western front

• Describe two features.


  - One feature was... For example...

  - Another feature was... For example
• How useful are Sources X and Y for an enquiry into?

  - Content: 'This source is useful because it (says/shows)...' '

  - Own Knowledge (+/-): 'This cross references with my own knowledge because...' 'However, I also know...'

  - Provenance (+/-): 'The provenance is useful because...' 'However...'

  
  

  X2
• How could you follow up?

  - Detail: Quote/Specific detail seen

  - Question: How typical/how successful/how effective/what challenges?

  - Source: Source bank (WW1 specific!)

  - How this might help: Show your thought process... qualitative or quantitative (or both!)
• Key Battles of the British Sector of the Western Front

  - The Battle of Arras (Apr 1917) - 160,000 British casualties

  - The Battle of Cambrai (Nov 1917) - first time tanks were used in significant force and first blood bank - 45,000 British casualties

  - Third Battle of Ypres (July-November 1917) - Infamous for quagmires which made evacuating casualties very difficult - 448,000 Allied casualties
• The Third Battle of Ypres/Passchendaele

  - Jul- Nov 1917

  - Allies advanced through four miles of mud later lost to the Germans

  - 448,000 Allied casualties

  - Battlefield was a quagmire of mud as a result of shellfire having destroyed the drainage systems and heavy rain made problem worse
• The Trench System


  Surprisingly complex system with three main types of trench.

  - Front line trench - 2.5m deep and 1m wide with soldiers spending approx 1 week in the front line. Soldiers were liable to being hit by enemy fire and sometimes their own artillery.

  - Support trench - Provided a second line of defence in case the front line trench was taken by the enemy. They also had first aid stations and kitchens to ensure front line men had medical treatment and hot food. Positioned a few hundred metres behind the frontline and were therefore safer.

  - Communication Trench - Used to move between the front and rear trenches. Also used to transport injured men to field hospitals.
• Front Line Trenches


  - Duckboards - wooden trench boards laid along the bottom of the trench to prevent ground becoming waterlogged.

  - Sump - narrow drainage channel underneath duckboards.

  - Firestep - Built in to enable men to see out of the trench and also climb up into no man's land

  - Barbed Wire - Barbed wire was used extensively, being laid several rows deep to protect the front line trench.

  - Dugout/Bolt Hole - Built into the sides of the trench to be used for protection, eating and sleeping.

  - Sandbags - Used to protect from enemy rifle fire and sometimes placed along the bottom of a trench to soak up water.
• Battle of Messines


  - June 1917

  - Most successful operation of the Western Front and precursor to Passchendaele - aim to recapture Messines Ridge.

  - 18 months of prep to dig 8,000m of tunnel and lay 22 mine shafts

  - Blew the crest off the Messines Ridge and killed 10,000 Germans in the explosion alone

  - German counter attacks were unsuccessful and significantly boosted morale for the allies
• Dangers facing tunnellers


  - Carbon monoxide poisoning (oxygen starvation) where candles would be used to measure oxygen levels. If the candle went out, it was time to leave!

  - Tunnel collapse (or explosion of mines already set leading to this).

  - Meeting enemy tunnellers who would have to be fought in hand to hand combat, blow you up or bury you alive.

  - Dangers led to development of the geophone - a pair of disc shaped microphones connected to earpieces so that enemy tunnellers could be spotted, before the British themselves were.
• Underground hospital at Arras

  - British WW1 field hospital abandoned in 1917

  - Could take in 700 casualties

  - Only in service or three days before a German shell hit the roof, collapsing it.
• Challenges of providing treatment underground

  - Risk of enemy shelling

  - Dark and dingy (difficulties in installing running water and electricity)

  - Difficulties moving supplies in - horse drawn railway was used

  - Difficult to achieve and maintain aseptic conditions
• Top five causes of illness

  - Pyrexia (fever of unknown origin)// high fever was often attributed to 'trench fever' which was spread by body lice: 97% of men infected

  - Inflammation of connective tissue (ICT)

  - Trench foot

  - Influenza

  - Scabies (infestation of mites in skin)
• Top five causes of injury

  - Shrapnel

  - Gunshot

  - Gas poisoning

  - Fractured femur (broken leg)

  - Wasp sting

  
  

  - Percentage of total deaths amongst British Army was 17.6%

  - Percentage of total injuries was 41.6%
• Brodie Helmet and Thomas Splint


  Two medical innovations which helped to reduce effects of injury...

  - Brodie Helmet was introduced as standard kit in 1915 and reduced head injuries by 75%

  - Thomas Split significantly reduced the death rate from a broken femur because it stabilised injury and controlled infection - following its introduction in 1916, the chance of death from this injury declined from 80%-20%. Was invented by Hugh Owen Thomas.
• RAMC (Royal Army Medical Corps)


  - The 'official' Army Medical Unit formed in 1898

  - Fought against centuries old culture of warfare where medical affairs were deprioritised

  - August 1914: 9,000 Warrant Officers and men of the RAMC compared to 113,000 by 1918

  - Initially provided inadequate care, but ability to cope improved as war went on.

  - Created RAMC Sanitary Sections which checked the sanitation of all barrack areas, cookhouses, billets etc.

  - Increasing realisation that speed was crucial and so Chain of Evacuation was set up.
• FANY (First Aid Nursing Yeomanry)


  - Voluntary Organisation who were a British all female registered charity formed in 1907

  - Leaders were Grace McDougall and Lillian Franklin

  - British Army wanted nothing to do with them and so funded their own ambulances and equipment.

  - Acted as a first aid link between the field hospitals and front line

  - Would rescue the wounded and administer first aid similar to a modern combat medic

  - Also set up their own hospitals and field stations, such as the Lamarck hospital opposite the Notre Dame.
• Challenges of Medical Treatment

  - Unprecedented Demand - as a result of machine gun fire and death on a scale never seen before

  - Limited resources - War disrupted supply chains + inadequate numbers of medics

  - The Working Environment - Stationary hospitals were hastily converted from schools and hotels. CCS were in muddy fields.

  - Challenging Attitudes - Medical care deprioritised and British Army did not allow female medics

  - Psychological Trauma - Constant exposure to blood and horrific injuries. Shell shock not just confined to soldiers.

  - Lack of Knowledge - No antibiotics for infection and lack of NHS meant fewer skilled professionals.
• Specific Challenges: Gunshot Wounds

  - Trenches protected soldiers' bodies, but left their heads vulnerable to enemy fire

  - Machine gunners could fire 600 rounds a minute, which wreaked havoc in the body, twisting tissue and splintering bone.
• Specific Challenges: Shrapnel


  - Biggest killer on the battlefield and cause of many facial injuries

  - Twisted metal shards produced from shrapnel blasts could rip a face off

  - Shrapnel's shape would often drag dirt into the wound

  - Was extremely difficult to locate and remove all pieces of shrapnel and control infection
• Specific Challenge: Wound infection

  - Fighting on farmland fertilised by manure meant wounds became infected quickly

  - Gangrene was rife and antibiotics not yet available

  - Sanitary section of the RAMC helped to combat this and carbolic lotion was used to wash wounds, which were then soaked in gauze

  - Another solution was debridement where tissue around the wound was cut away and the wound sealed
• Specific Challenge: Gas Attacks


  - Soldiers were terrified of gas attacks, even if only 9% of casualties in war were caused by gas... 3% as fatalities.

  - Chlorine - destroyed the victim's respiratory organs, bringing on choking attacks.

  - Mustard Gas - kill by blistering the lungs and throat if inhaled in large quantities and produced blisters all over the body.

  - Soldiers combated this by using cotton pads dipped in solution of bicarbonate of soda and held over the face.

  - Also used urine drenched cloths to put over their faces in an emergency.

  - Better prepared by 1918 when filter respirators (using charcoal as an antidote) became normal.
• Specific Challenge - Psychological Effects

  - Shell Shock (also known as war neurosis) is understood today as PTSD.

  - Symptoms include hysteria and anxiety, paralysis, limping and muscle contractions, blindness and deafness, nightmares etc.

  - By 1916, over 40% of casualties in fighting zones were victims of the condition and 80,000 cases passed through the British Army medical facilities during war.

  - Little sympathy at the time and it was thought to be a sign of emotional weakness and cowardice

  - Treatment was harsh and often included solitary confinement, electric shocks, physical reeducation or emotional deprivation.

  - Lucky ones received massage/rest/dietary treatments/sent home.
• Specific Challenge: Self Inflicted Wounds


  - Also known as 'blighty ones'.

  - Highly serious wartime military offence.

  - Often would be rifle shots to the hand or foot in the aim of being sent home.

  - Military authorities tried to trace injury back to wound which caused injury. If found guilty, men were sent to prison for lengthy periods.
• Triage


  The RAMC used triage to determine the level of care needed

  - Slightly Injured (quickly given treatment and then continued fighting)

  - Needs Hospital (transported by ambulance to nearest hospital base)

  - Beyond help (made comfortable, but little treatment was given as a priority to others. Sometimes killed by own men)
• Chain of Evacuation

  1 - Stretcher Bearers had most hazardous task of war removing dead and injured from no man's land, often under artillery or gas fire. Carried medical basics.

  2 - RAP was as basic as a dugout where basic first aid could be administered to either patch a soldier up, or send him on to the next stage.

  3 - Field Ambulance were half a mine from the front line. They were a tented area with two dressing stations - an advanced dressing station and a main dressing station. Still only limited treatment.

  4- CCS was 12 miles approx from the front line and had most things needed for the very sick e.g. operating theatres, medical and surgical wards. Approx 50 beds and 150 stretchers.

  5 - General/Stationary Hospital - Usually civilian hospitals or large buildings near railways. Quality varied considerably - could be a decayed convent, or a specialist centre for gas poisoning.

  6 - Railway - specially converted railway carriages taking soldiers home

  7 - Ships - converted passenger liners taking patients across the Channel for final leg

  8 - British Hospitals - most serious cases which attracted the best and most pioneering practitioners. Would deal with head and chest trauma, or those needed maxillofacial (mouth, jaw, face and neck surgery).
• Methods of transport

  - Human Stretcher Bearers - carried few medical supplies for short distances, but could get through quagmires.

  - Horse-drawn ambulances - relatively cheap and reliable and could carry people for longer than a stretcher bearer, but had the potential to get stuck in the mud and were slower than a mechanised ambulances.

  - Mechanised ambulances - fastest mode (Ford Model T had a top speed of 45mph) and could carry more supplies over a longer distance.
• Medical Innovation: Mobile X-Ray Unit

  - X-Ray discovered in 1895 by WC Rontgen

  - Military were some of the first to realise their potential.

  - Used by the military to locate shrapnel wounds so that surgeons could remove them quickly and prevent infection

  - Mobile X-Ray units were positioned to wherever there was most need.

  - Concept of protection from radioactive poisoning was non existent.
• Medical Innovation: Blood Transfusions

  - In 1900 Karl Landsteiner identified blood groups, - In 1907 Ludvig Hektoen notes benefits of matching blood groups for compatibility

  - In 1914 Richard Lewisohn shows sodium citrate to be an effective anticoagulant

  - Blood successfully transfused during WW1 because it was kept on ice for up to 28 days before being transferred to CCS.

  - Blood stockpiled before casualties arrived and Captain Oswald Robertson established the first blood bank on the Western Front in 1917 for the Battle of Cambrai.

  - Sodium Citrate was used to stop the blood from clotting

  - Stocked exclusively with blood group O (universal donor) and allied medical forces were given transfusion kits.
• Medical Innovation: Care of Amputees

  - Pre war: prosthetics are heavy and poor replacements for lost limbs

  - During war: Two American firms, Rowley and Hanger were invited by the government to open Queen Mary's Hospital where new prosthetics were developed and trialled on patients. Features included being lightweight, rustproof and with adjustable joints

  - Opening of hospital in Brighton for limbless soldiers - amputees would undergo 'educative convalescence' and learn how to overcome their injuries from children who were missing limbs.
• Medical Innovation: Plastic Surgery

  - Harold Gillies: plastic surgeon determined to restore function to facial features and an aesthetic result

  - Created the tube pedicle where tissue could be moved from A to B without fear of infection.

  - Despite innovations, disfigurements remained profound and patients often couldn't face going out in public

  - Faces were covered up and mirror removed in hospitals.

  - Nearby park benches painted blue especially for men with facial injuries.