Medicine Through Time: The British Sector of the Western Front, 1914-1918

Key events Key words

August 1914 War begins FANY First Aid Nursing Yeomanry. Helped Neurosurgery Surgery carried out on the nervous
the French & Belgians, but used by system, especially the brain and
Aug-Sept 1914 First trenches dug Britain after 1916 for ambulance spine
driving, nursing duties, and cleaning
Oct-Nov 1914 First Battle of Ypres
RAMC Royal Army Medical Corps Ypres The area around Ypres. An important
Winter 1914-15 First cases of trench foot
responsible for army medical care. Salient but vulnerable part of the Allied line
January 1915 First investigation of ‘shell shock’ Ranged from doctors to ambulance (a bulge surrounded by Germans in
drivers and stretcher-bearers higher positions overlooking them)
April-May 1915 Battle of Hill 60 & Second Battle of Ypres
Radiology Another word for X-ray department. Universal This blood group can be used in a
September 1915 Brodie helmet used (80% less head injury deaths) department Found at base hospitals and some blood group transfusion to a recipient with any
large casualty clearing stations other blood group
March 1916 Construction of Arras underground hospital
July-Nov 1916 Battle of the Somme Local anaesthetic Pain relief which numbs only the General Pain relief which puts a patient to
specific area of the body being anaesthetic sleep during an operation
April-May 1917 Battle of Arras
injected. This means that the
July-Nov 1917 Third Battle of Ypres patient is awake during the
operation
October 1917 Trench fever enquiry finds lice as the cause
Shrapnel Metal from a bomb or shell thrown Triage The dividing of patients according to
Nov-Dec 1917 Battle of Cambrai out after an explosion how seriously injured they were
May 1918 Delousing pits widely established
The Trench System on the Western Front Conditions and Transportation
Key Battles Frontline: attacks were made from here. Most dangerous area Craters: shelling created holes which also flooded when raining.
nearest the enemy and shelling (⅓ died). 15% of a soldier’s time. Soil: bacteria in fertilised farmland (a cause of gas gangrene).
The Battle of Ypres (three battles in 1914, 1915, and 1917): maintained Support: 80m behind the frontline and safer. 10% of their time. Traverses: zig-zag trench pattern were narrow and clogged.
control of the English Channel ports. German use of chlorine gas. Very Reserve: 100m behind the support and safer. Counter-attacks No Man’s Land: collecting casualties was dangerous under fire.
muddy,waterlogged trenches,and craters made it hard to access causalities. were made from here. 30% of a soldier’s time.
The Battle of the Somme, 1916: largest British battle in WWI. Led to Communication: connects the trenches and used for transport. Stretcher bearers: 16 for every 1000 men. Normally 4 men
400,000 casualties. Use of creeping barrage and tanks increased casualties. Artillery: at the very rear. used, but 6/8 needed in muddy conditions to carry a casualty.
Dugout: holes for cover and rest. Horse ambulance: used due to the muddy terrain. They made
The Battle of Arras, 1917: 25,000 men could be stationed in tunnels. injuries worse due to shaking. Usually 2 horses were used, but 6
Britain built an underground Hospital with 700 beds, electricity, running were needed in the worst terrain.
water, a railway system, and an operating theatre. Over 150,000 casualties. Ambulance cars: shortage at the start of war. Red Cross raised
The Battle of Cambrai, 1917: first large-scale use of tanks (over 450). Little money for 512. Hard to drive as many roads were destroyed.
artillery shelling beforehand meant the chalky ground was easier to cross. Trains & barges: transported the wounded to base hospitals.
 Medicine Through Time: The British Sector of the Western Front, 1914-1918
Injuries Care Treatment
Trench foot Royal Army Medical Corps (RAMC) Mobile X-ray units
Major problem caused by standing in waterlogged Responsible for medical care. Its responsibilities included keeping men 6 mobile vans were used throughout the British sector of the
trenches with no change of boots/socks. It could lead to healthy, through good sanitation but their main role was in treating the western front to identify bullets/shrapnel. There were a number of
gangrene and amputation. Prevention was key! 3 pairs of wounded and the sick. In 1914 = 9000 men; by 1918 = 113,000. weaknesses such as timing, poor quality, overheating, and that
socks given, changed twice a day. Whale oil rubbed into First Aid Nursing Yeomanry (FANY) they could only be used 3 times an hour.
feet. Foot buddies set up. Water pumps used but limited.
The first 6 women went in 1914, but the British didn’t use them. They Blood transfusions
Gas attacks (only 6.000 deaths) helped the French and Belgians, until the British accepted them in January 1915: first blood transfusions at base hospital, human to human.
Chlorine: Death by suffocation. Irritates eyes and 1916. They never numbered more than 450. FANY helped by driving 1915: Lewisohn added sodium citrate so blood could be stored
lungs. Soldiers soaked cotton pads in ambulances, delivering supplies, and even had a mobile bath vehicle.
Ypres 1915 1915: Keynes created a portable blood transfusion kit that could
urine and put it onto their faces, before
The chain of evacuation store blood and be used on the front line which reduced shock.
the introduction of gas masks in July.
1916: Rous & Turner added glucose citrate. Storage = 4 weeks.
Phosgene: Similar to chlorine gas but faster acting. It Regimental Within 300 m of frontline, gave immediate first aid but
1917: blood transfusion stations as CCS, massively helped.
Aid Post (RAP) basic aim to send men back to the fighting. Men often
Ypres 1915 killed a person in 2 days, but had no 1917: first blood bank at Cambrai, 22 units of blood saved 11 lives.
symptoms until suffocating 2 days later. walked there or were carried by other soldiers.
Advanced Within 400m of RAP, in a tent or shelter, could deal with Thomas splint
Mustard: Odourless gas. 12 hours = internal and Dressing 150 men. 10 medical officers but no surgery. This was part In 1914 men with leg injuries had a small chance of survival (20%).
Ypres 1917 external blisters, burns through clothes. Station (ADS) of the field ambulance (not the vehicle type!). The existing splint made things worse, due to the rough terrain. In
Shell shock Causality 7 miles from the frontline. Often near a railway line, 1915 the Thomas Splint was invented which kept the leg straight
clearing contained doctors and operating theatres, x-ray machines so the bone healed in the correct position, survival rates increased
Included tiredness, nightmares, loss of speech, and could deal with 1000 men. Used a triage system, with from 20% to 80%.
uncontrollable shaking, and complete mental breakdown. station (CCS)
30% operated on. Most important place after 1916. Brain surgery
80,000 British troops experiences shell shock. It was not
understood at the time, some were treated in Britain Base hospitals Near ports in France/Belgium, large hospitals with all Injuries to the brain were almost always fatal in WWI due to lack of
while others were accused of cowardice and shot. equipment and some specialist ones for gas/head injuries. experience/infection. Harvey Cushing pioneered new ideas:
Trench fever Arras Underground hospital built in 1916. 700 beds, operating • Development of magnets to remove metal fragments
theatre, water supply. Dressing station close to fighting. • Local anaesthetic to avoid brain swelling in surgery
Flu-like symptoms with high temperature, headache, and • After surgery, patients remained in the CCS for 3 weeks
aching muscles affecting 500,000 men. By 1918 lice were 20th century developments
• Specialist CCS Mendingham used for all brain injuries
found to be the cause and after this delousing stations
were set up and cases declined. Fumigation was also used. Antiseptic Difficult to carry out aseptic surgery in contaminated Plastic surgery
surgery conditions. Use of debridement or Carrel-Dakin method. Harold Giles pioneered plastic surgery in WWI:
New injuries Blood Landsteiner discovers blood groups in 1901, but it could • Set up specialist Queen’s Hospital in Kent, 1917
Shells and shrapnel: caused 58% of wounds. transfusions not be stored so had to be donor to recipient. • Using skin grafts
Bullets: responsible for 39% of wounds. X-rays Discovered by Rontgen in 1895, but they were not portable • Using jaw splints, wiring and metal replacement cheeks
Gas gangrene: could not be cured and spread rapidly. and were slow to use. • 12,000 operations done were carried out within a year