western front

• Medical conditions on the Western Front

  • Gas attacks
  • Trench fever
  • Trench foot
  • Shellshock
  • Gas gangrene
  • Shrapnel injuries
• Gas attacks


  Caused by chlorine, phosgene and mustard gas. Symptoms: Burning skin, internal and external blisters, death by suffocation. Massive psychological impact - fear and panic. Solution: Gas masks developed in 1915
• Trench fever


  Caused by body lice. Symptoms: Flu-like (high temperature, headache, aching muscles). Solution: Delousing stations set up
• Trench foot


  Caused by standing in cold water or mud. Symptoms: Painful swelling of the feet, eventually leading to gangrene (decomposition). Solutions: Rubbing whale oil on feet, keeping dry and changing socks regularly, amputation (worst case)
• Shellshock


  Caused by psychological damage. Symptoms: Tiredness, nightmares, headaches, loss of speech, shaking, mental breakdown. Solution: In some cases, treatment back in Britain. Generally, shellshock was misunderstood and sufferers were often accused of cowardice
• Gas gangrene


  Caused by open wounds infected by bacteria from soil. Symptoms: Dead tissue, gas build up in wound. Solution: Amputation of infected areas
• Shrapnel injuries


  Caused by being hit by bullets or shrapnel from rifles/explosions. Symptoms: Pieces of metal penetrating the body, taking with it parts of uniform, soil and dirt. Solution: Steel Brodie helmets worn to protect the head
• British woman's experiences as a Red Cross nurse: 'Treating wounds in a home-hospital under surgically clean conditions is a very different thing from dealing with mangled and shattered flesh where the wounds are filled with mud, torn clothing and shrapnel. Often these men had received no first-aid treatment, and their wounds had remained uncovered for as long as two or three days. With few exceptions all these cases were septic.'
• Chain of evacuation


  1. Regimental Aid Posts

  2. Dressing Stations (ADS and MDS)

  3. Casualty Clearing Stations (CCS)
• Regimental Aid Posts (RAP)


  Gave immediate first aid, aimed to get as many men as possible back to the fighting, could not deal with serious injuries - these patients were moved onto the next stage, usually located near to the frontline, in communication trenches or abandoned buildings
• Dressing Stations (ADS and MDS)

  Dealt with more serious injuries, located in abandoned buildings, bunkers or tents, in theory there should have been an Advanced Dressing Station with a Main Dressing Station half a mile behind it, but often this wasn't the case, staff belonged to a unit of the RAMC called the Field Ambulance
• Casualty Clearing Stations (CCS)


  Often dealt with critical injuries, set up in buildings such as factories and schools, often near a railway line, triage system - men divided into 3 groups: walking wounded, those needing hospital treatment, and those with no chance of survival
• The main stages of the chain of evacuation were not always followed in the same order for every casualty
• First aid


  Aimed to get as many men as possible back to the fighting
• First aid


  Could not deal with serious injuries – these patients were moved onto the next stage
• First aid


  • Usually located near to the frontline, in communication trenches or abandoned buildings
• Staff at the Dressing Stations

  Belonged to a unit of the RAMC called the Field Ambulance
• Triage system at CCS

  1. Men were divided into 3 groups:

  2. The walking wounded could be patched up and sent back to the fighting.

  3. Those needing hospital treatment were transferred to a Base Hospital.

  4. Those who had no chance of survival were made comfortable, but medical resources were not spent on them.
• Base Hospitals


  Located near the coast so wounded men could be shipped back to Britain
• As the war went on, CCSs did more of the jobs originally intended for Base Hospitals
• Base Hospitals


  • Divided patients up into different wards according to their wounds. This allowed doctors to experiment and specialise in particular injuries
• In 1918, the Germans launched a last-ditch offensive which threatened the CCSs, so much of the surgery was once again carried out in the Base Hospitals
• FANY


  First Aid Nursing Yeomanry. Founded in 1907. A women's organisation which sent volunteers to the Western Front. It supported medical services on the frontline, e.g. by driving ambulances and giving emergency first aid.
• The first 6 FANYs arrived in France in October 1914, but they initially helped the French and Belgian troops because the British wouldn't make use of them
• In 1916 the British army allowed FANYs to drive ambulances, replacing Red Cross male ambulance drivers. FANYs opened the way for more women (such as those in the Voluntary Aid Detachments [VAD]) to join in on the frontline
• RAMC


  Royal Army Medical Corps. The branch of the army responsible for medical care, founded in 1898.
• Beryl Hutchinson, a FANY in Belgium: 'At dawn I woke to a very queer noise and an even queerer smell. The Belgian Quarter-Master came round with gas masks. All our men had had gas masks already issued and were firing for all they were worth. Out of the mist came a procession of British, staggering up the lane or just lying in a groaning, gasping heap. They had the silliest bits of chewed cotton wool fastened to their faces. We had the idea that hot black coffee, being so very good for asthma attacks, might help…'
• At first horse-drawn ambulance wagons were used to carry the sick and wounded, but these were so shaky that they often made injuries worse
• Motorised ambulances were introduced with help from public donations. However, horse-drawn wagons were still used where the ground was too muddy for motor vehicles
• Wounded men were also taken by train or canal to Base Hospitals on the coast - some trains even had operating theatres
• Some of the wounded were transferred directly onto ships to be taken back to Britain
• The contaminated conditions made aseptic surgery impossible. Shrapnel, dirt and bits of uniform in wounds caused infection
• The sheer number of casualties meant the system often struggled to cope
• Methods of dealing with infection

  1. Debridement – the removal of dead or infected tissue

  2. The Carrel-Dakin method – using a sterilised salt solution in the wound through a tube (antiseptics like carbolic acid didn't work on gas gangrene)

  3. Amputation – removing infected limbs. 240,000 men had lost limbs by 1918
• The Thomas splint


  A large splint designed to keep limbs and joints still during surgery
• Many men died from shrapnel wounds to the leg because the leg was not kept rigid during transfer from the frontline to a CCS, leading to blood loss and infection
• Robert Jones came forward with a splint that his uncle, Hugh Thomas, had developed in the late 1800s. In December 1915 he was sent to Boulogne to instruct medics how to use it
• The Thomas splint improved the survival rate for these leg injuries from 20% to 82%
• Mobile x-ray units


  • X-rays were used from the start of the war to locate bullets and shrapnel in wounds
  • Problems: X-rays couldn't identify all objects in the body – e.g. fragments of clothing
  • An x-ray took several minutes, a long time for a wounded man to keep still
  • The x-ray machines could only be used for an hour before they overheated. 3 machines would be used in rotation, so that one worked while the others cooled down
• The Base Hospitals had static (non-moving) x-ray machines. The British also had 6 mobile x-ray units, which were vans loaded with x-ray equipment. The equipment was laid out in a tent at the back of the van