Now all roads lead to France and heavy is the tread
Of the living; but the dead returning lightly dance.
Edward Thomas, Roads

Wednesday, August 19, 2020

British Medical Responses to First World War Casualties. Part 1 of 2


Dressing Station

By Doreen Isherwood

The industrialization of war led to an unprecedented number of casualties during World War One. In response to the physical and mental trauma caused by the new weaponry, a corresponding rise in medical innovations occurred. Historian Lyn Macdonald expresses the view that “if nothing much came out of the battles at the front, the same cannot be said of the mirror image battles in the hospitals and laboratories behind it.”

Technological advances in the Western world, especially in the armament and chemical industries meant that “the First World War inaugurated the manufacture of mass death. . .” (John Keegan), but it also caused mass injuries, both physical and mental, that for some was a living death. In response, cooperation between scientists and medical professionals led to the development of treatments that would benefit the general public as well as combatants in WWI and all other conflicts since then. 

Infection and Gangrene

Doctors who had served in the dry conditions in the South African Wars were unprepared for conditions on the battlefields of northern France and Belgium. Here much of the land was poorly drained and enriched with manure, which favored the anaerobic gas bacillus. In these conditions, the injuries sustained by jagged splinters of shrapnel penetrating the flesh, carrying soil and clothing into the wound, allowed the bacillus to multiply rapidly.

Frederick Pottle, an American surgeon serving in France, describes the progress of the infection in graphic detail. He recounts the sensation of passing his hand over the skin of a patient at an advanced stage of the infection, feeling the gas bubbles shift and hearing them crackle. He emphasizes the necessity of speedy treatment to save the lives of men who would otherwise die of gas gangrene within a few hours despite radical amputations. An innovative technique developed by British, French, and American scientists and surgeons began to control and eradicate the infection in the early stages by continuous irrigation of the wound with the newly invented antiseptic that became known as Eusol. Intensive nursing care, as in all medical units, was essential in carrying out the treatment. The danger of tetanus from wounds infected in the fertilized fields was controlled by anti-tetanus serum, which was administered routinely at the first aid station. 

Shock and Blood Transfusion

The difficulty in deciding whether the patient was sufficiently recovered from shock to withstand surgery was one that faced all surgeons on the battlefront. Survival was greatly enhanced by the development of blood transfusions. In the years leading up to the outbreak of WWI, Viennese doctor Karl Landsteiner and team of researchers identified the four main blood groups and drew up guidelines for safe transfusions. The storage of blood was a major problem that was solved by the Canadian medical officer O.H. Robertson, who discovered that a solution of citrate glucose could preserve blood for up to 21 days. Research into transfusions slowed down at the end of WWI until 1940 when Charles Drew of Columbia University found that plasma could be more effective than whole blood in case of shock and superficial trauma, making refrigeration unnecessary. In the same year, Landsteiner discovered the Rh factor, making blood transfusions even safer. 

Field Surgery

Amputation Cases

Despite advances in sepsis control and surgical techniques, the extensive damage to extremities could leave amputation as the only option to save lives. By the end of the war about 41,050 British servicemen had lost limbs, and of these 26,262 were fitted with their first artificial limbs at Queen Mary's Hospital in Roehampton, London. Before the war, the purchase and fitting of artificial limbs was left to the individual patient, but surgeons at Roehampton took charge of the whole program, discharging the patient only when he was able to manage his new limb(s) and follow some kind of occupation. Physical and occupational therapy were in the forefront of rehabilitation, equipping patients with skills for daily living and preparing them for jobs in the outside world. We are now more aware of the grieving process that can accompany the loss of a body part and these vulnerable young men found social rehabilitation difficult, leading to depression and suicide in some cases.

Facial Disfigurement

Facial injuries, often caused by shell splinters, were a particular problem. Steel helmets that offered some protection were introduced by the French in July 1915, followed shortly after by the British. (Gilbert 173) Until then, troops wore their normal soft uniform cap that not only gave no protection but also added to the risk of infection as fibers entered the wounds. 

Plastic surgery was in its infancy during WWI, but again cooperation between specialists accelerated the development of new techniques. The task of humanizing a shattered face after surgeons had helped to establish some functional use was an overwhelming problem. In 1916 sculptor Derwent Wood, was given the opportunity to set up a new department called Masks for Facial Disfigurements at the 3rd London General Hospital. Because of the social stigma associated with facial disfigurement, loss of fiancées and families unable to cope with the ravaged faces, the men tended to withdraw, staying close to fellow sufferers. There were inevitable suicides as they despaired of a future. Psychology was in its infancy and emotional support was usually left to hard-pressed nurses. 

Source: This article originally appeared in the Summer 2012 issue of the Journal of the World War One Historical Association


  1. Very interesting. An excellent book on this topic is Emily Mayhew's 'Wounded' (OUP).

  2. Many of the lessons learned by military medicine were introduced into civilian medicine during and after the Great War. Some had to be re-learnd
    in WwII.

  3. Is this written by the Doreen Isherwood who worked with June Mellor in Edinburgh? Trying to get in touch. Thanks, Jane Mellor(June’s daughter)