Medicine on the Western Front

Joseph Lister first used carbolic acid to prevent infection in surgery in 1865, based on Louis Pasteur's work on Germ Theory. By the late 1890s, Lister's methods had laid the foundations for aseptic sugery. By 1900, most operations were carried out using aseptic methods.

--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 in wounds in the 1890s.

--The use of steam sterilisation.
                                             --------> A machine called an autoclave was invented in 1881, by the French scientist Charles Chamberland. It sterilised surgical instruments in boiling steam.

--The air was sterilised by being pumped over the heating system to kill germs. 
                                                                                                                    ----------> Two German surgeons, Gustav Neuber in the 1880s and Ernst von Bergman in the 1890s, first developed these methods.

Development of x-rays:

1895 - Wilhelm Roentgen - German physicist - was studying the effects of passing an electrical current through a glass tube covered in black paper.

He noticed that although everything in the room was darkened, a screen about a metre from the equipment had begun to glow. He called these rays that could pass through glass 'x'.

Further experiments showed him these rays could penetrate many objects.

The importance of these rays was understood immediately.

Impact:

1896 - radiology departments were opening in a number of British hospitals, contributing to advancing knowledge and applying the new science in a medical setting. 

Birmingham General Hospital - Dr John Hall-Edwards was one of the firstr doctors to make a diagnosis based off information from an x-ray (needle in a woman's hand)

Problems:

-Health risks - not fully understood. Radiation that was released was about 1500 times the amount that is released today. Exposure to x-rays was harmful - patients could lose hair or suffer burns.

-Roentgen had used a table-top machine, but the glass tube used with this was very fragile, so could break easily.

-Taking an x-ray of a hand took 90 minutes. 

-Larger x-ray machine were being developed, but were very difficult to move around.

-X-rays could not detect all object in the body (fragments of clothing - causes infections)

-Machine would overheat and could only be used for an hour at a time - so 3 machines on rotation - impractical. (by the end of the war, better machine had been invented by William Coolidge.)

However, these dangers and problems did not prevent the continuing use of x-rays.

Marie Curie invented radiological car. - with funding from wealthy French People.

Radiological car contains x-ray machine. They were very useful but there were only 20 of them (not typical). 

Curie trained 150 women to drive these vehicles that were also known as "Little Curies".

These Little Curies could be driven right up to the battlefield where army surgeons could use X-rays to guide their surgeries. 

If someone loses too much blood, then they are likely to go into shock and die. In the 19th and early 20th centuries, blood loss was often the result of complex surgeries.

With the development of aseptic surgery and x-rays in the late 19th century, it was possible to carry out more complex surgical operations safely. However, if the problem of blood loss could not be solved, then the success of these operations would be irrelevant.

-James Blundell did the first experiments in human blood transfusion in 1818 to help women under his medical care who lost blood when they gave birth.
-Between 1818 and 1829, Blundell carried out 10 transfusions, with up to half of the patients surviving.
-Blundell developed many of techniques and basic equipment which would continue to be used up to WW1.
-As blood couldn't be stored, transfusions were carried out with the donor directly connected to the recipient by a tube.

Problem:

Blood coagulates as soon as it leaves the body. This meant that the tubes which tranfused blood from one person to another could become blocked up.

Solution

There were attempts to find chemicals, such as sodium bicarbonate, to prevent clotting. 
(Professor Almroth Wright, a British scientist conluded that the soluble solution of certain acids could prevent clotting, but he thought that side effects such as convulsions could not be prevented)

Problem

Rejection of the transfused blood because the blood of the donor and the blood of the recipient was not compatible.

Solution

1901 - Austrian doctor Karl Landsteiner discovered the existence of three different blood groups - A,B and 0. The following year a fourth blood group, AB, was also found. 
1907 -Reuben Ottenberg, an American doctor - first person to match a donor and a recpient's blood type before a transfusion. He also identified blood group 0 as a universal blood group.

Rifles and explosives:

In a case study of over 200,000 wounded men admitted to Casualty Clearing Stations (CCS) on the Western Front, it was discovered that high-explosive shells and shrapnel were responsible for 58% of wounds. About 60% of injuries were to arms and legs.

Bullets were respondible for 39% of wounds. Machine guns could fire 450 rounds a min, and their bullets could fracture bones or pierce organs. Rifles could fire accurately at up to 500m, but lacked the speed of machine guns. 

Shrapnel, wound infection and head injuries

When men were injured by shrapnel or bullets, the metal would penetrate their body, taking with it the fabric of the uniform from the area surrounding the wound. The soil contained the bacteria for tetanus and gas gangrene (an infection caused by a lack of blood to an area in the body). The impact of tetanus was reduced by the use of anti-tetanus injections from the end of 1914. However, there was no cure for gas gangrene. The bacteria for gas gangrene spread through the body quickly and could kill a person within a day.

At the start of the war soldiers wore a soft cap as headgear. To protect against head injuries, a trial using the Brodie helmet was carried out in 1915. This was a steel helmet with a strap that prevented it being thrown off the head in an explosion. It was estimated that it reduced fatal head wounds by 80%, so the helmet was then provided to all soldiers fighting on the Western Front.

Not a major cause of death - only 6000 British soldiers died as a result of gas attacks.

British army gave troops on the Western Front gas masks from 1915, which became more sophisticated over time. 

Chlorine gas: 
-first used in 1915 by Germans
-led to deaeth by suffocation
-led to issuing of gas masks (before, soldiers used cotton pads soaked in urine)

Phosgene
-first used at the end of 1915 near Ypres
-smelled like recently cut hay
-6x more deadly than chlorine (also led to death by suffocation)
-could kill within 2 days

Mustard gas
-first used in 1917 by Germans
-killed 1% of those who came into contact with it
-odourless gas that worked within 12 hours.
-used as an irritant rather than to kill
-caused internal and external blistering, temporary blindness