BSOWF

• historical context of medicine - aseptic surgery


  Aseptic surgery - no germs in operating theatre to begin with

  Listers methods - rubber glovers, masks and gowns must be worn, autoclave machines used to sterilise instruments in boiling steam, wash hands face and arms before entering theatre, sterilise air by pumping over heating system to kill germs

  • this would have been hard in the battle fields due to muddy, dirty conditions
• historical context of medicine - developing x-rays


  1895 - accidental discovery by Roentgen. He realised these rays could penetrate many objects. He took an x-ray photograph of his wife's hand which showed not only her hand flesh and bones also her wedding ring -- VERY IMPORTANT FOR MEDICINE

  1896 - radiology departments opened in a number of British Hospitals, adding to knowledge and the application of new science in diagnosing problems
• historical context of medicine - Problems with early x-rays

  • Health risk - early x-rays burnt skin
  • glass tubes in machines - break easily
  • it took 90 mins to take one picture - this was a long time for someone who was in pain to stay still, only a limited amount of photos before they would overheat
  • the machines were very large - couldn't transport
• historical context of medicine - development of blood transfusion

  • Blood clots as soon as they leave the body -> tubes linking people became blocked up -- 1894 - Professor Write developed a soluble solution of certain acids preventing blood clots
  • A soluble solution of certain acids could prevent clotting eg, sodium bicarbonate -> side effects caused seizures
  • Some blood transfusions didn't work -> blood seemed to be rejected -- 1901-2 --> Austrian scientist discovered blood groups
• historical context of medicine - development of blood transfusion

  • Different people had different blood groups -> 1907 - American doctor identified universal Group 0 (anyone could have)
  • There was a danger of infection from unsterilised equipment -> cause further illness and death -> aseptic surgery
• Problems challenging in war environment at the beginning for medical context

  1. maintain aseptic environment in war area
  2. how do we get x-rays to an area? How do we get enough?
  3. how do we store blood?
• Trenches


  dug in zig-zag pattern

  more complex system in 1915

  line of trenches from English channel in the north to Switzerland in the south

  holes/dugouts at sides of trenches where men could take cover (protection) when needed

  depth 2.5m

  easier to defend then attack - barbed wire in no mans land, machines guns could rapid fire, gas
• Order of trenches

  1. Frontline - where attacks would be made from
  2. Support trench - 80m behind frontline ->troops would retreat back here if the frontline came under attack
  3. Reserve trench - 100m behind support trench ->where reserve troops could mobilise for a counter attack if frontline was captured
  4. Artillery emplacement - at the back

  communication trenches - runs between each trench
• medical problems caused by the conditions of trenches - Trench foot + frostbite


  stage 1 - painful swelling

  stage 2 - gangrene - decomposition of body tissue that is due to less blood supply

  Attempted solution -> prevention was key, otherwise amputation

  Ways to prevent - rub whale oil on feet, keep feet dry, regularly change socks
• medical problems caused by the conditions of trenches - Trench fever


  flu-like ->high temp, headache, aching muscles (half a million men)

  Attempted solution -> cause identified to be lice in 1918 (late in war) - delousing stations were set up
• medical problems caused by the conditions of trenches- shellshock


  Tiredness, headaches, nightmares, loss of speech, uncontrollable shaking and complete meltdowns (around 50000 men)

  Attempted solution ->conditions were not understood -- some hospitals treats (Edinburgh 2000 people (not many)), some where accused of cowardice are punished - shot
• 1st battle of Ypres


  12 oct - 11 nov 1914

  over 50000 dead
• 2nd battle of Ypres


  22nd april - 23 may 1913

  59000 dead

  germans used chlorine for first time
• battle of the Somme


  1st july - nov 1916

  day 1 = 57000 casualties - 20000 dead

  total - 400000 dead

  tanks used for first time
• batlle of Aras


  april 1917

  160000 dead
• 3rd battle of ypres


  31st july - nov 1917

  245000 dead

  mud
• problems with transport


  constant shelling and type of terrain the war was fought on left massive creators and holes in the ground - difficult to transport injured off the frontline
• problems with transport 


  before war, land was farmland, lots of fertiliser had been spread on it - meant that lots of bacteria in soil which infected wounds
• problems with transport 


  men who were injured needed to be moved from the frontline ASAP, stretcher bearers would carry them away - this mean they were often exposed to shelling and gunfire whilst moving patients (they could get injured as well)
• problems with transport 


  when the BEF was first sent to France in August 1914 they didn't send any motor ambulances - horse drawn ambulances couldn't cope with the amount of casualties -- this meant men were left to die or be captured
• problems with transport 


  patients were shaken about by the motion of the horse drawn ambulance - they would often make injuries worse which led to death in transit
• problems with transport 


  the times newspaper made an appeal for donations -> within three weeks they had enough money to buy 512 motor ambulances (arrived Oct 1914) - motor vehicles couldn't operate in muddy terrain so horse drawn ambulances were still used (worse terrain, they had to used 6 horses instead of 2)
• problems with transport 


  wounded men has to be transported by train in the last stage of journey to base hospitals - RAMC had to use french good trains for first few months - french good trains were not kitted out to look after wounded soldiers
• problems with transport 


  1st ambulance train - Nov 1914 - later some trains had operating theatres.

  As trains travelled, they needed to take supplies to frontline (delays) - injured soldiers had to wait hours/days in railway which often made injuries worse
• problems with transport 


  canal barges - slow but comfortable
• nature of wounds


  1. 58% of wounds caused by shrapnel ( fragments of metal) travelling at high speed hitting the body. About 60% went to arms and legs
  2. 39% of wounds caused by bullets from machine guns (450 rounds per minute) or rifle (accurate up to 500m)
• nature of wounds


  infection -

  shrapnel enters the body taking fabric from uniform - uniform covered in mud - mud = full of bacteria - gas gangrene, NO CURE - bacteria spreads through body quick (killed within a day)

  Anti-tetanus injections from 1914
• Gas attacks


  cause panic but not a major cause of death 6000

  1. Chlorine - 1915 - 2nd battle of Ypres - British retaliated at Battle of Loos in 1915 but the wind blew it back on them
  2. Phosgene - end of 1915

  both cause death by suffocation as it got into lungs

  3. Mustard - everywhere - 1917 - colourless, within 12 hours caused internal and external blisters, could pass through clothes to burn skin -- blindness and damage to the eyes
• gas attacks


  medical service didn't know how to deal with it

  • soldiers developed own gas masks: cotton pad soaked with urine pressed on face
  • gas masks were given to all GB troops July 1915
  • gas masks developed over time
• chain of evacuation


  More then half the British doctors served the Royal Army Medical Corps (RAMC) - the amount increased rapidly over the years to cope with the number of casualties : 1914- 3168, 1918- 13063

  they were helped by FANY (First Aid Nursing Yeomanry) a voluntary organisation providing help for medical services
• regimental aid post (RAP)


  200m from frontline

  in deserted trenches/buildings

  staff= regimental medical officer (RMO) + first aid trained stretcher bearers

  wounded walked or were carried there

  purpose - immediate 1st aid then , returned to trenches or moved on to stage 2
• Dressing station (ADS/MDS)


  400m from RAP = ADS

  1/2 mile from RAP = MDS

  in abandoned buildings/dugouts and bunkers, tents if possible

  staff = 10 medical officers + medical orderlies + stretcher bearers (RAMC) + nurses

  got there by walking or were carried

  built to deal with 150 soldiers but had to deal with 1000

  purpose - treating people for less then a week (week=max length stay)
• casualty clearing station (CCS)


  sufficient distance from frontline

  specialisation - could operate on most critical injuries

  wounded got their by motor/horse drawn ambulance

  TRIAGE - 1. walking around (patched + returned)

  2. those in need of hospital treatment - transported to a hospital

  3. those who were severely wounded, no chance of recovery, were made comfortable
• FANY 


  First Aid Nursing Yeomanry

  1916

  used for : transport, providing supplies, washing soldiers, setting up cinemas

  450 of them
• Base Hospital


  near the french and belgium coast

  wounded got there by train/boat

  CCS did more operations then the base hospital because it was quicker, to stop infection

  new techniques for treating wounded men - divide patients into different wards according to wounds

  soldiers sent to england - 'blighty' wounds - wounds too serious and soldiers didn't carry on
• Underground hospital at Aras


  in caves closed to the frontline

  700 spaces for stretchers

  operating theatres

  water + electricity

  800m tunnel

  400m from frontline but protected - underground

  April 1917 - abandoned - water supply got damaged
• chain of evacuation - theory vs reality - :(


  theory -

  stretcher bearers would bring wounded to RAP, they would then return to get more wounded

  reality -

  it was slow, difficult job, stretcher bearers were often injured carrying the wounded
• chain of evacuation - theory vs reality - :(


  theory -

  the injured would arrive RAP and first aid treatment

  reality -

  RAP in dugout as shellfire meant they couldn't put tents
• chain of evacuation - theory vs reality - :(


  theory -

  stretcher bearers would carry injured to MDS/ADS

  reality -

  patient exposed to weather winter = cold, summer = hot, rain = cold+wet
• chain of evacuation - theory vs reality - :(


  theory -

  ambulance would take wounded to CCS

  reality -

  motor got stuck so horse-drawn ambulance were used - slow, cause injuries to get worse (trotting)