Western Front Medicine
Major battles and their dates in chronological order (excluding Somme)
-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
Somme date and casualties
-1st July to 18th November 1916
-approximately 400,000 British casualties
which battle saw Germans first use poisonous gas and what gas was it ?
-2nd Battle of Ypres
-chlorine
3rd Battle of Ypres casualty count and frequent cause of death
-245,000 casualties
-men drowned in mud
Battle of Arras tunnels
-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
which battle saw the first large-scale effective use of tanks ?
Cambrai
6 locations in the chain of evacuation in order
-Regimental Aid Post (RAP)
-Advanced Dressing Station (ADS)
-Main Dressing Station (MDS)
-Casualty Clearing Station (CCS)
-Base Hospital
-English Hospitals
What was triage and where was it carried out ?
-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
what treatments were available at the CCS and what personnel were involved ?
-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
which part of the chain of evacuation was 400m away from the front line and normally in abandoned buildings or tents ?
ADS
The CCS at the battle of Passchendaele
-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
The medical facilities at Thompson's cave
-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
what were the problems of infection on the Western Front ?
-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
why were there so many amputations on the Western Front ?
-amputations were only way to stop infection
What was the Carrel Dakin method to stop infection 1917 and why was it a benefit at the front ?
-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
Why was it difficult to use an X-ray machine during fighting ?
-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
How were the problems of taking X rays overcome ?
-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
Thomas splint
-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%
how did patients die when they lost blood ?
shock
why was giving blood to patients a problem on the western front ?
-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
what developments were there in being able to store blood but what problem still remained ?
-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
Blood Depot at the battle of Cambrai
-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
why were brain injuries usually fatal ?
-problems of infections like in other wounds
-many casualties were unconscious or confused
-doctors had limited experience of neurosurgery
what problems in treating brain injuries were noticed ?
-quicker operation meant more chance of survival
-dangerous to move men too quickly though
-injuries could look minor but were serious
what was done to help brain injured patients survive ?
-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
who was the man connected to brain injury treatment on the western front ?
Harvey Cushing
why was plastic surgery needed ?
head injuries that didn't kill could cause severe disfigurement and difficulty eating
the work of Harold Gilles
-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
where was plastic surgery carried out and how many operations were carried out ?
-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