World War I was fought on an industrial scale, using weapons that caused injury on a scale never seen before. Artillery shells and machine gun bullets shattered bodies. Wounds quickly became infected from contact with the ever-present mud. Poison gas burned men’s lungs, and conditions like trench foot and trench fever affected many. Medical technology advanced in response to these challenges.
Penicillin (antibiotics) to treat infection was not discovered until 1928, by Alexander Fleming. He had worked in field hospitals during the war as a captain in the Army Medical Corps, where he saw many soldiers die from sepsis – inflammation that spread from an infected wound to the rest of the body. Battlefield medics were experimenting with antiseptics like sodium hypochlorite, putting it straight onto damaged tissue. But this did not reach deep wounds where bacteria hid, and antiseptics would often weaken patients’ immune systems, with fatal results. WWI medics began to understand more about how infections are spread – for example, that lice could spread typhus (trench fever) in the trenches.
Innovations in medicine
Broken limbs were common and dangerous injuries: at the beginning of the war, 80% of soldiers with a broken femur (thigh bone) died, usually from rapid blood loss when the femoral artery was severed. The Thomas Splint, invented before the war by Welsh surgeon Hugh Owen Thomas, was widely adopted as a way of holding broken bones in place. By 1916, 80% of soldiers with broken femurs survived.
Blood transfusions before the war were made directly from one person to another. Then a Canadian doctor, Lawrence Robertson, worked out how to take blood and transfer it to someone else using syringes. An American doctor, Captain Oswald Robertson, realised that blood could be stored for up to four weeks if it was mixed with a citrate and dextrose solution to prevent clotting and kept in glass bottles on ice. He set up the first blood bank on the Western Front in 1917. Finally a British surgeon, Lieutenant Geoffrey Keynes, invented a portable blood transfusion kit so that the injured could receive blood wherever they needed it.
Bullet and shrapnel wounds caused horrific damage to people’s bodies. The development of X-ray technology let surgeons see exactly where a bullet had penetrated so they could operate to repair the damage. The Polish chemist and physicist Marie Curie was the first woman to receive a Nobel prize, for her joint research into radiation. By late in 1914, as director of the Red Cross Radiology Service, she set up the first military radiology centre in France. She established 200 X-ray units at field hospitals and also developed a fleet of 20 mobile X-ray units, known as petite curies, so that wounded soldiers examined and treated quickly. She trained other women to drive them and, with her teenage daughter, they X-rayed hundreds of thousands of soldiers on the front lines.
Shrapnel caused many facial injuries, which were very traumatic for victims, especially when they returned to civilian life. A New Zealand-born surgeon, Harold Gillies, developed plastic surgery to treat them and pioneered the use of a patient’s own tissue for reconstructive surgery, which greatly reduced the chances of infection.
Post traumatic stress disorder
By the winter of 1914–15, ‘shell shock’ (or what’s now known as PTSD) had become a pressing medical and military problem affecting increasing numbers of frontline troops. Symptoms could range from tremors and spasms, paralysis or uncontrollable diarrhoea to unrelenting anxiety and terrifying nightmares. Stomach cramps seized men who had knifed enemy soldiers in the abdomen; snipers lost their sight. It was initially thought to be caused by the physical effects of artillery blasts on the human body.
After the battles of Arras, Messines and Passchendale, battalions found themselves overwhelmed by the flood of shell shock casualties. Although neither France nor Germany used an umbrella term such as shell shock, both countries recognised the condition as ‘male hysteria’. Many believed that shell shock was simply cowardice or malingering and best treated by military discipline. Treatments could be harsh – solitary confinement, electric shock treatment, shaming and emotional deprivation – but could also include massage, rest, dietary regimes, hypnosis and occupational training. Above all (as one hospital superintendent put it), although the medical officer must show sympathy, the patient ‘must be induced to face his illness in a manly way.’ Of shell shock victims sent to base hospital, four-fifths were never able to return to military service. Some men were shot for cowardice before their medical condition was even recognised.
However, some medics took a different approach. Charles Myers, a medically trained psychologist, believed the causes were psychological and the symptoms reflected repressed trauma. His perseverance convinced the Army to set up four specialist units near the front in December 1916 to manage acute or mild cases, while chronic cases were sent to base hospitals. Major Arthur Hurst developed more gentle methods of treatment, including rest, gradual exercise, agricultural labour, writing and role play to re-enact traumatic events.
By the end of the war, over 80,000 cases of shell shock had passed through British Army medical facilities. More than 60,000 men were still receiving care a decade after the Armistice was signed.