Government Action and War, 1905-20 » Blood Transfusion and Fighting Infection in the First World War

Blood transfusion: keeping blood from clotting

Many soldiers in the First World War (1914-18) did not die from the wound itself. They died because they had lost so much blood. The answer was a blood transfusion, which means putting one person's blood into another person's body. Doctors knew from earlier work that blood groups must be matched, but a practical problem remained: blood clots quickly once it leaves the body. Before the war, transfusions were mostly arm to arm, with the donor lying next to the patient. This was slow, difficult and rare.

Key terms:

• Sodium citrate: a chemical added to blood to stop it clotting, so it can be stored.
• Blood depot: a place where blood is collected and stored ready for use. Today we call it a blood bank.
• Gas gangrene: a deadly infection in which bacteria multiply in a deep wound, killing the flesh and producing gas.
• Debridement: cutting away dead and damaged tissue from a wound.

In 1914 a Belgian doctor, Albert Hustin, added sodium citrate to blood and used it successfully for a transfusion. Because the blood no longer clotted, it could be collected first and given later. The donor and patient no longer had to be in the same room. In 1917 an American army doctor, Oswald Hope Robertson, took this further. Working near the Western Front, he stored citrated blood, kept cool on ice, and set up what are usually described as the first blood depots. Blood could now be ready at the casualty clearing stations just behind the front line, where the badly wounded were operated on.

Fighting infection: the problem of gas gangrene

Infection was the biggest killer after the wound itself. The war was fought on farmland in Flanders and northern France, where the soil was full of bacteria from manure. Shells and bullets drove mud and scraps of uniform deep into the flesh. Some of these bacteria grow best without air, so they thrived deep inside damaged muscle. This caused gas gangrene. The flesh turned black, gas formed under the skin and the smell was awful. If it spread, the patient died. Cutting off the limb was often the only way to save a life.

Surgeons found two main ways to fight it.

This built on Lister's idea that antiseptics kill the germs that cause infection. The new methods did not end infection, because antibiotics did not yet exist. They did save many limbs and lives, and the speed of treatment was just as important as the method itself.

War or government: which caused change in 1905-20?

Two forces changed medicine in these years, and they were linked.

• Government action (1906-11): the Liberal Governments brought in school meals, school medical inspections and National Insurance. They did this partly because many recruits in the Boer War (1899-1902) had been too unfit to fight. These reforms improved the health of ordinary people for years.
• War (1914-18): the huge number of wounded gave doctors urgent problems and thousands of cases to learn from. Governments paid for hospitals, depots and research, because winning the war needed fit soldiers.

The government reforms mostly aimed to prevent illness in peacetime and reached everyone. The war speeded up specific treatments, such as transfusion and wound care, which later passed into hospitals at home. Neither stood alone: war and the fear of war pushed governments to act, and governments paid for what war showed was needed. A good answer weighs which made the bigger, longer-lasting difference.

Common mistakes

Exam-style question

How significant was war in bringing change to medicine in the years c1854-c1920? [16 marks]

You may use the following in your answer:

• Florence Nightingale at Scutari (1854-55)
• blood transfusion and fighting infection in the First World War

You must also use information of your own.

(Remember: at Scutari in 1854-55 deaths fell sharply once the sewers were cleared and nursing improved. Other facts you need come from earlier key topics of this breadth study.)