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In Flanders fields

December 3, 2014

Casualties of war at Essex Farm, near Ypres – by Jonathan Swan

In early 1917, the British Army front line ran in a rough semi-circle about two to three miles around the east of the town of Ypres in Belgium. On the night of 9 April the men of C Company of the 15th Battalion of the Royal Welsh Fusiliers were struggling to keep warm in their trenches to the north of the town. There had been sporadic artillery and machine-gun fire all day, and a gas alert or two, but nothing out of the ordinary. Then, at about 11.30pm, the Germans fired a salvo of rifle grenades at trench post 9, and five men were wounded. Their next destination, Essex Farm Advanced Dressing Station (ADS), was an important part of a medical evacuation chain that is today little appreciated.

An advance dressing station, WWI. By Ugo Matania. Wellcome Images

An advance dressing station, WWI. By Ugo Matania. Wellcome Images

During the early hours of 10 April, even as a counter-barrage was being called down, stretcher-bearers collected the casualties and took them back through the maze of trenches to an aid post about 800 yards away, near the battalion headquarters. From there they were taken to Essex Farm, another 1,500 yards away across the Yser canal. This is where they had their wounds initially dressed. It was the sort of place where so many injured men waited until they could be evacuated further back from the front line to safety and medical treatment. Essex Farm still stands today and is one of the most visited – but most poorly understood – battle sites in Belgium. For many it is closely associated with John McCrae’s poem ‘In Flanders Fields’, the lines of which are on a bronze plate at the top of the path down to the bunker. Visitors peer into the gloom of the seven chambers inside the low ADS concrete structure, but it is hard to imagine the scenes of wounded soldiers and their medical experiences. 

The origin of the name Essex Farm is obscure. McCrae was serving at an unnamed Canadian dressing station nearby when he wrote his poem, in early April 1915, but it is unlikely that he knew of Essex Farm. The name may derive from the 2nd Battalion of the Essex Regiment, who regularly passed through the area to get from their billets to the front line at Ypres in late May 1915. Aside from these associations, Essex Farm by August 1915 was a well-established ADS consisting of a series of dugouts in the canal bank. The concrete structure seen today dates from November 1916. It was last used by the British in December 1917, after which it was handed over to the French and subsequently the Belgians.

The ADS was at the front line of military medical care in World War I. Before it was the battlefield and behind it the Casualty Clearing Stations (base hospitals providing comprehensive medical and surgical treatment for the sick and wounded). The ADS was staffed by men of the Field Ambulances of the Royal Army Medical Corps (RAMC; the modern equivalent is the Medical Regiment). The Field Ambulance comprised ten medical officers and 220 RAMC men, with 50 or so Army Service Corps personnel attached as drivers, cooks and handymen. It was divided into three sections – A, B and C – and each of these was further split into a bearer subdivision, responsible for casualty collection, and a smaller tent subdivision, for care and treatment. On deployment, sections B and C each formed an ADS; section A was generally set up as the Main Dressing Station and headquarters. The purpose of the ADS was limited: it was a transient casualty management station. It was not tasked, nor equipped, for anything other than dressing and splinting. Recent research confirms that it was most definitely not a hospital, even in the loosest sense of the term.

In April 1917 Essex Farm was staffed by B and C sections of the 130th (St John) Field Ambulance RAMC, with a bearer section working forward at La Belle Alliance Farm. Their Main Dressing Station was at Gwalia Farm, about four miles away to the west. The wounded Fusiliers of our opening story were evacuated from the front line by their regimental stretcher-bearers. These were infantrymen but had been assigned to this duty and were non-combatants. They were first-aid trained and their role was simply to apply dressings and to extract casualties. Yet their physical presence in the trenches provided a powerful psychological boost to the injured and able-bodied alike.

When the five Fusiliers were injured, the stretcher-bearers carried them to the Regimental Aid Post at La Belle Alliance Farm. Here they were seen by their battalion Medical Officer (MO). His role was limited too: arrest bleeding, apply dressings, relieve pain and splint fractured limbs. Bearers from the field ambulance took over the casualties and they were loaded onto a trolley cart. Carrying up to four stretcher cases, each cart was hand-pushed along wooden rails all the way to Essex Farm. Lightly injured soldiers – the walking wounded – made their own way back.

Drawing of Essex Farm. RAMC Muniment Collection, Wellcome Library

Drawing of Essex Farm. RAMC Muniment Collection, Wellcome Library

Today there are seven rooms remaining in the Essex Farm complex – others were destroyed by shelling. There were also a number of dugouts, huts and tents, which no longer remain. A sketch (left) was drawn by a member of 69th Field Ambulance in late 1917, which we can use to form a picture of what happened there when the Fusiliers were brought in as casualties. As the trolley carts rumbled up across the bridge to Essex Farm, the duty MO would have been waiting in room 1, described as the Officers’ Mess. Coming out from behind a heavy anti-gas curtain over the door, he would assess each casualty in the light of an oxyacetylene lamp. The lightly injured or sick would be sent to room 2, in which the MO would check them over and send them down to the cookhouse for a cup of hot sweet tea. Any soldier assessed as likely to recover within two to four days was retained by the ambulance and so, depending on the tactical situation, he would remain at Essex Farm or be taken back to the Main Dressing Station at Gwalia Farm to recuperate. Meanwhile, stretcher cases were taken into room 3.

Shock as a medical problem was only beginning to be understood, but cold was seen as a major factor in casualty-recovery figures. For this reason, while soldiers waited to be seen, they were provided with cigarettes and hot water bottles, as well as hot drinks and dry blankets where available. An RAMC clerk would also take down their personal details and fill in the Field Medical Card for each injured man, a copy of which was pinned to the soldier’s uniform. They waited to go into room 5, which was described as a dressing room; the RAMC men were adept at quick and efficient splinting and bandaging. Surgery was not practised in the ADS, other than emergency amputations and the control of bleeding with ligatures.

In this pre-antibiotic era wounds were heavily contaminated but it was accepted that irrigation, excision and debridement was best managed at the Main Dressing Station and Casualty Clearing Station, further back from the front line. Prophylactic anti-tetanic serum was administered to all of the wounded and morphine was given for pain relief. A ‘T’ was written on a man’s forehead after the serum was administered, and an ‘M’ on his wrist if given morphine. It is important to appreciate that at the ADS the concept of medical triage related only to prioritising casualties for evacuation. Head, abdominal and chest cases were often kept at the ADS for a time to stabilise. The other casualties – walking and on stretcher – would go to room 7 and the huts outside to await transport onwards. The moribund would be discreetly moved to a warm hut or dugout; if still alive after the other casualties had been sent on, then a place would be found in the next ambulance car.

During the night, cars of the 4th Motor Ambulance Convoy would have been collecting casualties for the onward journey to the 10th Casualty Clearing Station at Remy Sidings (Lijssenthoek). There full medical and surgical facilities were available, together with a railhead for evacuation to the base hospitals on the French coast and beyond. But, poignantly, for some the journey ended at Essex Farm. Of the five men wounded on 9 April 1917, two survived, but the other three – Privates Bowen, Morris and Williams – are buried in the adjacent Essex Farm Cemetery.

The limited historical study of medical war facilities like Essex Farm is understandable. The first priorities of the frontline medical services were evacuating and managing casualties. Treatment happened behind the lines for those that survived the trauma of shelling and trench warfare. The British Army relied on the deployment of field ambulances because these mobile units were ideal for changing battlefield conditions. Essex Farm is not a typical structure: an ADS was usually set up wherever a safe and convenient location could be found in cellars, dugouts or captured pillboxes. This explains why many have been overlooked in surviving military records, in contrast to the Casualty Clearing Stations and base hospitals. Essex Farm was never famous during the war: Ypres Prison, the Asylum and Menin Road were of much greater renown. But today Essex Farm survives as a stark reminder of an industrial scale of warfare in which so many men were broken and damaged, in Flanders fields.

Jonathan Swan is a military historian specialising in the frontline medical services of World War I, and he previously served in the RAMC. He welcomes enquiries from anyone researching the human experience of the medical evacuation chain, from the front line via the Advanced Dressing Stations to the Casualty Clearing Stations and field hospitals, on the Western Front (


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