Western front

• Chain Of Evacuation


  1. Front-line trench

  2. Regimental Aid Post

  3. Aid Dressing Station

  4. Main Dressing Station

  5. Casuality Clearing Stations

  6. Base Hospitals
• Regimental Aid Post


  Had medical officers, stretcher bearers and could perform basic first aid
• Aid/Main Dressing Station


  Held in abandoned buildings, staffed by field ambulances (230 men could care for 150 casualties), stayed for 10 days
• Casualty Clearing Stations

  Carry out surgery, were usually in factories or schools, Triage (send back to front line, send to base hospital, or left to die)
• Base Hospitals


  Most complex surgery, brain, and plastic surgery, near coast for transportation
• RAMC

  Operated the army medical unit, 1918 –13000 officers, moved soldiers along the chain of evacuation, staffed the stages of the chain, divides into units called field ambulances
• FANY

  Made up of female medical staff
• FANY offered to help the BEF(british) but were refused due to sexist attitudes
• FANY worked with Belgian troops
• In 1916, Brits allowed FANY to help, drove ambulances, paved way for future women
• Trench foot


  Rotting of feet due to humidity – used whale oil on feet's and changed footwear regularly, led to painful swelling of feet, gangrene can set in, amputation was the only solution
• Trench fever

  Caused by lice – flu like symptoms, hot temperatures, headache, aching muscles, there were delousing stations
• Shellshock

  Deterioration of mental health – 80000 soldiers suffered, thought to be cowardice, led to tiredness, headaches, nightmares, shaking, depression
• Chlorine Gas

  Easy to counter with damp cloth, urination was a good deterrent, gave off a green cloud of smoke, irritated eyes, nose, throat, mouth, asphyxiation
• Phosgene gas

  1915 – colourless, irritated eyes, nose, throat, symptoms took 24 hours to manifest
• Mustard Gas

  Hung in the air, caused yellow blisters, irritated skin, most effective gas
• Shells and shrapnel caused 58% of wounds, 39% from bullets, 60% of injuries were in arms and legs
• Rifles took clothing in with bullets – make infection easier
• Germ theory

  Gave Lister the idea to use carbolic acid, caused aseptic surgery and made medical staff wash their hands before coming into surgery
• Rubber gloves and gowns


  Were being used and surgical instruments were sterilised before surgery
• x-rays

  Found and radiology advanced, were large and difficult to move, glass tubes were used to take the x-ray, glass tube was fragile, took 90 mins, released a lot of radiation
• Blood transfusions


  James Blundell – first ever blood transfusions, 1901 – three major blood groups discovered, and that blood groups had to match before transfusions, had to be direct until sodium citrate was discovered, and it successfully stored blood
• Wound Excision


  Cutting away of dead skin, done quickly to avoid infections, wound had to be stitched up
• Carrel-Dakin Method


  Carbolic acid was ineffective against gas gangrene, way of applying saline solution through tubes while operating
• 1918 – 240000 soldiers were amputees, led to creations of prosthetic limbs
• Thomas Splint


  The splint immobilised the hips or femur to allow bone to set – death rates dropped
• 1. rays

  Detected the exact position of bullets in wound, waiting time is reduced, base hospitals had static x rays, patients had to sit for several minutes, and fragile tubes that easily heat up had to be changed constantly
• 1917 – more advanced x-ray tubes are made
• Blood storage


  1915 – discovered the optimum amount for sodium citrate to store blood, 1915 - Blood with sodium citrate can be refrigerated for 2 days, 1916 – blood can be stored for 4 weeks be adding a citrate glucose solution
• Portable blood transfusion kit


  Made for the front line, blood transfusions given by a syringe – a new indirect method, stopped patient going into shock through blood loss
• Brain Surgery

  20% of injuries were to the face neck and head - caused by bullets and shrapnel, risk of infection, brain damage from movement, lack of neurosurgeons, electromagnets used to extract fragments of shrapnel, used the gather local rather than general anaesthetic, 71% survival rate
• Plastic Surgery


  1917 – new hospitals were made devoted to facial repairs, over 1000 beds and 11000 operations, used skin graft to fix bullets and shrapnel wounds
• British Sector of the Western Front

  • Three lines of trenches - front line trench (where most the fight took place), support trench (the backup trench), reserve trench (line of last defence), all connected by communication trenches, behind reserve trench there was artillery, there was machine gun bunkers, dugouts or living quarters, barbed wire so opposing soldiers could not get into trenches
• Second battle of Ypres

  Lasted 1 month – 59000 casualties, first use of chlorine gas used by Germans
• Battle of Somme


  55000 casualties in one day, 450000 casualties for the British, first use of creeping barrage – many artillery shells were fired at Germans, first use of tanks
• Battle of Arras

  160000 British causalities, site if complex underground hospital built by miners, could take in 700 casualties and a few meters away from the front line
• Problems of transporting wounded soldiers

  • Bad terrain, motorised vehicles were not popular, bad weather conditions, constant shelling left craters, lots of fertiliser in soil that had bacteria, stretcher bearers were used to transport men, but this was not effective as there were too many casualties, British army only have horse drawn ambulances – an appeal was made for motorised ambulances, wounded men were starting to be transported by train, soldier began to be transported by canals