Medical care throughout the First
World War was largely the responsibility of the Royal Army Medical Corps
(RAMC). The RAMC’s job was both to maintain the health and fighting strength of
the forces in the field and ensure that in the event of sickness or wounding
they were treated and evacuated as quickly as possible.
Every battalion had a medical
officer, assisted by at least 16 stretcher-bearers. The medical officer was
tasked with establishing a Regimental Aid Post near the front line. From here,
the wounded were evacuated and cared for by men of a Field Ambulance in an
Advanced Dressing Station.
A casualty then travelled by motor
or horse ambulance to a Casualty Clearing Station. These were basic hospitals
and were the closest point to the front where female nurses were allowed to
serve. Patients were usually transferred to a stationary or general hospital at
a base for further treatment. A network of ambulance trains and hospital barges
provided transport between these facilities, while hospital ships carried
casualties evacuated back home to ‘Blighty’.
As well as battle injuries inflicted
by shells and bullets, the First World War saw the first use of poison gas. It
also saw the first recognition of psychological trauma, initially known as
'shell shock'. In terms of physical injury, the heavily manured soil of the Western
Front encouraged the growth of tetanus and gas gangrene, causing medical
complications. Disease also flourished in unhygienic conditions, and the
influenza epidemic of 1918 claimed many lives.
Casualties had to be taken from the
field of battle to the places where doctors and nurses could treat them. They
were collected by stretcher-bearers and moved by a combination of people, horse
and cart, and later on by motorised ambulance ‘down the line’. Men would be
moved until they reached a location where treatment for their specific injury
would take place.
Where soldiers ended up depended
largely on the severity of their wounds. Owing to the number of wounded,
hospitals were set up in any available buildings, such as abandoned chateaux in
France. Often Casualty Clearing Stations (CCS) were set up in tents. Surgery
was often performed at the CCS; arms and legs were amputated and wounds were
operated on. As the battlefield became static and trench warfare set in, the
CCS became more permanent, with better facilities for surgery and accommodation
for female nurses, which was situated far away from the male patients.
Wounds to the extremities were so
severe that many thousands of soldiers had to have limbs amputated. In France,
a guillotine, a variation on the one used to cut off heads in the French
Revolution, was used to amputate limbs. As traumatic as it was, amputation
saved the lives of many men as it often prevented infection.
Infection was a serious complication
for the wounded. Doctors used all the chemical weaponry in their arsenal to
prevent infection. As there were no antibiotics or sulphonamides, a number of
alternative methods were employed. The practice of ‘debridement’ – whereby the
tissue around the wound was cut away and the wound sealed – was a common way to
prevent infection. Carbolic lotion was used to wash wounds, which were then
wrapped in gauze soaked in the same solution. Other wounds were ‘bipped’.
‘Bipp’ (bismuth iodoform paraffin paste) was smeared over severe wounds to
prevent infection.
Delays in treatment could mean the
difference between life and death, so innovations in transport changed the
nature of medical care during wartime. In battles that took place on foot or
horseback, medical treatment had to be close to the battlefield and the wounded
were vulnerable to further danger. Men had to be removed from the battlefield
by stretchers. Historically ships were used to transfer the wounded to safer
locations where a doctor could treat them, and hospital ships were developed on
board in which the wounded could be treated. During the Napoleonic Wars
Dominique Larrey developed ambulances drawn by horses to get wounded soldiers
away from the battlefield. In the First World War motorised ambulances and
trains made this a faster process.
In addition to wounds, many soldiers
became ill. Weakened immune systems and the presence of contagious disease
meant that many men were in hospital for sickness, not wounds. Between October
1914 and May 1915 at the No 1 Canadian General Hospital, there were 458 cases
of influenza and 992 of gonorrhoea amongst officers and men. Wounding also
became a way for men to avoid the danger and horror of the trenches. Doctors
were instructed to be vigilant in cases of ‘malingering’, where soldiers
pretended to be ill or wounded themselves so that they did not have to fight.
It was a common belief of the medical profession that wounds on the left hand
were suspicious. In a secret report during the war, Colonel Bruce Seaton
examined 1,000 wounds and injuries to Indian troops being treated at the
Kitchener Hospital in Brighton to find out whether any of them were
self-inflicted. After careful investigation, however, Seaton concluded that
there was no evidence to support the theory of self-wounding among the Indian
soldiers.
Wounding was not always physical.
Thousands of men suffered emotional trauma from their war experience.
‘Shellshock’, as it came to be known, was viewed with suspicion by the War
Office and by many doctors, who believed that it was another form of weakness
or malingering. Sufferers were treated at a range of institutions. Officers
went to Craiglockhart where they were treated by psychiatrists such as W H R
Rivers, and the men went to hospitals such as Netley, or were placed in
asylums. Treatment was vastly different at each institution: the officers at
Craiglockhart were given therapies such as talking cures; the men at Netley
were treated with more physical forms of ‘cure’ such as physiotherapy.
If a wound was serious enough it
meant the soldier going back home to receive further treatment. The hospitals
at home provided more technologically advanced treatment, away from the frantic
activity of the care near the battlefield. Many soldiers had to have further
surgery to clean up the hurried efforts of surgeons at the Front. A number of
therapies were available at the hospitals far away from the battlefield. In
Britain, the wounded were cared for in a range of buildings around the country,
from schools to stately homes. In some cases, suitable surroundings were deemed
an important part of the recovery process. The Pavilion in the seaside town of
Brighton was repurposed to provide a hospital for many of the wounded Indian
troops. These men were considered particularly vulnerable to the cold winters
in France and Belgium and were given electrotherapy to cure conditions believed
to come on from cold weather.
The First World War changed the ways
that soldiers were cared for when they were wounded. New technologies including
blood transfusion, control of infection and improved surgery ensured that,
although many men were permanently wounded, many more survived than died as a
result of their injuries.
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