Let's trace the path of a wounded Russian soldier on the fronts of the First World War. First aid at the front to the fighters was provided by orderlies and paramedics, most often it was the imposition of bandages. Then the wounded man followed to the forward dressing point, where the shortcomings in the imposition of bandages and tires were corrected, and the question of further evacuation was also decided. Further, the wounded had to arrive at the main dressing point (hospital), the role of which could also be played by a divisional hospital or an infirmary of public organizations located at a distance inaccessible to rifle and artillery fire.
It is worth making a small digression here regarding medical transport in the imperial army. In the overwhelming majority of medical units, the evacuation of the wounded in the early stages was carried out using outdated horse-drawn carriages, or even on foot. State Duma deputy doctor A. I. Shingarev at a meeting of the legislative assembly in 1915 said on this occasion:
“… by the time of the war, only a very small number of military units were supplied and equipped with a new type of two-wheeled carts (model 1912), while most of the transports turned out to be equipped with rattle cars according to the model of 1877 … These transports in many cases turned out to be abandoned, and in fact some parts remained without any vehicles”.
By February 1917, the situation had improved slightly - there were 257 wheeled horse and 20 mountain pack transports on the fronts. In the event of a shortage of "wheels" (and this was not uncommon), steam-powered stretchers and drags were used.
What about cars? Indeed, by the beginning of the war, almost thirty years had passed since the appearance of a self-propelled gasoline vehicle. In the Russian army by 1914 there were … two ambulances! It is worth mentioning the words of the famous doctor P. I. Timofeevsky, which date back to the pre-war 1913:
"At the present time there can be no doubt that in the next campaign cars will be destined to play a very important role as an important vehicle in general and a vehicle for the evacuation of the wounded in particular …"
Already in December 1914, 2,173 ambulances were purchased abroad, of which almost a hundred mobile ambulances were formed during the war. The unpreparedness of industry for the war of the Russian Empire had to be partially offset by purchases from the allies.
Mournful evacuation
But back to the treatment and evacuation of the wounded. All the work of military doctors at the beginning of the First World War was built on the principles laid down and tested back in the Russo-Japanese War. Their essence was in the speedy evacuation of the victims inland, where surgical intervention and treatment are carried out in silence and with sufficient medical equipment. Most of the wounded were to be moved to hospitals in Moscow and St. Petersburg, since there were not enough medical institutions in other regions of the country. The active army should be freed from the wounded and sick as soon as possible, so as not to limit the mobility of troops. In addition, the military leadership did its best to avoid a massive accumulation of wounded and sick soldiers in the rear of the armies - they rightly feared epidemics. However, when a wide stream of wounded poured in, who were mowed down by machine guns, flamethrowers, explosive bullets, shrapnel shells, gases and shrapnel, it turned out that the evacuation system was malfunctioning. In the fall of 1914, the Russian branch of the Red Cross described
“The unusual, first of all, the duration of the battle, waged continuously, while in previous wars, including the Russo-Japanese, battles were fought only for periods, and the rest of the time was devoted to maneuvering, strengthening positions, etc. The extraordinary power of fire, when, for example, after a successful shrapnel salvo, out of 250 people, only 7 people remain unharmed."
As a result, the wounded were forced to wait for the transfer at the head loading stations to the rear hospitals for days, while receiving only primary care at the dressing stations. Here, the sick suffered terrible agony due to the lack of premises, personnel, and food. Surgeons did not undertake to operate even with penetrating wounds into the abdomen - this was not prescribed by the instructions, and the qualifications of the doctors were insufficient. In fact, all the work of physicians in the early stages consisted only of desmurgy. Gunshot wounds were treated, even in hospitals, mostly conservatively, which led to the massive development of wound infections. When military ambulance trains arrived at the head evacuation points, which were chronically lacking (259 echelons throughout Russia), the unfortunate wounded, often with developed complications, were put into wagons without sorting and sent to the rear evacuation points. At the same time, traffic jams from several sanitary compounds were often formed, which also lengthened the path of the wounded to the long-awaited treatment. About what was happening at the rear evacuation points, reported in a report at a meeting of the budget commission of the State Duma on December 10, 1915, A. I. Shingarev mentioned earlier:
“The transportation of the wounded was not correct, the trains went, for example, not in pre-planned directions, they were not met by feeding points and feeding was not adapted at the places of stops. At first, they were horrified by this picture. Trains came to Moscow with people without food for several days, with unbound wounds, and if they bandaged them once, they did not bandage them again for several days. Sometimes even with so many flies and worms that it is difficult even for medical personnel to endure such horrors that were revealed when examining the wounded."
According to the most conservative estimates, about 60-80% of all wounded and sick evacuated into the interior of the country were not subject to such a long transportation. This contingent was supposed to receive medical care in the early stages of the evacuation, and such useless transfers of huge numbers of people complicated the state of health. Moreover, the transportation of the wounded inland was often organized in general by horse-drawn transport, or in unadapted railway wagons. Wounded and sick soldiers and officers could travel in wagons not cleared of horse manure, without straw and lighting … Surgeon N. N. Terebinsky spoke about those who arrived at the rear evacuation points:
"The vast majority arrived in a form that often made one wonder at the strength and vitality of the human body."
And only in such centers were they organized hospitals for 3000-4000 beds with good nutrition, sorting and treatment. The patients, who should have been treated for no more than 3 weeks, were left, while the rest were sent inland on field military ambulances. At intermediate stations, in order to avoid epidemics, infectious patients were separated, who were first placed in isolation wards, and then sent for treatment to "infectious towns". The seriously ill and chronically ill were transported further to the district evacuation centers and various hospitals of public organizations and individuals. This, by the way, was a definite disadvantage of military medicine of that time - a wide variety of organizations in charge of hospitals sharply complicated the centralized management. So, in October 1914, the Russian church organized a Kiev infirmary, to which not a single patient was admitted until December. Frontline medics simply did not know about its existence. At the same time, there was an acute shortage of hospitals, at least in the initial period of the war. So, at the beginning of September 1914, the chief of supply of the army of the Southwestern Front telegraphed to Headquarters:
“… according to the mobilization schedule, 100 hospitals were supposed to arrive in the rear area of the Southwestern Front, of which 26 were mobile, 74 were spare. In fact, only 54 hospitals arrived in the indicated area, 46 hospitals were not sent. The need for hospitals is enormous, and the lack of them is reflected extremely harmful in practice. I telegraphed the chief military sanitary inspector with a request to send the missing hospitals without delay”.
With a chronic shortage of beds in hospitals and the necessary medicines in the Russian army, an unpleasant "double standard" developed - first of all, they provided assistance to officers, and soldiers - whenever possible.
Ambiguous losses
Such a difficult situation in the organization of military medicine in the Russian army, in addition to the concept of immediate evacuation of the wounded to the deep rear, was largely due to the incompetence of the head of the sanitary and evacuation unit, Prince A. P. Oldenburgsky. He was not distinguished by any outstanding organizational skills, let alone a medical education. In fact, he did nothing to reform the work of military doctors at the front. In addition to the fact that by the beginning of the war, the army was provided with medicines and medical and sanitary equipment for only four months, the doctors at the front did not have a clear calculation of losses. One source authored by L. I. Sazonov mentions 9 366 500 people, of which 3 730 300 are wounded, 65 158 are "gas poisoned", and 5 571 100 are sick, including 264 197 infectious. In another source ("Russia and the USSR in the wars of the 20th century"), sanitary losses are already significantly lower - 5 148 200 people (2 844 5000 - wounded, the rest - sick). Doctor of Historical Sciences, President of the St. Petersburg Military Historical Society A. V. Aranovich generally cites data on the sanitary losses of the Russian army at 12-13 million people, which means that for 1,000,000 soldiers on the front, Russia lost about 800,000 people yearly. To a large extent, such a spread in numbers was due to the confusion in the management of evacuation and treatment of the wounded - there were too many people responsible for this department. The Main Sanitary Directorate was engaged in the supply of medical equipment and drugs. The Main Quartermaster Directorate supplied the army with sanitary and economic equipment. The evacuation was organized and controlled by the Main Directorate of the General Staff, and the Red Cross, the sanitary services of the fronts and armies, as well as the All-Russian zemstvo and city unions were involved in the treatment.
The widespread involvement of public organizations in the treatment of wounded soldiers spoke of the inability of the state to organize full-fledged medical support during a large-scale military conflict. Only by the summer of 1917 were steps taken to unite the command of medical and sanitary work at the front under a single command. By order No. 417 of the Provisional Government, the Provisional Main Military Sanitary Council and the Central Sanitary Council of the fronts were created. Of course, such belated measures could not lead to a tangible result and military medicine met the end of the war with depressing results. On average, out of 100 wounded, only 43 to 46 fighters returned to the military unit, 10-12 people died in hospitals, the rest became disabled in military service. For comparison: in the German army 76% of the wounded returned to service, and in France - up to 82%. Needless to say, the large losses of the Russian army on the fronts of the First World War were largely the result of the unpreparedness of the medical service and, as a result, seriously undermined the authority of the state in the eyes of the population?
For the sake of fairness, it should be noted that the idea of evacuating the wounded deep into the rear "at any cost" and "at any cost" also prevailed in the European powers. But in Europe, the road network was appropriately prepared for this and there was an abundance of transport, and the wounded had to be transported over much shorter distances. The most unpleasant thing in this situation is that if the military medical leadership of the Russian army abandoned the flawed concept of evacuation "at any cost" during the war, nothing good would come of it. There was a shortage of experienced doctors on the fronts, there was no sophisticated medical equipment (for example, X-ray machines) and, of course, there was a shortage of medicines.
