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Dr Emily Mayhew, Department of Humanities, Imperial College, London
18 October 2014
This talk was devoted to the men and women who rebuilt the military medical system from the ground up in response to the crisis in providing care for the wounded soldiers of the Western Front, The system that was created by their dedication, technical expertise and courage provided the foundation for the system that is used in Britain’s wars today. One needs to remember that in all pre-1914 wars, seven out of every ten people in a hospital had a disease, rather than a wound.
Dr Mayhew was concerned with the Western Front as her main subject. Other fronts were still dealt with on nineteenth century lines. Worst case scenarios from the recent Boer War became the norm in 1914-1918. Artillery caused 65 per cent of the men’s wounds, with shrapnel fragments the main cause. The terrible impact of shrapnel includes the force of the metal on the body, destroying soft tissue. There might be a small abdominal wound, but when the soldier was opened up, it would often turnout that all his internal organs had been destroyed. Antiseptics and anaesthetics were available from 1914, so a comparison with the primitive facilities in the American Civil War is not valid. Hospitals on the French coast were good, but were too far away from the Front. They were sterile and light, but many British Expeditionary Force (BEF) soldiers died because of lack of attention, and because the hospitals were in the wrong place.
A British Army Red Cross hospital in France c. 1916/17
A key element in the manpower provision was that of stretcher-bearers. Their importance can hardly be overestimated. Originally ‘bandsmen’, they were seen at the outset as ‘anyone too big or too stupid to do anything better’, but this strikingly ungenerous perception rapidly improved. Training at the Cambridge Hospital Aldershot covered the controlling of haemorrhages, the splintering of fractures, and the management of shock. Tourniquets were not encouraged, so haemorrhage was controlled by pressure. The stretcher-bearers had to be strong and fit. To achieve this, weights training was provided, and there were fitness walk up Box Hill in Surrey, with men carrying twelve stones in weight. They also went round the wards to create awareness of what to expect on the Western Front. RMCs insisted that ‘the really useful training will be that in France.’ Stretcher-bearers and regimental nursing staff became used to life on the Western Front, and to living together.
Morphine was used only as a very last resort, though it was freely available in capsule and tablet form. It was vital not to use too much, as the casualty would not be able to tell the stretcher-bearer what had happened to him. If unconscious, he would be s dead weight, and thus more difficult to carry. Being a soldier, and then a casualty, meant a complete dependency on someone else. There was a dread of ‘finding out what the wet is’ when a wounded man was brought in, and the careful laying out on a stretcher was carried out. From March 1915, stretcher-bearers talked about ‘patients’ in their letters home. The stretcher-bearers stayed at the rear, trying to remain unnoticed, as they were not popular. Amazingly to us, the soldiers thought that the stretcher-bearers should be fighting - and also that they brought bad luck. The general process of rescue was as follows. When the men went over the top, the stretcher-bearers would count up to thirty, and then follow them to listen, and look, for the wounded. In this way, the stretcher-bearer would, normally, be the first person to reach a wounded soldier. The stretchers, made of wood, were heavy, and thus imposed a great physical strain on the hands, arms and shoulders of the bearers. These men would then have to remember their way back across the battlefield, and then find an aid post which had escaped shelling. Once at the aid-post, the casualty would become a patient.
Stretcher-bearers on the field of battle in the Great War
When it came to surgeons in hospitals, the fact of hospital proximity was worth any number of trained staff. Surgeons needed to be close by the field of battle. Casualty clearing statins were critical, when requests were made for a big enough tent and enough beds to house the wounded. Obvious though it seems, the early treatment of the lightly or moderately wounded meant that they would be on their feet again sooner. Temporary tented hospitals tended to get better results than the mina hospitals - a situation which still applies in warfare today.
The system of care in France was allowed to operate as independently as possible from London’s control. Sometimes, stretcher-bearers on the field of battle were shot down, and patients would remain on the stretcher on the ground, to be rescued by orderlies. Casualties would be collected on trains, and taken to field hospitals. There was no ‘paramedic’ system as we know it today. The Quakers started their own stretcher-bearer training centre in Oxford, training people to treat fractures and perform amputations. There was quite an efficient medical records system, but unfortunately, at the end of the war, apart from a few samples, they were all destroyed. Diphtheria inoculations were carried out, but the country (and the world) was unprepared for the great ‘Flu of 1918, which killed millions. The concept of the virus was unknown in 1914-1918.
Some fifty per cent of British doctors had engaged in the war in some way by November 1918. Smaller hospitals, nearer the lines, were known as ‘casualty clearing hospitals’ or ‘field hospitals’. The large hospitals further away, had a capacity which was, or seemed to be, infinite. It took fifty lorries to move them after the Armistice.
In a fine exhibition in 2015 at the Temple Church, Fleet Street, central London, the war experiences of many volunteer Templars were described in detail. Some survivors later produced memoirs, such as Hilton Young, author of By Sea and Land. Several, such as Lieutenant E. Paul Bennett, Corporal James Leach, and Sergeant Hogan, were awarded the Victoria Cross for bravery. Raymond Asquith, the brilliant and gifted eldest son of the Liberal Prime Minister, H.H.Asquith, was killed in September 1916 during an advance from Ginehy to Lesboeufs. It is said that he lit a cigarette after his injury (he was shot through the chest) to conceal his state from his men, but died before reaching a forward dressing station. In the context of Dr Mayhew’s talk, the case of Major General Robert Blackham (Middle Temple) deserves a full record here. He was a senior medical officer in 1914-18.To prevent trench foot, Blackham developed a scheme for Foot preparation Rooms, providing massage and chiropody, ad ensured constant inspection of the men’s feet. Blackham was in charge of the main dressing station at the Somme advance on 3 July 1916. This was in the village church of Moulin de Vivier, and he used the altar as a shelf for dressings. The delivery of ammunition and conveying away of the wounded was carried out by means of simple narrow-gauge ‘tramways’. Following a deluge of rain on 7 July, Blackham recorded the severe difficulties experienced by stretcher-bearers. Later he wrote of his admiration for the medical officers, stretcher-bearers and other personnel of the Field Ambulances, who evacuated the wounded across the mud in the face of heavy shellfire. In one twelve-hour period on the Somme, Major General Blackham managed the treatment of 1800 wounded soldiers - a figure hard for us to grasp.
It is estimated that some 60,000 British soldiers received head or eye injuries during the Great War. Many of these resulted in lasting facial disfigurement. A pioneer of modern plastic surgery techniques was Dr Harold Gillies (1882-1960), an otolaryngologist and a New Zealander. Gillies (after Cambridge) joined the Royal Amy medical Corps, and was posted to Wimereux, near Boulogne. He worked with a French-American dentist, Valadier, whom he watched experimenting with new skin-graft techniques. Shortly afterwards, Gillies witnessed a leading surgeon, Hippolyte Morestin, remove a tumour from a patient’s face, and cover the lesion with new skin taken from the same patient. Gillies and the Army’s chief surgeon, William Arbuthnot-Lane, set up a facial injuries ward at the Cambridge Military Hospital, Aldershot, later replaced (by June 1917) with the far more adequate Queen’s Hospital at Sidcup, Kent. Gillies and his colleagues performed 11,000 operations on more than 5000 men. Harold Gillies’ cousin Archibald McIndoe joined his post-war practice, and himself later became a pre-eminent surgeon, treating airman with serious burns during World War Two.
Biography of Sir Harold Gillies by Richard Petty – book jacket
To deal with facial scars in 1914-18, painted metal prostheses were made to cover many of the worst disfigurements, with the aim of making a man’s face resemble as closely as possible what it had once been. The pioneer in this area was Francis Derwent Wood (1871-1926), who taught at the Glasgow School of Art from 1897 to 1905, and from 1918 to 1923 was professor of Sculpture at the Royal College of Art in London. Each prosthetic mask was built from a thin copper sheet / galvanised copper, to enable it to be painted after forming. The building of this was over a plaster cast of the subject’s face, made only after the wounds had healed. Every effort was made to paint the masks to match the man’s skin tone and texture. Given that all this was a century ago, it seems quite marvellous to us now.
Wood’s art background turned out to be of enormous practical use. He volunteered for hospital ward duty in 1914, and later opened a special clinic, the Masks for Facial Disfigurement Department, which was open from 1917 to 1919. Hundreds of masks were made, but unfortunately, no statistics were kept. FD Wood also created a number of war memorials, including the Liverpool Cotton Association and the Machine Gun Corps Memorial at Hyde Park Corner in London. The head of one of the two thieves crucified next to Christ, entitled The Penitent Thief (1918), in the Lady Lever Art Gallery, Port Sunlight, Near Birkenhead, is by Wood, as is a green bronze, entitled Psyche, nearby in the same gallery.
Francis Derwent Wood working on a patient’s facial mask
In her book Wounded: From Battlefield to Blighty, 1914-1918, Emily Mayhew tells the story of the army surgeon Henry Soutter, working at his field hospital near the front line in France when Queen Elizabeth of the Belgians appeared more than once with lorry-loads of supplies. On another occasion, a van appeared, driven by Professor Marie Curie, of all people, offering help, and bringing with her a mobile radiology laboratory. She had organised a fleet of mobile laboratories at her own expense. This natural generosity came partly from Marie Curie’s feeling that men were dying who might have been saved by the use of X-rays. Sadly, many surgeons did not feel as Soutter did about the presence of women near army operating theatres. There was anti-female prejudice here, as in so many other areas of military and civilian life. This sprang from sheer ignorance, with more than a dash of superstition.
An art room being used as an operating theatre during the First World War
Some 921,000 British and Empire servicemen died in the Great War. Many thousands came home permanently damaged physically and mentally. Some were lucky enough to recover, very slowly; others did not. It is thought that in 1928/9, a decade after the war, over two million men were in receipt of an injury-related disability pension. 220,000 officers and 419,000 other ranks were still receiving disability pensions in the late 1930s. Of the 41,000 (and more) British servicemen who had limbs amputated following their injuries, some two thirds lost a leg and more than a quarter of them an arm. Some 272,000 were injured, but did not require amputation. In Germany, 2.7 million men out of 13 million who had fought were disabled, permanently. Only 800,000 of these received disability pensions. In France there were 1.1 million (or more) war wounded, at least 100,000 of them totally incapacitated.
© 2016 Dr Robert Blackburn, Convenor, Literature and Humanities, BRLSI, based on notes taken during Dr Mayhew’s talk, with several additions.