Medicine in the Trenches

• Salient


  A bulge that extends into enemy territory
• How it all started

  1. Britain declared war on Germany on August 4, 1914

  2. British government sent the British Expeditionary Force (BEF) to northern France to try and stop the German advance through Belgium

  3. BEF met a German army more than double its size near Mons

  4. BEF pulled back to the River Aisne and trench warfare began
• The First Battle of Ypres (Oct-Nov 1914)


  • BEF had moved to the town of Ypres in Belgium to prevent the German advance to the sea
  • Germans launched an attack, Britain lost over 50,000 troops but kept hold of the Channel ports
• Use of mines at Hill 60 (April 1915)


  1. Germans had control of a man-made hill to the south-east of Ypres which gave them strategic advantage

  2. British tunnelled under the hill and placed 5 mines under it, blew the top off, and took this important strategic position
• The Second Battle of Ypres (April-May 1915)


  • Saw the first extensive use of poison gas (chlorine) by German troops
  • Soldiers were taken completely by surprise and had no defences, casualties were high
• The Somme (July-November 1916)


  • High casualty rate, 60,000 on the first day and over 400,000 Allied casualties by the end
  • First use of tanks in warfare
• Arras (April-May 1917)


  1. Allied soldiers joined up a network of tunnels, quarries and caves underneath Arras

  2. Rooms were built with running water and electricity, up to 25,000 men could be stationed in the tunnels

  3. British broke through the German lines and advanced 8 miles, but by the end of May there were nearly 160,000 British and Canadian casualties
• The Third Battle of Ypres (July-November 1917)


  • Conditions were horrendous, torrential rain caused a build-up of mud, some soldiers sank and drowned in the mud
  • Around 245,000 British casualties
• Cambrai (October 1917)


  • First large scale use of tanks, over 450 tanks were used against the German front lines
  • Tanks did not prove to be a war winning weapon as they were not used alongside infantry support
  • First mobile blood bank was also in use due to advancements in blood storage
• The British Expeditionary Force (BEF) was made up of 70,000 professional soldiers
• The British were very vulnerable to attack in the Ypres Salient as they were surrounded by the Germans on three sides
• In the Second Battle of Ypres, the Germans had advanced 2 miles closer to Ypres
• On the first day of the Battle of the Somme, 60,000 Allied casualties were suffered
• By the end of the Battle of the Somme, over 400,000 Allied casualties had occurred
• During the Battle of Arras, the British broke through the German lines and advanced 8 miles
• By the end of the Battle of Arras, there were nearly 160,000 British and Canadian casualties
• Around 245,000 British casualties occurred during the Third Battle of Ypres
• Over 450 tanks were used in the Battle of Cambrai
• The tanks did not prove to be a war winning weapon at Cambrai as they were not used alongside infantry support
• The first mobile blood bank was in use at the Battle of Cambrai due to advancements in blood storage
• Casualty Clearing Station (CCS)


  A large well-equipped medical facility, 7-12 miles behind the firing line. Used a triage system to sort more serious cases from less serious ones.
• Base Hospitals


  Hospitals located near the French and Belgian coast where wounded men who were treated there would be close to the ports to be transported back to Britain. There were two types - Stationary Hospitals and General Hospitals.
• As the war progressed, CCSs played an increasingly important role in dealing with wounds, as it became clear wounds had to be dealt with quickly to prevent infection
• Base Hospitals began experimenting with new techniques that could then be used in the CCSs, such as separating patients by type of wound
• In Spring 1918, the German Spring Offensive resulted in many CCSs having to move back, so much of the surgery required was once again undertaken at Base Hospitals
• Underground hospital at Arras


  • Located in 800m of tunnels, it had waiting rooms, 700 spaces for stretchers, an operating theatre, rest stations, and a mortuary. It had running water and electricity.
• The underground hospital at Arras was abandoned during the Battle of Arras after it was hit by a shell that damaged the water supply
• Prior to the war, medical advancements had been made in X-rays, blood transfusions, and antiseptic/aseptic surgery
• Advancements in X-ray technology during the war

  Rapid location of objects like bullets and shrapnel, but issues with overheating and need for multiple machines
• Advancements in blood transfusions during the war

  Use of sodium citrate and citrate glucose to prevent clotting and enable storage of blood
• Advancements in treating infection during the war

  Carrel-Dakin method of using saline solution, wound debridement, and amputation as last resort
• The Thomas splint


  • Developed by Hugh Owen Thomas, it pulled the leg lengthways to stop blood loss and reduce deaths from femur fractures
• Plastic surgery advancements


  • New techniques developed including use of metal plates, skin grafts, and artificial face plates. Specialist facial injury hospital set up at Sidcup.
• Brain surgery advancements


  • Improved methods and techniques like use of rubber bands, surgical magnets, and local anaesthetics led to higher survival rates