The First World War, for all of its horrors, was a time of enormous technological progress.
We talk in our regular episodes about the developments in flight, submarines, motorized
vehicles, soy sausages, the zipper, and so forth, but perhaps nowhere did advances come
as quickly and as often as in the field of medicine.
In fact, medicine advanced more in the four years of the war than in any other four-year
period in history either before or since.
I’m Indy Neidell; welcome to a Great War special episode about medical treatment during
the First World War.
Yes, medical treatment.
We’ll cover other aspects of medicine in other specials, since it’s a very large
topic.
When the war began, the world leaders in medicine were France, Germany, Britain, and Austria-Hungary.
Russia did have fine doctors, but not so many when compared to its enormous population.
Armies’ Medical Corps were called on to treat wounds, disease, poison gas victims,
flamethrower victims, shell shock, and also to improve sanitary conditions in the trenches.
The work was extremely difficult, often dangerous, and had a myriad of challenges according to
each battlefront.
The initial challenge was to bring a wounded man away from the fighting to a medical facility,
since the sooner you received medical attention, the more likely you were to survive.
Many wounds were also contaminated and infected by the filth and the mud of life on the front
or in the trenches.
The Western Front, because of the stalemate, allowed the medical Corps to have well-organized
structured systems running from the front lines back to base, and even specialized hospitals
far from the front or back home in Britain, France, or Germany.
Wounded soldiers would be carried by stretcher bearers, often themselves under fire, to a
first aid station where wounds could be temporarily treated to allow further transport to more
sophisticated and better equipped facilities.
The British army Medical Corps, as an example, had an evacuation plan as follows.
Stretcher-bearers brought the wounded to a Regimental Aid Post, then an advanced Dressing
Station, where the particular case would begin to be documented, and then they’d be transported
to a Casualty Clearing Station, which was a large unit with seven medical officers and
a substantial staff to help the doctors.
If they were expecting combat, then surgical teams would join these stations.
They were about 20 kilometers from the front, and usually treated a minimum of 200 soldiers,
though this number could exceed 1,000 during heavy fighting.
This was really the first place the soldier entered that was like a full-service hospital;
with actual operating tents and rooms, and the first place he’d see a nurse.
It might well also be the last, as evidenced by the large military cemeteries located near
Casualty Clearing Stations.
A side note here - the British had used X-Ray machines in the Boer Wars, so they had them
here pretty much from the beginning of this war.
Badly wounded soldiers might remain at the stations for a few weeks, and then be sent
to General, Stationary, or Base Area Hospitals, specialized hospitals for victims of gas,
venereal disease, shell shock, or epidemics.
They might also be sent to a hospital back home.
In the German army, wounded soldiers wore two information tags.
One to show what injury was diagnosed and the other to show what treatment had already
been given.
As you may imagine, whatever the soldier’s nationality, if he had superficial wounds
he may well be glad to enter the chain of evacuation to have a break from the front
until it was determined that he needed no further treatment and was sent back up.
Russia was faced with different problems.
For example, they trained thousands of new nurses but had a tough time transporting them
to where they were needed.
Interestingly, the Tsarina and her daughters became nurses, and as you may imagine, nurses
with titles were able to get postings far from the gruesome reality of the front.
When the war broke out, the first wounded Russians were put on trains and sent to Petrograd,
where they were just left at the station because no plans had been made to receive them.
Now, the Eastern Front was not static like in the west and so you couldn’t really build
semi-permanent medical facilities, and the fluctuations in the Eastern Front kind of
assured that soldiers quickly getting good medical treatment would be few and far between.
By 1917, wounded Russian soldiers, loaded onto trains, might wait four or five days
for basic medical care.
The death of doctors prompted foreign nationals to join the Russian Medical Corps.
American surgeon Dr. Malcolm Grow volunteered, was eventually awarded the Cross of St. George
by the Tsar personally, and would later become the first Surgeon General of the United States
Air Force and a Major General.
As I said, different fronts presented different problems, and one real front-specific problem
was malaria on the Salonika Front.
Up to 40% of the British and French soldiers there were disabled by malaria, and it killed
more troops there than combat did.
People referred to the Salonika Expeditionary Force one giant infirmary.
During the course of the war, over 1.5 million troops in total were infected with malaria.
But that was just a fraction of the millions upon millions of sick and wounded soldiers
the war produced.
Mud, filth, feces, rotting corpses, stagnant water, rats, and tightly packed men in trenches
produced some of the worst sanitary conditions possible.
When food was scarce, things got even worse as soldiers became more susceptible to disease.
Illnesses and epidemics were sometimes more deadly than the war itself.
The Spanish flu, which we’ll cover in detail later on, took about as many American soldiers
as combat did, and they were being ravaged by it even while still training at home in
the states.
But as a result of the enormous number and variety of wounds and illnesses, medicine
made great leaps and bounds.
Cellucotton, blood transfusions, and blood banks were big advances that grew out of the
war.
Motorized ambulances transported the wounded at a faster rate and mobile x-ray machines
could scan the wounded immediately.
Plastic surgery was invented for the hundreds of thousands of disfigured men whose faces
were too terrifying for them to lead normal lives.
Morphine had been around for decades, but it was used extensively and effectively as
a painkiller, and sphagnum moss turned out to be an excellent dressing for war wounds.
It’s light, has antiseptic properties, absorbs many times its own weight in fluids, and grows
throughout Britain.
Another thing that was discovered was the sterile properties of maggots.
Yeah, you heard that right.
A badly wounded soldier stuck in no-mans land for two days was finally brought in.
The wounds he had were typically fatal because of infection, but the doctor attending him
saw that the wounds were clean; there was new pink growth, and no infection.
The wound WAS, though, covered in maggots.
That doctor was a professor of surgery at Johns Hopkins Medical School and he publicized
his findings.
Research found that the maggots had medicinal properties; they ate only dead tissue, so
they in fact cleaned the wounds, they crawled into tiny recesses where topical antiseptics
couldn’t be applied, they gave off urea, which itself is an antiseptic that destroys
staphylococcus and other bacteria, and they promoted the growth of healthy tissue.
Penicillin wasn’t invented yet and until it became widespread, maggots were cutting
edge medical treatment.
They’ve even made a comeback today for use with certain skin ulcers.
The advances in medical treatment and medical technology changed the nature of war and the
wounded.
When the war began, if you were badly wounded you very probably died, but by 1918 you very
probably lived.
That is an enormous difference.
Even because of just one advance, the Thomas splint, you could see a huge difference.
In 1914, 80% of soldiers with broken femurs died, but because of the splint, by 1916 80%
of soldiers with broken femurs lived.
But the advances in the organization of medicine, and the chain of treatment, particularly caused
by the stalemate of the Western Front, were reflected first at home in Britain, France,
and Germany, and then the rest of the world, with chains of organization eventually creating
the modern medical systems of hospitals, clinics, and ambulances that we rely on today, rather
than simply a local general practitioner or a cottage hospital run by a charity.
And that is perhaps the biggest advance of them all.
Thanks to John Dewar Gleissner for helping with the research for this episode.
He actually wrote a whole book about the use of maggots in medicine and you can check that
out by following the link in the dublidu.
If you want learn more about the live in the trenches and the conditions there, you can
click right here to check out our first ever special episode.
See you next time.