by John Nichol
3. Overwhelmed
Major Ralph Brooke, a surgeon in the Royal Army Medical Corps, had much to think about as he set off from Southampton for France at the beginning of 1940 with the 400,000-strong British Expeditionary Force to bolster the French and Belgian armies against Adolf Hitler. What was preying on his mind was a lecture he had listened to by a surgeon in the Spanish Civil War, which had ended just a year before.
Josep Trueta had been a doctor with the defeated Republican forces, operating on those wounded in air raids and ground attacks in a beleaguered Barcelona. He had fled Spain after General Franco’s victory, and in London had introduced an audience of doctors at the Royal Society of Medicine to the horrors of modern warfare. What imprinted itself on Brooke’s mind was the picture Trueta painted of a never-ending stream of casualties, and of doctors having to choose to treat only those they thought could be saved. ‘The surgeon,’ Brooke wrote, ‘was forced to turn a deaf ear to the pleadings of the hopeless cases.’1
This life-and-death dilemma fascinated and horrified him. As a qualified barrister as well as a doctor, he found this an affront to the rights of the gravely injured. Yet he knew such choices lay ahead for him when what so far had been a phoney war with Germany turned into the real thing. Much responsibility would fall on people like him if lives were to be saved and the fighting men properly supported in the way they deserved. ‘It is not a comforting thought that our sons may be left to die after the battle because there is such a press of work and the number of surgeons is so small,’ Brooke mused. ‘If they are not to be denied their chance of survival, there must be sufficient personnel to deal with a sudden influx of cases as efficiently as at home. An enormous demand will be made on the medical services. Will this be met?’ It was a good question.
He himself was giving up a lot to do what he perceived as his duty. Leaving behind his private consultancy on the Sussex coast meant a drastic drop in pay, from £6,000 a year (well in excess of £250,000 today) to an army officer’s salary of £800. He could only hope that other established doctors like him would follow his lead, forego their comfortable lives at home and not flinch from the colours. He also knew he would have to put his life in serious jeopardy if he was to do his job as an army surgeon effectively. ‘One of the most important lessons we have learned from the Spanish War is that the wounded must be treated in the first four or five hours after they have been wounded, if they are to be saved. This can only be achieved by pushing the operating centres up to as near the front line as possible. Surgeons must themselves be prepared for sacrifices and the medical profession for a high mortality amongst its more skilled members.’
In even thinking about such matters, Brooke was streets ahead of his military commanders. The extensive medical service built up in the First World War had been dismantled afterwards in the vain hope that ‘the War to End All Wars’ had done precisely that. The regular ranks of the Royal Army Medical Corps were cut to a little over five thousand officers and men, but even more drastic was the pruning of the Territorials. The number of TA field ambulance units was slashed from forty-five to fifteen, general hospitals from twenty-three to three, and the fifteen casualty clearing stations axed completely. It would not be the last time that, in some post-conflict economy drive, Britain’s military medicine machine would be stripped to the bone.2 Nor was any attention given to the next generation of military doctors. RAMC doctors not only lagged way behind their civilian contemporaries in earning potential but, for unfathomable reasons, were on a lower pay grade than officers in fighting regiments. The result was that, in 1924, only seven candidates applied for forty new commissions and the entrance examination was cancelled.3
As for the work itself, it was less battlefield and more bureaucratic, its emphasis switched very much from surgery to hygiene and general health. Beneficial and important as this was, it meant that regimental medical officers were generally more skilled in siting latrines than in amputating limbs. Things did change as Britain woke up to the threat from Nazi Germany, and there was a sudden expansion of Territorial units, though to still only a fraction of its 1918 complement. With the outbreak of war in September 1939, frantic efforts were made to plug the gaps. Ralph Brooke was among those called from their hospital rounds and consulting rooms to do their duty.
The thoroughness and high expectation with which he approached his responsibilities were dented when he arrived at Camiers, near Boulogne, to find a shanty-town of Nissen huts and tents masquerading as a hospital capable of treating four thousand casualties. The lack of running water was just one problem, though there was plenty of it soaking the ground, where the spaces between beds were ankle-deep in mud. In the makeshift operating theatres there were tarpaulins on the floor instead of boards, and naked gas burners hung above the tables for light. Of this and other tented army hospitals in northern France, Brooke wrote, ‘Sepsis everywhere. It is quite unsafe to open the abdomen or the knee joint under such conditions.’ The military medical services, he concluded, had been allowed to lag behind every advance in medicine. ‘We have the equipment of the last war. We will just have to do the best we can.’ He could not believe how the follies of 1914–18 were being repeated. There had been a hospital at Camiers then, and it had been bombed frequently, because it was beside the railway line to Paris. Hundreds of nurses had been killed. ‘Now we are at war again, and the same incredibly foolish mistakes are being made again.’
As usual, the generals and the politicians had based their forward planning on how the last conflict had played out. The Maginot line would keep the Germans at bay and, if they did manage to pierce it, the war would quickly settle into a repeat of the static lines and trenched stalemate of the Western Front circa 1916. The military theorists who prophesied a fast-moving, tank-driven war with blitzkrieg – literally, ‘lightning war’ – thrusts of startling aggression and daring were ignored. The orthodox view prevailed, which, in terms of medical dispositions, meant a familiar staged structure of 1) regimental aid posts and advanced dressing stations in the front line, 2) large and generally fixed RAMC field ambulance units consisting of up to 250 doctors, medics, orderlies, drivers, etc., who would stabilize casualties so they could be evacuated to, 3) even more massive casualty clearing stations, from where the wounded would be filtered and funnelled to 4) base hospitals such as Camiers or by hospital ship back to England.4
The German strike through Belgium in the second week of May, bypassing France’s defences and dashing for the Channel coast, swept aside such tidy notions. In the disaster that was about to befall the British Expeditionary Force, doctors, orderlies and stretcher-bearers, with lives depending on them, would be the ones to stay at their posts and to keep their heads while, in the largest retreat in British military history, all around were losing theirs.
*
In a village in Belgium near the historic battlefield at Waterloo, Corporal R. H. Montague was in charge of a four-man RAMC stretcher party at an advanced dressing station. He watched kilted Cameron Highlanders, bayonets fixed on their bolt-action Lee Enfield rifles, heading forward cheerily to meet the advancing German forces. One tapped the blade and said, ‘Jerry does’na like this.’5 They never got close enough to find out the truth or otherwise of this proposition: bayonets were useless against tanks and crack infantry armed with rapid-fire Schmeisser machine pistols. Casualties were soon staggering back into the aid post, which itself came under fire from heavy-calibre mortars. Shells broke against the cobbled street and sent showers of lethal shrapnel into the air. It was time to move, and fast. The wounded were shovelled into ambulances, supplies into a 30cwt truck, and Montague stood on the rear step and clung on to the door handle as the 6th British Field Ambulance retreated at speed towards Brussels. There, they and two other medical companies arrived at the fashionable Hôtel Haute Maison, where, to their amazement, smartly dressed Belgian army officers and their ladies were sitting down to a formal dinner and dance.
It was a scene reminiscent of the Duchess of
Richmond’s famous ball on the eve of Waterloo a century and a quarter earlier – except that this time what was staring everyone in the face was not a famous victory but abject defeat. ‘They seemed blissfully unaware that their country was being overrun by a ruthless and well-equipped enemy,’ Montague recalled. ‘We, on the other hand, were straight from battle with fifty casualties in need of surgery.’ The hotel manager took one horrified look inside the ambulances pulled up outside and called a halt instantly to the party. As the Belgian officers and their mesdemoiselles were hustled out into the night, the ballroom was turned into a reception area for stretchers and the dining room into an improvised operating theatre. Napkins and tablecloths were torn up for theatre linen and, by the light of the chandeliers, two medical officers performed twenty operations, with the dental officer as anaesthetist.
The German divisions forged on, and as they broke through into the outskirts of Brussels, Montague’s outfit checked out of the hotel in a hurry, packing their supplies into wicker panniers, which they tossed into the trucks. The casualties, a dozen of them newly out of theatre, were loaded into the ambulances, and the convoy was off again. This was not how anyone had ever envisaged running a battlefield medical service but, as Montague noted matter-of-factly, ‘The rapid advance by the enemy and the fluid state of the front line rendered the old system of evacuation of the wounded impossible.’
One night they set up in a convent, the next in a school, then in an old brewery, a château and a farm. At an abandoned shoe factory, 150 casualties turned up at 11 p.m. Captain Ian Samuel, a GP until just a few months ago, and another doctor, performed eighteen operations over the next ten hours, including several amputations. A lull in the work at mid-morning gave them a short breather, but more casualties arrived and they were back at the table, cutting out a length of damaged bowel, closing up chest injuries and plugging liver wounds.6 Then they were on the move again. This was medicine on the run in what was turning into a full-scale rout.
Fighter planes flew overhead and buzzed them, strafing and bombing. The Englishmen had a grandstand view of the latest in weapons technology as dive bombers obliterated a town. Wave after wave of Junker 87 planes plunged to within a couple of hundred metres of the tops of buildings to release their loads. ‘The planes and the bombs emitted a high-pitched scream, which had a shattering effect on the morale of those below. We found ourselves caring not just for badly wounded British and French soldiers but local civilians. Many of the women and children were quite demented and very difficult for us to pacify.’
Here was the sort of mass-casualty situation the Spanish doctor Trueta had described in his lecture in London just a few months earlier. Now, every pocket of resistance was subjected to a Guernica bombardment from the air, with terrible consequences. Huge numbers of casualties were building up at the dressing station, which was handling as many as five hundred new cases a day. Samuel was so tired after hours of operations that he fell asleep leaning against a barn wall and only woke up when he fell over.
Whenever the medical convoy moved, it did so at night, slowly making its way down narrow roads clogged with fleeing refugees and retreating soldiers. ‘We were utterly weary, unpacking the equipment, dealing with casualties, repacking our ever-diminishing supplies and on the move again.’
Where precisely to stop and set up was a recurring problem. It was no good having a dressing station that casualties could not find or be directed to, but the situation was so fluid that any location was a matter of chance and last-minute choice. They tried to pick sites near churches and then post red crosses and arrows at the nearest crossroads. At night, a four-gallon petrol drum was upended, the shape of a cross cut in the middle and covered in red paper and a hurricane lamp placed inside. In the darkness of a blacked-out landscape, it would be a beacon of hope for the wounded, but also a tempting target for an enemy, who, many BEF medics feared, had little regard for such sanctuaries, whatever the strictures of the Geneva Convention. One ambulance unit identified itself as open for business by planting a large red cross flag in the ground. Within minutes it took a direct hit from a bomber. A clearly marked hospital ship, the Maid of Kent, was sunk in Dieppe harbour by German bombers, and an ambulance train that had pulled up on the quay next to her was flattened.
Montague found himself having to cope with sights and smells and sensations beyond anything he had ever experienced. In a matter of days, death had become commonplace in his world, but he was particularly moved by a nineteen-year-old second lieutenant whose bullet-shattered and gangrenous leg had to be cut off. He died in the night, and his burial in the morning was shot up by machine-gun fire from a passing German plane. Nothing, it seemed, was sacred any more. At another stop, a distraught army driver brought in an English officer whose entire lower jaw and tongue had been shot away. ‘But the most horrifying part was that he was still alive and conscious, though he could not speak, only move his eyes from side to side.’ They sent away the driver, reassuring him they would do their best, but they knew the officer had no chance of surviving. ‘Nothing could be done surgically and I knew we would probably be moving quite soon,’ Samuel said. But he could ease the man’s suffering. The doctor filled a syringe with morphine and injected him. With much relief, the watching Montague recalled, ‘we saw him lapse into unconsciousness and after about twenty minutes he died peacefully without any further trauma.’ But the trauma carried on for those who had been unable to save him. ‘When I think back on those terrible days,’ said Samuel, ‘I see that half face and know how ghastly war can be.’
The German machine rolled on relentlessly, pushing the retreating armies and fleeing civilians into an ever-tightening corner in northern France. Movement along the blocked roads towards the Channel coast was increasingly difficult, the traffic halting whenever planes appeared overhead and everyone flinging themselves into the ditches alongside. For the remnants of Corporal Montague’s 6th British Field Ambulance unit, it was not just from overhead that the attack was coming. Enemy infantry had forged ahead and now mounted an ambush on the column. Rapid machine-gun fire was spraying over them from either side. The impatient paid with their lives. Montague watched helplessly as a French soldier, tired of crawling along in the ditch, rose to his feet and began to run from the bullets. He kept his body bent low, ‘but to no avail, because another burst of fire knocked him flat into the ditch. I crawled to him but it was too late. He must have died instantly.’ The Englishman looked up from the body, chanced a glance behind him and saw that all the ambulances in the convoy were in flames. He was shocked. The vehicles were clearly marked with red crosses and yet they had been deliberately fired on, in complete defiance of the Geneva Convention.
But at least he now knew where he stood – or, rather, crouched. He, a medic, could take up arms in self-defence. He picked up the dead French soldier’s ancient carbine rifle – later, it proved to be a relic from France’s late-nineteenth-century colonial wars – and some clips of ammunition from his bandolier. ‘It appeared that the Germans did not intend to respect the red cross. I felt comfort in having something I could shoot back with.’
But there was little comfort to be found elsewhere as he looked around him at ‘destruction and desolation, bombed-out houses, some still burning, others flattened to heaps of rubble’. It was a fine early summer’s day, but the sky was black with smoke, which was even darker in the direction of the coast. At a village jammed with cars and lorries and thronged with thousands of British and French soldiers on foot, ‘the word went round that we should make for the port of Dunkirk.’ As they trudged in that direction, they picked up leaflets dropped from enemy planes with a map showing the areas the Germans already occupied. ‘We were virtually surrounded, with the sea as our only means of escape. From a military point of view, the situation looked hopeless.’ But the mood was defiant. ‘The consensus among us was that we would get home, though we had no idea how.’
*
Equally defiant was Major Ralph Brooke. He was st
aying put, determined not to leave the hospital in the French town of Rennes, to which he had been posted from Camiers, until he had done all he possibly could. His gloom at the news that Brussels had fallen to the Germans was compounded by his misery at the shattered young bodies he was having to repair. He was treating RAF pilots and crew, who from airfields in France were fighting against impossible odds to try to slow the enemy’s advance. ‘I am working at full pressure with wounded coming in all the time. I saw one of our machines soon after it had been brought down. It had burst into flames and two of the bodies were just charred masses with a heel bone sticking out. Even their identity discs were burnt beyond recognition. The third man has nearly every bone in his body broken and his back is one large burn. I have been working on him for two days. He has had three blood transfusions. Why he continues to live it is difficult to say.’
Like all military doctors, Brooke did not confine his caseload to those in uniform, and there was an increasing flood of civilian casualties to treat. He rushed to a refugee train, full of women and children, that had been machine-gunned and bombed. At the scene he found ‘two small mites quite dead, and one with half her face blown away. It was all very quiet. The women mostly sat looking into space like dumb animals. It was horrible beyond all conception.’ Streams of bullet-riddled cars pulled up outside the hospital, disgorging ‘bloodied, tired and hungry humanity’. The work was feverish and frenetic.
Surprisingly in these dire conditions, he was managing to put some new medical procedures into operation. Instead of gaping wounds being stitched, a process that locked in infection, they were first to be ‘debrided’, the technique by which all dead tissue and foreign bodies are removed and the muscle cut away until it contracts under the scalpel and bleeds healthily. The wound was then dressed lightly with gauze (not packed) and left undisturbed because ‘this affords the best chance of cure.’7 This was another lesson Trueta had brought from the infirmaries of the Spanish Civil War – excision of the wound, loose suture (if any at all) and immobilization in plaster of Paris or splints. It was an answer to gas gangrene, the fast-spreading infection of decaying human tissue that had been the deadly plague of the dressing stations and wards in the First World War. An RAMC officer had tested this new technique on the trickle of wounded he had to deal with from skirmishes around the Maginot line in the quiet weeks before the full-out German attack. Out of twenty-five cases, only two went septic. The word spread along the grapevine of junior doctors.