(Note: this article first appeared as a guest post on PocketTactics)
Introduction: Authenticity in Gaming
Authenticity matters in media. It matters in games. Titles like Modern Warfare, Medal of Honor and many others employ military advisors to improve the authenticity. An authentic game, even one set within a fantasy world, can still build authenticity with the player.
Authenticity was always key to us in the making of Call of Cthulhu: The Wasted Land too. Yes the game is partly-based on Lovecraft’s works of horror and science-fiction, but that did not stop us from trying to get the World War One setting as authentic as possible within the boundaries of good gameplay. Some of this was pretty easy – there is a fair amount of information on weapons and uniforms and the like.
For anyone new to our game, it is a turn-based strategy RPG inspired by both the works of pulp horror writer H.P. Lovecraft and a paper role-playing game, Call of Cthulhu. The Wasted Land is a journey through the trenches of World War One. In ‘The Wasted Land’ the player uses their team of investigators to uncover a deadly inhuman conspiracy underlying the Great War. Barbed wire, mustard gas and machines guns will prove to be the least dangerous thing the investigators encounter as they venture out into No-man’s Land to solve the mystery of the Wasted Land.
One area that plays a prominent role in the game but we found little source material for online was the medical side of the game. In our game your units can and do get wounded. While enjoyable gameplay in this case demands that they are able to recover from wounds much more rapidly than would be the case in reality, the nature of the equipment and process used for the first version of the game could have been much more authentic. However help was at hand and we’re grateful to the Wellcome Trust, who awarded us a small grant to research and improve the accuracy of the historical medical information in the game.
In a modern war such as the current Afghanistan conflict, the dangers to the solider are not that dissimilar to that faced by a British ‘Tommy’ in World War 1 (1914-1918) – bullets and shrapnel. However if a soldier is unlucky enough to have been wounded, it is here that one would see huge differences. In Afghanistan a Chinook helicopter may well arrive to evacuate the casualty with a Medical Emergency Response Team (MERT) onboard. This means that the Accident and Emergency (A&E) doctor, nurse and medical technicians will be working on the wounded from that moment to stabilise the wound for all of the 40 or so minute journey back to hospital. In 1914 it was a very different story. There was no concept of A&E doctors or many of the familiar techniques used as routine today. However the First World War did focus minds, ideas and technologies and is part of the evolving story of trauma medical care that has resulted in benefits not just in war but for a whole range of civilian injuries such as industrial accidents, for all. We can see this for example, in 1919 journals such as The Lancet saw a huge number of papers written by doctors exploring their wartime experiences and what they meant for future medical care.
Our Army Medical Services Museum Trip
As part of our research we went to visit the Army Medical Services Museum in Aldershot, outside London. There the director, Captain Pete Starling was incredibly helpful in talking to us about the topic and giving us a tour of the fascinating museum. Upon the outbreak of World War 1, the medical services of the British Army were not really prepared for the type of war they were about to become bogged down in. In 1914, the last major war had been the Boer War in South Africa and while this did feature rifles, artillery and machine guns, it was a hot and dry environment. By contrast the waterlogged trenches built upon manure-ploughed fields of Europe were infection prone environments adding the additional dangers of Tetanus and Gangrene to the immediate danger of the high velocity rifle. In the face of this new reality, the British army adapted fast as new technologies, processes and ideas rapidly filtered into the medical services. For example if you were unlucky enough to have been shot in the fima in 1914, you had about an 80% chance of death. This was in part because as your well meaning comrades moved you back from the front line, the broken bones inside the leg would be tearing and ripping the muscles inside the leg – possibly hitting an artery, resulting in wound-shock (the huge and rapid loss of blood) that would probably finish off what the rile shot started. However the invention and deployment of the Thomas Splint – a metal frame to hold and protect the wounded leg, meant that by 1917 your chances would have completely flipped to an 82% chance of survival.
The evolution of the treatment of other wounds was similar; at the start of the war a chest shot or head shot would have been bound and the soldier left to his own healing devices. As the war progressed and new ideas (e.g pioneered by the US surgeon Harvey Cussing) for the treatment, coupled with the use of technologies such as X-ray to locate and identify bullet and shell fragments, meant that by the end of the war surgeons were operating on such wounds to remove these objects. The overall preparedness also advanced with the army stocking up on vitals such as blood prior to a big battle, ready to help the wounded.
Upgrading the Ingame Kit
There are 3 levels of medical equipment available to the solider in the field during World War 1. We had (unintentionally) replicated this in the game – however with the support of the Wellcome Trust grant we’ve been able to update the text and images in the game from generic medical sounding/looking things to objects that are realistic representations of the period equipment.
So the Small First Aid Kit, is now a Basic Field Dressing. This is what the normal soldier would be carrying into battle. It was a sealed waterproof package with two identical gauze dressings inside. This was carried in a special pocket in the uniform jacket. If a soldier was shot, an assisting colleague would pull the package from the soldier’s own pocket and apply it to him – the idea being your own dressing was used on you if you were unlucky enough to need it. The two identical parts were used to dress the entrance wound and the exit wound of a rifle shot.
The next level up is what was our Medium First Aid Kit. The authentic version of this is the Stretcher-bearer’s haversack. Stretcher-bearers were soldiers whose job was to follow behind the advance and bring the wounded back into their home trenches and into an aid station. This was a very dangerous job requiring repeated sorties into No-man’s Land even after the battle was over. A Stretcher-bearer was not armed and so sometimes people with religious/moral objections to killing would be given this role. Their haversacks would consist of more types of dressings including a larger gauze shell dressing – a bigger item that was used to cover a shrapnel wound. The medical training a Stretcher-bearer had varied considerably and was often dependent on what the Regimental Medical Officer (RMO, see below) may have given them. There would be 18 Stretcher-bearers per battalion of about 700 men.
The next level up from this was the Regimental Medical Officer (RMO). This was a qualified doctor who oversaw the care of a battalion. This was also a dangerous role involving being exposed to shellfire and other hazards on the front-line, indeed some 740 British RMOs were killed during the 1914-1918 war. Like the Stretcher-bearers, an RMO was unarmed. What they were equipped with was a wicker pannier that contained a much larger range of medical equipment including splints, syringes (with ampoules of morphine). In battle the RMO’s job was to stabilise the casualties ready for transport back to the rear lines. While the RMO was a qualified doctor, very few had much prior experience with the wounds they would have to deal with in war. Most had been general practitioners and so spent much of their time dealing with coughs and sneezes rather than machine gun wounds.
Gas! Gas! Masks On!
World War 1 saw the invention of a number of new weapons such as the tank, however it was the deployment of chemical warfare that was to cause the front-line solider a whole new dimension of horror. The first use of such weapons was Chlorine in April 1915. This attacked the respiratory system, causing the larynx and bronchial passages to swell-up, choking the victim. Initially, there was little treatment or protection for the soldiers but advances were rapidly undertaken. It was soon realised that victims could be treated by thinning the blood and by stopping them panicking (if they did it further depleted the oxygen in the blood). The medical services were involved in the development of protection from this form of warfare too. Initially it was just a pad hung over the mouth dipped in a mixture of Sodium Thiosulphate, Washing Soda, Glycerine and Water. Then a smoke-hood type mask until the development of the small box respirator. This had a flutter valve and a charcoal filter to remove impurities from the air breathed in. As the treatments evolved, so did the weapons; Phosgene was another chemical agent used which was also a respiratory irritant like Chlorine but far more aggressive. Then mustard gas was developed, which damaged any exposed skin and was treated by immersing the victim in a saline bath to ease the suffering.
We have replicated some of these dangers within the game. Clouds of a greenish gas can be found around the battlefield (visually they look more like mustard gas). Standing in these or moving through them causes damage to a unit within. The more you move within, the more damage you take. This can be mitigated by the wearing of a gas mask, however to replicate the far from perfect levels of protection offered, the level of protection from this varies.
The Journey of the Wounded
The Stretcher-bearers would gather the wounded from No-mans Land and take them to the Regimental Medical Post (RMP). Here the RMO would be stabilising the wounded as best he could. More Stretcher-bearers would then take the casualties to a Field Ambulance (not a vehicle but a unit). This could be a journey of 1000 yards or more over very rough ground and as such there may well be relays of stretcher-bearers every 100 yards to carry the wounded. From here the wounded could be taken to the casualty clearing station – a series of tents holding about 200 beds. This journey might be via Stretcher-bearers to the nearest road then via horse-drawn ambulance. At the casualty clearing station there would also be surgeons ready to perform life saving procedures. Then the wounded could be moved by rail to hospitals in the major port cities which is where we would encounter female medical staff for the first time. The aim was to get the wounded fit for active service as soon as possible. However if not possible then via hospital ship, the wounded could be taken back to Blighty (Britain) if the injury was deemed serious enough (a ‘Blighty wound’).
We have replicated this to an extent in the game via Regimental Aid Posts. These remodelled locations can be found dotted around the trenches. When a unit is placed within the area of influence of one, they can recover some Hit Points per turn. This represents the greater access to medical equipment and the skills of the RMO and makes these points valuable positions to use in the game.
Home By Christmas?
The First World War was arguably the first truly ‘modern’ war. The was as true of the killing of people as it was of their healing too. Both advanced rapidly over the four year course of hostilities. Many of these advances then work their way through from the military into the civilian arena, so benefiting more than just the solider. At the outbreak of war, the common view was for a short sharp conflict with glorious cavalry charges. However barbed wire, mud, high explosives and machine guns soon turned it into a battle of attrition. Such was the loss of life and the horrific injuries that those who saw this war vowed it would be ‘the war to end all wars’, that following the slaughter, the great nations of the earth would never again resort to such methods. They were sadly wrong.