Medicine western front

• Describe two features of the underground hospital at Arras

  -the hospital was complex and well equipped

  -included water, electricity, capacity for 700 patients, operating theatres and a mortuary

  
  

  -it was close to the front line of attack in Arras in 1917

  -treatment for wounded could be more quickly accessed and would give the injured a better chance of survival
• Describe two features of ill health among soldiers that arose from the trench environment

  -The soldiers often developed trench foot

  - They had to stand in wet and muddy trenches •

  
  

  -Many men became infested with lice and developed trench fever

  -It was difficult to keep clothes clean
• Describe two feature of dressing stations

  -usually a short distance behind the trenches

  -often based in abandoned buildings but sometimes they were just in tents

  
  

  -staff would treat minor injuries so the soldiers could return to fighting as soon as possible

  -more severe injuries were passed down the chain of evacuation where there would be better facilities
• Describe two features of the use of the Thomas splint


  -reduced the risk of amputation or death

  -the splint kept the leg rigid as the injured man moved down the line of evacuation and this reduced the chance of further infection or bleeding

  
  

  -the Thomas splint began to be used for soldiers with leg injuries

  -it had been developed before the war but only came into use on the western front in 1916.
• Describe two features of blood transfusions on the western front during the First World War

  -Initially transfusions on the Western Front were carried out using a syringe and tube, with the donor present

  -This stopped the patient going into shock from blood loss

  
  

  -A blood depot was set up before the Battle of Cambrai

  -The army developed ways of dealing with large numbers of casualties on the Western Front
• Describe two key features of a stretcher bearer

  -recovered the dead and wounded sometimes during breaks in fighting and under fire

  -they carried basic medical equipment such as bandages and morphine

  
  

  -it took 4-8 men to carry a stretcher dependant on the terrain

  -often never enough stretcher bearers
• Describe two key features of regimental aid posts (RAP)

  -they were very close to the frontline (200m)

  -they were often in communication trenches or deserted buildings

  
  

  -there would be a battalion regimental medical officer whose job was to distinguish the difference between lightly wounded and those needing serious medical attention (triage)

  -if you could not be treated at RAP you would be sent to a dressing station
• Describe two features of a casualty clearing station

  -they were large well-equipped medical facilities

  -located about 7-12 miles away from fighting usually in tents or huts but sometimes in schools or factories. They were also located near railway lines to allow the next stage of evacuation to take place

  
  

  -CCS closest to the frontline would operate on the most serious injuries e.g. chest injuries

  -when arrived they would be separated into three groups: walking wounded, hospital treatment and no chance of survival
• Describe two features of base hospitals

  -located near french or Belgian coast so the wounded could be transported back to Britain if needed

  -CCS were more important than base hospitals as they would operate whereas base hospitals were for recuperation after

  
  

  -they divided patients up into different wards so each doctor could specialise in injuries

  -they had operating theatres, x-ray departments and poison treatment
• Describe two features of shellshock

  -affected lots of men (around 80000 British troops)

  -caused tiredness, headaches, nightmares, complete mental breakdown, loss of speech and uncontrollable shaking

  
  

  -some were treated back in Britain for example Craig Lockhart hospital

  -condition was not well understood. Some accused of cowardice and even shot
• Describe two features of shells and shrapnel and how they caused injury

  -fired from artillery/field guns

  -responsible for 58% wounds

  
  

  -in an explosion the could kill/wound immediately

  -caused there to be a scattering of shrapnel over wide area
• Describe two features of bullets and how they cause injury

  -Bullets responsible for 39% of wounds

  -Machine gun bullets could fracture bones or pierce organs
• What was the Brodie Helmet?


  It replaced the soft cap helmet and provided a more protective approach. It was a steel helmet with strap to prevent it being thrown off in an explosion. It was introduced in 1915 and is thought to have reduced fatal head wounds by 80%
• What was wound excision or debridement?

  Cutting away dead, damaged and infected tissue from around the wound to stop the spread of infection.
• What was the Carrel-Dakin method?

  This involved using a sterilised salt solution in the wound through a tube to flush out infection. The solution only lasted six hours
• What was the Thomas splint and how did it increase chance of survival?

  1914-15- gunshot wounds to legs only had 20% chance of survival, this was because it created a compound fracture that pierced the skin

  -Thomas splint stopped the joint from moving and prevent blood clots around the femur. The survival rate improved from 20% to 82% due to this
• What were some weaknesses of mobile x-ray units?

  -could not identify all objects in the body

  -the x-ray itself could take several minutes to take

  -overheated really easily so had to be used in rotation

  -glass also broke easily
• Who initiated the mobile x-ray units?

  Marie Curie understood the importance of X-ray for detecting shrapnel and was responsible for equipping 20 mobile X-ray vans to work in the french area of the western front. 2 X-rays would be taken from different angles to detect shrapnel
• How did blood transfusions develop in 1915

  -Laurence Bruce Robertson used an indirect method to transfer donor blood to a patient in the base hospital in Boulogne

  -Geoffrey Keynes designed a portable blood transfusion kit that was used to provide transfusions in a casualty clearing station however still couldn't store blood

  -Richard Lewisohn discover by adding sodium citrate to blood the need for donor to donor transfusion was removed

  -Richard Weil that sodium citrate enabled the blood to be stored for two days
• How did blood transfusions develop in 1916

  - Francis Rous and James Turner found that by adding citrate glucose solution to blood it could be stored for a much longer period- up to four weeks
• How did blood transfusions develop in 1917

  -blood transfusions were being given in the casualty clearing stations as a routine measure to cure shock
• What did Oswald Hope Robertson do?

  Before the battle of Cambria he stored 22 units of universal blood and he built a carrying case packed with ice and sawdust. He called it a 'blood depot'. During the battle he treated 20 severely wounded Canadian soldiers and 11 survived. This was the first time that stored blood had been used to treat shock
• How did Harvey Cushing increase survival rate of brain injury

  - quick to operate=more likely to survive so casualty clearing stations used for brain surgery

  -dangerous to move men to soon post-op so patients remained at CCS for three weeks

  - head wounds may look minor but could still be severe so all were examined thoroughly

  - 1917 Harveys survival rate was 71% compared to the general 50%
• What did Harold Gillies do?

  He specialised in facial reconstruction and plastic surgery. he used pedical tubes which growled excess skin on the patient to use as a skin graph so it wouldn't be rejected. By the end of the war nearly 12000 surgeries had been carried out.
• Explain two features of aseptic surgery

  -Lister first used carbolic acid in 1865 based on Pasteur germ theory

  -all medical staff had to was their hands, faces and arms before entering operating theatre

  
  

  -Charles Chamberland invented the autoclave in 1881

  - used steam sterilisation to clean surgical instruments
• Explain two features of X-ray development

  -developed by Wilhelm Roentgen in 1895

  -led to radiology departments opening in a number of hospitals in 1896

  
  

  -radiation was a problem and patients could be burnt or lose their hair

  -glass tubes could be broken easily and machines were difficult to move around as they were so big
• Explain two features of blood transfusions


  -blood could not be stored and had to be used straight away

  -donor and patient had to be connected by wire but this led to rejection and blood clotting

  
  

  -blood groups were unknown until 1901 by Karl Landsteiner

  -this prevented blood being rejected. A,B and o were the main groups
• What was the RAMC?

  Royal Army Medical Corps, responsible for medical care. They were founded in 1898.
• What was the FANY?

  First Aid Nursing Yeomanry. They were founded in 1907. They were the first women's voluntary organisation, providing frontline support. E.g. driving ambulances
• What was the order of the evacuation route

  -Stretcher bearer

  -regimental aid post (RAP)

  -dressing stations

  -casualty clearing station

  -base hospital
• How did infection cause injury and death

  Shrapnel and bullets carried fabric from clothes into wounds. Soil full of bacteria from fertiliser use

  Soil contained tetanus and gas gangrene
• How was the risk of infection reduced

  Anti tetanus vaccinations from end of 1914 however no cure for gas gangrene and it could kill a person in one day
• How did gas attacks cause death

  -Chlorine (first used at second battle of Ypres by Germans in 1915). Led to death via suffocation

  -Phosgene was similar to chlorine but faster acting could kill person in two days

  -Mustard (used in 1917 by Germans) odourless gas which worked within 12 hours causing both internal and external blisters
• How did they try to reduce mortality rates from gas attacks

  -soldiers soaked cotton pads with urine and pressed them to their faces

  -troops given gas masks from 1915