history:western front
RAMC and FANY, royal army medical corps and first aid nursing yeomanry
the trenches
injuries and illnesses
medicine in the early 20th century
medical advances
battles
trench system
first battle of ypres, october-november 1914- british managed to hold onto ypres which was vital in maintaining access and control of 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- the germans made very slight gains towards ypres. the battle was notable as being the first time chlorine gas was used. it was first used by germans
third battle of ypres, july-november 1917-the british used a creeping barrage to make small gains to break out of the ypres salient. the awful weather left the ground waterlogged and many drowned
the somme, july-november 1916- notable for the extremely high casualties on both sides, the battles on both sides of the river somme saw two new strategies by the british- the creeping barrage and the first use of tanks- but these made 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 were used to launch the battle which was initially successful but ended with little progress and high numbers of casualties on both sides.
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
trench construction- first trenches were hurriedly dug by troops. often used existing ditches or banks to make it easier. the trenches were constantly maintained and improved with drains and steps added
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 waterlogging, craters and holes from explosions. the trenches could be muddy and very crowded
all three rows of trenches were linked by communication trenches. there were artillery emplacements at the back. the reserve trench was where troops could be stationed for counter attack. dugouts were holds in the side of the trench for the troops to take cover. the support trench was where troops would retreat to and from the frontline. trenches formed a zig-zag pattern. the frotnline trench was where attacks were launched
gas attacks- caused mostly temporary, blindness, coughing, burns. july 1915, gas masks were given to all british troops before this they protected their faces with cotton pads soaked with urine.
head injuries- caused by shrapnel. 1915- soft caps replaced by brodie helmets.
shell shock- caused mental breakdown. sufferers accused of cowardice. treated close to the front or evacuated to british hospitals
trench fever- flu-like symptoms, lasted for months. caused by lice so in 1918 troops were deloused
trench foot- caused by standing in waterlogged trenches. lead to gangrene and treated with amputation. to try and protect their feet they used whale oil, spare socks and pumps to drain trenches, and duckboards to keep their feet above the water
bullets- could penetrate organs and facture bones
high explosive shells and shrapnel-most responsible for deaths and injuries, removing limbs and causing major internal injuries.
specific injury problems- all weapons caused major blood loss. bullets and shrapnel has to be located then removed. extensive head wounds required brain surgery or facial reconstruction
wound infection- soil contained tetanus and gas gangrene bacteria. would enter wounds when they were lying on the ground. 1914 tetanus injections were given but no prevention for gas gangrene
medical workers- all workers from RAMC but later volunteers were allowed for driving ambulances, cooking and cleaning
underground hospital at arras- thompsons cage- close to the front line in tunnels. 700 beds, operating theatre and a mortuary, it had running water and electricity
transport problems- difficult terrain so only stretcher bearers and horse wagons.
roads and railways destroyed
constant shelling and artillery fire
no motor ambulances were sent and not enough horses
public appeal raised money for 512 motor ambulances
chain of evacuation- regimental aid post- first aid, field ambulance- dressing stations, about a mile back from front line. medical officers, orderlies and stretcher bearers and in 1915 nurses. look after men for a week
casualty clearing station- larger and better equipped, buildings for life-threatening injuries.
base hospitals- medical staff for specialised treatment, patients stayed for long time
x-rays- 1895-william roentgen test tube in black paper, rays from the tube lit up a screen. rays could pass through human flesh not bone. put paper down to create first x-ray image.
problems- required keeping still for a long time
high doses of radiation were released and patients burnt and lost hair
large machines were too heavy to be moved easily
blood transfusions- 17th century- blood transfusions from animals to humans but loss success rate
james blundell-first human blood transfusion between 1818 and 1829. developed useful techniques and equipment but there were problems. blood had to be transferred directly from the donor to the recipient as it couldn't be stored. low survival
1901-karl landsteiner discovered 3 blood grouped and 1902 team found a 4th. transfusions only work between people with the same blood group
aseptic surgery- joseph lister-1900. operating theaters were clean, sterilised clothing, cloths, surfaces and equipment. masks were worn
1878-robert koch developed steam steriliser after 1887 all surgical equipment was sterilised.
1890-rubber gloves to stop germs
new techniques for infections- antiseptic and aseptic surgery werent possible at war. wounds already infected
surgeons used chemicals to kill bacteria but didnt work against gas gangrene
1917- carrel-dakin method-steralised salt solution
infections very deep this didnt work, surgery was developed to remove the damaged and infected tissue and traces of bullet or shrapnel.
remaining way was to amputate limb
blood transfusions- blood loss could lead to shock=death. 1915-limited transfusions as blood couldnt be stored
1915- richard lewisohn- adding sodium citrate to blood stopped it from clotting for short time. richard weil used fridges, stored longer
1916- francis rous and james turner-citrate glucose-stored longer
battle of cambrai 1917- oswald hope robertson- 22 units in blood depot. used to treat from shock and demonstrated potential
the thomas splint- december 1915- used and reduced death rate to lower than 20% from broken limbs. splint kept leg rigid, reduced blood loss.
advances in surgery- brain injuries- new surgical techniques=success rate. facial injuries=plastic surgery improvements=harold gillies
mobile x-ray units- located bullets and shrapnel before operating. used in base hospitals from 1914 and some casualty clearing stations. mobile units- closer to the front and number increased. images not as clear as static machines but prevented many deaths