The medical system during World War One was very complex and offered different levels of patient care for the wounded.  Each level of care would become less mobile the farther it was located behind the front.

The first level of care was provided on the battlefield by a medical officer or stretcher bearer. The wounded were then evacuated to a main or field dressing station where minor emergency surgeries could be performed.

Casualty Clearing Stations

If required, a soldier would then be evacuated by motorized convoy to a Casualty Clearing Station (CCS). CCS were typically located close to railway lines and within a few miles from the fighting and served to treat patients quickly and return them to the front.  Patients requiring longer term care would be evacuated by rail to a base hospital.

[Nursing sisters and soldiers] Le Touquet, France
Initially, nursing sisters were not sent to CCS as they were located so close to the fighting. With the start of trench warfare, and fighting remained at one location for a long period of time, the CCS tents were replaced by more permanent buildings resulting in more staff and equipment being added and more complicated surgeries taking place. Due to the increasing functions served by the CCS, nursing sisters began being posted to CCS.

Casualty Clearing Station No. 4 – Winnipeg Connection

CCS No. 4 was organized in Winnipeg in March 1916 by the Manitoba Medical College. It was commanded by Lieutenant-Colonel S.W. Prowse, a specialist in Ear, Nose and Throat at Winnipeg General Hospital.

Dr. S.W. Prowse     Credit: University of Manitoba College of Medicine Archives

CCS No. 4 arrived in England in June 1916 and operated there until June 1917 when it relocated to France.  It ceased operations in April 1919.

At least eight nursing sisters, who were Winnipeg General Hospital School of Nursing graduates, worked at CCS No. 4 under the direction of Lieutenant-Colonel Prowse.  Nursing sisters Johnson (1907), Howe (1911), Paynter (1911), Cochrane (1913), McGill (1913), Webb (1913) Lynch (1914) and Mitchell (1914) all served in France at CCS No. 4.


Canadian Stationary and General Hospitals

Soldiers requiring more extensive surgery or longer term care were moved to Stationary Hospitals that were also close to railway lines and set up in buildings that once functioned as schools, churches and hotels. Stationary hospitals typically had about 250 beds; a Matron in Chief was in charge of 16 nurses that were posted to these hospitals.

The longer term care of the wounded took place at the General Hospitals. Canada operated 16 General Hospitals during WWI, with each army division being supported by two General Hospitals. As the war progressed, many hospitals that were considered Stationary hospitals were re-designated as General Hospitals.


Canadian Special Hospitals

Granville Canadian Special Hospital

By 1917, the CAMC took over the responsibility for eight “Special Hospitals” from the British Army.  These hospitals treated orthopedic, tubercular, eye and ear problems, “shell shock” and venereal diseases, as well as provided physiotherapy. Many Winnipeg General Hospital nursing sisters served at Granville Special Hospital, Ramsgate and Buxton, West Cliff Canadian Eye and Ear Hospital, Folkestone and the Canadian Red Cross Special Hospital, Buxton.

In addition to the Special Hospitals, CAMC operated eight Convalescent Hospitals in England for soldiers requiring additional time to recover from their injuries and for CAMC staff to recover from illness or injury.


Specialization of Treatment

As the war progressed, specialization of treatments began out of necessity. For a nursing sister to have experience in a particular condition was considered a great asset. Specialist nurses were sent to special hospitals such as West Cliff Canadian Eye and Ear Hospital, Folkestone and to special wards for fractured femur cases. Dieticians were appointed to bases and some nurses engaged in the specialist work of mental health because of the number of soldiers suffering from ‘shell shock’ (now known as post-traumatic stress disorder).

[Alfreda Attrill’s diploma she received for Military Massage course, Granville Canadian Special Hospital, Buxton, 1918]
One important specialty was the “Military Massage Corps” – where nurse masseuses performed work that would later be named physiotherapy. This was especially important in helping soldiers dealing with amputations and damaged limbs in order to increase blood flow and healing. The Granville Canadian Special Hospital at Buxton offered a three-month course in Military Massage.  Winnipeg General Hospital nursing sister, Alfreda Attrill (1909), received a training in this specialty in 1918.