World War 1 Case Study Flashcards
1
Q
When did Britain declare war on Germany?
A
August 4th 1914 when Germany invaded France through Belgium
2
Q
Why did Britain send the British Expeditionary Force to Northern France?
A
To try to stop the German advance but by the end of 1914 much of Belgium and Northern France had been occupied by the Germans
3
Q
What happened after the initial fighting in WW1?
A
Both the British and Germans pulled back their forces and Trench Warfare began (most fighting on the Western Front between 1914-1918 was trench warfare) so it became a defensive war using trenches with some offensive attempts to capture enemy trenches and land
4
Q
Give 4 facts about casualties in the British sector in WW1
A
2.7 million casualties in the British sector of the Western Front, 700,000 of these casualties were not seen by medical services as they were killed/prisoners, remaining 2 million were treated by medical services in France or England, of those treated 150,000 died from their wounds
5
Q
Which 4 strategic areas did the British sector include?
A
Ypres, Arras, Albert, River Somme. Many of the largest battles were fought here
6
Q
Identify the 4 key British battles in WW1
A
Ypres Salient 1914-15, The Somme 1916, Arras 1917, Cambrai 1917
7
Q
What was the ‘Salient’ in Ypres?
A
An area under British control surrounded by Germans on 3 sides. The Germans held the high ground whilst British were in the lower, wetter areas
8
Q
What happened in the First Battle of Ypres in 1914?
A
In autumn, Germans attacked the British positions around East and North East of Ypres. Britain kept Ypres but lost 50,000 troops
9
Q
How did the Germans hold height advantage over the British in the Ypres Salient battle and how did the British respond?
A
They held Hill 60 south east of Ypres and in April 1915 British soldiers mined underneath the hill and blew up German defences to capture the hill
10
Q
What happened in the Second Battle of Ypres in 1915?
A
Between April to May the second battle started. First time Germans used Chlorine Gas on the Western Front. British losses were 59,000 men and Germans moved 2 miles closer to town of Ypres
11
Q
When and how did the British push back the Germans from Ypres?
A
British finally pulshed back the Germans in the rainy 1917 battle of Passchendaele. Costly victory with 245,000 casualties
12
Q
When and what was the Battle of the Somme?
A
Largest British attack in WW1 which lasted July to November 1916 and aimed to take ground from Germans. There were huge casualties on both sides but especially for the British with 57,000 casualties and 20,000 dead on the first day alone
13
Q
Why was the Battle of the Somme significant? 2 reasons
A
First use of tanks however they were not effective at that point, use of creeping barrage (artillery bombardment that moved towards the German trench as British approached it)
14
Q
How did the battle of Arras go from being a success for the British to virtually stopping?
A
In April 1917 they advanced 8 miles into enemy territory but by May 1917 the attack virtually stopped with the Allies suffering 160,000 casualties
15
Q
What was significant about the battle of Arras?
A
The allies (Britain, New Zealand, Canada) built over 2.5 miles of tunnels as shelter to prepare to attack the German line (a new tactic). Tunnels could shelter 25,000 men and contained accommodation, a railway, water, electrical supplies and a hospital big enough 700 beds
16
Q
What happened in the battle of Cambrai 1917?
A
First large scale attack by the British tanks to attack over German line (over 450 tanks used however no artillery bombardment which surprised the Germans). British succeeded at first helped by tanks however Germans counter attacked after the British attack stopped and all land taken by the British was lost
17
Q
When were trenches first dug and why?
A
By British and French Armies in Northern France in 1914 to act as a barrier to stop rapid advance of the German army
18
Q
What were trenches like at first? 2 points
A
Temporary and built quickly using sandbags and shovels in existing ditches, needed to be constantly repaired due to weather and constant bombing
19
Q
How did trenches develop as the war went on? 4 points
A
Became part of the ‘stalemate’ used to defend and launch attacks, became more compex with bunkers/drainage/hospitals/accommodation, became more dangerous with machine guns/concrete bunkers/barbed wire as defences, new weapons such as tanks/gas/machine guns/artillery/airplanes evolved to fight on this terrain
20
Q
What is an important thing to remember about trenches across the Western Front?
A
They were different from one place to another so not every soldier had the same experience
21
Q
Identify 11 key features of a trench
A
Firebay, dugout, parapet, ammunition shelf, firestep, duckboard, no mans land, Brodie’s helmet, elbow rest, sandbags, barbed wire
22
Q
What is a firebay?
A
Where troops did their shooting, they would be protected by sandbags
23
Q
What is a duckboard for?
A
To prevent soldiers standing in water to prevent trenchfoot
24
Q
What is a firestep for?
A
Allows soldiers to fire towards the other trench, trenches were 2.5m deep
25
What is a parapet?
Low protective wall
26
What is an ammunition shelf?
Area in which ammo was kept under the firestep
27
What is a dugout?
Area dug into the side of the trench where men could take protective cover
28
What are communications trenches?
Trenches that run between other trenches, linking them together
29
What are support trenches?
80m behind the frontline trench. Troops would retreat here if under attack. Spent 10% of time here
30
What are frontline trenches?
Where attacks were made from the most dangerous area. Only 15% of a soldiers time spent here
31
What are reserve trenches?
100m behind the support trench where troops would be mobilised to counter attack the enemy if they captured the front line
32
How much of a soldiers time was spent away from the trenches?
45%
33
Identify 3 advantages of the trench system
Simple to make and cheap to build, easy to defend with few men using barbed wire/artillery/concrete bunkers/machine gun fire, provided some shelter/protection
34
Identify 4 disadvantages of the trench system
Hard to attack as had to cross no mans land (area between two trenches) which has been destroyed by shell fire and was a mass of mud and craters, trenches were very dirty and unhygienic as there was no running water or flushing toilets, in summer sewage dead bodies and heat led to horrific smell and disease everywhere, in winter bad weather led to flooding and frostbite (6000 cases in December 1914)
35
Why did the terrain on the Western Front make it difficult to transport wounded men away from the front line? 7 points
Constant bombing and shelling created a landscape of stagnant water craters, muddy, roads destroyed, rotting corpses, unexploded munitions, chemical waste, wounded could only be collected at night
36
Why did the trench system make it difficult to transport injured men? 2 points
Trenches were clogged up with men and equipment which made it hard for stretcher bearers to manoeuvre whilst under fire. Number of wounded overwhelmed the medical system
37
How were the wounded carried away from the front line?
4 stretcher bearers carried them once they were in a stable condition under enemy fire. The faster a man could be evacuated and treated, the greater the chance of survival
38
What type of ambulances were originally used and what were 3 problems with them?
Horse-drawn ambulance wagons. Could not cope with number of wounded, shaky transport often made injuries worse, lack of ambulance meant many men were left to die
39
What was the first solution to the problem of ambulances?
News of the problems reached Britain so The Times appealed for donations and raised enough for 512 motor ambulances. By October 1914, the first motor ambulances reached the front line sent by the Red Cross
40
What was the issue with motor ambulances?
The worse the terrain, the less effective therefore horses continued to be used (up to 6 in horrendous conditions)
41
What was the second solution to the problem of ambulances?
To reach Base Hospitals on the French Coast, the Royal Army Medical Corps used specially designed ambulance trains from November 1914. Stretchers could fit down the side of the carriage and some had operating theatres.
42
What was the issue with ambulance trains and how was this solved?
They blocked supply routes in France. Canals were used which were comfortable and slow but could transport the wounded onto barges back to Britain
43
What are the cause and the symptoms of trench foot?
Caused by standing in waterlogged trenches. Feet would swell, go numb and skin would turn red or blue. Could lead to gangrene and amputation of limbs
44
What were 4 attempted solutions for trench foot?
Medical officers ordered soldiers to carry 3 pairs of socks and change them twice a day, rub whale oil on their feet, pump out waterlogged trenches, ad duckboards (difficult due to constant bombing)
45
What was Trench Fever spread by and what were 8 symptoms?
Spread by lice. Eye pain, high temperature, headache, rash, joint pain, aching muscles, back pain, men could be ill for up to 1 month
46
How many men on the Western Front were affected by trench fever?
An estimated half a million
47
How were the number of trench fever cases reduced?
Delousing stations were set up: clothes wer disinfected, men bathed, chemicals sprayed on men to prevent lice
48
What are 6 symptoms of shell shock?
Tiredness, headaches, nightmares, loss of speech, uncontrollable shaking, complete mental breakdown
49
How many British troops experienced shell shock?
An estimated 80,000
50
What 3 things happened to soldiers who experienced shell shock?
Accused of cowardice, punished, some even shot
51
What percentage of wounds were high explosive shells and shrapnel (fragments of metal) responsible for?
58%. 60% of which were to the arms and legs
52
What percentage of wounds were bullets responsible for?
39%
53
What was the treatment for shrapnel wounds to the arms and legs?
Amputation. Over 41,000 had their limbs amputated
54
Why was the steel Brodie Helmet invented?
Due to the high number of head wounds. It was given to all soldiers and reduced fatal head wounds by 80%
55
How was gangrene caused?
Most injuries got infected due to bacteria in the soil
56
When and how was the impact of gangrene reduced?
Tetanus injections from the end of 1914
57
What type of gangrene could not be cured and how quickly could it kill?
Gas gangrene. Often could kill in a day
58
What 3 things could artillery bombardments, gun fire and bombs all do?
Break bones, destroy tissue, pierce vital organs. Many never made it to hospital
59
When were x rays discovered and who by?
1895 by William Roentgen
60
When were radiology (x ray) departments set up and what happened for the first time there?
As early as 1896. One set up at Birmingham General Hospital where Dr John Hall-Edwards was one of the first doctors to locate a needle in a women's hand
61
Identify 4 problems with X rays
Health risks not understood - radiation levels were 1500 times stronger than today so patients could lose hair or suffer burns, Reontgen's x ray machine contained a very fragile glass tube, x rays took about 90 minutes to complete, big x ray machines were immovable
62
What was a huge problem when surgical operations became more complex in the 19th and 20th century?
Blood loss which caused shock and death
63
Who did the first experiments on human to human blood transfusions and when?
James Blundell developed techniques so transfusions were possible by the start of WW1
64
What did Karl Landsteiner discover?
Discovered blood groups (A, AB, B, O) in 1901 and O was the universal blood group which meant donor and patients could be matched
65
What were 2 problems with early blood transfusions?
Blood could not yet be stored so had to be used straight away, donor of the blood had to be connected directly to the recipient of the blood
66
What is antiseptic surgery?
Killing germs in wounds. Methods like using carbolic spray stop wounds being infected by germs in the operating theatre
67
What is aseptic surgery and what 4 methods does it involve?
Preventing germs reaching wounds. Medical equipment steam sterilised whilst room was air sterilised to kill germs, medical staff had to hash before entering surgery, wore clean gowns, rubber gloves
68
What was the Royal Army Medical Core (RAMC)?
Branch of army responsible for medical care which organised and provided treatments to wounded and sick whilst being responsible for keeping men healthy
69
By how much did the number of men in the RAMC increase?
In 1914 there were 9000 men but by 1918 there were 113,000 who acted as stretcher bearers and doctors
70
By how much did the number of nurses in the RAMC increase?
Well trained nurses from Queen Alexandria were allowed to join. Increased from 300 in 1914 to 10,000 by 1918. They acted as volunteer cooks, washers, cleaners
71
What was the First Aid Nursing Yeomanry (FANY)?
First women's voluntary organisation to send volunteers to the Western Front. They helped by driving ambulances, driving supplies to the front line and setting up mobile bath units that could bathe up to 40 men an hour
72
By how much did FANY numbers increase?
In 1914 there were 6 women but by 1918 there were over 500
73
What did FANY pave the way for?
Volunteer Aid Detachment (VAD) nurses to help medical services
74
What was the 'Chain of Evacuation'?
Quick and efficient system to get the wounded from the frontlines to a safe area where they could be treated which was needed because there was such a large number of casualties. There were four main stages of the chain but the order was not the same for every casualty
75
Identify the 4 stages of the Chain of Evacuation
Regimental Aid Post, Advanced Dressing Stations & Main Dressing Station, Casualty Clearing Stations, Base Hospitals
76
How did Soldiers get to the Regimental Aid Post?
Soldiers walked there or were carried by stretcher bearers, stretcher bearers carried basic medical supplies and there were usually 16 men per battalion (1000 soldiers)
77
What happened at the RAP? 4 points
Located within 200 metres of the front line in communications trenches, aim was to give immediate first aid and get as many men back to the front line as quick as possible, could not deal with serious injuries- sent to ADS, led by a Regimental Medical Officer with some stretcher bearers
78
What happened at the ADS & MDS? 7 points
ADS within 400m of RAP, MDS about half a mile away, in tents or bunkers to provide protection from enemy shelling, could only look after men for a week, staffed by 10 medical officers and stretcher bearers and nurses too, in total could deal with about 150 men, often in battles like Ypres they dealt with 1000 casualties in 2 days at Hooge
79
What happened at Base Hospitals? 5 points
Situated near ports on French/Belgian coast on train lines and canal rivers, had operating theatres/x rays/laboratories/specialist centres for treating gas poisoning and head wounds, specialist wards allowed doctors to become experts in treatment of particular wounds, treat up to 2500 patients at once, patients with 'Blighty Wounds' sent back to England
80
Give 7 points about what Arras underground hospital was like
Full working hospital built in 800m of tunnels in 1916, essentially a dressing station close to the front, waiting rooms for the wounded, 700 spaces for stretchers to be used as beds, an operating theatre, a mortuary, electricity, water supply
81
When and why was Arras underground hospital abandoned?
During battle of Arras in 1917 when its water supply was destroyed by a shell
82
Identify 8 types of sources which you can use to better understand medical issues in WW1
Army statistics, government records of aspects of the war, medical records, medical articles by doctors/nurses who took part in war, national newspaper reports, personal accounts of medical treatments by soldiers or doctors/nurses, photographs, national army records for individual soldiers
83
What was the major problem for the RAMC dealing with infections caused by gas gangrene?
Wasn't possible to perform aseptic surgery due to the contaminated conditions and large number of wounded men
84
Why was amputation used as a treatment and how many limbs had been amputated by 1918?
If antibiotics or wound excisions failed to stop the spread of infection. Over 240,000 by 1918
85
What did wound excisions/debridement involve?
Cutting away the dead/damaged/infected tissue from around a wound to reduce infection which needed to be done as quickly as possible to prevent infection spreading. Shell/shrapnel fragments also removed and afterwards the wound had to be closed with stitches, often antiseptics were used to kill infection
86
What was the Carrel-Dakin method?
Antiseptics like carbolic lotion were inefficient when treating gas gangrene so by 1917 the Carrel-Dakin method was the most effective and involved putting sterilised salt solution containing sodium hypochlorite and boric acid in a wound through a tube. The solution only lasted 6 hours and had to be made as soon as it was needed which was a problem if large numbers of men needed treatment. This method drastically reduced cases of gas gangrene and therefore need for amputation
87
Why was the Thomas Splint created?
In 1914/15 men with gunshot or shrapnel wounds had 20% chance of survival and the current splint which was used to secure the leg did not work as it didn't keep the leg straight so by the time injured soldiers reached the CCS they had suffered blood loss, shock and gangrene. Some soldiers dragged their injured comrades away from the battlefield which caused enormous damage as the broken bone tore muscle and occasionally arteries so Hugh Thomas invented the Thomas Splint
88
Describe the Thomas Splint in 4 points
Tested on a hospital in London, the metal frame held the fractured limb and it straight so the bone healed in the correct position, from December 1915 medical practitioners on the front were trained on how to use the Thomas Splint, survival rates for gunshot and shrapnel wounds rose from 20% to 80%
89
How were mobile x ray units used?
Two x rays taken from different angles to help a surgeon identify the location and size shrapnel/bullets which made it easier to extract in order to help stop infection. 6 mobile vans were used throughout the British sector of the Western Front called 'Petite Curies' named after Marie Curie who invented them
90
Identify 5 weaknesses of x rays
Couldn't detect all objects in the body for example fragments of clothing in a wound, took a long time to perform an x ray, tubes in x ray overheated quickly so could only be used once an hour and there had to be three machines used in rotation, mobile vans took a while to set up, picture quality was poorer than x rays in Base Hospitals
91
Identify 3 improvements to x rays
Cellulose based films coated with photographic emulsions replaced fragile glass photogenic plates, hot cathode tube replaced the cold tube which had a short life, by the end of the war French and Americans had collaborated to introduce a flying x ray unit to transport to carry equipment to where they were most needed
92
When and why were blood transfusions introduced and who by?
Lawrence Robertson in 1915 in the base hospital at Boulogne to prevent shock of blood loss in casualties, many men recovered using this method
93
Where were blood transfusions at by 1917?
Being carried out in Casualty Clearing Stations
94
What did Geoffrey Keynes do?
Designed a portable blood transfusion kit and from 1915 he used this to provide blood transfusions on the front line. It could store blood to take blood to the front line which stopped soldiers bodies going into shock from blood loss
95
Why was the identification of blood groups important?
Less risk of using the wrong blood type during transfusions, type O was used as a universal donor
96
Identify 2 advances with the problem with storing blood
In 1915 Richard Lewisohn found that by adding the anti-coagulant sodium citrate blood stopped clotting so could be stored, In 1916 Francis Rous and James Turner found that by adding a citrate glucose solution to blood it could be kept refrigerated for up to 4 weeks
97
What was the Blood Bank at Cambrai?
In preparation for the battle of Cambrai Oswald Robertson stored 22 units of type O blood in sodium citrate solution and packed it in ice filled ammunition cases in the first 'blood depot', 20 Canadians were treated using this blood and 11 survived. This was the first time blood had been used to treat soldiers in shock which showed it has the potential to save lives
98
State 2 reasons why brain injuries were almost always fatal at the start of the war
Very few doctors had experience of neurosurgery before the war, infection in the head was common and it was difficult to move when through the chain of evacuation
99
What did an American neurosurgeon called Harvey Cushing do about brain injuries? 3 points
Experimented with use of magnets to remove metal fragments from the brain, used a local anaesthetic (patient awake but wounded and numb) instead of general (patient asleep) to prevent brain swelling, he operated on 45 patients in 1917 and 71% survived in comparison to the usual 50% survival rate
100
Identify 3 observations about brain surgery and the new methods related to each
Men who were operated on quickly had a higher chance of survival so some CCS became specialist brain centres and during the Third Battle of Ypres all head injuries went to the CCS at Mendinghem, it was dangerous to move men quickly after an operation so patients stayed at the CCS for three weeks after surgery, injuries may be hiding more severe injuries so all head wounds were carefully examined
101
What 2 anaesthetics replaced ether and chloroform?
Gas and oxygen which were safer and gave better results
102
What 2 things did Oswald Robinson do after the Battle of Cambrai?
Given charge for the training of transfusion teams for the British army, set up blood bank facilities at battalion aid stations
103
Who was Harold Gillies?
A nose/throat/ear surgeon who developed the use of plastic surgery in the war to restore parts of the face which had been destroyed by shrapnel
104
What 3 operations did Harold Gillies devise to overcome problems with plastic surgery?
Delicate surgery couldn't be done in France so Queens Hospital in Kent opened in 1917, skin grafts involved taking skin from one area to graft onto the wounded area and these areas were connected by a tube pedicle (waterproof tube of flesh resistant to infection) before growing back, jaw splints/wiring/metal replacement cheeks used for facial reconstruction
105
How did Gillies treat Lieutenant William Spreckley?
To fashion him a new nose, Gillies read about an old Indian idea known as the ‘forehead flap’. He took a section of rib cartilage and implanted it in Spreckley’s forehead. It stayed there for six months before it could be swung down and used to construct the nose. From start to finish, the process took over three years. Spreckley was admitted to hospital in January 1917 at the age of 33 and discharged in October 1920
106
What was a failure of Gillies work?
A pilot named Henry Lumley was admitted to Sidcup with horrific facial burns. To repair them, Gillies attempted to take a massive face shaped flap from his chest. The massive graft soon became infected, and unable to bear the trauma of surgery, Lumley died of heart failure. This taught Gillies that plastic surgery had to be carried out in small stages rather than one big operation
107
Gillies knew that for the flesh to remain alive it had to remain attached, how did he solve this problem?
His solution involved leaving the flesh attached at one end, rolling it into a tube and attaching the other end near to where the graft was needed. Called the tube pedicle. Living tissue was encased by the outer layer of skin which was waterproof and infection resistant. Gillies was able to leave these tubes in place for weeks at a time, with little risk. Once a blood supply had grown into it from the new end, the original connection could be cut. From there the flesh could be swung into place.
108
What did Gillies do before the Battle of the Somme in 1916?
A specifically-designed hospital was opened in Sidcup. It treated 2,000 patients after the Battle of the Somme alone
109
How many hospitals in France specialised in plastic surgery by 1915?
7
110
How many plastic surgery operations had taken place by the end of the war?
Over 12,000
111
Give points about casualty clearing stations
Patients with serious injuries divided into three groups: walking wounded, no chance of recovery and those who needed hospitals. Located near railway lines so wounded could be transported home
112
How many soldiers died due to gas attacks in WW1?
6000, they were very unprepared for it
113
How did chlorine gas kill?
By suffocation. Before gas masks, soldiers would soak cotton pads in urine and press them to their faces
114
How quickly could phosgene act?
Within 2 days, faster acting than chlorine
115
What was mustard gas?
Odourless Gad that worked within 12 hours. Caused internal and external blisters and could pass through clothing to burn skin. Used from 1917
116
What was the solution to gas masks?
Given gas masks from July 1915 which became more sophisticated over time
