Medicine on the Western Front - unfinished

Key battles

First Battle of Ypres (12th October-11 November 1914):

• Established the Western Front

• British troops moved to Ypres to prevent the Germans from capturing the ports on the coast 

• British needed access to the coast to ensure reinforcements and equipment could arrive by ship to help the army

• End of 1914: the British has lost 50,000 soldiers

• the battle had established the line of trenches from the English Channel down to Switzerland

Second Battle of Ypres (22 nd April - 25 th May, 2015): 

• Use of poisoned gas (first time the Germans used chlorine gas)

• Was a surprise to soldiers and suffocated hundreds 

• They had no protection from the gas at this point (other than urinating on a handkerchief and holding it over their noses)

• Allied lost 60,000 men 

• Germans lost 35,000 higher casualty numbers 

Battle of the Somme (1st July - November, 1916:)

• High casualty numbers

• Aimed to take land from the Germans (giant casualties)

• First day: British casualties over 57,000 with deaths of around 20,000

• Overall: the British sustained 420,000 casualties, 125,000 deaths

• The British tried:

• The creeping barrage ~ British launched artillery fire at the German trenches just ahead of the advancing British infantry (shelled own men)

• Tanks were used ~ they suffered huge technical problems (not successful)

Battle of Arras (April 1917): 

• Tunnelling

• chalky ground at Arrans allowed the British to build a series of underground tunnels to shelter from German attacks

• More than 2.5 miles of tunnels were built in 5 months which could accommodate 25,000 men with electricity, lights, running water, a railway system and a fully functioning hospital

• In April the British launched an attach on the Germans from the tunnels with the aim of breaking through the German lines

• was a success except for the advance being slow and 160,000 British and Canadian casualties recorded.

Third Battle of Ypres/ Battle of Passchendaele (31 st July to November 1917): 

• Difficult fighting conditions

• the British army aimed to remove the German advantage of higher ground

• on the first day were able to advance two miles

• the weather soon turned to rain and the ground became water logged so much so that men fell in the mud and drowned

• It made the evacuation of the injured increasingly difficult

• British casualties numbered 245,000

Battle of Cambria (20th October- December 1917): 

• First large scale use of tanks

• characterised by the first large-scale use of tanks by the British (nearly 500)

• moved easily across the barded wire and their machine guns were very effective against the Germans 

• The use of tanks protected soldiers from German gun fire and shells

• After initial success the British were forced back with 40,000 British casualties recorded

The Chain of Evacuation

Regimental Aid Post

• Generally located within 200m of the frontline, in communication trenches or deserted buildings

• made up of a Regimental Medical Officer, with some help from stretcher bearers with first aid knowledge

• Wounded walked in themselves or were carried in by other soldiers

• purpose = to give immediate first aid and get as many men back to the fighting as possibleh

• could not deal with serious injuries (had to be moved to the next stage in the chain of evacuation)

Dressing Stations (ADS and MDS)

• there should have been advanced dressing stations (ADS) about 400m from the RAP and a Main Dressing Station (MDS) a further half mile from the frontline

• this was often not the case, and there may have only been one dressing station

• the Dressing Stations were located in abandoned buildings, dug-outs or bunkers, to protect the wounded from enemy shelling (tents would also be used) 

• Each dressing station would be staffed by ten medical orderlies and stretcher bearers of the RAMC

• From 1915, there were some nurses available for this part of the chain of evacuation

• To the Dressing Station, men would either walk, if there were able, or be carried in by stretcher bearers in stages

• Those working at the Dressing Stations belonged to a unit of the RAMC called the Field Ambulance 

• each Field Ambulance unit could deal with 150 wounded men, but they would have to deal with many more

• The Field Ambulance unit at Hooge near Ypres dealt with 1,000 casualties during two days during the Third Battle of Ypres 1917

• no facilities to tend to the wounded for more than a week

• Men who had been treated either returned to their units if they were fit to fight, or they would be moved on to the next phase of evacuation

Casualty Clearing Stations (CCS)

• located a sufficient distance from the frontline to provide some safety against attack, but close enough to be accessible by motor ambulances

• the CCS closest to the frontline would specialise in operating on the most critical injuries, such as those to the chest

• They were set up in buildings such as factories or schools that were often located next to a railway line to allow the next stage of evacuation to take place quickly

• wounded soldiers were divided into three groups (triage)

• helped medical staff make decisions about treatment

• The three groups were:

1. The walking wounded who could be patched up and returned to the fighting

2. Those in need of hospital treatment who would be transported to base hospitals once they had

received any immediate treatment for life threatening injuries.

3. Those who were severely wounded that there was no chance of recovery were made comfortable, but were not allocated medical resources that could be used to save others.

• Third Battle of Ypres in 1917 - 24 CCS with 379 doctors and 502 nurses

• treated more than 200,000 casualties, 30% received operation in the CCS. Base Hospitals

• Base Hospitals were located near the French and Belgian coast, close to ports where men could be taken back to Britain

• At the start of the war there were two types of base hospitals, the stationary hospital and the general hospitals (similar)

• Men were treated in both types until they could be returned to the fighting or returned to Britain

• Casualty Clearing Stations played an increasingly important role in dealing with wounds, instead of Base Hospitals

• if contaminated wounds were not dealt with quickly wounded men were more likely to develop gangrene

• CCSs started doing operations that it was originally believed would be done in Base Hospitals

• By May 1916, most head and chest patients had been operated on before their arrival

• Base Hospitals become increasingly responsible for continuing the treatment begun in the CCS.

• The size of the Base Hospitals increased especially after a new major attack took place

• 1917, three new Base Hospitals with a total of 2500 beds were created

• the Base Hospitals were not carrying out their intended role, so important roles emerged for them

• They experimented with new techniques which, were used in the CCSs, (dividing up patients into separate wards depending on their injuries, such as amputees, head wounds, chest wounds)

• Allocating doctors to specialist wards enabled them to become expert in then treatment of particular wounds.

• The Casualty Clearing Stations retained their role as the most important place for operations until the spring of 1918

• The static nature of trench warfare had meant that the CCSs had been relatively safe during the war

• in March 1918 the Germans launched a major attaci and this forced many CCS to have to move back (most surgery was undertaken at base hospitals again)

The underground hospital at Arras

• November 1916 - tunnelling began under the town of Arras

• In 800m of tunnels, a fully working hospital was created so close to the frontline that it was a dressing station

• It was sometimes called Thompson’s Cave after the RAMC officer who was responsible for equipping it

• There was space for 700 spaces were stretchers could be used as beds, an operating theatre, a mortuary and places for stretcher bearers to rest

• Electricity and piped water were supplied to the hospital

• The hospital was abandoned during the Battle of Arras in 1917, when its water supply was damaged by shelling

Medicine at the start of the war

• Trench warfare - created new issues in terms of treating the wounded and the sick

• men who had been wounded needed to be moved away from the front line as quickly as possible

• moving the injured was not easy during a battle

• The faster an injury could be treated, the more likely a person was to survive

• Away from the front line, it was possible to carry out more advanced medical procedures further increasing the chance of a person’s survival.

• The army employed stretcher bearers to carry the wounded away from the battlefields during the day and night

• This was a physically and mentally demanding as the men were heavy and in large amounts of pain

• Moreover, it was dangerous as the Germans would continue to fire shells and target gunfire after an attack (the British and French did the same to the German soldiers)

• Carrying bodies at night was very difficult because shells had made the ground very uneven so stretcher bearers had to watch their step very carefully

• When it was muddy, carrying stretchers became even harder

• When the BEF was first sent to France, the military leadership only sent horse-drawn ambulances (it was soon realised that this was a mistake as they couldn’t cope with the large number of casualties

• Some soldiers died or were captured by the Germans because the ambulances took so long to arrive

• men who were transported by horse-drawn ambulance

• wagons were shaken about and this exacerbated their injuries

• By October 1914, The Times newspaper had raised enough money to buy 512 motor ambulances, which increased the number of wounded who could be treated and also reduced the amount of shaking about for the injured men

• The first motor ambulances arrived in France in October 1914

• However, motor ambulances could not operate in muddy terrain (they got stuck) and so the army continued to use horse-drawn ambulances

• When it was muddy or the terrain was very uneven, the army used 6 horses to pull the ambulances rather than 2

• The army set up Base Hospitals near the French and Belgian coast so that wounded men could easily be sent back to Britain if their injuries were so serious that they could not return to fighting

• it quickly became clear that many injuries needed much faster treatment as gangrene developed if contaminated wounds were not dealt with quickly.

• The wounded men were often transported to the Base Hospitals by train.

• To begin with, the British did not have specially designed trains for transporting the wounded and so they used trains designed for goods

• by November 1914, they had specially designed trains which were specially designed for stretchers (these new trains made transporting the wounded more comfortable)

The trench system

• The trenches were dug quickly in 1914

• both sides wanted to protect the positions they had claimed and their routes to the sea in northern France and Belgium

• they developed into a more advanced system that lasted throughout the war rather than one simple line of trenches.

• The trenches stretched from the French and Belgian coasts of the English channel, down through those countries and all the way towards Switzerland.

• The trenches were dug in a zigzag pattern as a defensive strategy. This would prevent enemy soldiers from being able to see, or fire, directly along a trench.

• However, the trenches were narrow and often got blocked. This led to problems moving and treating the wounded during battles.

Front line trench - closest to the enemy, soldiers fired across No Man’s Land from the front line trenches.

Communication trench -

connected the other lines of trenches. Soldiers would use them to move between the other trenches.

Support trench - These were dug behind the front line trenches. Soldiers would retreat to them during an attack.

Reserve trench - These were dug behind the support trenches. Soldiers would use these to prepare for a counter-attack.

No Man’s Land - This was the stretch of land between the Allied and German trenches.

Dugout - These were dug into the sides of trenches. Men would use these when they needed protection and rest.

Doctors and nurses

Doctors

RAMC (Royal Army Medical Corps)

• In 1914, all the medical officers who were all male belonged to the RAMC

• The RAMC consisted of different ranks from ambulance drivers, stretcher bearers and doctors

• Their job was to keep men healthy by encouraging good sanitation and treating the wounded and sick in the war

• Doctors had to learn quickly and were often dealing with unfamiliar conditions and situations

• Numbers quickly expanded with 9,000 in 1914 to 113,000 by 1918 to help with the increasing casualty numbers (over 50% of British doctors served in the war)

• More doctors were able to be recruited by raising the age of service to 45.

Nurses

Queen Alexandra’s Nurses

• In 1914, the British army only accepted Queen Alexandra trained nurses, therefore these were the official military nurses

• The British government originally turned away other volunteer nurses (they found work looking after the French and Belgium armies instead)

• Only 300 caring for soldiers on the Western Front in 1914 proved to be too little (although numbers did increase to 10,000 by the end of the war)

• With the increasing numbers of casualties, the British government soon changed their policy so thousands of women began working to support the British army, scrubbing the floors of operating theatres, cooking and washing for those injured

VADs (Volunteer Aid Detachment)

• One group of volunteers from the middle and upper classes was the VAD

• In the beginning they had very little experience of nursing so were mainly cleaning

• by 1917 their experience had progressed and many were performing nursing duties like changing dressing and administering pain killers

FANY (First Aid Nursing Yeomanry)

• It was founded in 1907

• They were a British independent all-female registered charity that originally worked on horseback as the founder of FANY believed they could reach a wounded soldier faster

• In WW1 however they drove ambulances

• Although its members wore a military style uniform they were not part of the army.

• FANY provided front line services e.g. driving ambulances, administering first aid, transporting supplies like food to the front line, set up soldier’s entertainment like cinemas and ran mobile bath units

• Over 1,600,000 men were saved or treated by the doctors and nurses who served in World War One and were therefore able to be sent back to fight

• It has been acknowledged that this enormous amount of men conserved to fight again was an important factor in helping the British win.

Wounds on the Western front

Explosives & Shrapnel

• Devastating wounds on the Western Front were the product of increasingly powerful weapons

• Artillery fire was the greatest danger to soldiers - studies suggest that high explosive shells and shrapnel were responsible for 58% of all wounds to soldiers

• These weapons developed during the course of the war to become more powerful e.g. the British developed a Howitzer which could send 900kg shells a distance of 12 miles

• With factories churning out millions of shells, continuous bombardments could last for weeks or months

• Some shells were developed to cause maximum casualties

• They consisted of a hollow shell packed with steel or lead balls and a timer fuse

• They were designed to explode in mid-air above the enemy, sending the steel or lead balls flying in all directions

• This type of shell was called shrapnel (although the word ‘shrapnel’ also refers to any

• small fragment of metal in the air when a bomb explodes).

When a shell exploded it could kill or injure a soldier immediately. Artillery shells severed

limbs or inflicted major internal damage to the body and head, often causing rapid blood

loss. Shell fragments and shrapnel could be very small which made them very hard to find.

Most shrapnel injuries were to arms and legs, although head injuries were also common,

especially before soldiers had steel helmets!

Gunshot wounds

Studies show that bullets were responsible for 39% of wounds. Rifles had developed so

that soldiers no longer loaded them one bullet at a time. Instead, they had a cartridge

case so they could be fired more quickly. Machine guns could fire even more quickly - 500

rounds per minute. They were a major part of trench defences and had a devastating

impact against attacking forces approaching over No Man’s Land. Bullets were designed

with a more pointed shape which drove them deeper into the body from a longer distance.

Machine gun and rifle bullets had the power to break

major bones, and in the early stages of the war

soldiers who suffered a gunshot wound to the legs had

only a 20% chance of survival. Over 41,000 men had

limbs amputated. Gunshot wounds could also pierce

vital organs such as the liver and kidneys and caused

huge damage to the tissue around the entry wound.

Wound infection

The more powerful bullets and shell fragments could

penetrate deep into the body. What added to their

danger was the material they carried- fragments of

muddy clothing and soil which led to infection. The

Western Front battlefields were particularly

dangerous because they used to be farmland, and

therefore contained manure. Soldiers often had to

wait a long time to be rescued from No Man’s Land and

trenches, so, infection had time to develop in wounds.

Gas gangrene was a particularly dangerous infection caused by bacteria in soil. The

infection could kill someone within a day and there was no cure. Wounds would become

hugely swollen with gas, turn white, and then turn green and made a bubbling sensation

when pressed! Tetanus was another common infection, although its impact was reduced by

the use of anti-tetanus injections from the end of 1914.

Gas Attacks

The first gas capable of killing the enemy was Chlorine

gas. It was first used by the Germans in 1915 at the

second battle of Ypres. It suffocated hundreds of

soldiers- their only protection was to urinate on a

handkerchief and hold it over their nose. Other forms

of gas were used later in the war. Phosgene gas was

faster acting than chlorine, killing an exposed person

within two days. Mustard gas was used in 1917. It was

odourless and usually worked within 12 hours. Exposed

skin would blister and if the gas was inhaled, the

soldiers’ lungs would blister and fill with blood.

The effects of gas included blindness, loss of taste and smell and coughing. These

symptoms usually disappeared after a couple of weeks. Although gas attacks caused great

panic and fear, gas never developed into a war-winning weapon. It killed less than 5% of

British soldiers. In July 1915 all British soldiers were given gas masks so it was easy to

defend against. However, gas attacks were greatly feared by soldiers, and the large

number of gas casualties clogged up treatment areas, making it harder for doctors to

treat other injuries.

Illnesses in the trenches

Surgical advances on the Western Front