Medicine on the Western Front Flashcards
What was the problem with horse drawn ambulances?
- Artillery shells and bombs destroyed many roads making them unusable
- men were shaken about making their injuries worse
- it was very slow and often lead to capture
Why were motor ambulances eventually used?
public donations
Why did the British revert to using horse drawn ambulances even after receiving funding for motor ones?
The motor ones couldn’t operate in muddy conditions
How many horses were used in the muddiest conditions?
6 instead of the usual 2
When did the first ambulance train arrive?
October 1914
What did the RAMC use before the ambulance train arrived?
French cargo trains
What did the most advanced ambulance trains have?
Operating theatres
What were the advantages of barge ambulances over train?
- harder targets for the Germans
- allowed wounded to bypass Base Hospital and be taken straight back to Britain
What were the 3 main injuries / diseases / illnesses on the western front?
Trench foot
Trench fever
Shellshock
What were the symptoms of trench foot?
Painful swelling of the feet caused by standing in cold mud and water. In the 2nd stage, gangrene set in
Define gangrene
the decomposition of body tissue due a loss of blood supply
What was the solution for trench foot?
Preventions and if gangrene developed, amputation of the leg
What were the preventions for trench foot?
Keeping feet dry
Regularly changing socks
rubbing whale oil into feet
What were the main symptoms of trench fever?
Flu like symptoms with high temperature, headache and aching muscles
Why was trench fever a major problem?
It affected half a million men on the western front
What was the approach to defeating trench fever?
In 1918 when it the cause was identified with lice delousing stations were set up
What was the effect of delousing stations?
The numbers experiencing trench fever declined
What were the symptoms of shellshock?
tiredness, headaches, nightmares, loss of speech, uncontrollable shaking and complete mental breakdown
What was shellshock later identified as?
PTSD
How many british troops experienced shellshock?
80,000
What were the treatment methods for shellshock?
Treatment back in britain for major cases
Some soldiers were accused of cowardice and punished - some were even shot
Why could minor wounds lead to death?
the soil was filled with rich fertiliser that carried bacteria that could cause gangrene infections
When was the brodie helmet introduced?
1915
What was the effect of the brodie helmet?
Reduced head wounds by 80%
What was the previous alternative to the brodie helmet?
a flat cap
When was chlorine gas first used?
April-May 1915, Second Battle of Ypres by the Germans
What were the effects of chlorine gas?
death by suffocation
What were the original gas masks made of?
Cotton pads soaked with urine pressed to soldier’s faces
When were gas masks introduced?
1915
When was phosgene gas first used?
end of 1915, near Ypres
What were the effects of phosgene gas?
similar to chlorine (death by suffocation) but was faster acting, killing an infected person within 2 days
When was mustard gas first used?
July 1917 by the Germans
What were the effects of mustard gas?
internal and external blisters and could pass through clothing to burn skin
Why was mustard the most effective gas?
It was odourless and worked within 12 hours
What was the chain of evacuation?
Aid posts Dressing stations Casualty clearing stations Ambulance units Base hospitals
The first trenches were built in a hurry and weren’t at all advanced. How were they improved over time?
- Steps added: decrease number of accidents
- Drains added: reduced water and mud in trenches; reduced amount of trench foot cases
Where were all medical workers from initially?
The RAMC, however over time volunteers such as those from FANY were allowed.
What were the roles of medical volunteers on the Western Front?
The FANY and other volunteers were mainly tasked with:
- Driving ambulances
- Cooking
- Cleaning
What do FANY and RAMC stand for?
- First Aid Nursing Yeomanry
- Royal Army Medical Core
There was a hospital at Arras. What was special about it?
- Underground hospital
- Very close to to front line in tunnels underneath town
- Space for 700 beds, operating theatre, and a mortuary.
- Running water and electricity
What problems did the RAMC and FANY face on the Western Front?
- Stretcher-bearers and horse-wagons were the only option in difficult terrain
- Many roads and railways had been destroyed
- Constant fire made recovery of injured difficult
- Initially, no motor ambulances were sent and there weren’t enough horses to cope.
How many motor ambulances did the government buy?
512
Problems with early x-rays
- Photography was at an early stage- taking x-rays required complete stillness for a long time
- High doses of radiation released- patients burnt + lost hair
- Large machines = too heavy to be moved easily
When were mobile x-ray units used?
After 1914. Before this, static x-rays were used at base hospital and some casualty clearing stations.
Benefits of mobile x-rays
- Numbers increased as war went on
- Used closer to the front- faster diagnosis
Drawbacks of mobile x-rays
- Images weren’t as clear as static x-rays, but they still prevented many deaths
How did blood transfusions begin?
1600s: Animal to human transfusions; very low survival rate
How did blood transfusions develop before 1900?
1818-1829: James Blundell performs first human to human transfusions.
Problem with James Blundell’s blood transfusions
Blood had to be transferred directly from donor to recipient as it couldn’t be stored. Around half of the recipients survived.
How did blood transfusions develop before WW1, at the beginning of the 20th century?
1901: Karl Landsteiner discovered three blood groups
1902: His colleagues found a fourth blood group. They found that blood transfusions only worked between people of the same blood group.
When were blood transfusions used on the Western front?
From 1915 onwards. Limited due to no method of blood storage.
What happened in 1915 that improved blood transfusions?
Richard Lewisohn found that sodium citrate could be added to blood to stop it from clotting, so could be stored for a short time- a week.
How was the development of 1915 (blood transfusions) initially improved?
Richard Weil used fridges to store the sodium citrate treated blood for much longer- a few weeks.
What happened in 1916 that revolutionised blood transfusion capabilities?
Francis Rous and James Turner added citrate glucose which allowed blood to be stored for far longer- for months.
When were the newly improved blood storage methods utilised?
Battle of Cambrai, 1917- Oswald Hope Robertson stored 22 units of blood to treat Canadian soldiers suffering shock due to blood loss. This demonstrated its potential.
Aseptic conditions before 1900 generally
- Operating theatres + wards thoroughly cleaned
- Surgeons and nurses wore sterilised clothing
- Sterilised cloths covered surfaces and equipment
- Surgeons and nurses wore masks to prevent breathing germs into a wound
Aseptic conditions before 1900- specific developments
- 1878- Robert Koch develops steam steriliser for surgical instruments
- 1887 onwards- All surgical instruments sterilised
- 1890- Anyone touching the patient wore rubber gloves to prevent germs from hands passing to wounds/instruments
What was an issue at Dressing and Casualty Clearing Stations?
Antiseptic and aseptic surgery was impossible, and many wounds were already infected by the time when patients were operated on.
Due to the issue at Dressing and Casualty Clearing Stations, what did surgeons revert to?
They went back to using chemicals to kill bacteria but this didn’t work against gas gangrene.
When did the Carrel-Dakin method begin to be used and what was it?
- By 1917
- Sterilised salt solution passed through wound using tubes. More effective than chemicals.
When did the Carrel-Dakin method not work and what was the solution to this?
When infections were too deep. Surgery was developed to remove the damaged and infected tissue as well as to remove all traces of the bullet/shrapnel.
What was the final solution if the previous methods didn’t work at curing infection?
Amputation.
How many soldiers died due to broken legs before December 1915?
80%
What was used from December 1915 onwards?
The Thomas Splint. It kept the leg rigid which reduced blood loss, meaning that the death rate from broken bones decreased to under 20%.
How did plastic surgery improve?
The large number of facial injuries meant that surgical techniques had to be developed. These developments were led by Harold Gillies, who worked at Queen’s Hospital in Kent.
