospitals were set up in nearby buildings, such as the hotel de la Paix, the villa normande - temporary hospital no. 45 - the Notre-Dame institute, the Hotel de Russie and the casino.

The Organisation of the Hospitals

Each hospital for the wounded operated by one of the organisations of the Red Cross on the domestic front had a manager, a military nursing sister, a general administrator and a deputy, a general secretary and deputies, a head surgeon and between six and fifteen assistants, an ophthalmic doctor, an otorhinolaryngologist, a stomatologist, two radiographers, a plaster specialist, an electrotherapist and two physiotherapists. Each ward, of which there were sometimes up to thirty, was managed by a head nurse who had a team of eight nurses. The temporary hospitals also had operating theatres, sterilisation and bandaging rooms, a fluoroscopy room, a pharmacy, an equipment and bandaging department, a laundry department, a store and a library, with about fifty staff.

Notes: (1) Les 300 jours de Verdun. Ed. Italiques / Service historique de la Défense, Paris 2006. (2) A. Pousse. 1916: le réduit d'Avocourt, Fort de Regret, ouvrage de Froideterre. In " Une soutane sous la mitraille ", La chasse au Snark, 2000. (3) L. Laby, 1916 in: Les carnets de l'aspirant Laby. Médecin dans les tranchées. Bayard, Paris 2001. (4) P-A. Muenier. L'angoisse de Verdun. Presses universitaires de Nancy, 1991. (5) Mignon (médecin-inspecteur général), Le Service de santé pendant la guerre 1914-1918, Masson, Paris, 1926 &1927. (6) B.Marc, Les infirmières dans les premiers temps de la guerre de 1914-1918. Histoire des Sciences médicales, 2002. (7) " Miracles de Charité " Lecture Pour Tous, 15/01/1916. (8) Pour la santé de nos soldats. Le Monde Illustré, 4/11/1916. (9) B.Marc, cf supra (10) Ce que nous a dit le sous-secrétaire d'État du Service de Santé, Le Monde Illustré, 4/11/1916. (11) Idem. Source: Bernard MARC, Hospital Doctor, CH Compiègne - PhD student in contemporary history (Paris IV-Sorbonne) - Masters Lecturer in "Contemporary conflicts" at the Jules Verne university, Amiens - Member of the New York Academy of Sciences - "Les Chemins de la Mémoire n° 165" Review - October 2006 for MINDEF/SGA/DMPA