A war unlike any before
World War One was fought on a scale that had never been experienced before.
At the Battle of Waterloo in 1815, the main infantry weapon was the muzzle-loading musket, which fired up to four shots a minute. At the Battle of the Somme, just over a century later, machine gunners could fire off 600 rounds a minute. High velocity rounds wreaked havoc in the body, twisting tissue and splintering bone. Fighting on farmland fertilised by manure meant that wounds quickly became infected; gangrene was rife.
Faced with this challenge, new equipment and techniques were invented that, across four years of fighting, would end up saving thousands of lives.
How were soldiers injured in WW1?
The path to treatment
This journey would have been familiar to many wounded soldiers, though the actual route taken would have varied. In quiet periods, a wounded soldier could be evacuated from battlefield to base hospital in less than 24 hours.
Inside a World War One hospital
Conditions in a World War one hospital were tough. The men and women working there had to provide care for terrible injuries without much of the basic materials and equipment that are taken for granted today.
Medical innovation in World War One
The wounds inflicted on millions of soldiers drove the development of new medical techniques and inventions.
Giving and storing blood
The British Army began the routine use of blood transfusion in treating wounded soldiers. Blood was transferred directly from one person to another. But it was a US Army doctor, Captain Oswald Robertson, who realised the need to stockpile blood before casualties arrived. He established the first blood bank on the Western Front in 1917, using sodium citrate to prevent the blood from coagulating and becoming unusable. 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, which secured a broken leg. At the beginning of the war 80% of all soldiers with a broken femur died. By 1916, 80 % of soldiers with this injury survived.
Speed of treatment
From January 1915 the British military medical machine moved closer to the front line. Casualty clearing stations were now better equipped and, crucially, more surgeons were closer to the battlefield. There were now fewer delays in administering potentially life-saving treatment. Soldiers with wounds that would have been fatal were now more likely to survive.
Treating casualties on the frontline today
Today's military medics are faced with many of the same problems as their counterparts in the First World War. What do they owe to those medical pioneers, and how much has changed?
Key developments still in use today
What does modern treatment owe to the First World War? Professor Christine Hallett of the University of Manchester explains how modern medicine continues to be influenced by advancements made during World War One.
Shock treatment of wounds
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 to 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.
Antiseptic wound treatment
Today, heavily infected wounds are rarely seen thanks to the discovery of antibiotics in 1928 and their widespread adoption throughout the 1940s. However, our understanding of the treatment of wounds owes much to the experimentation with antiseptics seen in the First World War. The Carrel-Dakin technique, which delivered sodium hypochlorite directly to damaged tissue in deep wound-beds, came to be viewed as best-practice. 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.
Cleanliness and hygiene are key weapons in preventing the spread of infection in both army accommodation and military hospitals. Soldiers living in the squalid conditions of the First World War trenches were susceptible to a range of infections, including typhus fever carried by lice. The treatment of so-called trench fever extended our understanding of how to break the spread of such infections, with the more hygienic practises adopted in First World War base hospitals helping to structure modern approaches.
Post-traumatic stress disorder
The modern military has a much more detailed knowledge of psychological trauma, or Post-Traumatic Stress Disorder. Patients benefit from a wide range of approaches, including Cognitive Behavioural Therapy (CBT). During World War One, some thought ‘shell-shock’ was a physical condition, caused by the percussion of shell-blast on the brain tissue; others saw it as essentially an acute form of psychological distress. These controversies fed into the work of the psychoanalytic movement in the early twentieth century, which can be viewed as the forerunner of CBT.