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Medicine: The British sector of the Western Front (Medical advances (New…
Medicine: The British sector of the Western Front
The Western Front - the trenches
The trench system
All three rows of trenches were linked by communication trenches
the reserve trench was where troops could be stationed for counter attack
dugouts were holes in the side of the trench for troops to take cover
the support trench was where troops would retreat to from the frontline
trenches formed zig-zag patterns
the frontline trench where attacks were launched
Trench construction
the first trenches were hurriedly dug by troops. They often used existing ditches or banks to make it easier. The trenches were constantly maintained and improved, for example, with drains and steps added
Battles on the Western Front
First battle of Ypres, October - November 1914
Battle on Hill 60, April 1915
Second Battle of Ypres, April-May 1915
The Somme, July-November 1916
Arras, April- May 1917
Third Battle of Ypres, July-November 1917
Cambrai, November-Decmeber 1917
Terrain and transport
terrain varied in different places and according to weather conditions. It could be very difficult to get around where there was deep mud and water logging, and craters and holes from explosions. The trenches themselves could be muddy and very crowded
Injuries and illnesses
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 the removed. Extensive head wounds required brain surgery and/or facial reconstruction
Wound infection
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
Gas attacks
Head injuries
shell shock
trench fever
trench foot
bullets
high-explosive shells and shrapnel
RAMC and FANY
Underground hospital at Arras
Also known as Thompson's Cave, the hospital was very close to the front line in the tunnels underneath the town. It included space for 700 beds, an operating theatre and a mortuary. It was supplied with running water and electricity
Transport problems
many roads and railway lines had been destroyed
constant shelling and artillery fire made recovery of the injured very difficult
difficult terrain meant that in some places only stretcher-bearers and horse wagons could be used
initially, no motor ambulances were sent and there were not enough horses to cope. Public appeal in Britain raised money for 512 motor ambulances
Medical workers
Initially, all medical workers were from the RAMC but later, volunteers were allowed, from, for example, FANY. The volunteers were mostly used to drive ambulances and for cooking and cleaning
Chain of evacuation
regimental aid post - field ambulance - dressing stations - casualty clearing stations - base hospitals
Medicine in the early 20th century
Blood transfusions
1901, Karl Landsteiner discovered three blood groups snd, in 1902, his colleagues found a fourth group. They discovered that transfusions would work only between people of the same blood group
Aseptic surgery
operating theatres and wards were thoroughly cleaned
surgeons and nurses wore sterilised clothing
sterilised cloths covered surfaces and equipment
surgeons and nurses wore masks to prevent breathing infection into a wound
In 1878, Robert Koch developed a steam steriliser for surgical instruments. After 1887 all surgical equipment was sterilised
X-rays
1895 - Wilhelm Roentgen covered a test tube in black paper he was surprised to find that rays from the tube lit up a screen
problems with early x-rays:
photography was at an early stage so taking x-rays required keeping still for a long time
high doses of radiation were released and patients were burnt and lost hair
large machines were too heavy to be moved easily
Medical advances
Mobile x-ray units
mobile used closer to the front line - the number increased as the war went on - their images were not clear but still prevented many deaths
Advances in surgery
brain injuries led to new surgical techniques and improved success rate - facial injuries led to huge improvements in plastic surgery
The Thomas Splint
reduced death rate from broken limbs from 80% to fewer than 20%
Blood transfusion
blood loss could lead to shock which often caused death. Blood transfusions were used from 1915 but were limited as blood could not be stored
in 1915, Lewisohn found that adding sodium citrate to blood stopped it clotting, so it could be stored a short time. Weil used refrigerators to store it for much longer
in 1916 Rous and Turner added citrate glucose which meant blood could be stored even longer
in preparation for the battle of Cambria in 1917 Robertson stored 22 units of blood in what he called the first 'blood depot'
New techniques for infections
By 1917, the Carrel-Dakin method, in which sterilised salt solution was moved through the wound using tubes, was found to be more effective
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 or shrapnel
surgeons went back to using chemicals to kill bacteria but this didn't work against gas gangrene
if this didn't work, the only remaining way to save the patient was to amputate the limb
antiseptic and aseptic surgery was not possible in Dressing Stations and CCS and many wounds were already infected by the time the patient was operated on