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Medical developments in World War One

The scale of the fighting during World War One as well as the kinds of injuries sustained meant that doctors and scientists had to develop new ways of treating patients. Louise Bell looks at some of the key medical technologies that emerged during the war.

World War One was the first conflict where the number of deaths from wounds outstripped those from disease. Shrapnel and machine gun fire destroyed men’s flesh and left behind some of the worst injuries ever seen. New weapons caused complex wounds that needed new surgical techniques, in areas such as orthopaedics and plastic surgery. Wound care developed further with antiseptic treatments, such as the Carrel-Dakin technique, which consisted of regular irrigation through rubber tubes placed in the wounded area. There were also psychological wounds to contend with. And though wounds proved more fatal than disease, illness was still rife at all of the fronts.

Fragments of an explosive bullet extracted from the wound of a soldier in 1914

Fragments of an explosive bullet extracted from the wound of a soldier in 1914

This photograph shows several explosive bullet fragments extracted from the leg of Milan Stavić, a private in the Serbian army, at the Russian field hospital at Valjevo in western Serbia. A bullet like the one in this photograph would explode within the body, and its fragments would act like shrapnel. 

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Medical care in conflict depends on various factors, from the number of doctors and nurses available to the climate and geology of the land being fought on and the number of soldiers requiring treatment. Living conditions on the Western Front meant that many men suffered from gas-gangrene, trench foot and trench fever. The heat of the Middle East brought with it its own complications, as did the extreme cold in Salonika, where frostbite became common. Diseases such as malaria (which had major epidemics in Macedonia, Palestine and Mesopotamia, in particular), typhoid (in the Mediterranean) and dysentery (on the warmer fronts, in particular) raged amongst those stationed on these fronts. Venereal disease was another problem for forces on both sides – as well as for civilians – and a matter of great concern among government and military powers.

Faced with the unique nature of wounds sustained in World War One, doctors and scientists developed a number of innovative techniques, tools and treatments.

Treating fractured femurs

The Thomas splint was introduced to the Western Front in 1916, and between then and 1918 it reduced the rate of mortality from fractures, and from fractures of the femur in particular, from 80% to 20%.[1] The splint was originally designed in the 1870s by Hugh Owen Thomas, who is considered the father of orthopaedic surgery in Britain, with the intention that it would stabilise a fracture and prevent infection. However, it was not widely used until his nephew, Robert Jones, introduced it for use in the war. Essentially, the splint keeps the leg immobile which prevents further bleeding (caused by the movement of broken bones) and helps to align the fractured pieces. By keeping the leg secure, it furthermore made the men more comfortable during transportation.

The instructions for application contained the following suggestions for when it should be used:

    1. For all fractures of the thigh bone, except where there is an extensive wound in the upper part of thigh or buttock, which would interfere with the fitting of the ring.
    2. In severe fractures about the knee-joint or upper part of the tibia.
    3. In certain cases of extensive wounds of fleshy part of thigh.[2]

Ideally, a team of three (an operator and two assistants) was required to apply the splint. There were 12 different stages in its application, all of which served to make the patient as comfortable as possible. The main goal of the splint was to allow practitioners to move the patient without causing him pain, or any further damage to the injured part.

Alexander Fleming's notebook, June 1917 - 1918

Alexander Flemings lab books from work as RAMC Captain in WWI.

Alexander Fleming, the bacteriologist best known for his discovery of penicillin, worked on alleviating the symptoms of gas gangrene.

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Artificial limbs

Although the Thomas splint reduced the mortality rate of wounded soldiers significantly, injuries from new weapons still resulted in many men returning with physical disabilities. Around 41,000 British servicemen lost at least one limb after being wounded in combat.[3] A number of hospitals opened with the sole purpose of helping men with amputations, two of the best known being the Princess Louise Scottish Hospital for Limbless Sailors and Soldiers, based in Erskine, and the Queen Mary Convalescent Auxiliary Hospital, based in Roehampton.

When the war broke out, the making of prosthetic limbs was a small industry in Britain. Production had to increase dramatically. One of the ways this was achieved was by employing men who had amputations to make prosthetic limbs – most commonly at Erskine and Roehampton, where they learnt the trade alongside established tradespeople. This had the added advantage of providing occupation for discharged soldiers who, because of their disabilities, would probably have had difficulty finding work.[4]

The main material used in the construction of these artificial limbs was wood, with willow found to be the most suitable, due to its pliable nature. As the war progressed, the makers of artificial limbs experimented with newer and lighter materials. Towards the end of the war and into the 1920s, light metal became common. Standardisation of limbs came gradually. It was not until the early 1920s that the Government Research Laboratory finished designing what would become known as the ‘Standard Wooden Leg’, which was to be manufactured by all limb makers from a prescribed pattern. Standardisation was useful because artificial limbs were more often than not repaired by someone other than the original maker.

Once a limb had been fitted, a man had to learn how to use it. Hospitals placed a huge emphasis on rehabilitation. Rehabilitation focused on enabling men to pursue both recreational activities and employment. At institutions like Erskine and Roehampton workshops were set up to teach patients to do everything from joinery and hairdressing to basket weaving and bee keeping. Tools were also adapted for men who had lost limbs, especially for those who were using artificial arms.

The treatment and training of disabled and discharged soldiers in France by Sir Henry Norman

The treatment and training of disabled and discharged soldiers in France. Report ... by ... Sir Henry Norman

This report provides an insight on amputees who struggled to deal with the heavy and uncomfortable prosthetics provided for them.

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Facial reconstruction and plastic surgery

Before World War One, plastic surgery was rarely practiced as a specialism. Usually, work was undertaken by whichever surgeon received the case. But from the Battle of the Somme onwards there was a huge rise in facial mutilations, and a separate medical field developed as a result, focused on treating such injuries. Plastic surgery also became less dangerous, thanks to improvements in asepsis and general anaesthetic.

The most influential figure in facial reconstruction during World War One is Harold Gillies. Born in New Zealand, Gillies studied medicine at Cambridge and qualified as a surgeon in the UK. After heading to France to serve in the war with the Royal Army Medical Corps, Gillies met Auguste Charles Valadier, a dentist working on replacing jaws that had been destroyed by gunshot wounds. It was during this period that Gillies turned his attentions to facial plastic surgery.

Plastic Surgery of the Face, by Harold Gillies

Harold Gillies' Plastic Surgery of the Face 1920

An example of Gillies’ jaw work.

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Usage terms Harold Delf Gillies: You may not use the material for commercial purposes. Please credit the copyright holder when reusing this work.  Sidney Walbridge [photographer]: Public Domain.
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Gillies’s focus was on the aesthetic side of plastic surgery: he wanted to make patients look as similar to their pre-injured state as possible. He was famed for his use of the tubed pedicle technique: only partially removing tissue from its original site so it retained a blood supply during transfer to another site, and reduced the risk of infection. This allowed large quantities of still-living skin to be transferred from one section of the body to the other.

Plastic Surgery of the Face, by Harold Gillies

Harold Gillies' Plastic Surgery of the Face 1920

Gillies’ aimed to make patients look as similar to their pre-injured state as possible. In 1920, he published a book instructing other surgeons on how to achieve this.

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Usage terms Harold Delf Gillies: You may not use the material for commercial purposes. Please credit the copyright holder when reusing this work.  Sidney Walbridge [photographer]: Public Domain.
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Speaking in 1951 at the Festival of Britain, Gillies pointed out that his tubed pedicle technique had been accepted and used, developed and enhanced, in every country in the world. He also praised the plastic surgeons working at Sidcup in World War One, saying that they ‘developed [the technique’s] use beyond all conception.’[5] Operating from 1917 until 1925, the hospital at Sidcup became a major centre for facial injury and plastic surgery. The service treated 5000 men for facial injuries and included separate units for British, Canadian, Australian and New Zealand patients.

Blood transfusion

Blood transfusion in World War One refined techniques already in use. Direct transfusion from donor to recipient was impractical for such wide use, especially on, or near, the front lines. Blood was collected and stored before battles occurred, a process that, according to F Boulton and D J Roberts, ‘significantly widened the scope of transfusion’.[6] The initial problem with how to stop blood from clotting while in storage was partially solved by the discovery that paraffinising the inside of the glass collection vessel delayed clotting for a sufficient length of time.[7] Citrate was also discovered to be an effective anticoagulant. US Army Captain Oswald Hope Robertson showed that stored universal donor or cross-matched blood could be given safely and quickly to forward medical units.[8] Blood could be stored for up to 26 days without any negative effects, and could be transported to where it was required. As a result, by 1918 transfusions were being performed much closer to the front lines than clearing stations, as a means of improving survival during evacuation of the wounded to field hospitals. Primarily, transfusions were used to treat severe haemorrhage and shock, before an operation took place. However, transfusions could also aid with carbon monoxide poisoning and wound infection, and so were increasingly used during and after operations as well as before.

The war necessitated rapid developments in all areas of medicine and medical technology. From the moment a soldier was wounded until after he had returned home, the treatment he received was different from that experienced by soldiers even a generation ago. Many medical techniques used today have their origins in those developed during World War One.

Footnotes

[1] Colonel H W Orr, ‘The Use of the Thomas Splint’, in The American Journal of Nursing, Vol. 20, No. 11 (August 1920), pp. 879–80.

[2] The National Archives: AIR 2/136.

[3] Mary Guyatt, ‘Better Legs: Artificial Limbs for British Veterans of the First World War’, in Journal of Design History, Vol. 14, No. 4 (January 2001), p. 311.

[4] John Reid, The Princess Louise Scottish Hospital For Limbless Sailors And Soldiers At Erskine House (Glasgow: printed for private circulation by James Maclehose and Sons, 1917), p. 26.

[5] The National Archives: WORK 25/23/A2/B2/158.

[6] F Boulton and D J Roberts, ‘Blood Transfusion At The Time Of The First World War – Practice And Promise At The Birth Of Transfusion Medicine’, in Transfusion Medicine, Vol. 24, Issue 6 (British Blood Transfusion Society, December 2014), p.330.

[7] Lynn G Stansbury and John R. Hess, ‘Putting the Pieces Together: Roger I. Lee and Modern Transfusion Medicine’ in Transfusion Medicine Reviews, Vol. 19, No.1 (January 2005), p. 82.

[8] Lynn G Stansbury and John R Hess, ‘Blood Transfusion in World War I: The Roles of Lawrence Bruce Robertson and Oswald Hope Robertson in the “Most Important Medical Advance of the War”’ in Transfusion Medicine Reviews, Vol. 23, No. 3 (July 2009), p. 232.

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  • Louise Bell
  • Louise Bell is a researcher of First World War prosthetics, medicine and disability.