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Unlock This CourseThe First World War (1914-18) was fought with weapons that made wounds worse than anything doctors had seen. Machine guns and high-explosive shells tore through bodies. Shell fragments, called shrapnel, smashed bones and flew into faces and heads. Doctors had to treat huge numbers of badly hurt men, and they had to learn fast. Surgery had already changed by 1914, with anaesthetics, antiseptics and aseptic methods. The war pushed it much further.
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A shell or bullet could shatter the femur, the thigh bone. In 1916 about 80 per cent of men with a compound fracture of the femur (where the broken bone pushes through the skin) died. Carrying a man on a stretcher with a loose, broken leg caused terrible pain and shock, and the bone ends tore the flesh.
The answer was an old invention. Hugh Owen Thomas, a Liverpool surgeon, had designed the splint in the 1800s for leg diseases. His nephew Robert Jones, the army's chief orthopaedic surgeon, pushed for the splint to be put on at the front line, and he trained medical staff to use it. It was supplied routinely from 1917. By 1918 the death rate for these fractures had fallen to about 20 per cent.
The splint held the leg still straight away, before the man was moved. That cut pain and shock, and it stopped the bone ends doing more damage on the way to hospital.
Many men survived with shattered faces. Harold Gillies, a New Zealand-born surgeon in the army medical service, set out to rebuild them. In June 1917 the Queen's Hospital opened at Sidcup, in south-east London, with over 1,000 beds. It was a specialist hospital for facial and jaw injuries, and its beds included its convalescent hospitals.
Gillies developed and made much use of a method in which he cut a strip of skin, usually from the chest, and folded it into a tube. One end stayed joined to the body, so the skin kept its blood supply and stayed alive. He moved it to the face a little at a time. The tube also kept the raw edges covered, which lowered the risk of infection.
The Sidcup hospital carried out more than 11,000 operations on over 5,000 men up to 1925. Many could look in a mirror again and return to normal life. Gillies' methods became the basis of modern plastic surgery.
Head wounds were common, because men looking over a trench top were hit by bullets and shrapnel. Brain surgery was very dangerous, and about half of the men with such wounds died. The American surgeon Harvey Cushing led a medical unit in France. He and other surgeons took great care to clean the wound and remove damaged tissue. He also used a magnet to pull out iron shrapnel from deep in the brain. Survival rates rose, and surgeons learned lessons that were used in brain surgery after the war.
Surgeons could not operate well if they did not know where a bullet or a shell fragment lay. X-rays solved this by showing bone breaks and metal inside the body. But X-ray machines were in big city hospitals, far from the fighting.
Marie Curie, the scientist who had worked on radioactivity, set out to bring them to the soldiers. She helped to fit out cars with an X-ray machine and a generator run by the car's engine. These vehicles were nicknamed the 'petites Curies', and about 20 were built. Her daughter Irène, then 17, helped to run them. Curie also helped to set up around 200 X-ray rooms at hospitals behind the lines. X-ray pictures let surgeons find the metal and operate more accurately.
These were real improvements, but the war did not change everything. Many wounds still became infected, which is a story for the next lesson. What changed was skill, speed and planning, helped by science and technology such as X-rays. The war also gave surgeons huge numbers of cases to learn from.
Explain TWO ways in which surgery in the First World War was different from surgery in the 1850s. [6 marks]
(Remember that in the 1850s patients could be given chloroform, but surgeons still worked very fast, there were no antiseptics and infection killed many.)
One difference is in how surgeons found out what was wrong inside the body. In the 1850s there was no way of seeing inside a patient, so a surgeon had to rely on touch and on what he could see in the wound. By the First World War, X-rays could show broken bones and the exact position of bullets and shrapnel. Mobile X-ray units, such as Marie Curie's 'petites Curies', took this technology close to the front line, so surgeons could operate with far more accuracy.
A second difference is the type of operation. In the 1850s surgery was mostly quick amputation, because a leg could be removed in minutes, which limited pain and blood loss. By 1917, with anaesthetics and cleaner methods in regular use, surgeons could carry out long and delicate operations. Harold Gillies rebuilt shattered faces with skin tubes at the Queen's Hospital in Sidcup, and Harvey Cushing removed shrapnel from the brain with a magnet. Operations like these would have been impossible in the 1850s.
This reaches the top level because each way is a direct comparison, with precise facts about both periods.
Name both periods in every paragraph ("In the 1850s ... whereas by the First World War ..."). Facts about only one side score no more than half marks.