Development of Surgical Methods and Medical Innovation

Treating Wounds and Injuries

• The development of new types of weapons in World War One caused death and injury on a scale never seen before; new methods of treating soldiers that were wounded and injured were needed.
• Vaccination:
• Many soldiers in the trenches died from tetanus and typhus
• In the first year of the war, tetanus was the cause of 32 deaths per 1000 deaths on the Western Front
• The development of vaccinations in 1915 against typhus and tetanus reduced the death rate to 2 per 1,000 deaths
• Amputations and artificial limbs:
• Many soldiers had limbs amputated to stop the spread of gangrene
• The war years saw advances in the development of artificial limbs and moving joints
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• Caption: Soldiers receiving vaccinations

Treating Wounds and Injuries

• Plastic surgery:
• This was a great advance for soldiers who suffered serious wounds from bullets and shell damage, especially to the face
• End of 1915 - seven hospitals in France had specialist areas for coping with wounds requiring plastic surgery
• One key figure was Harold Gillies, a British army surgeon, who developed a specialist department in Kent to treat facial injuries
• This department opened in 1917, providing 1,000 beds and treating over 2,000 soldiers injured in the Battle of the Somme
• Medical professionals discovered how to graft skin also
• Brain surgery:
• Huge numbers of head and brain injuries required surgeons to develop surgical methods, especially brain surgery
• Two developments helped this process:
• The ability to undertake blood transfusions
• Use of X-rays to locate metal fragments inside the head
• Harvey Cushing, an American surgeon, invented a magnet to extract bullets from head wounds

Treating Wounds and Injuries

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• The Thomas Splint:
• In the first few years of war, 80% of soldiers who had their femur broken by gunfire died from the injury
• Medical officers only had simple splints which did not stop the broken bones from moving, causing blood loss and infection
• In 1916, an invention by Welsh surgeon, Hugh Owen Thomas, caused the death rate to reduce from 80% to 20%
• This invention was the 'Thomas splint'
• It stabilised the fracture, putting the leg lengthways to prevent the bones from grinding against each other
• This reduced blood loss and infection and decreased the number of amputations required
• Robert Jones, Thomas' nephew, who worked as the British Army's Director of Military Orthopaedics in 1916, made sure the 'Thomas splint' was available for use at the front

Treating Wounds and Injuries

• Development of aseptic surgery:
• One of the biggest causes of death was infection
• In the late-19th century, surgeon Joseph Lister pioneered aseptic surgery (performing surgery under sterile conditions reduced the onset of infection post-operation)
• On the battlefield, less hygienic conditions meant it was difficult to prevent infection of a wound
• It was through a trial and error process that surgeons attempted to overcome difficulties of infection
• Use of chemicals such as carbolic acid and hydrogen peroxide to kill bacteria already in wounds
• Surgeons discovered cutting away infected tissue and soaking a wound in saline solution reduced infection rates
• It was only really by World War Two and after the discovery of penicillin that infection was properly addressed

Treating Wounds and Injuries

• Blood transfusion:
• Blood transfusions had been tried since the time of William Harvey, but most patients died shortly afterwards
• Major advance in 1900, when Karl Landsteiner discovered blood could be divided into four types and each patient needed blood from someone of the same type
• This advance meant that many soldiers were saved on the Western Front
• However, the problem remained that it was not possible to store blood because it clotted so quickly
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Treating Wounds and Injuries

• Blood transfusion:
• A solution to the blood clotting problem came through a number of discoveries:
• 1914 - American scientist, Richard Lewisohn, discovered sodium citrate could be added to blood to prevent it from clotting
• O. H. Robertson used this method to keep blood fresh during the war
• Scientists discovered keeping blood refrigerated allowed it to be stored for longer periods
• 1917 - British surgeon, Geoffrey Keynes developed a portable machine that could store blood to enable transfusions
• Portable X-rays:
• Discovered by William Rontgen in 1895 and became significant during the First World War
• X-rays saved lives by allowing surgeons to easily locate bullets, shrapnel and fragments of metal in a wounded soldier
• This reduced infection which was a common cause of death
• The problem in 1914 was that there was very few X-ray machines portable enough to be used on the front
• Marie Curie, a pioneer in radiography, at the start of the war concentrated on developing a portable X-ray machine
• October 1914 - 20 radiology vehicles constructed carrying X-ray machines were available on the front line
• By 1916 X-ray machines became the standard across casualty clearing stations