Royaumont Abbey, 1914
The most well-known SWH hospital was established in the 13th century Royaumont Abbey, 40 miles north of Paris. With no connection to the British medical services and under control of the French Red Cross (and later the French army), the voluntary hospital at Royaumont would remain in continuous operation from 1915 until the end of the war, caring for mostly French, Senegalese and North African patients. With the exception of two male chauffeurs employed temporarily at the start, Royaumont was served by an all-female staff of surgeons, doctors, nurses, bacteriologists, radiographers, orderlies, ambulance drivers, cooks and administrators.
Situated in the Reims-Soissons-Noyon region and 12 miles from Creil, the railhead and clearing station which distributed patients, Royaumont was ideally located to accommodate French Front casualties.
From their arrival in December 1914 it took the women just over a month (with one failed inspection by the French Red Cross Service de Santé) to perform the enormous task of transforming a large, dirty and draughty Cistercian abbey deficient in water, heating and lighting, into a functioning military hospital equipped with wards, 100 beds, operating theatre, laboratory and x-ray facilities.
They received their first patients on 10 January 1915. During that first year Royaumont’s Chief Medical Officer Dr Frances Ivens (who was later decorated with the Légion d’honneur for her service) remarked that she had, “never seen such wounds, gangrenous and offensive”. While admissions waxed and waned through 1915, during periods of military inactivity Royaumont staff were always aware they needed to be prepared for an inevitable rush during major campaigns. The years 1916 and 1918 were particularly trying for the women.
During the German ‘Big Push’ on the Somme district in 1916 patients poured into the hospital, being situated only 25 miles behind the firing line. Radiologist Dr Agnes Saville reported, “on July 2nd the anticipated rush began…for 10 days, almost without intermission, it continued”. Staff worked under the “incessant thunder and boom of the great guns” as stretcher cases arrived unceasingly from Creil. The Battle of the Somme obviously continued far beyond 10 days, however during its first week alone Royaumont staff admitted 200 patients; 251 bacteriological and 406 x-ray exams were taken with 160 operations performed. Throughout these busy periods, when “our operating theatre was hardly left vacant”, the medical women worked round the clock. There was little respite too for the nurses and orderlies in the wards where “morning dressings were no sooner over than evening dressings had to begin”. Day orderlies frequently worked past midnight to help the night staff.
While the work carried out for casualties from the Somme in 1916 proved difficult, nothing could have prepared the staff for the ferocious German onslaught from 27 May 1918 on the Aisne. The firing line was between Reims and Soissons and particularly close to Royaumont’s advanced unit at Villers-Cotteréts, which had been established in 1917. Staff had worked between both hospitals, often during exceedingly volatile military situations. This reached a head in 1918 when the Germans were only 4 miles from Villers-Cotteréts, which was dramatically abandoned and evacuated to Royamount, just as Soissons was captured. SWH driver Katherine Fulton described the resulting movement of patients, equipment and supplies during continuous air raids:
“Troops and guns streamed along the roads, newly cut trenches, bomb holes gaped with awful reality. For ten days I lived in my ambulance…nothing seemed real as I tore along without headlights [helping] to load and unload countless stretchers with their groaning burdens”.
During a one-month period from the end of May, 1240 patients were admitted with 1100 x-ray exams made and 891 operations performed. Remarkably, during this period there was a staff of only 14 doctors (there would never be more than 16 throughout the war). One staff member described the unrelenting admissions and intense conditions when the hospital was overflowing with patients, including those from the evacuated Villers-Cotteréts, “when we had to work almost in total darkness” under nightly bombings at Royaumont:
“A hell and a shambles...men literally shot to pieces; the crashing of bombs and the thunder of the ever approaching guns…the flickering candles, the anxiety lest the operated cases might haemorrhage and die in the dark…the [fear] that the door might be thrown open and a German officer walk in on them”.
Therapy at Royaumont
Royaumont doctors gained a reputation for surgical skill and diagnostic excellence, despite having been regarded with suspicion in the early days by the French authorities, who had insisted on overseeing operations. Their anxiety abated rather quickly; Royaumont surgeons were soon considered more favourably than their male counterparts in other French military hospitals. Royaumont surgeons were particularly diligent in keeping up-to-date with new developments, such as the use of the Thomas splint in fractures and the use of electrotherapy for damaged muscles and nerves. Dr Ivens also experimented with using sunshine for wound treatment, and recuperation in the open-air of the abbey cloisters became a notable therapeutic at Royaumont.
Perhaps most significantly, during a time when the medical profession was generally unfamiliar with gas gangrene infection, Royaumont staff are remembered for their success in pioneering new approaches to its treatment, using x-rays and bacteriology for diagnosis. Gas gangrene was particularly acute amongst soldiers fighting in northern France, where the soil was heavily polluted with the responsible bacteria. During the Somme offensive, when 5 occupied beds became 400 within 3 weeks, Dr Ivens later recalled, “cases of gas gangrene poured in and the work had been strenuous and exhausting…we were then successfully trying [sera treatment] in some of the worst infections”.
By 1918, French authorities insisted that all cases had to be operated on within 24 hours of hospital admission. The benefits of early operative treatment were recognised to be of fundamental importance at Royaumont. It was reported 90% of Royaumont admissions were already infected with gas gangrene, and in one example, during one week of 115 cases of severe gas gangrene, there were only 5 deaths. Moreover, it was even noticed (with a degree of surprise) by the Service de Santé how many limbs were saved from amputation at Royaumont compared with other military hospitals, where amputation was apparently more willingly performed. Much of this was owing to the exhaustive work undertaken in the bacteriological laboratory; wound swabs were taken immediately on every admission and examined instantly to identify those infected with gas gangrene. Additionally, radiologists were able to identify different type of gas infections solely by x-ray. The joint surgical, medical, bacteriological and radiology work at Royaumont even came under the favourable gaze of a leading gas gangrene professor at the esteemed Pasteur Institute.
10,861 sick and wounded patients (mostly battle casualties) were treated at Royaumont between 1915 and 1918, and the mortality rate was staggeringly only 1.82 %. Overall the work carried out at this Scottish Women’s Hospital was an extraordinary achievement, particularly given that it had only been several decades since the first women in Britain had qualified as doctors and surgeons.
This photograph album offers a fascinating visual record of the doctors, surgeons, nurses, orderlies and drivers and the patients they cared for, as well as the converted abbey wards, operating theatres and grounds of the beautiful former Cistercian abbey at Royaumont. Unfortunately the album is undated, however we believe the majority of photographs were taken between 1915 and 1917.
Further reading: Eileen Crofton, The Women of Royaumont: A Scottish Women's Hospital on the Western Front (Birlinn, 1999).