western front

• frontline trenches : closest to enemy, traverses protected soldiers from shell blasts, 15% of time spent here
• support trench : behind frontline, 10% time spent here
• reserve line : furthest from front line, 30% time spent here
• Second Battle of Ypres, April-May 1915

  -Germans use chlorine gas for the first time

  -allied casualties estimated 60,000

  -German casualties : 35,000
• Battle of the Somme, July-November 1916

  -400,000 allied casualties

  -high casualties put great strain on medical resources

  -bad weather; rain, sleet & snow
• Battle of Arras, April 1917

  -allies created tunnels in chalky ground

  -hospital & operating theatres

  -running water & electricity

  -700 beds

  -could shelter from artillery fire
• 3rd Battle of Ypres 1917

  -bad rain ; ground became waterlogged

  -men drowned in mud

  -245,000 British casualties
• Battle of Cambrai 1917

  -first large scale tank attack from British (450)

  -after initial success British forced back: 40,000 British casualties

  -first blood bank here - 11 survived (Oswald Hope)
• impact of terrain :

  -stretcher bearers collected wounded often under gunfire & at night

  -mud & shell craters: moving wounded hazardous

  -trenches clogged with equipment & men, manoeuvring corners with stretchers was difficult
• transporting wounded :

  -horse drawn carriages could not cope with no. of wounded & made injuries worse

  -october 1914 : 512 motor ambulances bought

  trains but slowed down movement of other trains with men & supplies

  -canals used more often
• trench foot:

  -waterlogged trenches; numb, swollen, blistered & turning blue feet - tight boots also restricted blood flow

  -January 1915, 27th division of British Army lost 1/6 of men to trench foot

  -made to change socks twice a day & rub whale oil into feet
• gas gangrene:

  -2nd stage of trench foot

  -flesh & body tissue dies due to loss of blood supply

  -amputation
• trench fever:

  -flu like symptoms

  -spread by lice, lived in seams of clothing & blankets

  -medical officer inspected 560 men & found 420 lice

  -when came out of frontline, uniforms fumigated, washed & ironed

  -between 1917-18, 15% of men unfit for duty due to trench fever
• rifles:

  -more efficient due to cartridge case

  -automatic rapid fire

  -more pointed bullets

  -even more damage from greater distance
• machine guns:

  -could fire 500 rounds per minute

  -defensive weapon
• artillery:

  -cannons became more powerful

  -howitzer could shoot 900kg shell 12 miles

  -caused 50% of casualties

  -position & aim didn't have to be repositioned all the time
• Shrapnel:

  -hollow shell packed with steel balls, lead or gunpowder & timer fuse

  -exploded mid air above enemies

  -caused maximum casualties

  -sent metal fragments at fast speed over a wide area
• RAMC royal army medical corps:

  -branch of the army

  -responsible for medical care

  -establised in 1898
• infection:

  -more powerful bullets & shell fragments, deeper into body & infection caused due to microscopic manure amounts

  -gas gangrene, carried by bacteria in soil, in early stages had sweet smell, wounds became hugely swollen with gas

  -turned white then green & made bubbling sound when pressed
• head injuries:

  -1916 Brodie helmet: steel, strap stopped it getting thrown off head in explosion

  -reduced fatal head wounds by 80%

  -over 60,000 British men suffered wounds to head & eyes
• gas attacks:

  -killed 6000 British soldiers, 5% died in gas attacks

  -loss of sight, taste, smell & coughing

  -healed within 2 weeks of treatment

  -used oxygen to get rid of traces of poisonous gas
• FANY first aid nursing yeomanry

  -first women's voluntary organisation to send volunteers to western front

  -frontline support for medical services e.g driving ambulances, emergency first aid

  -founded in 1907
• Queen Alexandra's nurses

  -formed most nurses on Western Front

  -well trained

  -300 in 1914 - 10,000 by 1918

  -at first army would only accept them & not volunteers
• VAD volunteer aid detachment

  -mainly middle & upper class women

  -best known medical volunteers

  -took growing casualties for them to be accepted

  -did lot of scrubbing & cleaning but by 1917, were changing dressing & giving painkillers
• Chain of evacuation:

  1. stretcher bearers
  2. regimental aid post RAP
  3. dressing stations (ADS & MDS)
  4. casualty clearing stations (CCS)
  5. Base hospitals (general or stationery hospital)
• RAP regimental aid post:

  -no more than 200m behind firing trench

  -poorly lit & often under fire

  -immediate first aid (light wounds, bandage & sent back to battle)

  -serious injuries to dressing stations

  _1 medical officer & team of up to 30 orderlies & stretcher bearers for each batallion
• dressing stations & field ambulance:

  -field ambulance: large, mobile medical unit

  -deal with up to 150 men but often more

  -dressing station often derelict building
• CCS casualty clearing station

  -seven to 12 miles from frontline

  -near railway lines so could be moved to base hospitals

  -seven doctors with other nursing staff

  -triage; divided into 3 groups upon arrival

  -could take 1000 casualties at a time

  -performed more operations than hospitals
• Base hospitals

  -civilian hospitals or converted buildings

  -continued treatment from ccs

  -divided patients into wards according to wounds

  -some sent to England on trains or to fight

  -by 1918, some too up to 2500 patients

  -had operating theatres, labs for identifying infections, x-ray departments & specialist centres for treatment (e.g. gas poisoning)
• wound excision or debridement:

  -cutting away dead & damaged tissue from wound

  -stopped spread of infection

  -closed by stitching

  -first used by Riche in October 1914
• Amputation:

  -last resort

  -sometimes only way to prevent spread of infection or death

  -by 1918, this happened to 240,000 men
• Thomas Splint

  -pulled leg lengthways, stopped bones grinding on each other, reduced amount of blood lost

  -previous splint kept leg rigid, many died on route to CCS

  -increased survival rate for leg wounds; 20% to 82%

  -Splint's nephew made sure splint was used from 1916 onwards

  -used as near to frontline as possible
• mobile x-ray machines:

  -could not detect all objects e.g. clothing fragments

  -wounded man had to lie still for several minutes

  -tubes were fragile & overheated quickly

  -reduced death rate
• Richard Lewisohn

  -american doctor

  -discovered adding sodium nitrate stopped blood from clotting

  -meant blood could be stored & donor did not have to be present

  -saved many lives

  -store deteriorated quickly
• Geoffrey Keynes

  -British surgeon

  -created portable machine for storing blood

  -could take blood to frontline

  -soldiers could receive blood sooner, stopping bodies going into shock

  -saved many lives
• Oswald Hope Robertson

  -American doctor

  -built case with ice & sawdust that could store glass bottles of blood for up to 26 days : blood depot

  -first used 1917, Battle of Cambrai

  -donors did not have to go to CCS
• Harvey Cushing:

  -used magnet to remove metal fragments from brain

  -used local anaesthetics as general lead to brain swelling, made surgery more risky

  -learned that quicker the operation, the higher the survival

  -and that dangerous to move men too soon after operation
• Harold Gillies:

  -New Zealand surgeon

  -persuaded British army to open facial care unit in Kent in 1917

  -by 1918 11,000 operations had been carried out there

  -November 1915, 7 hospitals in France had specialist areas for dealing with plastic surgery & wounds to the head
• stretcher bearers:

  -basic medical supplies : bandages & morphine

  -four men to a stretcher, sometimes 6-8 due to thick mud

  -16 bearers in a battalion (up to 1000 soldiers)

  -often under fire

  -often not enough of them