Western front

Question 1

Key Battles of the British Sector of the Western Front

Answer 1

• The Battle of Arras (Apr 1917) - 160,000 British casualties
• The Battle of Cambrai (Nov 1917) - first time tanks were used in significant force and first blood bank - 45,000 British casualties
• The Battle of the Somme (July-November 1916) - 1st July was the worst day in British Military History with 60,000 casualties and 420,000 British casualties by November
• Third Battle of Ypres (July-November 1917) - Infamous for quagmires which made evacuating casualties very difficult - 448,000 Allied casualties

Question 2

The Trench System

Answer 2

• Front line trench - 2.5m deep and 1m wide with soldiers spending approx. 1 week in the front line.
  Soldiers were liable to being hit by enemy fire and sometimes their own artillery.
• Support trench - Provided a second line of defence in case the front line trench was taken by the enemy. They also had first aid stations and kitchens to ensure front line men had medical treatment and hot food.

Communication Trench - Used to move between the front and rear trenches. Also used to transport injured men to field hospitals.

Question 3

Front Line Trenches

Answer 3

• Duckboards - wooden trench boards laid along the bottom of the trench to prevent ground becoming waterlogged.
• Sump - narrow drainage channel underneath duckboards.
• Fire step - Built in to enable men to see out of the trench and also climb up into no man’s land

-Barbed wire was used extensively, being laid several rows deep to protect the front line trench.

• Dugout/Bolt Hole - Built into the sides of the trench to be used for protection, eating and sleeping.
• Sandbags - Used to protect from enemy rifle fire and sometimes placed along the bottom of a trench to soak up water.

Question 4

Dangers facing tunnellers

Answer 4

• Carbon monoxide poisoning (oxygen starvation) where candles would be used to measure oxygen levels. If the candle went out, it was time to leave!- Tunnel collapse (or explosion of mines already set leading to this).
• Meeting enemy tunnellers who would have to be fought in hand to hand combat, blow you up or bury you alive.- Dangers led to development of the geophone
• a pair of disc shaped microphones connected to ear pieces so that enemy tunnellers could be spotted, before the British themselves were.

Question 5

Challenges of providing treatment underground

Answer 5

• Risk of enemy shelling
• Dark and dingy (difficulties in installing running water and electricity)
• Difficulties moving supplies in
• horse drawn railway was used
• Difficult to achieve and maintain aseptic conditions

Question 6

Top five causes of illness

Answer 6

• Pyrexia (fever of unknown origin)// high fever was often attributed to ‘trench fever’ which was spread by body lice: 97% of men infected
• Inflammation of connective tissue (ICT)
• Trench foot
• Influenza
• Scabies (infestation of mites in skin)

Question 7

Top five causes of injury

Answer 7

• Shrapnel
• Gunshot
• Gas poisoning
• Fractured femur (broken leg)
• Wasp sting
• Percentage of total deaths amongst British Army was 17.6%- Percentage of total injuries was 41.6%

Question 8

Brodie Helmet and Thomas Splint

Answer 8

Two medical innovations which helped to reduce effects of injury..

• Brodie Helmet was introduced as standard kit in 1915 and reduced head injuries by 75%
• Thomas Split significantly reduced the death rate from a broken femur because it stabilised injury and controlled infection
• following its introduction in 1916, the chance of death from this injury declined from 80%-20%. Was invented by Hugh Owen Thomas.

Question 9

RAMC (Royal Army Medical Corps)

Answer 9

• The ‘official’ Army Medical Unit formed in 1898
• August 1914: 9,000 Warrant Officers and men of the RAMC compared to 113,000 by 1918
• Initially provided inadequate care, but ability to cope improved as war went on.
• Created RAMC Sanitary Sections which checked the sanitation of all barrack areas, cookhouses, billets etc.
• Increasing realisation that speed was crucial and so Chain of Evacuation was set up.

Question 10

FANY (First Aid Nursing Yeomanry)

Answer 10

• Voluntary Organisation who were a British all female registered charity formed in 1907
• Leaders were Grace McDougall and Lillian Franklin
• British Army wanted nothing to do with them and so funded their own ambulances and equipment.
• Acted as a first aid link between the field hospitals and front line
• Would rescue the wounded and administer first aid similar to a modern combat medic
• Also set up their own hospitals and field stations, such as the Lamarck hospital opposite the Notre Dame.

Question 11

Challenges of Medical Treatment

Answer 11

• Limited resources - War disrupted supply chains + inadequate numbers of medics
• The Working Environment
• Stationary hospitals were hastily converted from schools and hotels. CCS were in muddy fields

-Medical care deprioritised and British Army did not allow female medics

Question 12

Triage

Answer 12

The RAMC used triage to determine the level of care needed
- Slightly Injured (quickly given treatment and then continued fighting)
- Needs Hospital (transported by ambulance to nearest hospital base)
- Beyond help (made comfortable, but little treatment was given as a priority to others. Sometimes killed by own men)

Question 13

Methods of transport

Answer 13

• Human Stretcher Bearers - carried few medical supplies for short distances, but could get through quagmires.
• Horse-drawn ambulances - relatively cheap and reliable and could carry people for longer than a stretcher bearer, but had the potential to get stuck in the mud and were slower than a mechanised ambulances
• Mechanised ambulances

Question 14

Medical Innovation: Mobile X-Ray Unit

Answer 14

• X-Ray discovered in 1895 by WC Rontgen- Military were some of the first to realise their potential.
• Used by the military to locate shrapnel wounds so that surgeons could remove them quickly and prevent infection
• Concept of protection from radioactive poisoning was non existent.

Question 15

Medical Innovation: Blood Transfusions

Answer 15

n 1900 Karl Landsteiner identified blood groups, - In 1907 Ludvig Hektoen notes benefits of matching blood groups for compatibility

• In 1914 Richard Lewisohn shows sodium citrate to be an effective anticoagulant
• Blood successfully transfused during WW1 because it was kept on ice for up to 28 days before being transferred to CCS.
• Blood stockpiled before casualties arrives and Captain Oswald Robertson established the first blood bank on the Western Front in 1917 for the Battle of Cambrai.
• Sodium Citrate was used to stop the blood from clotting

Question 16

Medical Innovation: Care of Amputees

Answer 16

Pre war: prosthetics are heavy and poor replacements for lost limbs
- During war: Two American firms, Rowley and Hanger were invited by the government to open Queen Mary’s Hospital where new prosthetics were developed and trialled on patients.
Features included being lightweight, rustproof and with adjustable joints

Question 17

Medical Innovation: Plastic Surgery

Answer 17

• Harold Gillies: plastic surgeon determined to restore function to facial features and an aesthetic result
• Created the tube pedicle where tissue could be moved from A to B without fear of infection.- Despite innovations, disfigurements remained profound and patients often couldn’t face going out in public
• Faces were covered up and mirror removed in hospitals.

Question 17

Specific Challenges: Gunshot Wounds

Answer 17

• Trenches protected soldiers’ bodies, but left their heads vulnerable to enemy fire
• Machine gunners could fire 600 rounds a minute, which wreaked havoc in the body, twisting tissue and splintering bone.

Question 18

Specific Challenges: Shrapnel

Answer 18

• Biggest killer on the battlefield and cause of many facial injuries
• Twisted metal shards produced from shrapnel blasts could rip a face off
• Shrapnel’s shape would often drag dirt into the wound

Question 19

Specific Challenge: Gas Attacks

Answer 19

• Chlorine - destroyed the victim’s respiratory organs, bringing on choking attacks
• Mustard Gas - kill by blistering the lungs and throat if inhaled in large quantities and produced blisters all over the body
• Soldiers combated this by using cotton pads dipped in solution of bicarbonate of soda and held over the face.
• Also used urine drenched cloths to put over their faces in an emergency.

Question 20

Specific Challenge -Psychological Effects

Answer 20

Shell Shock (also known as war neurosis) is understood today as PTSD.

• Symptoms include hysteria and anxiety, paralysis, limping and muscle contractions, blindness and deafness, nightmares etc.
• By 1916, over 40% of casualties in fighting zones were victims of the condition and 80,000 cases passed through the British Army medical facilities during war.

Question 21

The Third Battle of Ypres/Passchendaele

Answer 21

• Jul- Nov 1917
• Allies advanced through four miles of mud later lost to the Germans
• 448,000 Allied casualties
• Battlefield was a quagmire of mud as a result of shellfire having destroyed the drainage systems and heavy rain made problem worse

Question 22

Battle of Messines

Answer 22

• June 1917
• Most successful operation of the Western Front and precursor to Passchendaele
• aim to recapture Messines Ridge.
• 18 months of prep to dig 8,000m of tunnel and lay 22 mine shafts
• Blew the crest off the Messines Ridge and killed 10,000 Germans in the explosion alone
• German counter attacks were unsuccessful and significantly boosted morale for the allies

Question 23

Specific Challenge: Wound infection

Answer 23

• Gangrene was rife and antibiotics not yet available- Sanitary section of the RAMC helped to combat this and carbolic lotion was used to wash wounds, which were then soaked in gauze

Question 24

Specific Challenge: Self Inflicted Wounds

Answer 24

• Also known as ‘blight ones’.- Highly serious wartime military offence.
• Often would be rifle shots to the hand or foot in the aim of being sent home.
• Military authorities tried to trace injury back to wound which caused injury. If found guilty, men were sent to prison for lengthy periods.

Question 25

Chain of Evacuation

Answer 25

1 - Stretcher Bearers had most hazardous task of war removing dead and injured from no man’s land, often under artillery or gas fire. Carried medical basics.

2 - RAP was as basic as a dugout where basic first aid could be administered to either patch a soldier up, or send him on to the next stage.

3 - Field Ambulance were half a mine from the front line. They were a tented area with two dressing stations - an advanced dressing station and a main dressing station. Still only limited treatment.

4- CCS was 12 miles approx. from the front line and had most things needed for the very sick e.g. operating theatres, medical and surgical wards. Approx. 50 beds and 150 stretchers.

5 - General/Stationary Hospital
- Usually civilian hospitals or large buildings near railways. Quality varied considerably - could be a decayed convent, or a specialist centre for gas poisoning.

6 - Railway - specially converted railway carriages taking soldiers home

7 - Ships - converted passenger liners taking patients across the Channel for final leg

8 - British Hospitals- most serious cases which attracted the best and most pioneering practitioners. Would deal with head and chest trauma, or those needed maxillofacial (mouth, jaw, face and neck surgery).

Question 26

underground hospitals Arras

Answer 26

• British WW1 field hospital abandoned in 1917
• Could take in 700 casualties
• Only in service or three days before a German shell hit the roof, collapsing it.