-Marne 7th to 12th september 1914
-1st Battle of Ypres 12th October to 11th November 1914
-2nd Battle of Ypres 22nd April to 25th May 1915
-Arras 9th April to 16th May 1917
-3rd Battle of Ypres (Passchendaele) 31st July to 10th November 1917
-Cambrai 20th November to 7th December 1917
-1st July to 18th November 1916
-approximately 400,000 British casualties
-2nd Battle of Ypres
-chlorine
-245,000 casualties
-men drowned in mud
-2.5 miles of tunnels dug in 5 months by tunnelling companies
-25000 men could be stationed in tunnels and 24000 used in first wave of attack
-Tunnels had electric light, running water, light railway system and full functioning hospital
-tunnels had to be evacuated after being hit by German shell
Cambrai
-Regimental Aid Post (RAP)
-Advanced Dressing Station (ADS)
-Main Dressing Station (MDS)
-Casualty Clearing Station (CCS)
-Base Hospital
-English Hospitals
-CCS
-triage was sorting the wounded into 3 categories
1.walking wounded-patched up and returned to fighting
2.hospital treatment-treated for immediate life threatening injuries and then sent to a base hospital
3.severe wounds-judged as having no chance of recovery so made comfortable but resources not used on them-only people likely to survive their injuries
-treatment done on wounds at risk of gangrene and other life threatening injuries-originally done at base hospital but found that success required speed
-done by doctors (some with specialised knowledge) and nurses as support
ADS
-24 CCS in the Ypres salient
-379 doctors
-502 nurses
-200,000 casualties treated
-30% of men admitted were operated on
-3.7% of men admitted died
-underground hospital at Arras
-fully working hospital was created so close to front line it was in fact a dressing station as casualties moved up chain of evacuation
-waiting rooms were available and spaces for 700 stretchers
-had beds, an operating theatre, rest stations for stretcher bearers, mortuary, electricity and piped water
-many infections caused by gas gangrene and carbolic acid was ineffective on gas gangrene
-impossible to perform aseptic surgery near front line due to unhygienic conditions and the large number of wounded who required immediate treatment to live
-disagreements between medics on the front line and doctors in Britain who didn't understand the conditions medics faced everyday on the front line
-amputations were only way to stop infection
-alternative to asceptic surgery which couldn't be done in trenches
-helped prevent infections and limit amputations
-used a sterilised salt solution in the wound through a tube
-simple to use (just water and salt) so could be done on the Western Front
-X rays took several minutes and wounded needed to stay still-difficult with wounded soldier in pain
-X ray tubes were fragile and overheated so could only be used an hour at a time and then left to cool down-many wounded needed an X ray so this was a major hinderence
-Machines were heavy and fragile so only base hospitals and large CCS has them-but a lot of surgery done in smaller CCS and ADS so X rays needed there too
-Could not detect all objects in the body and clothing needed removing-difficult with injured soldier
-overhearing-3 machines used at one time-one could cool while the other was in use
-tube technology-better tubes developed by American William Coolidge but only available after 1917 when the USA entered the war
-availability-6 mobile X ray units created
-developed to stop joints moving and was easy to use
-bullet or shrapnel wound caused compound fracture and to be treated leg needed to be kept rigid which the Thomas splint did
-little knowledge of it at the beginning of the war
-increases survival rate from 20% to 82%
shock
-blood couldn't be stored so transfusions given by live donors
-needed large amounts of blood during battle and donors would be soldiers who were needed in battle
-blood group of donor and patient needed to match but there wasn't time to check blood groups
-1915- adding Sodium Citrate stopped clotting and meant blood could be stored in refridgerators for up to 2 days and a live donor no longer needed
-1916-adding Citrate glucose resulted in storage for up to 4 weeks
-refridgerators still needed and only a few CCS had power were the blood was needed
-Oswald Hope Robertson devised a new method of storing blood at CCS
-stored 22 units of universal donor blood (O) in glass bottles
-Robertson built carrying cases for the bottles
-used ammunition boxes filled with ice and sawdust
-during battle 20 severely wounded Canadian soldiers treated with stored blood-some of ot had been collected up to 26 days prior
-none expected to survive but 11/20 did because of blood given to them
-showed the potential use of stored blood to treat soldiers in shock and save lives
-problems of infections like in other wounds
-many casualties were unconscious or confused
-doctors had limited experience of neurosurgery
-quicker operation meant more chance of survival
-dangerous to move men too quickly though
-injuries could look minor but were serious
-specific CCS became brain injury centres eg Ypres 1917- Mendingham CCS
-patients stayed at CCS for 3 weeks after surgery
-all head wounds examined very carefully
Harvey Cushing
head injuries that didn't kill could cause severe disfigurement and difficulty eating
-Gilles was an ENT specialist but became interested in facial reconstruction
-Gilles had no experience in this area of surgery so devised new operations as problems occured eg tube pedicle skin grafts
-all operations in Britain and from 1917 all at the Queen's hospital in Sidcup, Kent-Gilles involved in creating design to match his needs
-by 1918 12,000 operations carried out