History Medicine - Western Front

First started when John Lister used carbolic acid to prevent infection in surgery in1865.

Features:

• All medical staff had to wash their hands, faces and arms before entering the operating theatre.
• Rubber gloves and gowns were worn, decreasing the rate of infection
• The use of steam sterilisation. A machine called an autoclave was invented in 1881 which sterilised surgical instrumentsin boiling steam.
• The air was sterilised by being pumped over the heating system to kill germs.
• Surgeons and nurses wore masks to prevent breathing infection into a wound.

In 1895, when Wilhelm Roentgen covered a test tube in black paper he was suprised to find that rays from the tube lit up a screen. He experimented and found out that these rays could pass through many objects, including human flesh but couldn't pass through bone. He then put photographic paper between the tube and his hand to create the first x-ray image.

Radiological departments were opened the following year and were used to diagnose embedded objects and bone problems.

Problems with early x-rays:

• Photography was still at an early stage so taking x-rays required the patient staying still for a long time.
• Doctors did not understand the dangers of radiation so high doses of radiation was released which caused burns and hair loss.
• Large machines were too heavy to be moved around easily.

In the 17th century, doctors carried out blood transfusuions from animals to humans but people rarely survived.

James Blundell performed the first human to human blood transfusuions between 1818 and 1829. He developed useful techniques and equipment but there were problems. Blood had to trasferred directly from donor to the recipient as it could't be stored, and only about half the recipients survived.

In 1901, Karl Landsteiner discovered three blood groups but in 1902 his colleagues found a fouth group. They discovered that transfusions would only work between people of the same blood group.

First Battle of Ypres, October - November 1914:

The British managed to hold on to Ypres, which was vital in maintaining access and control the English Channel ports, but the Germans gained ground.

Battle on Hill 60, April 1915:

The British tunnelled into and under the hill and exploded five mines from the tunnels, which enabled them to take the hill.

Second Battle of Ypres, April-May 1915:

The Germans made very slight gains towards Ypres. The battle was notable as it was the first time chlorine gas was used. It was first used by the Germans.

The Somme, July-November 1916:

Notable for extremely high casualties on both sides, that battles on both sides of the Somme saw two new strategies by the British - the creeping barrage and the first use of tanks - but these had little impact

Arras, April-May 1917

In 1916, the British linked and expanded the underground tunnels, quarries and caves for the shelter and movement of troops. The tunnels, quarries and caves for the shelter and movement of troops. The tunnels were used to  launch the battle, which was initially successful but ended with little progress and high numbers of casualties on both sides.

Third Battle of Ypres, July-November 1917

The British used a creeping barrage to small gains to break out of the Ypres Salient. The awful weather left thr ground waterlogged and many drowned.

Cambrai, November-December 1917

This battle was notable for the first large scale use of tanks, which were successful but were not backed up so the british were forced back.

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Gas attacks were greatly feared but were not a majr cause of seath. The caused (mostly temporary) blindness and coughing, and also burns. In July 1915, gas masks were given to all British troops. Before this, they protected their faces with cotten pads soaked with urine.

Head Injuries were unexpectedly common and were mostly caused by shrapnel. By late 1915, the soldiers' soft caps were replaced by Brodie helmets, which reduced head wounds.

Shell shock caused a wide range of symptoms, including a total mental breakdown, Some sufferers were accused of cowardice. Many were treated close to the Front but some were evacuated to British hospitals

Bullets from rifles and machine guns could penetrate organs and fracture bones.

Trench fever produced flu like symptoms, which could last for months and keep reoccuring. It was caused y lice so, in 1918 troops were deloused, which reduced cases.

Trench foot was caused by standing in waterlogged trenches. It could lead to gangrene, treated with amputation. To try and protect troops' feet, they were given whale oil and spare socks, pumps were used to drain trenches and duckboardss were added for soldiers to keep their feet above the water.

High-explosive shells and shrapnel were responsible for most deaths and injuries, removing limbs and causing major internal injuries.

Specific Injury Problems

Some injuries had rarely been seen before, while others had never been seen on this scale. All weapons, but particularly explosions, could cause major blood loss. Bullets and shrapnel had to be located and then removed. Extensive head wounds required brain surgery and/or facial reconstruction.

Wound Infection:

This was a major problem as soil on the Western Front contained tetanus and gas gangrene bacteria. These would enter wounds either during attack, or when victims were lying on the ground before being collected. From late 1914, tetanus injections were given but there was no prevention for gas gangrene.

1. The Regimental aid Post was close to the front line. The Regimental Medical Officer was helped by stretch-bearers in administering first aid. He sent more serious injuries on to the next stage.

2. The Field Ambulance was a mobile medical unit of the RAMC, which set up dressing stations. They were about a mile back from the front line in derelict buildings, dugouts or tents. These stations were staffed by medical officers, orderlies and stretcher-bearers and, from 1915, som nurses. Thy could look after men for a week. Serious cases were sent straight to the CCS.

3. Causualty Clearing Stations were larger and better equipped, were situated in buildings several miles from the front line, and were staffed by doctors and nurses who prioritised treating life-threatening injuries to men who had a chance of survival. They became the most important place for efforts to reduce risk of infection until March 1918, when base hospitals regained that role.

4. Base Hospitals were situated near ports on the coast. They had many medical staff, including doctors who specialised in certain treatments. Patients could stay for some time before returning to the front or being sent home by ship for further treatment.

RAMC

The Royal Army Medical Corps. This branch of army was responsible for medical are and was formally founded in 1898.

FANY

First Aid Nursing Yeomanry. Founded in 1907, this was the first women's voluntary organisation to send volunteers to the Western Front. It provided frontline support for the medical services, for example driving abulances and engaging in emegency first aid.

The first 6 FANYs arrived in France on 27 October 1914. However, the British refused to make use of them so they devoted their energies to helping French and Belgium troops.

Finally, in Januarly 1916, the British army decided to allow FANYs to drive ambulances. They became the first women to carry out this role.

In November 1916, tunnelling began under the town of Arras. In 800m of tunnels, a fully working hospital was created so close to the front line that, in reality, it was actually a dressing station.

From here, wounded soldiers would move through the chain of evacuation. It was sometimes called Thompson's cave after the RAMC officer who was responsible for equipping it.

There were waiting rooms for the wounded, 700 spaces here stretchers could be placed as beds, an operating theatre, rest stations for the stretcher bearers, and a mortuary to lay out the dead.

Electricity and piped water were supplied to the hospital.

The hospital was ambandoned during the Batlle of Arras in 1917, when it was hit by a shell which destroyed the water supply, but luckily did not injure anyone.

• Difficult terrain meant that in some places only stretcher bearers and horse wagons could be used.
• Many roads and railway lines had been destroyed.
• Constant shelling and artillary fire made recovery of the injured very difficult.
• Initially, no motor ambulances were sent and there were not enough horses to cope. Public appeal in Britain raised money for 512 motor ambulances.

The Thomas Splint

From December 1915, the Thomas Splint was widely used and reduced the death rate from broken limbs to fewer than 20%. This was because the splint kept the leg rigid whch reduced blood loss. Previously, 80% of soldiers with broken legs died.

Mobile X-Ray Units

X-rays were essential in locating bullets and shrapnel before operating. Static machines were used in base hospitals from 1914 and in some Casualty Clearing Stations. Mobile units were used closer to the front and their numbers increased as the war went on. Their images were not as clear as those from the static machines but still prevented many deaths.

Advances in Surgery

The number of brain injuries during the war led to the development of new surgical techniques and improved the success rate. The large number of facial injuries led to huge improvements in plastic surgery, led by harold Gillies who worked at the Queen's Hospital in Kent.

Antiseptic and aseptic surgery was not possible in Dressing Stations and Casualty Clearing Stations, and many wounds were already infected by the time patient was operated on.

Surgeons went back to using chemicals to kill bacteria but this didn't work against gas gangrene.

By 1917, the Carrel-Dakin method, in which sterilised salt solution was moved through the wound using tubes, was found to be more efective.

This didn't work when infections were very deep in the body, so surgery was developed to remove the damaged and infected tissue as well as removing all traces of the bullet of shrapnel.

If this didn't work, the only remaining way to save the patient was to amputate the limb.

Blood loss could lead to shock which often caused death. Blood transfusions were used fom 1915 but were limited as blood could not be stored.

In 1915, Richard Lewisohn found that adding sodium citrate to blood stopped it clotting, so it could be stored a short time. Richrd Weil used refrigerators to store it for much longer.

In 1816, Francis Rous and James Turner added citrate glucose which meant blood could be stored even longer.

In preparation for the Battle of Cambrai in 1917, Osworald Hope Robertson stored 22 units of blood in what he called the first 'blood depot'. He used it to treat Canadian soldiers suffering from shock and demonstrated its potential.