Western Front

• Previous medical advances:

  • Aseptic surgery - removing all germs from operating area pre-surgery
  • X-rays - invented in 1895. However they could be dangerous and machines were fragile and hard to transport
  • Blood transfusions/banks - previously donor and patient had to be directly connected, but banks meant that blood could be stored
  • Blood groups (1901) - donor blood wouldn't be rejected
• Trenches:

  • War declared 4th August 1914
  • Used to hide during stalemate
  • Became more complex from 1915
  • Zig-zag pattern
  • Dugouts for hiding
  • Barbed wire in No man's land
• Trench types:

  • Frontline - nearest enemy where soldiers shoot from
  • Command - 10-20m behind firing line
  • Support - 200-500m behind front. Used for retreat
  • Reserve - 100m behind Support. Reserve soldiers wait
  • Communication - connect all trenches to send supplies and messages
• Key battles:

  • 1st Ypres 1914
  • 2nd Ypres 1915 - 1st use of chlorine gas
  • Somme 1916 - 400,000 deaths
  • Arras 1917 - underground hospital
  • 3rd Ypres - Ypres Salient where British were surrounded on three sides
  • Cambrai 1917 - 1st large scale use of tanks
• Common conditions 1:

  • Trench foot: Cause: cold + damp Symptoms: gangrene Cure: limbs amputated
  • Trench fever: Cause: lice Symptoms: flu-like Cure: delousing station
  • Gas gangrene: Cause: infected wounds Symptoms: dead skin Cure: amputation
• Common conditions 2:

  • Shellshock: Cause: psychological Symptoms: mental breakdown Cure: labelled cowards
  • Shrapnel injuries: Cause: bullets/shrapnel Symptoms: lacerations Cure: helmets/armour
  • Gas attacks: Cause: chlorine, phosgene, mustard gas Symptoms: blisters, death, fear Cure: gas masks
• Chain of evacuation:

  1. Regimental Aid Post (RAP)
  2. Advanced/Main Dressing Stations (ADS/MDS)
  3. Casualty Clearing Station (CCS)
  4. Base Hospitals
• RAPs:

  • Immediate first aid
  • Got people ready to fight again
  • No capacity for serious injuries
  • Located near the front line
• ADS/MDSs:

  • Minor injuries
  • Abandoned buildings
  • Meant to be ADS with an MDS behind
  • Staff were from RAMC Field Ambulance
• CCSs:

  • Often critical injuries
  • Old buildings near railways
  • Triage system:
  • 1.Walking wounded - sent back to fight
  • 2.Hospital treatment - sent to base hospital
  • 3.Terminal - made comfortable
• Base Hospitals:

  • Located near the coast
  • Sent men back to to Britain
  • Later, CCSs did more of the BH's jobs
• Royal Army Medical Corps (RAMC) - branch of the army responsible for medical care, founded in 1898
• First Aid Nursing Yeomanry (FANY):

  • Founded in 1907
  • Women's organisation that sent volunteers to the front
  • Ambulance driving, first aid
• Arras underground hospital:

  • Starting Nov 1916
  • Waiting rooms
  • 700 spaces for beds
  • Operating theatre
  • Mortuary
  • Electricity, water supply
  • Abandoned during Battle of Arras 1917
• Transporting wounded:

  • Horse drawn - shaking made injuries worse, in short supply
  • Motorised ambulances - from public donations, short supply, can't be used on muddy ground
  • Train/boats - carried men to Base Hospitals/ports for UK
  • Stretcher-bearers - men carried wounded off fields, only carried one at a time, risk from shaking/lifting/falling
• Problems with trench treatment:

  • Contaminated locations - no aseptic surgery
  • Shrapnel, dirt, clothing in wounds
  • System couldn't cope with volume of casualties
• Dealing with infection:

  • Debridement - removal of infected tissue
  • Carrel-Dakin method - sterilised salt solution
  • Amputation - removing limbs
• Thomas Splint:

  • Large splint to keep limbs still to reduce blood loss
  • Survival rate 20-82%
• Mobile X-ray units:

  • Used to locate metal in wounds
  • Base hospital had static ones, there were 6 mobile vans
  • However, they could only see metal, took a long time, and had to cool down after 1 hour
• Blood transfusions:

  • Carried out in Base Hospitals, later in CCSs
  • Keynes created a portable blood transfusion kit for the frontline
• Blood Banks:

  • 1915 - discovered how to store blood and stop it clotting
  • 1916 - discovered how to store it for 4 weeks
  • Cambrai - a doctor brought a portable blood bank to treat soldiers
• Head injuries / brain surgery:

  • 20% of wounds
  • Originally, they were mostly fatal
  • Cushing - used new techniques e.g magnets for metal and local anaesthetic
• Plastic surgery:

  • Gillies developed new methods for restoring faces
  • Queens Hospital (Kent)
  • 1917 - 12,000 operations