ww1 medicine

• Rifles, explosives and shrapnel:

  • Discovered that of 200,000 wounded men admitted to CCS on the Western Front high explosive shells and shrapnel were responsible for 58% of wounds
  • Shells could kill or injure a soldier immediately
  • Machine guns could fire 450 rounds a minute. Their bullets could fracture bones or pierce organs.
• wound infection

  • When men were injured by shrapnel or bullets the metal would penetrate their body, taking the fabric of the uniform with it.
  • Was no cure for gas gangrene.
  • The bacteria for gas gangrene spread through the body quickly and could kill a person within a day.
• head injuries

  • Brodie Helmet was trialled in 1915 to protect against head injuries
  • Is estimated that it reduced fatal head wounds by 80%.
  • The helmet was then provided to all soldiers fighting on the Western Front.
• gas attacks

  • Only 6,000 British soldiers died as a result of gas attacks.
  • Chlorine- First used by the Germans in 1915 at the Second Battle of Ypres, Led to death by suffocation.
  • Phosgene- First used at the end of 1915 near Ypres. Similar effects to Chlorine but was faster acting, killing an exposed person in 2 days
  • Mustard- First used in 1917 by the Germans. Was an odourless gas that worked within 12 hours. Caused internal and external blisters and could pass through clothing to burn the skin
• horses

  • August 1914- the BEF decided not to send any motor ambulances to France.
  • Instead used horse-drawn ambulance wagons.
• horses- positives

  Could access areas motor ambulances could not
• horses- negatives

  • Men were shaken about, which made their injuries worse
  • Lack of transport led to soldiers being left to die or being taken prisoner
• trains

  November 1914- the first ambulance train designed for carrying wounded soldiers arrived in France.
• trains- positives

  • Some trains contained operating theatres
  • Space for stretches on both sides of the carriage
• trains- negatives

  • Concern that moving injured on the railways damaged the war effort as there were too many trains moving around on the rail network
• canal burges

  Concerns about the disruption to the rail network led to the decision to make use of canal barges to transport the wounded to Base hospitals.
• canal burges- positives

  • Comfortable journey for soldiers
  • Could be transferred directly onto ships transporting men back to Britain
• canal burges- negatives

  • Journey was slow
• 1. stretcher bearers

  4-8 men would recover the dead and wounded during breaks from fighting. Carried basic medical supplies. There were 16 per battalion of 1,000.
• 2. regimental aid post

  • Close to the front and would move forward when casualties were expected
  • Would bandage light wounds with dressings and men would go back into action.
• 3. field ambulance and dressing station

  • Mobile unit with medical officers, support staff and nurses
  • In tents or derelict buildings
  • Would receive wounded from RAP and triage them.
• 4. casualty clearing station

  • Would be in large tents or schools and factories.
  • Had 12 doctors with nurses.
  • From 1917 started performing more operations than hospitals
  • Had beds for 50 and could deal with 1,000 casualties at a time, but usually had more.
• 5. Base hospitals

  • Civilian hospitals or large converted buildings near railways so patients could be moved quickly.
  • In 1918 had 2,500 patients.
  • Had operating theatres, labs and x-ray departments. Some had specialist centres i.e. Rouen for victims of gas attacks.
  • Most sent back to England from here, but some did go to recovery wards and returned to fight.
• new techniques- wounds

  • Cutting away of dead, damaged and infected tissue from around the site of the wound.  Needed to be done as soon as possible because infection
  • amputations- By 1918 – 240,000 men had lost limbs because it was the only way to prevent the spread of infection and death
  • the Carrel-Dakin method involved using a sterilised salt solution in the wound through a tube.
• new techniques- thomas splint

  • In 1914-15, men with a gunshot of shrapnel wound to the leg only have 20% chance of survival because the wounds created a compound fracture
  • Robert Jones and Hugh Thomas designed a splint to stop joints from moving – the Thomas Splint.
  • This increased the survival rate for this type of wound from 20% to 82%.
• new techniques- mobile x ray units

  • X-rays were used to identify shell fragments and bullets in wounds which could otherwise cause infection.
  • Problems- Tubes used in the machines were fragile and overheated quite quickly meaning that the machine could only be used for about one hour at a time
  • Base Hospitals and large CCS had static x-ray machines.
• new techniques- blood

  • Use of blood transfusions from 1915 in the British sector of the Western Front was pioneered by Robertson.
  • He used the indirect method, where a syringe and tube was used to transfer the donor to the patient.
  • Purpose of this was to stop the patient going into shock through blood loss before surgery.
  • 1916, Rous and Turner found that adding citrate glucose could store it for up to 4 weeks.
• head injuries

  • About 20% of all wounds in the British sector of the Western Front were to the head, face and neck, as this was the most exposed.
  • Injuries could be caused by both bullets and shrapnel
• plastic surgery

  • Harold Gillies developed work into plastic surgery.
  • This was important as head injuries that might not kill, could cause severe disfigurement.
  • August 1917 – key hospital providing this surgery was Queen’s Hospital in Kent.
  • By the end of the war, nearly 12,000 operations had been carried out.
• plastic surgery- positives

  • Were able to replace and restore parts of the face that had been destroyed.
  • Just after a year after Queen’s Hospital opened, nearly 12,000 operations had been carried out.
• plastic surgery- negatives

  • Gillies had no background in this type of surgery so had to devise new operations to deal with problems as they confronted him
• brain surgery

  • Injuries to the brain were likely to prove fatal at the beginning of the war due to: The issue of infection, Difficulties in moving men, Very few doctors had experience of neurosurgery before the war
  • Harvey Cushing developed new techniques in brain surgery
  • Cushing operated on 45 patients in 1917 with an operation survival rate of 71%.
• brain surgery- positives

  • Cushing operated with a 71% survival rate.
  • Improved understanding in head injuries and surgery.
• brain surgery- negatives

  • Inexperience of doctors in dealing with head wounds.