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Walking
with Ghosts, - Medical and Health |
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The First World War resulted in massive rates of death, injury, and disease across all fronts, To provide complete coverage of the topics associated with medical and health issues that were a result of the First World War can not be undertaken on this website. However, this page provides a few topics for discussion, and hopefully will lead the visitor to carry out some further detailed investigation. Some items of principal interest are carried on this page, and other topics for discussion are provided at the bottom of this page.
Firstly, many facets of modern medicine which we now take for granted, were in their infancy at the time. For instance,
X-Rays,
Blood Transfusion,
Anaesthesia
were relatively primitive, and the casualties of the First World war were a spur to their development. It should also be remembered that there were NO ANTIBIOTICS in those days, - it was to be another 20 years or so before penicillin and similar medicines were to become available.
During the Great War the types of injury sustained were numerous and horrific. The vast majority of these injuries were caused by high explosives and constant artillery bombardments, and the frequent random shelling had a devastating effect on the minds and bodies of those involved.
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Stretcher bearers recovering a casualty
from the mud of the battlefield. |
Bringing a casualty in to a front line
hospital, where the principle of triage was used to prioritise the treatment
of casualties. |
Surgeons had to work quickly and under pressure - they quickly learnt new skills
due to the pressures of war. An
account of working in a casualty clearing station by Dr John Hayward provides
a vivid account as to how the institution of small mobile hospitals near the
fighting line had revolutionized the surgery of the War, and was the means of
saving thousands of lives. It was found that the fatal sepsis and gas gangrene
of wounds could be avoided if effective operation was performed within thirty-six
hours of their infliction, and all dead and injured tissue removed, in spite
of the extensive mutilation incurred.
The essential parts of a C.C.S. were: (1) A large reception marquee. (2) A resuscitation
tent, where severely shocked or apparently dying cases were warmed up in heated
beds, or transfused before operation. (3) A pre-operation tent, where stretcher
cases were prepared for operation. (4) A large operating tent with complete
equipment for six tables. (5) An evacuation tent, where the cases were sent
after operation, to await the hospital train for the Base. (6) A ward tent for
cases requiring watching for twenty-four hours, or too bad for evacuation.
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At the outbreak of World War I in August 1914 many hospitals already had x-ray machines. But these machines, although pimitive by modern standards, were far removed from the battlefield where many people were facing dire injury and death. As the war dragged on and casualties mounted people realized that many lives could be saved if quick diagnosis by x-ray was possible. One of these people was Marie Curie.
Curie launched a project to establish a radiological service for the French army and bring x-ray machines nearer to the battlefield. She obtained vehicles that could be converted into mobile x-ray units and worked with x-ray equipment manufacturers to get suitable machines. By the end of the war she had built twenty mobile radiological units. In 1917 and 1918 these mobile facilities took more than a million x-rays. Having x-rays near the battlefield meant that doctors could locate and treat wounds more quickly and save more lives. Marie Curie’s efforts during the war saved thousands of lives and set an example in the humane use of technology.
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Generally speaking, blood transfusion was not practiced by the majority of surgeons in Great Britain before the First World War, and its use in the last 2 years of the war was chiefly derived from the work which had been done on it in the United States.
There were several key discoveries, which assisted this change.
In 1914 researchers noted that sodium citrate prevented blood from clotting.
The following year, Richard Lewisohn found a safe concentration at which citrated
blood might be transfused. As this blood could also be refrigerated for several
days its use in war was clear. Traditional person-to-person transfusions, which
had been practiced successfully in peacetime, were not always practicable in
a battlefield situation. As an alternative blood could be collected, citrated,
stored in bottles and transported to where it was needed. But it was not until
1917 that this knowledge was fully applied.
Having first been used in base hospitals, preserved blood was eventually used
at a Casualty Clearing Station in the late part of 1917 and this provided new
opportunities to save lives. It was time wasting to wait for casualties to arrive
and then proceed to take blood from donors, but now, with preserved blood a
ready supply was available. By storing blood in advance the first Blood Depot
- the forerunner of the Blood Bank - came into being.
Away from the unusual conditions of war surgeons preferred to use fresh blood
and it was some time before the idea of blood transfusion became accepted. Although
voluntary blood donations began in London in the early 1920s, the first centralised
blood banks did not appear until the late 1930s.
There was no difficulty in procuring blood donors. Usually the spirit of comradeship would provide donors. But towards the end of the War, a 3-week leave in England after the donation secured many offers from lightly wounded men. Dental patients and soldiers with minor injuries, sprains, and flat feet were also used as donors. Syphilitic and malarial subjects were rejected, as well as those with other infectious diseases, such as trench fever. A healthy donor, it was thought, could withstand the loss of 700-1,000 cc. of blood.
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Anaesthesia was generally in the form of chloroform and ether mixtures, open ether, and gas and oxygen. Shipway's apparatus (seen illustrated below) in was a popular means of administering a mixture of chloroform and ether, as was Boyle's apparatus. However, it can be seen that by modern standards, anaesthesia was primitive and there was ample scope for development.
Shipway's Apparatus
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Some other topics for discussion include;-
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