A look back: Caring for WWI soldiers along the Casualty Evacuation Route

By Carole Limata |

Carole Limata ArticleWhen American nurses volunteered to serve during World War I, they were reassured that they would not be serving at the fighting front in eastern France. Instead, 10,000 nurses and aides were stationed in tent hospitals in the French countryside. Although they were safe from direct gunfire, they faced the challenge of caring for the sick and injured with limited resources and medical supplies, while camping in the harshest of weather conditions. While working in the wilderness in tented hospital units, it was reported that by the end of the war, 500 volunteer nurses had died from illnesses, such as meningitis, pneumonia, influenza, and tuberculosis.

An elaborate “Casualty Evacuation Chain” snaked almost 600 miles through France to the Port of Calais,  where thousands of wounded soldiers were ferried to England for recovery. The journey could take weeks. Town halls and hotels along the route were converted to hospitals. As more hospitals were needed, hundreds of stationery tents were assembled to serve as medical hospital units where the injured could be cared for as they traveled through France by transit convoys. Because only a limited number of automobiles were available during the war, convoys consisted of 20-30 horse-drawn wagons. They carried the wounded and all the supplies needed to make the tedious trip to the next field hospital, including water, medicine, and food for both men and horses. Transit convoys could take the wounded only a short distance before they were forced to stop and allow the nurses at the tented hospital units to care for the sick and injured. 

Nurses and aides often spent their free time writing in diaries and sending letters home. Thanks to technology, the diaries of many British, Australian, and American nurses and aides who served in World War I are now online. The first one I read was A Volunteer Nurse on the Western Front. Olive Dent’s diary is so detailed that it was used by researchers who wrote the BBC series, The Crimson Field. After reading Dent’s description of field nursing, I ordered more diaries of wartime nurses and nurses’ aides and began a summer of reading.

Since these diaries were written over 100 years ago, they are sometimes difficult to read. The English of the early 20th century is different from the English language today. The tremendous wartime challenges are clear though. And despite that, these diaries are filled with lively stories of resourcefulness, hardiness, and determination to help the war effort. They contain detailed summaries of the casualty evacuation route and life at field hospitals, complete with drawings and sketches. During the summer season, nurses lifted up the sides of the tents to create open-air wards and picked flowers in the countryside, but summer also brought heat, torrential rains, wild animals, mice, ants, bees, and mosquitoes. In the winter, they faced brutal cold, frost, ice, and snow. Many weeks, field hospitals reported they had admitted and assessed thousands of soldiers with only a handful of nurses. This inspired me to translate more nursing stories for a novel, Angels in Brooklyn.

Here are some excerpts from the novel that I compiled:

Long before sunrise, the bitter cold awakened the nurse from her slumber. Determined to get a good night’s sleep, she had prepared her bed the night before in anticipation of a frosty morning. She slept with three pairs of socks and a knit cap. Over her flannel nightgown, she wore two cashmere sweaters. She arranged her bunk with three army-issue wool blankets and buried a piping hot-water bottle beneath them. Lastly, when she was securely positioned inside her cocoon, she covered herself with her tapestry traveling rug for extra warmth.

When she decided it was time to prepare medications, she found six broken medicine bottles. It had been so cold during the night that some of the medicines and syrups had turned to ice and expanded, breaking their glass containers. She also noticed that the beaker of glass thermometers had transformed into a rather odd-looking glass sculptor when the carbolic bath they were soaking in had frozen into ice. After lining up the unbroken bottles near the fire to melt, Adeline sat down to write a report on what had occurred. To her surprise, she discovered that her fountain pen would not release its ink.

The D-I’s, the dangerously ill patients, were isolated in smaller tents. The orderlies were quick at assembling these pup tents to separate the dying soldiers from the others. The D-I’s were designated for one-on-one nursing care but there were not enough nurses to care for them. Often one nurse watched over two to three soldiers, holding their hands, wetting their brows, and praying over them as they died in her arms.

Both the injured and the ill came, and there were never enough beds for all of them. The nurses fretted about laying the stretchers directly on the ground because they knew the mice and ants would be attracted by the smell of infection. Later, the nurses would have to splash water on the wounds before caring for them.

While living in tents and facing extreme weather conditions of heat, frost, and rain, nurses continued to write their stories. I am still amazed by the resolve of these dedicated women and awed by both their selfless spirit and willingness to sacrifice for their country. Through all the hardships they endured, they kept their spirits high and amused themselves with walks in the woods and summer outings to the beach. In the evenings, they organized talent shows and costume parties. 

Today’s nurse is certainly different from yesterday’s nurse, but the heart of nursing remains the same. Although we’re not camping out in the frozen wilderness, we continue to work through the night when the rest of the world is sound asleep and face the cold at 5:00 a.m. to prepare for early morning shifts. Today’s resilient healthcare workers are facing a new battleground as they bravely stand up to protect their patients and themselves in the fight against COVID-19. Just as courageous as yesterday’s nurses, today’s nurses are facing the challenge just as fearlessly. 


Throughout her 40-year nursing career, Carole Limata, MSN, RN, worked as a staff nurse, supervisor, maternity instructor, and clinical nurse specialist before retiring in 2008. She is the author of Luna Babies and the Ellis Angels series: Ellis Angels: The Nurses of Ellis Island Hospital, Ellis Angels on the Move, and Angels in Brooklyn. She is a member of Sigma’s Nu Xi at-Large Chapter in California, USA, and in 2017, she received an Excellence in Nursing Research Award from her chapter in recognition of her nursing history research.

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