Experiments in Surgery & Medicine on the Western Front (Edexcel GCSE History): Revision Note

Advances in surgery during the First World War - Summary

• The type and extent of injuries on the Western Front gave doctors the chance to improve their surgical techniques

• Surgeons developed methods for treating:

  • Infection

  • Blood loss

  • Bone fractures

  • Brain injuries

  • Facial wounds

• Doctors used existing technologies, such as:

  • Thomas Splint

  • X-rays

• Doctors also used new techniques, such as:

  • The Carrel-Dakin method

  • Blood banks

• These advances helped soldiers recover from injuries that would have been fatal before the war

New techniques in wound & infection treatment

• Trench conditions led to deadly infections like gas gangrene

  • Doctors had to act quickly

  • Doctors used several methods to treat infection

Wound excision

• Also called debridement

• Dead or infected tissue was cut away to stop infection spreading

• The wound was stitched closed

Carrel-Dakin method

• A sterilised salt solution was passed through the wound

• This technique was more effective than antiseptics like carbolic acid

• The solution only lasted six hours

Amputation

• If other methods failed, the limb was removed to stop the infection spreading

• By 1918, 240,000 men had lost limbs

The Thomas Splint

• Fractures to the femur were often fatal due to:

  • Blood loss

  • Infection

  • The difficult terrain causing further damage to the leg

• The Thomas Splint:

  • Pulled the leg bones into alignment

  • Reduced internal bleeding

  • Made amputation less necessary

• Survival rate from femur fractures increased from 20% to 82%

Mobile X-rays

• X-rays enabled doctors to locate bullets and shrapnel before surgery

• They did have some drawbacks:

  • X-rays could not detect objects like clothing fragments

  • Injured soldiers had to remain still during an X-ray

  • Machines overheated and took a long time

• Base Hospitals and some CCSs used unmoving X-rays

• Six mobile X-rays were used close to the frontlines 

  • Scans were lower quality

  • The ability to travel to injured soldiers across the Western Front was very convenient

The Battle of Cambrai & blood banks

Blood transfusions in the British sector

• Blood transfusions were used from 1915 in Base Hospitals and 1917 in CCSs

Key individuals

• Lawrence Bruce Robertson

  • Used a syringe to transfer blood from the donor to the patient

• Geoffrey Keynes

  • Designed a portable blood transfusion kit

  • Added a device to help prevent the blood from clotting

• Richard Lewisohn

  • Added sodium citrate to prevent blood from clotting

• Richard Weil

  • Discovered that sodium citrate allowed blood to be refrigerated and stored for two days

• Francis Rous and James Turner

  • Added citrate glucose which allowed storage of blood for up to four weeks

The blood bank at Cambrai

• During the Battle of Cambrai in 1917, Doctor Oswald Hope Robertson stored 22 units of universal blood in glass bottles

• The blood was:

  • Collected 26 days before being used

  • Stored in ammunition boxes packed with ice and sawdust

• Of 20 Canadian soldiers treated for shock from blood-loss, 11 survived

  • It demonstrated the potential of blood transfusions to save lives

Advances in surgery

• Head wounds accounted for 20% of all wounds in the British sector of the Western Front 

  • Injuries were mainly the result of bullets and shrapnel

Why were injuries to the brain such an issue in the First World War?

Brain surgery

• Harvey Cushing was an American neurosurgeon

• His improved brain surgery by:

  • Using magnets to remove shrapnel from the brain

  • Discovering that local anaesthetic prevented the brain from swelling

• He had an operation survival rate of 71% compared to the average of 50%

Plastic surgery

• Harold Gillies was a New Zealand doctor specialised in ENT

• Gillies:

  • Used skin grafts to rebuild faces

  • Set up the Queen’s Hospital in Kent for plastic surgery

    • By 1917, 12,000 surgeries had been carried out here