WW1: Medicine

• 1914 - 1918 = WW1, Allies (FR, GB + Belgium) fight German Imperial Army
• Area where fighting happened = Western Front
• Autum 1914, Allies + Gers realise can't beat each other ouright, build trenches (N.FR to Belg)
• Army tried to improve Medical Care after huge losses at Somme, more medical posts set up in preparation for 3rd Battle of Ypres.
• April 1917, Gers have retreated to Hindenburg Line
• Before Battle of Cambrai, Captain Robertson sets up Blood Bank

• Dug down in ground, upper level fortified in sandbags
• Wet areas = trenches built upwards using sandbags of clay, called "breastworks"
• Ideally 6-7ft deep
• constructed by entrenching, sapping or tunnelling 
• Mounds of earth built from side of trench to split into sections - called traverses
• Trench systems expanded during War
• Trenches ideally built in 3 parallel lines
• Ideal trench system, reality = organised trenches hard, might have to be built quickly as troops advanced , terrain can cause problems

• Both sides tunnelled under No Man's Land to reach enemy trenches
• Dangerous for tunnellers, they could be buried alive, suffocated or meet the enemy but less costly than a normal infantry attack through NMLand
• 1916, Allies built tunnel network under Arras, used to hide 24,000 men before B of Arras, tunnels dug up to Ger line, so men could safely reach enemy line, lots of ground gained on 1st day. But over 150,000 GB casualties in total.
• Battle of Messines (3rd Battle of Ypres) 19 mines blown up under Ger line, around 10,000 Ger soldiers killed instantly, 2 mines used to destroy defences oh hills - HILL 60 & Caterpillar
• Trench Maps better source than layout given in training manuals as they are more realistic. 
• Trench maps drawn using photos from air, teams on ground also collected info, but planes missed some stuuf e.g. machine guns placements deliberately hidden

• Shelling & entrenchment damaged terrain & roads. GB army used horse-drawn & motor vehicles to move supplies, but terrain hard to negotiate 
• Railways = more important, move supplies & troops behind F.Lines, not always near F
• 1917, GB built a light railway network behind lines, easier to evacuate men & transport supplies (e.g. men, ammunition) through muddy terrain

RAMC

• Ran field Ambulances, moving casualties was an issue because of terrain
• RAMC Fiels Ambulances were units, not vehicles and set up mobile medical stations
• Stretcher Bearers carried casualties thorugh realy posts until they reached a medical post
• Field Ambulance Transport inc Teams of strecher bearers, Horse, Wagons, Carts, Motor Ambulances (RAMC started using them in 1915)
• RAMC developed Chain of Evacuation

FANY

• Women trained in first aid, veterinary skills, signalling and driving 
• Mainly worked as field ambulances, moving wounded men
• Staffed 2 KEY Ambulance Convoys: Calais Convoy & St Omer Convoy
• Driving skills of FANY v.useful, they had to drive as smoothly as possible to avoid injuring men further, Canal barges used to move worst cases.
• Ran a mobile soup kitchen, bathing vehicle, staffed hospitals, ran a hospital canteen and organised concerts for troops

• Soldiers exposed to illness, infection, gas attacks etc
• Weather, exposed to cold & frostbite, particularly Winter 1916 -17
• Trench Foot, skin and tissue on feet broke down, docs used ampuatations to stop gangrene spreading, more common at start of war, whale oil used to create waterproof layer on feet
• Dysentry caused diarrhoea & dehydration, dirty water & unhygenic latrines helped it to spread
• Vermin, spread disease, rats, lice, maggots, flies. Trench Fever & Typhus spread by lice
• Docs didn't make link between lice & trech fever till 1918, delousing stations set up to try and stop ourbreaks of disease, but weren't always successful

Gas Attacks, 4 types:

• Lachrimatory Gas, first used 1914, also called "Tear Gas" caused inflammtion of nose, throat lungs and blindness. Meant to disable soldiers, not kill them.
• Chrlorine Gas, 1st deadly gas used on W.Front,1915, killing agent, slowly suffocated victims
• Phosogene, caused suffocatioon, could take 24hrs for symptoms to set in, colourless
• Mustard Gas, blistering agent, extended exposure = blindness & lung infections, could take up to 5 wks to die, gas could cling to clothes for hrs putting medical staff at risk

• Trenches often protected body, but the head was exposed,in 1915 "Brodie" helmets were issued, before these head injuries were fatal
• Dr Harvey Cushing treated Head injuries during the war, pioneered new surgical techniques that were still being used in the 1970's. He used x-rays to locate shrapnel and drew it our using magnets. He reduced brain surgery death rate by 50%. Though there was slow evacuation & limited brain imaging techniques.
• Dr Harold Gillies developed a plastc surgery technique called the tube pedicle, made skin grafting & facial reconstruction more effective.
• Concussion from shell explosions, hit by flying debris, buried under collapsed buildings/trenches, poisoned by Carbon Monoxide 
• Ground infected by dead bodies, unhygenic latrines (holes about 4/5ft deep)
• Wounded men had to lie in contaminated mud in trenches or no man's land for hrs/days

Anti-tetanus injections given to soldiers at F.Line, Wounds washed in carbolic lotion (antiseptic solution) closed up & wrapped in bandages soaked in carbolic acid. Paraffin paste called Bipp used to cover wounds to prevent infection. Amputation was a common way to stop life-threatening infections before anti-biotics were discovered in the 1920's.

Before the War the mehtod of Primary closure was used regarding wounds. It meant Docs explored wound for objects that neede removing, washed the wound with antispetic and then closed it up. 

• During the War, Belgian Doctor, Anthony Depage developed delayed Primary Closure, a better way to treat wounds.  First the wound was properly explored, objects removed, he realised removing all damaged tissue and then washing the wound with antispetic decreased infection chances. Then he left the wound open to air for 24-48 hrs, then looked at a swab under the microscope to check for bacteria, if the wound wasn't infected, he closed it up. 
• 1915, Alexis Carrel & Henry Dakin develop new way to prevent infection, Dakin created antiseptic solution that could be flushed into a wound using rubber tubes before closure, called irrigation, Depage then used this metho.
• Wilhelm Roentgen discovered x-rays in 1895
• GB had 528 x-ray units, took mobile x-ray machines to CCS, men could be treated closer to FL
• 1917 Robert Jones releases a book advising Docs in GB how to treat fractures using splints
• New method called the syringe-cannual technique was developed, Docs took blood from Donr using needle & syringe & transfused it quickly to patient. Tricky as blood could clot in syringe.