How trenches caused trench foot where infection causes

                               How did doctors help the wounded in world war one Medicine and care had to develop very quickly during the war to deal with different types of injuries and casualties and In this essay I will talk to you about how the doctors in World War One  helped  the wounded . After reading on the subject online I will talk about injuries on the battlefield , medical advances during the war , treatment in hospitals  and what key developments from World War One  are still in use on the front line today. The main sources for this essay will be from https://prezi.com/gxlshlrhm2hl/how-were-soldiers-injured-in-ww1/ ,  bbc iwonder   And http://www.bbc.co.uk/schools/0/ww1/25403864 -bbc  schools ww1 and contemporary sources from- https://livesofthefirstworldwar.org/injuries-treatment-trenches  Firstly, the soldiers were injured in many different ways, leg wounds were the most commonly recorded area of injury and amputation was often needed. Arm injuries were often caused by high explosive artillery shells. Only 12 percent of wounds recorded were to the chest, this is a small percentage  because many soldiers who were hit in the chest  usually died so they never made it to the hospital in time so their injuries weren’t recorded.The living conditions in the trenches were very dirty, especially caused by the mud, caused one surgeon to say ” every gunshot wound is… more or less infected at the moment of infliction”Also, standing in water for long periods of time in the trenches caused trench foot where infection causes the flesh of the foot to decay and die.Also, the number of head wounds early in the war led the government to introduce the ‘Brodie helmet’ as standard kit for the soldiers in 1915. Poisonous gas was also  used as a weapon for the first time in World War One. It had some grave effects .Some gas was intended to only cause runny noses and watery eyes.. Others were far more dangerous. When gas was first  used, doctors and nurses did even not know how to treat even simple symptoms. Gas could affect someones vision  and breathing in just a few minutes so protective masks were given to all soldiers. Some fumes remained  on clothes causing blisters and sores. Bathing and washing would have solved the problem but this was impossible in the trenches. Many soldiers suffered from the effects of gas attacks for the rest of their lives.The Royal Army Medical Corps (RAMC) was set up to care for British troops. It used a special system called ‘triage’ where sick soldiers were put into 1 of 3 groups which are;Slightly injured – Soldiers who didn’t need much care. They were quickly given treatment anywhere  and then carried on fighting. Need hospital – Soldiers who  were in a critical condition andneeded to be transported by ambulance to a hospital for treatment. They were taken in motor or horse-driven ambulances to the nearest hospital base. Beyond help – Soldiers who did not have much chance of getting better and were going to die,. They were made comfortable but little treatment was given as priority was given to others who could actually get better .Working in a World War One hospital was not for the faint hearted.  By January 1915, British medical authorities had realised that too many wounded soldiers were dying before they could reach proper treatment. Casualty clearing stations had seen emergency improvements since the start of the war.  Within months they were to become more like field hospitals. Surgeons and military nurses were now operating in tented trauma centres, usually  within earshot of the fighting.     Sir Henry Souttar, a well known  surgeon, described the situation he was in while setting up his hospital in a Belgian town. “We had no knives, and no artery forceps, and not a stitch of catgut. Some Belgian doctors who had been working there lent us a little case of elementary instruments, and that was absolutely all we had.” “In four days we admitted three hundred and fifty patients, all of them with injuries of the most terrible nature. Arms and legs were torn right off or hanging by the merest shreds, ghastly wounds of the head left the brain exposed. For four days and four nights the operating theatre was at work continuously, till one sickened at the sight of blood.” While surgeons in military hospitals could expect to work  in better conditions than those in volunteer hospitals such as Souttar’s, they remained very under-resourced. Even in the large hospitals further behind the frontline, there was little change.. A typical base hospital housed approximately 300 staff.      From 1917, these medical staff could be tasked with caring for as many as 2,500 patients at any one time.    The path to treatment can be quite a long one, firstly the soldier hasto wait for the stretcher bearers and then they are taken to the regimental aid post for minor help then a motor ambulance takes them to a casualty clearing station then they are loaded onto the hospital which then takes them to the base hospital. This journey would have been familiar to many wounded soldiers . The route would have been varied, but on a quiet day a wounded soldier could be evacuated from the battlefield to the hospital in just less  than 24 hours. An example of a soldier who needed treating is Charles frampton who was admitted into the hospital, because of a shrapnel wound on his right hip and a fractured femur. “He had been operated on before admission but an infection developed … the infection.. kept expending and he died on the 19th of august” was a letter by by the registrar of the hospital he was admitted to. The letter also contained details of the cementry he was buried inThe wounds inflicted on millions of soldiers  drove the development of new medial techniques and inventions . The British Army began the routine use of blood transfusion in treating wounded soldiers. Blood was transferred straight from one person to another(using blood bottle where up to 500 ml could be transferred).. But it was a US Army doctor, Captain Oswald Robertson, who realised the need to store blood before injured soldiers arrived. He made  the first blood bank on the Western Front in 1917, using sodium citrate to prevent the blood from clotting and becoming useless.. Blood was kept on ice for up to 28 days and then transported to casualty clearing stations for use in life-saving surgery where it was needed most.                                                                                     Innovations developed in the First World War had a massive impact on survival rates – such as the Thomas splint, named after pioneering Welsh surgeon Hugh Owen Thomas and was invented by Robert jones, an orthopaedic surgeon and nephew of Hugh Owen Thomas , which secured a broken leg. And is now a common piece of equipment in emergency departments of hospitals world wide.  At the beginning of the war 80% of all soldiers with a broken femur died. By 1916, 80 % of soldiers with this injury survived(not all credit can be given to the leg splint though).                                                 From January 1915 the British military medical machine moved closer to the front line. Casualty clearing stations were now much better  equipped and, importantly, more surgeons were closer to the battlefield. There were now fewer delays in giving potentially life-saving treatment. Soldiers with wounds that would have been fatal were now more likely to survive.Modern treatment owes a lot to the First World War and there are quite a few key developments still in use today.Blood is now routinely used in hospitals throughout the world, with stockpiles that can be called upon when required. In the military, the Medical Emergency Response Team is able to give wounded soldiers blood on the ground, helping  prevent deaths from shock. Developments in wound shock treatment in the First World War – from the use of saline, through direct donor-to-patient blood transfusion and the development of techniques to store blood – have helped shape much of modern practise.Today, heavily infected wounds are a  rare site because of the discovery of antibiotics in 1928 and their widespread adoption throughout the 1940s. However, our understanding of the treatment of wounds is due to the experimentation with antiseptics seen in ww1 The Carrel-Dakin technique, which gave sodium hypochlorite directly to damaged tissue in deep wounds came to be viewed as a very good technique. A British version of Dakin’s Solution, known as EUSOL (Edinburgh University Solution of Lime) continued to be used to treat wounds until the late twentieth century.The modern military has a much more detailed knowledge of psychological trauma, or Post-Traumatic Stress Disorder. Patients are benefited from a wide range of approaches, including Cognitive Behavioural Therapy (CBT). During World War One, some thought that  ‘shell-shock’ was a physical condition, caused by the vibration of shell-blast on the brain tissue; and other people saw it as  a form of psychological distress. These controversies fed into the work of the psychoanalytic movement.           

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