5.3 Conditions requiring medical treatment

• Main medical problems on the Western Front:

  Conditions in the trenches were very unpleasant. Sanitary, or hygienic, conditions for such large numbers of people posed a problem. In summer, the combination of sewage and dead bodies made the smell dreadful, whilst in winter, bad weather gave rise to both flooding and frostbite. In November and December 1914, there were over 6,000 cases of frostbite. Rat infestation was normal. A number of medical problems were caused by these conditions.
• Trench foot

  Painful swelling of the feet, caused by standing in cold mud and water. In the second stage of trench foot, gangrene set in. Gangrene is the decomposition of body tissue due to a loss of blood supply.

  ·      Prevention was key

  ·      Rubbing whale oil into feet to protect them

  ·      Keeping feet dry and regularly changing socks

  ·      If gangrene developed, then amputation was the only solution to stop it spreading along the leg.
• Trench fever

  Flu-like symptoms with high temperature, headache and aching muscles.

  This condition was a major problem because it affected an estimated half a million men on the Western Front.

  ·      By 1918, the cause of trench fever had been identified as contact with lice.

  ·      Delousing stations were set up. After this, there was a decline in the numbers experiencing the condition.
• Shellshock

  Symptoms included tiredness, headaches, nightmares, loss of speech, uncontrollable shaking and complete mental breakdown. 

  It has been suggested that about 80,000 British troops experienced shellshock.

  ·      The condition was not well understood at the time.

  ·      In some cases, such as Siegfried Sassoon and Wilfred Owen, this involved treatment back in Britain. The Craiglockhart Hospital in Edinburgh treated 2,000 men for shellshock.

  ·      However, some soldiers who experienced shellshock were accused of cowardice. Many were punished for this-some were even shot.
• Rifles and explosives:

  In a case study of over 200,000 wounded men admitted to Casualty Clearing Stations (CSS) on the Western Front, it was discovered that high-explosive shells and shrapnel were responsible for 58% of wounds. When a shell exploded, it could kill or injure a soldier immediately. A shell explosion also scattered shrapnel (fragments of metal in the casing), which travelled at fast speeds over a wide area. This meant that anyone who was in the way of the shrapnel was likely to be wounded. About 60% of injuries were to arms and legs. 
• The case study also found that bullets were responsible for 39% of wounds. Machine guns could fire 450 rounds a minute, and their bullets could fracture bones or pierce organs. Rifles could fire accurately at up to 500m, but lacked the speed of machine guns.
• Shrapnel, wound infection and head injuries

  When men were injured, either by shrapnel or by bullets, the metal would penetrate their body, taking with it the fabric of the uniform from the area surrounding the wound. The soil in the region, which had been intensively farmed with large quantities of fertiliser before the war, contained the bacteria for both tetanus and gas gangrene. Gangrene is an infection caused by a lack of blood to an area in the body. Gas gangrene is an infection that produces gas in gangrenous wounds.
• When wounds were exposed to the soil the presence of these bacteria made infection much more likely. The impact of tetanus was reduced by the use of anti-tetanus injections from the end of 1914. However, there was no cure for gas gangrene. The bacteria for gas gangrene spread through the body quickly and could kill a person within a day.
• At the start of the war, the headgear worn by soldiers was a soft cap. To protect against head injuries, a trial using the Brodie helmet was carried out in 1915. This was a steel helmet with a strap that prevented it being thrown off the head in an explosion. It was estimated that it reduced fatal head wounds by 80%, so the helmet was then provided to all soldiers fighting on the Western Front.
• The effects of gas attacks

  Gas attacks caused great panic and fear, as is shown in Wilfred Owen’s poem Dulce et Decorum Est. It was not, however, a major cause of death, with only about 6,000 British soldiers dying as a result of gas attacks. The British army gave troops on the Western Front gas masks from 1915, which became more sophisticated over time. Still, gas attacks were greatly feared by soldiers on the Western Front.
• Chlorine:

  First used by the Germans in 1915 at the second battle of Ypres. It led to death by suffocation. The medical services had no experience in dealing with gas attacks, and so had to experiment with treatments. Gas masks were given to all British troops in July 1915. Before this, soldiers developed their own system of gas masks. They soaked cotton pads with urine and pressed them to their faces to help stop the gas entering their lungs.
• Phosgene:

  First used at the end of 1915 near Ypres. Its effects were similar to those of chlorine but it was faster acting, killing an exposed person within two days.
• Mustard:

  First used in 1917 by the Germans. It was an odourless gas that worked within 12 hours, causing both internal and external blisters and could pass through clothing to burn the skin.
• Summary: 

  ·      Common medical problems that faced men fighting on the Western Front were trench foot, trench fever and shellshock.

  ·      The introduction of the Brodie helmet saved many lives by protecting the head against shrapnel injuries.

  ·      Gas attacks caused burning skin and suffocation.
• What led to many illnesses on the Western Front?

  Trench conditions
• How did heavy rainfall affect soldiers in the trenches?

  It caused flooded trenches and prolonged wetness
• What was a consequence of overflowing toilets in the trenches?

  Contamination of food and drinking water
• What thrived in the hot and damp conditions of the trenches?

  Rats
• What illnesses arose in the trenches?

  Trench foot, trench fever, and shell shock

  
• How did trench conditions affect troop morale?

  They reduced morale and increased casualties
• What were the main health issues caused by trench conditions?

  • Trench foot
  • Trench fever
  • Shell shock

  
• What were the conditions of the trenches described as?

  Unhygienic and cramped
• How did extreme weather affect trench conditions?

  It worsened the smell of sewage and dead bodies
• What illness was caused by contaminated water and food?

  Dysentery
• How many cases of frostbite were reported in December 1914?

  6,000 cases
• What were the causes and symptoms of trench foot?

  • Cause: Prolonged exposure to wet conditions
  • Symptoms: Swelling, numbness, foul smells, gangrene
• What treatment was used for trench foot?

  Changing socks and using duckboards
• What was used to create a waterproof barrier for trench foot?

  Whale oil
• What was sometimes necessary to prevent further infection from trench foot?

  Amputation
• What were the causes and symptoms of trench fever?

  • Cause: Lice from rats
  • Symptoms: Flu-like symptoms, headaches, muscle pains
• What was ineffective in treating trench fever?

  Drugs like quinine
• What measures were taken to combat trench fever?

  Disinfecting clothes and delousing stations
• What are the causes and symptoms of shell shock?

  • Cause: Cramped conditions and violence
  • Symptoms: Tiredness, nightmares, mental breakdowns
• What is shell shock now referred to as?

  PTSD
• How were soldiers with severe shell shock treated?

  Rest and treatment back in Britain
• What was the purpose of the Brodie helmet introduced in 1915?

  To protect soldiers from head injuries
• What percentage of wounds were caused by bullets according to a case study?

  39%
• What percentage of wounds were caused by explosions?

  58%
• What was a common result of bullet wounds?

  Infection due to harmful bacteria
• What was the effect of shrapnel from explosions?

  Scattered smaller pieces of metal