Medical service of the German Army during World War I

The Great War, hastily determined as “the war to end all wars” never actually managed to achieve that aim, but quite the contrary did recarve the map of the world, led to numerous conflicts including the most bloody one thirty years later and resulted in millions of casualties and sufferings across the Europe. However, WWI contributed a lot to development of industries, military science and, last but not least, amended theory and practice of the medical service of the Great Powers. Although evolution of medicine by the beginning of the Great War in comparison with that during the European wars of the XIX century was incommensurably higher, trench warfare as an integral part of the WWI did take military medics by unpleasant surprise. Galloping technological advance not only gave birth to hitherto unseen armored monsters, nicknamed “tanks”, but also suggested a flagrant idea of utilization of toxic agents to gas enemy troops en masse. The Great War also turned out to be a powerful spur to development of artillery, and three quarters of war dead in 1914 fell victims to shell fire.   

Before 1915, aiding procedure to wounded military personnel, be it own soldiers or enemies, was well-tested for decades. Wounded soldiers left at the battlefield stood a better chance of being saved as the natural shift of the front during maneuver warfare resulted in shift of line of fire. They would be found either by their own orderlies during attack or by enemies during retreat. In both cases medical assistance would be rendered to a certain extent.

However, trench warfare at the Western Front since the end of 1914 and at the Eastern Front one year later, with combat operations at stabilized fronts with deeply regimented defense didn’t conform to those rules that seemed inviolable in former times. Soldiers lingered in damp dirty trenches and dugouts enclosed with barbed wire, in unsanitary conditions, surrounded by rats who spread disastrous diseases. Even collection of dead bodies and committing to the earth became problematic now and then because of the machine gun fire from the enemy lines. As a result, wounded soldiers would often be left to die in throes in the no man’s land. Just that very “no man’s land”, blood-soaked and covered with dead bodies of yesterday’s peasants, workers and students, may be regarded as a gloomy symbol of a trench warfare of the Great War. All quiet on the Western Front…   

Let’s proceed to description of a structure of a Medical service of the German Army and powers of its departments and units.

The Medical service, or Sanitätswesen, being an independent branch of the German Army, permeated all the other branches of military service and its activities were closely connected with those of nearly every Army unit and formation of the German Empire.

Chief of Military medical service (Chef des Feldsanitätswesens), being a member of the General Headquarters (Grosse Hauptquartier) took command of the Medical service upon mobilization. He was also put in charge of the Volunteer medical service (Freiwillige-Krankenpflege) gathering reports on its activities from military inspectors (Militär-Inspekteur).

Each Army headquarters (Armee-Oberkommando) had a Chief of the Army medical service (Armeearzt), while each service area, or Etappe appointed its own Chief of the service area medical service, an Etappenarzt. Base medical stations (Etappen-Sanitätsdepot), Wounded transportation section (Krankentransport-Abteilung) and several sections under military hospitals (Kriegslazarett-Abteilung), one for each Army Corps, were placed under authority of the Etappenarzt.

Chief of the medical service of the Army Corps, known as Korpsarzt, being a member of the Corps headquarters, was placed in charge of twelve field hospitals (Feldlazarett). In case of  the Reserve Corps, or Reservekorps, the number of subordinate field hospitals was considerably less and consisted of four to six hospitals. Although field hospitals formed a part of the Train units (Train), they were put under operational command of the Medical service.

Chiefs of the medical service of Army and Reserve Corps had two medical experts, surgeon and hygienist, attached to their staffs and delegated with advisory and consultant authority.

Medical service at the divisional level was represented by a Divisional doctor, or Divisionsarzt, with one or two sanitary companies (Sanitäts-Kompagnie) at his command. Each regiment and battalion had staff list of military physicians, medical orderlies (Sanitätssoldaten) and auxiliary stretcher bearers (Hilfskrankenträger) at their disposal.

Restructuring of the German Army under Paul von Hindenburg, the new Chief of the General Staff, concerned the Medical service as well with implementation of new directives in 1916. Thus, one sanitary company and two field hospitals were placed under divisional command and authority of the Divisionsarzt since December 1916. All the remaining units were attached to the Army medical service, while field hospitals were taken out of authority of Chiefs of the medical service of the Army Corps.

At the very beginning of the Great War material and technical resources of German medical units were strengthened with captured enemy vehicles, that were transferred from the occupied territories. Naturally enough that trucks of various European manufacturers made the base of the medical motor vehicle fleet. Come April 1915, all the motorized medical units were combined into Medical logistics automobile detachments (Etappen-Sanitäts-Kraftwagen-Abteilungen) and soon after rearrangement of motorized units they were redesignated Medical vehicle detachments (Sanitäts-Kraftwagen-Abteilungen, or SANKA) and placed under the authority of corresponding Armies. It goes without saying that transportation of wounded soldiers and medical equipment was their main mission. Material resources of Medical vehicle detachments were also used to deploy mobile radiography and disinfection laboratories.

Army instructions stipulated the following sequence of actions in respect of a wounded soldier at the battlefield.

Lightly wounded servicemen (Leichtverletzte) were sent afoot on their own either to regimental and company aid stations (Truppenverbandplatz) or to divisional aid stations (Hauptverbandplatz) of greater strength, depending on the proximity of such a first-aid post. Badly wounded soldiers were transported to either station on the very same account. Grading of arrived soldiers and distinguishing of walking wounded from seriously wounded was made by the medical personnel of sanitary companies. The former were then sent to Holding stations for lightly wounded (Leichtkranken-Sammelstelle) and to Base sections for lightly wounded (Leichtkranken-Abteilung) afterwards. The latter were transported to field hospitals where transportable wounded were separated from untransportable ones.

Thereupon transportable soldiers were collected by Wounded transportation section (Krankentransport-Abteilung) personnel who conveyed them to the nearest railroad station, from which victims of hostilities were sent home by hospital trains (Lazarettzug) to reserve hospitals (Reservelazaretten) that have been deployed in the territory of the German Empire. Untransportable wounded were nursed by personnel of field hospitals. As Feldlazaretten were obliged to follow their Divisions with the shift of the front, care of untransportable wounded in such a case was transferred to military hospitals (Kriegslazarette).

Therefore the main mission of doctors from field and military hospitals was to ensure the fastest, so far as it was possible, recovery of badly wounded soldiers so that they could have been transferred to much more comfortable reserve hospitals in the German territory. 

As it was mentioned above, field hospitals formed a part of the Train units (Train), while military hospitals were made up of personnel from front-line Service area military hospitals sections (Etappen-Kriegslazarette-Abteilung), each service area having enough manpower to deploy three fully equipped military hospitals.

A little digression is worth being made here. As is generally known, delegates from 14 governments met in the Swiss city of Geneva on October 26, 1863 at the international congress, known as the First Geneva Conference. As a result, “Geneva Convention for the Amelioration of the Condition of the Wounded in Armies in the Field” was adopted. It particularly stipulated that an equilateral red cross against white background henceforth serves a symbol of neutrality of wounded and sick soldiers, medical and ambulance personnel, hospitals, transport and depots. Ships, railway vehicles, motor cars and buildings of medical institutions were supplied with flags and identification panels bearing the established Red Cross insignia. Medical and ambulance staff wore relevant armbands on their uniform and work wear. That symbol, however, was modified by the Ottoman Empire authorities who believed that the cross was, by its very nature, offensive to Muslims. As a result Islamic crescent of a red colour on a white background was adopted for Mahometan personnel.

Original articles of the First Geneva Convention had been subsequently revised and expanded due to the rapidly developing nature of war and military technology. Though its provisions were modified twice prior to the Great War – in 1868 and 1906, its humanitarian basis remained unchanged: persons and equipment bearing the protective sign of the Red Cross are immune from capture and destruction by enemy forces.

Unfortunately, idealistic concept conceived by the founding fathers of the Geneva Convention was not always followed in practice. Even the Great War regarded by many as the last major armed conflict based more or less on chivalry spirit had not been an exception. Let me cite just one of multiple dramatic examples of deliberate violations of the Geneva Convention widely covered by the WWI-era German press. What is at issue is a deadly aerial attack of the French bombers on the German military hospital in Labry that took place on August 01, 1918, on the fourth anniversary of the outbreak of the Great War.

Here’s an article from the 56th issue (August 09, 1918) of the “German Newspaper of the Government of Sebastopol and its Environs” (Deutsche Zeitung für das Gouvernement Sewastopol und Umgegend) that was published by the headquarters of the 217th Infantry Division.

“German Hospital Bombed by Enemy Airplanes

Two were killed, another 67 wounded on August 01 following an aerial raid of several enemy airplanes from a bomber squadron on the German military hospital in Labry near Conflans. That was another violation of international legislation widening pleiad of dishonorable actions of the crime-ridden Entente infamous for inhuman treatment of POWs, murder attempts and killings”.

Detailed description of that grievous incident had been previously published in the 135th issue (August 06, 1918) of another military newspaper, “Bulletin of the Jildirim Army Newspaper” that was printed in Damascus.

“New Air Attack on a German Military Hospital

Two were killed, another 67 wounded including 13 seriously injured following an airstrike of several airplanes from an enemy bomber squadron on the German military hospital Labry in Conflans on August 01. In fact that disgusting incident wasn’t unexpected as the Entente tries to compensate its numerous defeats and failures in honest action with treacherous aerial attacks on German military hospitals. However, that recent “success” of the Entente is worth being reported worldwide as it was performed intentionally and voluntarily. Location of the military hospital rejects straight away all the eventual excuses and evasions. Thus, the hospital was deployed on the French territory soon after the war broke out and was located in premises constructed especially for that purpose near the village of Labry. No military factory that could have been a target for enemy airstrike is situated nearby. Moreover, bombs were dropped in broad daylight on complex of buildings whose roofs and yards were specially decorated with giant red cross insignia according to the Geneva Convention provisions, clearly visible from the height of several thousand meters”.   

Having completed that necessary historical digression let’s return to the issue of transportation and quartering of the wounded.

It’s worth mentioning here that relief of field hospitals by deployment of military hospitals was irrelevant under trench warfare circumstances. Nursing untransportable wounded during the “static hostilities” was performed jointly by field hospitals and divisional aid stations personnel. As for the military hospitals, during the lull in combat activities they would be deployed at service areas and functioned as ordinary hospitals. Their typical patients would be wounded soldiers who normally would be sent home to reserve hospitals during maneuver warfare. Hence, those measures favored reduction of transportation expenses, railways workload as well as contributed to disengagement of medical personnel badly needed at other fronts.

By the end of the Great War the German Army consisted of 314 sanitary companies, 22 stretcher bearer units (Krankenträger-Abteilungen) and 72 military hospitals sections (Kriegslazaretten-Abteilungen). Material and technical resources of German Medical service consisted of 23 base medical stations (Etappen-Sanitätsdepot); 592 field hospitals, including 113 reserve hospitals and 26 Landwehr hospitals; 62 hospital trains; 100 hospital trains for lightly wounded soldiers (Leichtkrankenzuge) as well as 85 hospital trains run by various charitable institutions (Vereins-Lazarettzuge).

According to statistics available, 4,215,662 wounded German soldiers approximately were treated by the Medical service of the Second Reich, excluding those seeking assistance for treatment not related to combat activities.