Following a Physician’s Footsteps in Flanders: The Centenary of the Somme

FORMATION OF THE 36^TH (ULSTER) DIVISION

In 1914, political tensions were running high in Ireland. The Liberal government in Westminster had promised home rule but this was resisted by the Conservatives and Unionists. Nationalists and Unionists formed armed volunteer militia and civil war seemed imminent.

When war broke out in Europe, internal tensions eased (for a while) and large numbers of the Ulster volunteers joined up. Permission was granted for them to form their own Division in Kitchener’s New Army, the 36^th (Ulster) Division. Recruitment and training took some time so it was October 1915 before the Division was deployed in France.¹

The Ulster Division comprised 3 Brigades (107^th, 108^th and 109^th) of 4 battalions. Each battalion was made up of 1000 men and 36 officers. There were also various support companies such as engineers and logistics. ¹

MEDICAL CARE IN WORLD WAR I

The Royal Army Medical Corps supplied one Field Ambulance unit (a Boer War innovation) in support of each Brigade. The role of the Field Ambulance was to evacuate and treat casualties but major injuries were only definitively treated in the Casualty Clearing Stations or Base Hospitals well behind the front. Each Field Ambulance had 10 officers and 240 men divided into 3 sections which in turn were divided into stretcher bearer and tented sections. Of note, there were only 32 stretcher bearers for each battalion. ^{1, 2}

There were 7 motor ambulances attached to each Field Ambulance – those belonging to the 36^th Division were a particular source of pride as they were funded by various towns in Ulster whose names were inscribed on the coachwork. Each ambulance could hold 12 seated or 4 lying casualties! ^{1, 2}

The difficulty for the wounded soldier was, of course, getting from No-man’s land back to effective help.

The first link in the chain was the Regimental Aid Post, manned by the Regimental Medical Officer (RMO) and some stretcher bearers. This was usually sited in the 3rd trench behind the front line. The wounded either walked there or were carried by comrades. Wounds would be dressed and a drink of water and cigarette offered! (Figure 1)^{1, 2}

Fig 1.

A soldier has his wounds dressed. Image credit: The Somme Association.

Casualties were then moved to the Advanced Dressing Station (ADS) about a mile back from the front by stretcher, hand cart or in Thiepval wood during the Somme, by a light tramway.^{1, 2} The following is a quote from an Ulster Division orderly at an ADS during the Somme:

The doctor tried to look over each patient as soon as he arrived… the dead was left to one side. The ones there was no hope for was put in a tent and morphia and cigarettes was all that was used in there. It was a terrible thing to light a cigarette for a soldier and see him die before he finished it. All we did was redress a wound if he needed it and if somebody needed a bit of tidying up we did that as well. The only operations that was done regular like was taking off an arm or a leg or stitching up wounds. ¹

The next step was transfer to the Field Ambulance HQ by motor ambulance – some major surgery could be performed there but for those in need of advanced care, a further trip to a Casualty Clearing Station was required by train or motor ambulance. These were large, well equipped units sited near railway lines. Today, their former location often corresponds with large war cemeteries.

BATTLE OF THE SOMME

For one week prior to “zero hour”, artillery shelled the fortified German positions at the Schwaben redoubt opposite the 36^th. What wasn’t known then was that shrapnel shells don’t cut barbed wire and that a high percentage of the high explosive shells aimed at the German fortifications, machine gun nests and dug-outs didn’t explode.

The Ulster Division went over the top just before 0730 hrs on the 1^st July 1916 and despite suffering enormous casualties overcoming intact barbed wire and German defenses, achieved its objectives and occupied the German trenches.

Unfortunately, the neighbouring divisions on either side failed to advance so that the 36^th were raked by machine-gun fire from both flanks and German defenders came back through their own trench network on both sides. Communication with British HQ was minimal so the opportunity to reinforce the success of the 36^th was wasted. Eventually, they had to pull back with further loss of life. Out of an effective strength of about 10000 or so, there were 5104 casualties on the 1^st July with 2069 deaths. The Division won 4 Victoria Crosses that day out of 9 across all 17 divisions involved in the battle. ^{1, 2}

DR FRANK MONTGOMERY

The RMO at the Regimental Aid Post of the 109^th Brigade was 24-year old Dr Frank Percivale Montgomery from Lower Crescent in South Belfast. Frank had graduated in Summer 1915 and was a distinguished Irish international rugby fullback prior to the war. During the initial bombardment and the first few days of the battle, he retrieved many wounded men from the front lines and No-man’s land whilst under fire (RMOs had a high attrition rate) and was awarded the Military Cross. ² It is sobering to think that in today’s terms he was a Foundation Year 1 doctor!

Later in the war, he helped pioneer the use of portable X-ray equipment and on his return to Belfast became a Consultant Radiologist with a special interest in Radiotherapy. The original Purdysburn Fever Hospital was renamed Montgomery House in his honour before finally becoming Belvoir Park Hospital in the 1960s. ^{2, 3}

He was knighted for his services to the NHS in 1953 and chose as his motto “Lux ex umbra” which he interpreted as “knowledge from shadows” – an apt choice for a Radiologist! He died at the age of 80 in 1972. ^{2, 3}

REFLECTION

Before writing this piece, I knew a little about the tremendous loss of life during the Somme. What I didn’t appreciate medically was the long route taken by so many of the wounded before receiving life-saving interventions. So what progress has Ulster made in 100 years? Very shortly, we will be recruiting young men and women to staff our own Air Ambulance that will potentially bring life-saving interventions to those who need it or evacuate them quickly to a base hospital. I’m sure Frank Montgomery would approve.

EDITOR’S NOTE

On behalf of the Ulster Medical Journal, I would like to pay tribute to our Editorial Assistant, Mrs. Marie Murphy, who retired from her post recently. For 12 years, Marie has created order out of chaos in the UMJ office and made each new Editor feel most welcome. I know my predecessors, Barry and Patrick, will join me in wishing Marie a long and peaceful retirement. You will be missed.

ULSTER MEDICAL SOCIETY PROGRAMME OF LECTURES: AUTUMN 2016

Presidential theme: “Medical Myths and Legends”

October 2016

Thursday 6^th October 8.00pm, North Lecture Theatre, Medical Biology Centre, Lisburn Road, Belfast.

PRESIDENTIAL ADDRESS. President Professor Patrick J Morrison CBE MD DSc.

Thursday 20^th October, Postgraduate Centre, Belfast City Hospital. Buffet 1pm; Talks 2-4pm (final times TBC).

JUNIOR DOCTORS PRIZE FORUM / RESEARCH OPPORTUNITIES SYMPOSIUM

November 2016

Thursday 10^th November 8.00pm, Whitla Medical Building Seminar Rooms 3 & 4, Lisburn Road, Belfast.

JOINT MEETING WITH THE ULSTER SOCIETY FOR THE HISTORY OF MEDICINE

THE GARY LOVE LECTURE

Thursday 24^th November Buffet 5.00 pm, Lecture 5.30pm, Postgraduate Centre, Belfast City Hospital

JOINT MEETING WITH BELFAST CITY HOSPITAL MEDICAL STAFF

2016 BELFAST CITY HOSPITAL LECTURE

December 2016

Thursday 1^st December 8.00 pm, North Lecture Theatre, Medical Biology Centre, Lisburn Road, Belfast

THE SIR THOMAS AND LADY EDITH DIXON LECTURE

Wednesday 7^th December Buffet 5.30 pm, Lecture 6.00 pm, Centre for Medical and Dental Education and Training, Altnagelvin Area Hospital.

THE DESMOND WHYTE MEMORIAL LECTURE