The Historic Environment

• Battles on the Western Front

  • First Battle of Ypres - British held onto Ypres, which was vital in maintaining control of the English channel ports, but the Germans gained ground
  • Battle on Hill 60 - British tunnelled into and under the hill and exploded five mines from the tunnels, allowing them to take the hill
  • Second Battle of Ypres - Germans made slight progress. First time chlorine gas was used. Used by the Germans
  • The Somme - High casualties on both sides. First use of tanks and creeping barrage by the British, but had little impact
• Battles on the Western Front (2)

  • Arras - British expanded underground tunnels, quarries and caves for sheltering and movement of troops. The tunnels were used to launch the battle, initially successful but ended with little progress and high casualties on both sides
  • Third Battle of Ypres - British used creeping barrage to make small gains. Awful weather left ground waterlogged and many drowned
  • Cambrai - First large scale use of tanks, successful but not backed up so the British were forced back
• The first trenches were hurriedly dug by troops. They often used existing ditches or banks to make it easier. The trenches were constantly maintained and improved, for example with drains and steps added
• Terrain on the Western Front varied in different places and according to weather. Deep mud, waterlogging and craters / holes from explosions could make it difficult to get around. The trenches could be muddy and overcrowded
• The Trench System

  • Three rows of trenches linked by communication trenches
  • Reserve trench where troops could be stationed for counter attack
  • Support trench where troops would retreat to from the frontline
  • Frontline trench where attacks were launched
  • Artillery emplacements at the back
  • Dugouts in the side of the trench for troops to take cover
  • Trenches formed a zig-zag pattern
• Injuries and Illnesses

  • Gas attacks - caused temporary blindness, coughing and burns. Gas masks were given to all troops but before that, they protected their faces with cotton pads soaked in urine
  • Head injuries - Mostly caused by shrapnel. Common. Head wounds were reduced by replacing soft caps with Brodie Helmets.
  • Shell Shock - caused mental breakdown and a variety of symptoms. Some sufferers were accused of cowardice. Many were treated near the front but some were evacuated to British hospitals
• Injuries and Illnesses (2)

  • Trench Fever - Flu-like symptoms, could last months. Caused by lice, after troops were deloused, cases decreased
  • Trench Foot - Caused by standing in waterlogged trenches. To protect their feet, they were given whale oil and spare socks, pumps were used to drain trenches, and duckboards were added to help keep their feet above the water.
  • Bullets could penetrate organs and fracture bones
  • Explosive shells and shrapnel were responsible for most deaths and injuries, removing limbs and causing major internal injuries
• Injuries could cause major blood loss, Bullets and shrapnel had to be located and removed. Head wounds could require brain surgery or facial reconstruction
• Wound infection - Soil on the Western front contained tetanus and gas gangrene bacteria which would enter wounds. From late 1914, tetanus injections were given but there was no prevention for gas gangrene
• With battles miles away from hospitals, they needed medical facilities in the field. The 'chain of evacuation' for the wounded evolved as the war went on. Most medical care was provided by the RAMC and FANY.
• Initially all medical workers were from the RAMC but later, volunteers were allowed, from FANY for example. Volunteers were mostly used to drive ambulances and for cooking and cleaning
• There was an Underground Hospital at Arras, known as Thompson's Cave, in the tunnels beneath the town, and very close to the front line.

  It included space for 700 beds, an operating theatre and a mortuary. It was supplied with running water and electricity
• Transport Problems

  • Difficult terrain meant that in some places only stretcher-bearers and horse wagons could be used
  • Many roads and railway lines had been destroyed
  • Constant shelling and artillery fire made recovery of the injured very difficult
  • Initially, no motor ambulances were sent and there were not enough horses to cope. Public appeal in Britain raised money for 512 motor ambulances
• Chain of Evacuation

  • The Regimental Aid Post was close to the frontline. The Regimental Medical Officers was assisted by stretcher-bearers in first aid. More serious injuries were sent to the next stage
  • Dressing stations were a mile back from the front line in derelict buildings, dugouts or tents. They were staffed by medical officers, orderlies, stretcher-bearers and from 1915, some nurses. However serious cases went to the:
  • Casualty Clearing Stations (CCS) - larger and better equipped, situated in buildings several miles from the frontline, staffed by doctors and nurses who prioritised treating life threatening injuries to men who had a chance at survival.
  • Base Hospitals were situated near ports on the coast. They had many medical staff, including specialised doctors. Patients could stay for some time before returning to the front or being sent home by ship for further treatment.
• The three important developments in medicine in the early 20th century, used in the first world war were:

  • X-rays
  • Blood transfusions
  • Aseptic Surgery
• X-Rays

  In 1895, when Roentgen covered a test tube in black paper and was surprised to find that rays from the tube lit up a screen. He experimented and found that these rays could pass through many objects including human flesh but not bone. He put photographic paper between the tube and his hand to create the first x-ray image. Radiology departments opened the following year and were used to diagnose embedded objects and bone problems.

  Problems with early x-rays:

  • Photography was at an early stage so taking x-rays required keeping still for a long time.
  • High doses of radiation were released and patients were burnt and lost hair
  • Large machines were too heavy to be moved easily
• Blood Transfusions

  • In the 17th century, doctors carried out blood transfusions from animals to humans but people rarely survived
  • Blundell performed the first human to human blood transfusions between 1818 and 1829. He developed useful techniques and equipment but there were problems. Blood had to be transferred directly as it couldn't be stored, and only half of the recipients survived.
  • In 1901, Landsteiner discovered three blood groups and his colleagues found a fourth in 1902. They discovered that blood transfusions only work with people of the same blood group
• Aseptic Surgery

  • Due to the work of Lister, antiseptic surgery was well established by 1900 and aseptic conditions began to be used
  • Operating theatres and wards were cleaned thouroughly
  • Surgeons and nurses wore sterilised clothing
  • Sterilised cloths covered surfaces and equipment
  • Surgeons and nurses wore masks to prevent breathing infection into a wound
  • Anyone touching a patient wore rubber gloves to stop germs passing from their hand to a wound or an instrument
  • In 1878, Koch developed a steam steriliser for surgical instruments. Since 1887, all surgical equipment was sterilised
• The type and extent of injuries on the western front led to experimental techniques for treatments. By 1918, many medicine and surgery advancements had been made.
• New techniques for infection on Western Front

  • Antiseptic and aseptic surgery was not possible in Dressing Stations and Casualty Clearing Stations, and many wounds were already infected by the time the patient was operated on
  • Surgeons tried chemicals to kill bacteria but they don't kill gas gangrene
  • By 1917, the Carrel-Dakin method, where sterilised salt solution was moved through the wound using tubes, was found more effective
  • This didn't work on deep infections, so surgery was developed to remove damaged and infected tissue as well as all traces of bullets or shrapnel
  • If all unsuccessful, limb amputation was the only way to save the patient
• Blood transfusions western front

  • Blood loss could lead to shock, causing death often
  • Blood transfusions used from 1915, but limited as blood can't be stored
  • In 1915, Lewisohn found that adding sodium citrate to blood stopped it clotting, so it could be stored a short time.
  • Weil used refrigerators to store it for longer
  • In 1916, Rous and Turner added citrate glucose, meaning blood could be stored even longer
  • To prepare for the Battle of Cambrai, Robertson stored 22 units of blood in the first 'blood depot' . He used it to treat Canadian soldiers suffering from shock and demonstrated its potential
• From December 1915, the Thomas Splint was widely used and reduced the death rate from broken legs from 80% to less than 20%. The splint kept the leg rigid, reducing blood loss.
• Advances in Surgery

  • Large Number of brain injuries during the war led to development in surgical techniques and improved the success rate.
  • Large number of facial injuries led to huge improvements in plastic surgery, led by Gillies who worked at Queen's Hospital in Kent
• Mobile X-ray units

  • X-rays were essential in locating bullets and shrapnel before operating.
  • Static machines were used in base hospitals and some CCSs in 1914
  • Mobile units were used closer to the front and became more common as the war went on
  • Their images were less clear than static machines, but they prevented many deaths still