Trenches

• ypres: problems

  - the germans had the high ground

  - salient

  - british muddy waterlogged trenches
• ypres: 1st battle

  oct/nov 1914
• ypres: 2nd battle

  - april/may 1915

  - first use of chlorine gas by germans
• ypres: 3rd battle (passchendaele)

  - july/nov 1917

  - 245,000 casualties

  - extreme muddy trenches
• somme

  - july/november 1916

  - 60,000 casualties on first day

  - 400,000 casualties total
• arras


  - april 1917

  - underground hospital 700 beds

  - 160,000 british casualties
• cambrai

  - november 1917

  - robertson blood banks

  - 450 tanks (not enough infantry)
• stretcher bearers

  - 16 per 1000 man battalion

  - morphine and bandages

  - 6-8 bearers per wounded soldier
• Regimental Aid Post (RAP)

  - close to the front line

  - in a dug out or behind a wall (dirty)

  - 1 battalion medical officer
• Field Ambulance and Dressing Station


  - ambulance = mobile team of drs and assistants (after 1915 nurses also)

  - tent/ buildings a mile behind front line
• casualty clearing station

  - large tents/ huts 10 miles from front

  - team of 7 drs + nurses did operations like amputations

  - had operating theatres and xray machines

  - triage system

  - 1000 patients at a time
• base hospitals

  - close to rail lines and roads

  - advanced operations

  - up to 2500 patients

  - operating theatres, xray department, specialist gas centres
• war wounds

  - key issue = blood loss

  - artillery, shell, shrapnel and rifle

  - treatment = amputations
• infection

  - gangrene from dirty conditions

  - debridement + amputations
• gas

  - chlorine and phosgene 1915: suffocation

  - mustard 1917: irritation

  - urinated on hanky to hold on face

  - july 1915 gas masks
• trench fever

  - lice in clothing and blankets

  - salvarson 606 ineffective

  - 15% men unfit for duty by 1918
• trench foot

  - waterlogged, muddy conditions

  - lead to gangrene and amputations
• shell shock

  - psychological illness

  - army had no sympathy

  - approx 80,000 recorded cases
• treating infection

  - aseptic surgery impossible

  - soldiers already infected by muddy fragments

  - carol dakkin method 1917- sterile solution via tubes

  - debridement + amputation

  - by 1918 240,000 men lost limbs
• splints

  - 20% survival of ppl shot in leg with compound fractures

  - pulled leg straight

  - increased survival rate to 82%
• blood transfusion

  - 1915 sodium citrate allowed blood storage

  - blood banks eg cambrai 1917
• xray machines

  - not enough

  - overheated and had to let them cool

  - made them smaller and portable

  - by 1916 most ccs and base hospitals had xray machines

  - soldiers can be treated faster
• plastic surgery

  - skin grafts 1915

  - harold gillies specialist centre, queens hospital kent

  - 11,000 reconstructive surgeries by 1915
• brain surgery

  - Harvey Cushing used a magnet to remove metal fragments from the brain.

  - Also used local anaesthetic rather than a general anaesthetic as the latter caused the brain to swell.

  - Operations were carried out at the CCS as this meant men could be operated on quickly

  - rubber bands on head reduced bleeding