Medicine on the Western Front

The Ypres Salient: Germans had the higher ground, and therefore the advantage. Tunnelling and mines were used by the British at Hill 60. Lower ground meant liability to flood. Important due to ports of Dunkirk and Calais

• 1st Battle: Oct-Nov 1914
• 2nd Battle: April-May 1915
• 3rd Battle: July-Nov 1917

The Somme: July 1916-Nov1917

• 1st July - 20,000 deaths and 60,000 casualties
• 400,000 casualties overall = pressure on medical services (only 174 officers)

Arras: April-May 1917

• Soldiers dug out tunnels in the chalky ground and created an underground network in 1916. Led to rooms, including an underground hospital w/ up to 700 beds.

Cambrai: Nov-Dec 1917. 450 tanks used, but not enough infantry to support.

Difficult to move around at night -> communication difficult

Collecting men from no man's land meant risking getting attacked by the enemy

Lots of tight/narrow spaces, corners, and mud.

Shell-damaged terrain.

1917 - The British built a light railway network to make it easier to move to/from the frontline.

Zig-zag pattern.

The Frontline: Where attacks were made

Support Trenches: 80m behind front line for retreat in case of attack

Reserve Trenches: 100m behind the support in case of capture to mobilise a counter-attack

Communication trenches: ran between and connected everything

No Man's Land: Between front lines of both sides. Saps = small trenches in this area.

Artillery emplacements: Usually always at the rear

Dugouts: dug into the side for cover w/ sandbags + duckboard

Barbed wires in front to deter the enemy from attacking head-on.

Infection e.g. Trench Fever, Typhus (body lice) + Trench foot (mud)

• The area was previously farmland, which means fertilisers were commonly used, and the bacteria could cause infected wounds.
• Mud, waste, blood, disease vermin + body lice

The bombing of infrastructure (trains, barges, boats...)

• Hard for ambulances to travel quickly

Cold

• Sore limbs, miserable, slow, frostbite

Unhygienic 

• Dirty water -> dysentery, diarrhoea and dehydration

Psychological impact i.e Shell shock (emotional trauma/brain damage). Shaking, tired, hearing loss. Seen as cowards.

Need for a good diet

Trench fever: Caused by body lice, flu-like symptoms. Treated w/ electric current. Prevented by disinfecting clothes and creating delousing stations. Could relapse years after with heart issues and anxiety/depression.

Trench foot: Caused by mud/waterlogging. Treated with cleaning/amputation. Prevented by changing socks, dry feet and whale oil. 20,000 in winter 1914-15 

Shell shock:  Caused by stress, resulted in tiredness, nightmares, uncontrollable shaking. Treatment not well understood. Affected 80,000 and some were shot. Facial tics, muscle cramps, uncontrollable diarrhoea. 

Weapons -

• Rifles: Rapid fire
• Machine guns: pierced organs and fractured bones
• Artillery: Bombardments. 1/2 of all casualties.
• Shrapnel: Exploded mid-air w/ mas dmg.
• Chlorine gas: Death by suffocation. 1st used @ 2nd Ypres 1915. Gas masks used.
• Phosgene gas: Faster than chlorine. W/in 2 days.
• Mustard gas: Odourless, worked in 12hrs, w/ blisters and burns.

Gangrene: Decomposition due to lack of blood supply. Infected wounds.

Mobile medical stations. Stretcher bearers carried casualties through relay posts until they reached a medical post or could be moved by rail, road or river. Included a team of SB's, horses, wagons, carts and motor ambulances (1915 - 250) 1917 = light railway network.

Medical officers learnt about never-seen-before wounds.

Regimental Aid Post - few metres behind the front line in a dugout. First aid. Medical officers judged wound severity with triage.

Advanced Dressing Station - 350m from RAP in tents/buildings. Main Dressing Stations set up 1 mile behind. Collected w/ horse-driven ambulance/SB's.

Casualty Clearing Station - Seriously injured men from MDS via motor ambulances. Surgical/medical wards in huts, nurses, mobile X-rays. Could be treated up to 4 weeks.

Base Hospitals - up to 400. Often specialist e.g. gas. Large buildings close to transport networks. X-rays. Treated until ready for front line or home.

Arras 1917: Underground hospital w/ 700 beds, op theatre, rest for SB's and running water.

Founded in 1907.

Women trained in first aid, veterinary skills, signalling and driving. Mainly worked in field ambulances to move wounded men, supplies + rations between coastal ports -> frontline

Driving skills useful. Seriously injured men needed a smooth ride.

Also ran a soup kitchen and bathing vehicle, a canteen and organised concerts.

Thomas Splint: Reduced infection of compound fractures and by 1915 only 20% died.

X-rays: discovered in 1895 by Wilhelm Roentgen. Made mobile units. Made aseptic surgery effective because surgeons didn't have to find shrapnel themselves. Were fragile + overheated.

Blood transfusions: Blood loss was a BIG issue. Base hospitals used the syringe-cannula technique to transfer blood. Extended to CCS in 1917

Blood banks: Captain Oswald Robertson set up a blood bank for Cambrai 1917. Adding Sodium Citrate allowed blood to be stored w/o clotting. Helped quicken transfusions + inc. success.

Brain surgery: Magnets removed fragments from brain w/ local anaesthetic. Dr Harvey Cushing.

Plastic surgery: Harold Gillies developed skin grafts. @ Queen Mary's.

Aseptic technique: Disinfect hands, gloves, sterilised, carbolic lotion,