Authenticity matters in media. It matters in games. Titles like Call of Duty and Medal of Honor employ military advisors to create a more authentic experience. An authentic game, even one set within a fantasy world, can build a credible, immersive world for the player.
Our turn-based strategy RPG Call of Cthulhu: The Wasted Land is inspired by both the works of pulp horror writer H.P. Lovecraft and a paper role-playing game, Call of Cthulhu. In ‘The Wasted Land’ the player leads their team of investigators to uncover a deadly inhuman conspiracy underlying the trenches of The Great War.
Authenticity was always key to us in the making of Call of Cthulhu: The Wasted Land. The game might be based on Lovecraft’s works of horror and science-fiction, but that did not stop us from trying to get the World War I setting as authentic as possible within the boundaries of good gameplay.
The medical side of the game plays a prominent role, but we found little source material for in our online research. Imagine how excited we were when The Wellcome Trust awarded us a small grant to research and improve the accuracy of the historical medical information in the game.
The dangers faced by a soldier in a modern war such as the current Afghanistan conflict, aren’t all that different from those faced by a British ‘Tommy’ in World War I – chief among those dangers are bullets and shrapnel. What’s really different today is what becomes of a soldier after he or she has been wounded. On the modern battlefield, a Chinook helicopter may well arrive to evacuate the casualty with a Medical Emergency Response Team onboard. This means that the Accident and Emergency (A&E) doctor, nurse and medical technicians will be working to stabilise the casualty for the entire journey back to hospital. In 1914 it was a very different story. Obviously there were no helicopters, but there was no concept of A&E doctors, let alone sophisticated modern procedures and pharmaceuticals. The First World War focused the great medical and technological minds of the time towards evolving traumatic medical care. That leap forward has resulted in benefits not just for battlefield medicine but across a whole range of civilian injuries, too.
Our Army Medical Services Museum Visit
As part of our research, we went to visit the Army Medical Services Museum in Aldershot, outside London. The director, Captain Pete Starling, was incredibly helpful and gave us a tour of the fascinating museum.
Upon the outbreak of World War I, the medical services of the British Army were not really prepared for the type of war they were about to become bogged down in. The last major war prior to 1914 had been the Boer War in South Africa. While this conflict featured rifles, artillery, and machine guns (like the Great War), 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 quickly adapted 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 femur in 1914, you had about an 80% chance of death. Beyond the trauma of the injury itself, your well-meaning comrades would have moved you back from the front line, causing the broken bones inside the leg to tear and rip at your muscles. If the bones tore an artery, the resulting rapid loss of blood would probably finish off what the rifle shot had started. 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 procedures pioneered by the American surgeon Harvey Cushing, coupled with new technologies such as X-rays 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. 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 In-game Kit
Thanks to the Wellcome Trust grant and our visit to the Army Medical Services Museum, 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.
Originally, there were 3 levels of medical equipment available to the British soldier in the field during World War I. We had (unintentionally) replicated this in the game originally – but the updated Call of Cthulhu features more historically accurate kit.
The Small First Aid Kit item is now a Basic Field Dressing. This is what the typical British soldier would be carrying into battle in World War I. It was a sealed waterproof package with two identical gauze dressings inside, carried in a special pocket in the uniform jacket. If a soldier was shot, a colleague would pull the package from the wounded soldier’s pocket and apply it to him – the idea being your own dressing was reserved for you if you were unlucky enough to need it. The two dressings were used to dress the entrance wound and exit wound of a rifle shot.
The next level up 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 to 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 or moral objections to fighting would be given this role. Their haversacks would consist of more types of dressings including a larger gauze shell dressing – bigger than the basic field dressing, this was used to cover a shrapnel wound. The medical training given to a stretcher-bearer varied considerably and was often dependent on what the Regimental Medical Officer (RMO) may have given them. There would be 18 Stretcher-bearers per battalion of about 700 men.
Every large unit had a Regimental Medical Officer (RMO). This was a qualified doctor who oversaw the care of a battalion. This was a dangerous role involving being exposed to shellfire and other hazards on the front-line – and indeed some 740 British RMOs were killed during the Great War. Like the stretcher-bearers, an RMO was unarmed. They were equipped with a wicker pannier that contained a much larger range of medical equipment including splints and 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.
The Journey of the Wounded
Stretcher-bearers would gather the wounded from No-man’s 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 as we understand the word today, but a medical unit. This could be a journey of 1000 yards or more over very rough ground and as such there were often 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. From there, wounded could be moved by rail to hospitals in the major port cities which is where they would encounter female medical staff for the first time. The aim was to get the wounded fit for active service again as soon as possible. Those whose injuries were deemed too serious to allow them to return to combat would be taken back to Britain (a “Blighty wound”).
We have replicated this to an extent in the game via Regimental Aid Posts. These remodeled 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.
At the outbreak of the First World War, most people thought it would be a short, sharp conflict with filled glorious cavalry charges. The realities of barbed wire, mud, high explosives, and machine guns soon turned it into a battle of attrition like the world had never seen before. But as horrific as “the war to end all wars” was, we’ve all benefited from the advances in medical technology that it made possible. We’re very grateful to the Wellcome Trust for the great opportunity to learn about this period of medical history, and to make Call of Cthulhu: The Wasted Land better. We hope you’ll find it as interesting as we did.