Injuries, Illness and Mental Malady: Medicine in WWI
World war One (WWI) was designed and intended to be a brief conflict between European powers as Germany sought to expand its borders and its influence on Europe. Instead, it became a long, drawn-out total war that encompassed the world that claimed the lives of millions – both soldiers and civilians. As the death toll rose on the battlefield, further casualties were multiplying behind the battle lines. The deplorable conditions and deadly circumstances faced by soldiers led directly to incredibly high rates of disease, parasitic infestation and psychological trauma that would make them unfit for service on the front lines. As soldiers continued living in unsanitary and unsafe condition, more suffered from wasting illnesses, injuries and mentally incapacitating challenges that the leaders of the war could not have conceived of prior to the lines in the sand being drawn. The treatment of injuries, illnesses and psychological conditions was a vital component of the war behind the scenes. An analysis of medicine in WWI reveals the results of horrific conditions experienced by those embedded in the war effort and the challenges that soldiers faced both during and after the war ended. With over six million civilian and soldier casualties attributed to disease and injury and more active duty military sustaining life altering injury or amputation or lingering psychological ailments, the enemy within was often equally as deadly as the enemy on the other side of the battlefield.
Sanitation and Hygiene
Although military manuals detailed specific sanitary and hygienic guidelines to be used by soldiers at the front, the conditions of WWI made following these guidelines all but impossible. Sanitation guidelines dictated that soldiers should bathe regularly, get plenty of rest and always wear dry, clean clothing but very few of these guidelines were practical on the front lines. The reality of trench warfare painted a far different, darker picture. In British trenches, specific living pits were constructed which allowed protection from inclement weather and from falling shrapnel, these were usually used by officers. Non-officers were expected to dig out holes towards the back of the trench, and many were injured or killed by these “pozzies” caving in due to constant rain. Since regular latrines could not be used in the heat of battle or while under enemy fire, pits were dug inside the trenches and often ran out into the rest of the trench, contaminating the water underfoot. As noted by a member of the field ambulance from Australia, the number of sick outnumbered the wounded, which was inexplicable to medical workers until they were informed of the deplorable conditions in the trenches. Soldiers were stuck without adequate fresh food or water and were forced to deal with open latrines. And all too often, corpses actually were left unburied out in the open
Pests and Disease
The lack of proper sanitation contributed to the severe infestation of pests into the trenches, and the soldiers stationed there for anywhere between four to sixteen days at a time had little to no relief or escape. Almost 97% of soldiers in the trenches were infested with lice, which caused trench fever. Lice easily spread as soldiers were forced to remain close together for warmth in the wet and cold weather. Soldiers often had to wait at least ten days between bathing, therefore the lice infestation and trench fever was consistently escalating. Although trench fever was not deadly like typhus, up to 80% of soldiers diagnosed were out of active duty for as long as three months. This drastic reduction of able-bodied soldiers at the front line enabled the war of attrition to continue with very little progress. The conditions of the trenches also contributed to other diseases such as Pneumonia, Trench Foot, Malaria, Meningitis, Tuberculosis, Empyema, Septicemia, Scarlet Fever and the Measles. Diabetes was also a significant factor in WWI as insulin had not yet been discovered and the only treatments for diagnosed men were restrictions in diet. In addition to the often deadly and well-recognized diseases above, venereal disease was prevalent throughout the overwhelming majority of the fighting force. As a result, soldiers were incapacitated for indefinite periods of time, significantly weakening the number of personnel available for offensive strikes. Meanwhile, those tasked with helping the wounded from the front lines were left with a daunting and often dangerous task.
Recovering and Treating the Wounded
Treating injured or wounded soldiers from the front line was a tense, tedious and often tragic affair. The struggle for necessary medical attention began long before the wounded arrived at the medical ships or tents. Stretcher-bearers from the medical corps throughout the war would have to venture onto the battlefield, risking enemy fire in the process, to retrieve wounded soldiers who were unable to walk on their own. These stretcher-bearer units often faced the same dangers that the surging soldiers did from machine gun fire to shells falling on them – and the wounded men they were responsible for carrying. The process of retrieving wounded soldiers from the battle field was a time-consuming one. In at least one instance, carrying a wounded General from the field of battle back to the medical tent took ten hours, as the medical tents were set up five or six miles behind the front-lines. Often, in areas of heavy fighting, the medical tents and hospitals ran out of room, and there were rows and rows of wounded soldiers, awaiting treatment. Stretcher-bearers were specially trained to stop the bleeding on the field at all costs, and often carried their patients for miles on their backs to get them to a hospital tent.
Map of WWI
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Which ailment would be the most horrific for soldiers on the front line to face?
Medical Care for the Injured
When treatment for wounds was finally administered, doctors worked with a much more limited array of medical understanding than is available today. Since no antibiotics or sulphonamides were available during WWI, infection was the primary concern of field hospitals behind the battle lines. Infection was to be prevented at all costs by either the process of debridement, which involved cutting away tissue around the wound to prevent it from becoming infected, or by “Bipping” which was an application of a paste containing bismuth, iodoform and paraffin on the most severe wounds treatable. Since WWI saw horrific injuries due to the technologically advanced weaponry, the wounds received on the extremities were often severe enough to require amputation. Although amputation now seems extreme with the modern understanding of medical technology, the liberal use of it during the Great War is actually thought to have spared the lives of countless soldiers by preventing potential infection from lingering, horrific wounds. The French, in an ironic if useful advancement, created a miniature version of the guillotine which was used to amputate limbs that were too far gone for repair or treatment.
Mental Afflictions - Shell Shock
Not all wounds received from soldiers were physical. The psychological impact of the war were apparent on all sides, and often lingered long after the fighting ceased. Doctors and stretcher bearers were trained to not only treat the physically wounded, but to identify soldiers who had self-inflicted injuries in order to escape the fighting. “Shell shock”, an all-too-common phenomenon for those sent back from the front lines, occurred all too frequently. Its symptoms varied significantly from soldier to soldier, but the end result remained the same. Shell shock is known currently as post-traumatic-stress disorder, but at the time of WWI, doctors had little experience or resources to draw from in determining its origin. Patients were commonly said to have “lost their senses or their nerve”, but the effects and implications went far deeper. Soldiers suffering from this psychological disorder were still incapable of serving their duty on the front-lines, and were often removed from duty for several months at a time. In many cases, these embattled soldiers were unable to return to the front lines at all. Many soldiers, determined to go back to the front lines to do their duty, were so fearful of the prospect that they considered suicide as a viable alternative to facing the horrors of war again. As pointed out by Psychologist Grafton Smith “Here was a man who of his own initiative had asked his doctor to certify him as ready to go back, yet in his sleep the train of thought started by the discussion of the possibility of his return working subconsciously, had stirred up images of what this implied, and reinstated emotions of so terrifying a nature that in his dream he preferred suicide to facing the ordeal again.” As more and more fighting men were removed from the fighting for psychological reasons, shell shock became all too familiar. Doctors and psychologists came to recognize the need for empathy and support for these men who had suffered through such horrific conditions. Psychologically in the field, soldiers simply broke down from the continual and unrelenting pressure. Everyday soldiers had to contend with seeing friends and colleagues wounded, hearing the incoming mortars and shells but not being able to escape them, hearing reports of incoming gas attacks without proper insulation and hearing the screams of the dead and dying in the no-man’s land between the lines of trenches. All of these daily horrors took a dreadful toll on those exposed to them for significant periods of time. Many men found it nearly impossible to cope, and were therefore pulled from the line as their conditions intensified and worsened. Some doctors in specialized hospitals for the psychologically affected were able to recognize the specific and special condition of their patients and treat them with courtesy, empathy and recognition. The importance of approaching these wounded men without a preconceived bias became imperative in gaining knowledge about shell shock.
The inhumane nature of modern warfare experienced in WWI made for an intense and altogether hostile experience for those who actively fought in the war and in those responsible for providing medical treatment. Understanding and analyzing the medical treatment that was available then compared to the present allows for greater understanding of the horrors of war. Medical officers worked with what was available, often in period of great shortages of the most needed supplies, such as water, bandages and morphine. Many of the wounded carried out of the trenches and the battle fields ultimately bled to death prior to ever reaching medical aid. But the courage and resolve of the medical corps saved the lives of thousands more, despite the fact that many of those who experienced the horrors of war first-hand would suffer psychological consequences for years to come. By the time the WWI ended, millions of lives had been lost, and many more would be affected for years into the future. Knowing that this horror would be repeated not too long in the future gives greater sympathies for those who underwent this trauma and those who would face it in the years to come. Understanding the impact of the war from a psychological and physical medicine standpoint enables a greater understanding for the experience of the war itself, and lends to compassion from those who were forced to participate in it.
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© 2015 Julie McFarland