Review of 'Volunteers and the Medical Response to the Great War' by Richard Preston (January 2023)

This is an account of the civilian response to the medical emergency of treating casualties during the Great War. Both men and women volunteered and there was a co-ordinated response involving the establishment of hospitals close to railway junctions throughout the country. In Cumbria, for example, the hospitals were set up close to the railway connection from London to Glasgow. Voluntary Aid Detachments (VADs) had been set up in preparation for military emergencies in 1909 by the Red Cross and the Order of St John. By the summer of 1914 there were over 2,500 Voluntary Aid detachments in the UK. Volunteers were aged between 23 and 38 and, because the voluntary work would be un-waged, they were mainly from a moneyed middle- or upper-class background. There were three times as many female volunteers as male, and the proposed work was divided between them – transport was the preserve of men, cooking and nursing of women.

When war was declared in August 1914, reserves were called up and all pre-planned operations were set into action including the VADs in all parts of the country. The initial conflict involving the BEF in Belgium & France led to many casualties who were to be moved back to the UK. After being assessed at the French coast, the soldiers who could survive a journey by sea and train were sent to Southampton where they boarded ambulance trains. The idea was to transport them to Auxiliary hospitals all close to railway lines throughout the country. These hospitals were set up in schools, workhouses and private houses, some holding only 20 beds but the larger ones over 100. The first auxiliary hospital in the North Riding of Yorkshire was set up in Swinton Grange near Malton. Soon there were 35 hospitals with over 900 beds in the county. In all over 18,000 servicemen were nursed in a variety of hospitals over the period 1914 -20. Fundraising was an important contribution to the activity of the Red Cross. This was used to provide clothing and comforts for the soldiers.

Every VAD unit involved just over 50 people. The men’s VAD unit was comprised of a commandant, a medical officer, a quartermaster, a pharmacist and 48 men divided into four sections, each with a section leader. Their job was to organise transport of the casualties from the railway station to the auxiliary hospital. Initially these units were dependant on the use of lorries, loaned to them by local tradesmen, to transport the wounded. But as the war progressed, they acquired ambulances, initially horse drawn but eventually motor ambulances. There were cases where private cars (with chauffeur) were offered when no other transport was available. There was always a problem over petrol – it was rationed and the VAD units were dependent on Army issue. After the Army organised petrol sales, once again fund raising was used to pay the cost. 

Some VAD units were depleted by volunteers who joined the RAMC as well as young men who were keen to join the BEF as part of the war effort. Female VADs were discouraged from volunteering to serve in France as they were deemed to be inadequately trained. This was proved wrong when Katherine Furst took volunteers to France in 1914, initially as canteen workers. During a medical emergency they were pressed into hospital service and proved their worth. Eventually volunteers aged over 23 and with at least three months experience of nursing in auxiliary hospitals were accepted for overseas service.

The women’s VAD units were responsible for nursing, sewing and cooking. Each unit was similar to the men’s VAD units except the units were given different tasks within the hospital. These auxiliary hospitals could be set up in local schools, church halls, private houses and old workhouses. The smaller hospitals contained about 25 beds but as the war progressed these were amalgamated and larger hospitals with over 100 beds were more usual.
The level of care and the skills of the VADs can be recognised by the low mortality rates in these auxiliary hospitals. Fewer than ten cases are noted in most county records.

At the end of the war, these auxiliary hospitals were closed down as the soldiers were discharged. The excess funds were distributed to local medical institutions.

Report by Peter Palmer