Western Front

• The Trench System

  • Frontline trench: where attacks would be made from
  • Support Trench: About 80 metres behind the frontline trench and troops could retreat here is frontline trench was under attack
  • Reserve Trench: At least 100 metres behind support and was where reserve troops could be mobilised for a counter-attack if the frontline trench was captured by the enemy.
  • Communication Trench: ran between the other trenches
• Features of a Trench:

  • Parapet: top of the trench
  • Periscope: useful for spying on the enemy
  • Dug out: holes in the side of trenches for taking shelter and rest
  • Duckboards: stop water + mud
  • Fire step: Stood on to fire over the trench
  • Wooden Support- used to stop the trench from falling
  • Sandbags- protect soldiers from bullets and bombs
  • Soldier: 1 week in frontline, 4 weeks in support, 8 weeks in reserve

  
• The First Battle of Ypres (12th Oct-11th Nov 1914)

  • British lost 50,000 troops
  • Germans captured Hill 60 (a man made hill south-east of Ypres), the British dug tunnels and placed 5 mines underneath, which allowed the British to take the hill when they exploded.
  • Digging tunnels was very dangerous- many died
• The Second Battle of Ypres (22 April- 25 May 1915)

  • British lost 59,000 men
  • Germans moved 2 miles closer to the town of Ypres
  • First use of chlorine gas by the Germans
• The Battle of the Somme (1st July-November 1916)

  • British had 57,000 casualties and 20,000 deaths on the first day
  • British suffered over 400,000 casualties
  • First use of Tank Warfare
  • Creeping barrage- artillery launched ahead of the British infantry as it advanced
• The Battle of Arras (April-May 1917)

  • 24,000 men hiding in tunnels attacked German trenches
  • Aim to break through the German lines - advanced 8 miles in first few days, but then no further
  • 16,000 British and Canadian casualties
  • Created underground networks using existing tunnels, caves and quarries to shelter from the German attacks- also worked for underground movement
  • Up to 25,000 men could be stationed in the tunnels
• The Third Battle of Ypres (31st July- Nov 1917)

  • Aim to break out of the Ypres salient + remove German advantage
  • Launched main attack on 31st July
  • Advanced 2 miles on first day
  • Weather turned into rain and waterlogged the ground- many well fell into the mud and drowned
  • Moved the edge of the salient back by 7 miles
  • 245,00 casualties
• Salient: an area of a battlefield that extends into enemy territory, so that it is surrounded on three sides by the enemy and is therefore a vulnerable position.
• The Battle of Cambrai (20th Oct- 6th Dec 1917)

  • First large-scale use of tanks- nearly 500 used, easily moved across the barbed wire
  • Artillery barrage changed to give Germans less warning of the attack
• Shellshock

  • Symptoms: tiredness, headaches, loss of speech, uncontrollable shaking
  • 80,000 British troops experienced it
  • Solutions: sending them back to Britain
  • They were often accused of cowardice and many were punished and shot
• Trench Fever

  • Symptoms: flu like, high temperature, headache, aching muscles
  • Affected half a million men
  • Solutions: delousing stations were set up and number of cases declined
  • 1918: caused identified to be contact with lice
• Trench Foot

  • Symptoms: swelling of feet, caused by cold mud and water, gangrene set in in the second stage
  • Solution: Prevention- rubbing whale oil into feet to protect them, keep feet dry and regularly checking them
  • If gangrene set in amputation was needed to stop it spreading
• Gangrene: the decomposition of the body tissue due to loss of blood supply
• Effects of Gas Attacks

  • Caused great pain and fear
  • NOT a major cause of death, only 6,000 British died
  • Gave out gas masks
• The Nature of Wounds: Rifles and Explosives

  • Over 200,000 wounded men admitted to Casualty cleaning stations
  • High-explosive shells and shrapnel responsible for 58% of wounds
  • Everyone in the way of shrapnel were likely to be wounded
  • 60% of injuries to arms and legs
  • Bullets responsible for 39% of wounds
  • Machine guns could fire 450 rounds a minute and fracture bones or pierce organs
• Shrapnel, Wound infection and Head Injuries

  • The soil contained bacteria for tetanus and gas gangrene- when wounds exposed infection was very likely, bacteria for gas gangrene spread very quickly and could kill a person in a day
  • Beginning of war soldiers wore a soft cap
  • Then a Brodie helmet: steal with a strap which reduced head wounds by 80%
• Train, Barrage and Ship Ambulances

  • Wounded might be transported by train or canal in the final stage of their evacuations
  • 1914: First ambulance train in France- had space for stretchers down the sides and later contained operating theatres
  • Canal barrage's journeys were slower but more comfortable
• Problems of Transport and Communication

  • Landscapes full of craters and holes caused major transport problems
  • Bacteria in soil infected wounds
  • Stretcher bearers carried the wounded, but had to expose themselves to shelling and gunfire
  • Further away from the frontline the easier to carry out medical procedures
• Horse Drawn and Motor Ambulances

  • Horse drawn ambulance wagons couldn't cope with the large numbers of casualties
  • Wagons were shaken about making injuries worse
  • Led to soldiers being left to die to taken prisoner by Germans
  • Appeal raised money for 512 motor ambulances
  • Motor ambulances couldn't operate in muddy conditions so horse-drawn continued to be used
  • In bad terrain 6 horses rather than 2 pulled ambulances
• RAMC-Royal Army Medical Corp: The branch of the army responsible for medical care and was founded in 1898
• FANY-First Aid Nursing Yeomanry: Founded in 1907, the first women's voluntary organisation to send volunteers to the Western Front. It provided frontline support for the medical services (e.g driving ambulances)
• The Evacuation Chain

  1. Regimental Aid Posts (RAP)
  2. Dressing Stations
  3. Casualty Clearing Stations (CCS)
  4. Base Hospitals
• Phosgene Gas

  • First used at the end of 1915 near Ypres.
  • Effects were similar to those of chlorine but it was faster acting, killing an exposed person within two days.
• Mustard Gas

  • First used in 1917 by the Germans.
  • It was an odourless gas that worked within 12 hours, causing both internal and external blisters and could pass through clothing to burn the skin.
• Chlorine Gas

  • First used by the Germans in 1915 at the second battle of Ypres.
  • It led to death by suffocation.
  • The medical services had no experience in dealing with gas attacks, and so had to experiment with treatments.
  • Gas masks were given to all British troops in July 1915. Before this, soldiers developed their own system of gas masks. They soaked cotton pads with urine and pressed them to their faces to help stop the gas entering their lungs.
• Regimental Aid Post (RAP)

  • Located with in 200m of the frontline
  • Wounded men would walk or be carried by other soldiers
  • The purpose was to give immediate first aid and to get men back to fighting
  • It could not deal with serious injuries
• Dressing Stations

  • Advanced dressing stations (ADS) about 400m from the RAP and main dressing stations (MDS)
  • Located in abandoned buildings, bunkers or dug outs to be protected from enemy shelling
  • Staffed by 10 medical officers, medical orderlies and stretcher bearers
  • They would either walk or be carried on stretchers
• Casualty Clearing Stations (CCS)

  • Located a sufficient distance from the frontline to provide safety but close enough for an ambulance.
  • Set up in buildings such as factories or schools and were often by railway lines
  • Sorted wounded into 3 groups: Walking wounded- men who could be patched up and then return to the fight, those in need of hospital treatment- needed to be transported to a base hospital once treated for any immediate life threatening injuries. Severely wounded, no chance of survival- were made comfortable, but given less medical resources.
• Base Hospitals

  • Near French/Belgium coasts- close to ports to be transported home
  • Treated until could be returned to Britain for further treatment or return to the fight.
  • CCS started doing the operations that should be done at base hospitals
  • Experimented with new techniques, once successful sent to CCS
  • Tunnels under the town of Arras- fully working hospitals closer to the frontlines- waiting rooms, 700 spaces for stretchers, operating theatre, mortuary, electricity and water supplied to hospital.
• Aseptic Surgery

  • Medical staff had to wash their hands, face and arms before entering the operating theatres
  • Rubber gloves and gowns were worn
  • Use of stream sterilisation
• The underground hospital at Arras

  • 800 m of tunnels
  • It was sometimes called Thompson’s Cave
  • A waiting rooms for the wounded
  • 700 spaces where stretchers could be placed as beds
  • An operating theatre
  • Rest stations for stretcher bearers
  • Mortuary to lay out the dead
  • Abandoned during the Battle of Arras in 1917-hit by a shell which destroyed the water supply, but luckily did not injure any people.
• X-Rays


  Accidental development

  • Wilhem Roentgen was studying the effects of passing an electrical current through glass tube covered in black paper and a screen a metre away from the equipment began to glow.
  • Called these rays 'x'
  • Could penetrate many objects
• Limitations of X-Rays

  • High exposer to radiation and patients could lose hair or suffer burns
  • Glass tube was very fragile- could break easily
  • X-ray of a hand took about 90 mins
  • Large x-rays were hard to move
• Blood Transfusions

  • James Blundell did the first experiments into transfusions
  • 1818: helped a woman who lost blood when giving birth
  • 1818-1829: carried out 10 transfusions and half survived
  • Developed many techniques
  • However blood couldn't be stored so carried out with the donor being directly connected to the recipient by tube.
• Limitations of Blood Transfusions

  • Blood clots as soon as it leaves the body and the tubes which transferred blood could become blocked
  • Rejection of the blood when the donor/ recipient's blood was not compatible.
  • Danger of infection from unsterilised equipment.
• New Treatments

  • Wounds and Infections
  • Thomas Splint
  • Mobile X-rays
  • Blood Transfusions
  • Blood Banks at Cambrai
• Wounds and Infection

  • Wound excision or debridement: cutting away of dead, damaged and infected tissue from around the site of the wound.
  • Amputation: To stop the spread of infection-by 1918 240,000 men had lost limbs
  • The Carrel-Dakin method: involved using a sterilised salt solution in the wound through a tube, but the solution only lasted for six hours and so had to be made as it was needed
  • This helped to stop infections spreading
• Thomas Splint

  • Men with gunshot/shrapnel wounds to leg only had 20% survival rate
  • The splint used to transfer the wounded man didn't keep the leg rigid- lost lots of blood
  • Robert Jones + Hugh Thomas designed a splint to stop joints moving
  • Increased survival rate from 20% to 82%
  • Lost less blood
• Mobile X-Rays

  • Identified shell fragments/bullets in the wouds
  • Could not detect all objects in the body
  • Took a long time
  • Tubes were fragile and overheated quickly- could be used for an hour and then left to cool down
• Blood Transfusions

  • Administered in the CCS as a routine measure in the treatment of shock in 1917
  • Geoffrey Keynes designed a portable blood kit, but it didn't use stored blood, but there was a device to regulate the flow of blood and helped prevented clotting.