Going Over The Top: CCS on CBS - A tale of Casualty Clearing Stations on the Western Front

By David Flin

The TV series MASH, produced by CBS, was a success, and made the actor Alan Alda a star. It tells of a Mobile Army Surgical Hospital (MASH) unit during the Korean War, although a lot of the elements included in the show are derived from the Vietnam War.

What has this got to do with WWI? The answer is Casualty Clearing Stations, CCS as they were called. There had been some debate as to what the best way of treating casualties from the Front was. The options came down to treating them as close to the Front as possible, getting the wounded into surgery more quickly, but where the conditions were likely to be much worse; or having the theatres far from the Front, where operating conditions could be as good as the technology of the day permitted, but the wounded would take longer to arrive.

As I mentioned in an earlier article, Sir Anthony Bowlby, Consulting Surgeon to the British Forces, insisted that complex surgery could be done at the Front, the closer the better. General Haig was convinced by the benefits, and arranged for a large expansion in the number of such units. The ability to get seriously wounded men into theatre much faster saved many lives and limbs.

The Operating Theatre, 41st Casualty Clearing Station, 1918

There was one problem with this. The Hague Convention of 1907 stated that hospitals should not be subjected to bombardment unless they were serving a military purpose. People felt that healing wounded soldiers such that they could return to the war was a military purpose, and so hospitals, ambulances, and stretcher bearers were considered valid targets, and hospitals were frequently shelled.

It’s a perfect set-up for a programme like MASH, with the heightened drama that the CCS can come under fire whenever the writers feel it will liven the story-line up. You have societies in turmoil, with the old order being over-turned through the slaughter taking place.

To prove this last point, all one has to do in Britain is look into any parish church, and read the war memorial. With one solitary exception, the war memorial will list those from the parish killed in the War either by alphabetical order or by chronological order. The one exception is a small parish church in the tiny hamlet of Coalcleugh in Northumberland, where the war memorial reads: “We give thanks to God for bringing all our men safely home.” It is unique in Britain. However, the war memorials give an equality to the fallen. Compare to the War Memorials in Britain for the Boer War, where the dead are listed strictly by rank.

In addition to a society undergoing change, you’ve got a variety of nationalities involved: British and French and Belgian; Australian and Canadian and New Zealander; Indian and Gurkha and Algerian; Nigerian and South African and Jamaican; Chinese and Irish and countless others. You’ve got a variety of religions: Catholic and Protestant and Non-Conformist; Muslim and Hindu and Sikh; you’ve even got a significant proportion of Atheists. You have the situation of Conscientious Objectors who were stretcher bearers, and the sheer courage involved in risking their lives – stretcher bearers were considered perfectly legitimate target, and by definition, went to where people had already been demonstrably hit – without being able to shoot back.

It’s tailor-made for a programme looking at the countless ways of conducting mass slaughter, and trying to get humour, pathos, and human interest.

On top of that, you’ve got any number of social issues brewing. Home Rule for Ireland, Votes for Women, anti-Colonial activities here and there. You’ve got women, in the form of nurses, being pretty darn close to the Front line. In some cases, a CCS might be close to the third trench line. Sister Edith Appleton, for example, in her war diaries, describes in her entry for 5 September 1915 that from her CCS, she could see “poor men caught on the barbed wire in the front of the German lines.”

Imperial War Museum copyright image Q31794

Another quote from her diaries might give a flavour. “Under fire from Saturday. The first big shell landed quite close to our hospital, and the air was so thick with red dust, bits, and smoke that we could not see out of our windows. We had operations on at the time, and it was difficult for us to go on as usual. After the first shock, we tried to become used to the five-minutely explosions of the big shells close to us. It was difficult, and my knees did shake.”

If that couldn’t be a scene ready-made for depiction, either in a novel or in a TV drama, I don’t know what is.

You’ve also got massive developments in medical knowledge at this time. Experience is a hard teacher, but they had plenty of practise. Plastic surgery made a huge advance; prosthetics for lost limbs, how to treat gas injuries. Most importantly, they learned how to triage efficiently. “We have taken in over 200 wounded today (10 March, 1916), quite overwhelming us.” There were four nurses at CCS3.

In many ways, MASH works better as CCS, at the railing that Alan Alda’s character goes through about the futility and pointlessness of war strikes a powerful chord for 1914-1918, arguably more so than for 1950-1953.

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David Flin is the author of the SLP books Six East End Boys, Tales from Section D, The Return of King Arthur and Other Alternate Myths, and Bring Me My Bow