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Main Dressing Station

In Italy the Main Dressing Station for battle casualties (battle MDS) was invariably situated near a road seething with traffic. The air of bustle on the road pervaded the dressing station too, with its staff of at least six medical officers and up to 200 men, including the Army Service Corps drivers and the medical orderlies. Down this road, fighting against the almost ceaseless stream of traffic pressing towards the forward areas, came the ambulance cars.

Routes to the Main Dressing Station were, in some cases, raw, newly-formed roads hurriedly constructed by the Engineers, or else winding Italian roads that seemed more concerned with strangling their hills, rata-like, than providing a way for traffic. It was not unusual for ambulance cars to arrive at the Main Dressing Station in winter with their bodywork streaked and plastered with clay from scraping along the inner bank, either in squeezing past other vehicles on the narrow stretches or through skidding down into the ditch at the side of the road. Over the long, dependable summer months, the Main Dressing Station could be placed on any type of road, its location being governed only by the evacuation routes.

The road alongside the Main Dressing Station reverberated with the noise of traffic; sometimes it was the clattering of whirling chains on road or mudguard, sometimes the hammering roar of passing squadrons of tanks and the rumble of tank-transporters. In addition, the unit’s lighting plant whirled for long hours with its slack, rattling roar.

At any hour of the day or night ambulances halted outside the reception centre. From them came the walking wounded and the stretcher cases. If it was dark, the stretcher-bearers moved with a studied shuffling between Ambulance and Reception, Reception and Resuscitation and Theatre, Theatre and Evacuation—searching out the ground with their feet.

Every so often there was lifted from an ambulance car a patient with one arm lightly bound to a rigid arm-rest, a part-empty transfusion bottle in the frame clamped to the stretcher, with the red rubber giving-set running down to the needle taped in place in the bend of his elbow. Exposed bandages on walking patients showed patches of dried or damp blood; bandaged hands or arms were dirty and streaked with flakes of blood dried hard. Faces were grimy, with a heavy stubble of beard. A man moving among them, unbandaged and seemingly unhurt, would perhaps be an exhaustion case.

The wounded entered the reception centre with the air of understanding, patient waiting that wounded men always seemed to bring with them. In contrast, the staff of the reception centre worked with all speed to examine their new patients and classify them for treatment. All the more serious or badly shocked cases went to the unit’s resuscitation centre with its heated room or tent. Later, some would be moved into the operating theatre.

It was always difficult for medical officers to decide which cases should be operated on at the Main Dressing Station and which should wait until the Casualty Clearing Station was reached. Major surgery was best dealt with at the Casualty Clearing Station as it had better surroundings and equipment for that purpose, and the stability that allowed serious cases, such as abdominals, to be held till they were fit to travel to the General Hospitals. Special conditions arose, however, such as existed at the battle of Tebaga Gap, which made it impossible to evacuate the wounded in time for surgical attention in rear units. Under such conditions major surgery was done at the Main Dressing Station, and extra surgical teams were provided so that all the work could be carried out efficiently.

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At other times the work was shared by the two units, both working together to allow the maximum amount to be done in the shortest time. Priorities of operation for different types of wounds were laid down as experience dictated. At the time of the battles to break through to the plains of Northern Italy, first priority was given to cases of serious bleeding, mangled limbs, large muscle and open chest wounds. During these battles wounded were operated on at the Main Dressing Station, at the Casualty Clearing Station, at the special British head, eye, and maxillofacial hospital, and at our General Hospital at Senigallia, while some were flown to Bari to have their first operations performed at our hospital there. The Main Dressing Station provided resuscitation for the serious cases, giving blood transfusions if necessary, before evacuating them to the Casualty Clearing Station.

The evacuation centre cared for a spaced and steady procession of wounded. Some were drowsy with morphia, others relaxed with the heartening knowledge that they were within sheltering walls after a trying ordeal and the discomfort of travelling. Some came startled and alarmed out of the deep fogginess of anaesthesia, others answered questions obediently and from mere habit, as though they had found something more interesting to hold their attention and had replied out of politeness. This population was transitory, patients being sent on to the Casualty Clearing Station as soon as they were fit to travel.

After a period as battle MDS the unit would be tired—sleep was disturbed by the internal noises of the dressing station at work or by the external noises of war; and there was, too, the steady drain of energy from long and intense concentration and the persistent call for quick and precise work.

But the unit preferred to be battle MDS rather than sick MDS or in reserve. The life was more exacting and more urgent. Constant thought and ceaseless energy saved life and limb for the wounded: the work left a sense of satisfaction and a keen appreciation that it was a task in which any man might take pride.

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‘I was admitted to 1 NZ Mobile Casualty Clearing Station at Forli. When I was carefully examined at seven o’clock in the evening it was found that the femoral artery had been severed. The sack of the calf of my leg was opened widely but was bleeding only a little. I was operated on and put to bed with my leg in an iron frame, and 15,000 units of penicillin were injected every three hours from nine o’clock on the night of 20 December to nine o’clock in the morning of 26 December. Also, injections for protection against gas-gangrene poisoning were given six-hourly from midnight on 20 December to six o’clock on 23 December.

‘In spite of all this attention my leg began to get discoloured by 23 December and I had lost all feeling below the knee. The medical officer told me my leg would have to be amputated or else it would most likely endanger my life. At eight o’clock that evening I went into the operating theatre and was put under an anaesthetic. Then my leg was amputated through the lower third of my left thigh. On Christmas Eve I had another transfusion of two pints of blood. For several days I could feel the heat and cold in my missing leg just as plainly as if it were still there, and that sensation wore off only after two or three weeks.’