1. The role of war in the development of Surgery 1845-1918
Learning Objectives: 1. To be able to identify and explain the links between war and developments in surgery 2. To evaluate the extent to which war helped make developments in surgery

2. Food for thought…
Watch the following short clip of images taken from World War One ( ).
Look carefully for evidence of living conditions and use of weapons.
What possible issues could these create from a medical point of view?

3. What do you think?
Make a mind map in your book to show your ideas.
Identify as many possible medical problems as you can think of, based on the nature of the first world war
E.g……
Blindness
Artillery
World War
One
Gas
Breathing/lung problems
Death
You have 15 minutes!

4. SUMMARY
Adolf Hitler

5. Living conditions in the Trenches
Waterlogged Trench
Trenches were open to the elements 365 days a year, meaning that soldiers had to deal with all weather conditions and the problems that came with them, from sun burn to snow!
But the weather in France and Belgium was very similar to here in Britain - very rainy! Trenches were often waterlogged, and that in itself led to its own problems!

6. Living conditions in the Trenches
TRENCH FOOT
Trench foot an occupational hazard of living in the trenches. The constant surrounding of water made it almost impossible for soldiers to keep their feet dry, resulting in a rotting of the flesh that impossible to cure once it reached a certain stage.
Many bad cases of Trench foot were treated by amputation at the knee, rendering a solider useless for combat.
Some soldiers (but not all) would benefit from prosthetic legs later on.

7. Weapons
GAS
This photograph shows German soldiers (You can tell by the shape of the helmet!) wearing gas masks.
Both sides used gas as a weapon during the First World War, mostly Chlorine or Mustard gas, which had similar effects.
Many soldiers who fought in the war often described gas attacks as the most terrifying experience of the whole war – although less than 10% of deaths were actually caused by gas.

8. Weapons
GAS
The effects of gas tested medical staff on the front line to the best of their abilities. The effects varied from blindness (permanent on occasion – but most often temporary, as was the case with Adolf Hitler), choking effects, bleeding of the lugs, asphyxiation (suffocation) and severe sickness – often with soldiers coughing or throwing up blood and tissue from their own damaged lungs.
The effects of gas were impossible to stop once inhaled passed a certain point, and it was the development of technology (gas masks) rather than surgery that solved the problem.

9. Weapons
Artillery
Artillery was one of the most significant weapons of the war. Artillery bombardments were almost constant, with both sides firing shells (packed full of explosives) at each others trenches.
Quite often the shells were to break the barbed wire in order to prepare for an attack, but they intentionally ruined trenches too, causing huge destruction on both the land and soldiers in the trench.
Many soldiers were left with missing limbs, or shrapnel wounds which often got infected.

10. Going over the top The nature of warfare
Going over the top – launching an attack on enemy trenches, meant advancing into ‘no man’s land’. Soldiers were exposed to enemy machine gun fire, and if injured (rather than killed) faced an agonising wait for the medics to arrive after the ‘push’ to round up casualties.
Many men bled to death where they lay, others were desperate for blood by the time they reached medical help. They also ran the risk of infection in the wound. Soldiers often had multiple shot wounds.

11. The dressing station
One of the biggest pressures on surgeons of the First World War was the sheer amount of soldiers they had to attend to.
Before they reached a hospital for treatment wounded soldiers were sent to the ‘dressing station’ where they would receive basic treatment – such as the dressing of wounds.
The following slide shows a painting done by Henry Tonks, a surgeon. He was trying to show what kind of a place the dressing station was.
What message is shown in the picture? Write down your ideas.

13. New developments in surgery
The war presented new problems which required new solutions.
Firstly, many soldiers were getting infections from shrapnel wounds, after bits of metal and cloth from their clothing. But surgeons discovered they could prevent infection by soaking the wound in saline solution (a form of salt water). However, as antibiotics were yet to be invented, serious infection could still not be solved.

14. New developments in surgery
Due to the seriousness of some of the injuries on the battle front, some surgeons even found themselves attempting the first ever brain surgery – although success was very limited.
The First World War even saw the development of plastic surgery. Harold Gilles, a doctor from New Zealand asked permission to set up a plastic surgery unit in the British Army.

15. Gilles’ Plastic Surgery methods
Gilles was aware of these developments and asked for permission to set up a plastic surgery unit
He began to experiment with ways to reconstruct facial injuries. He wanted patients to look normal again
Before WWI French surgeon Morestin worked on facial surgery
Before WWI French and German surgeons were developing skin grafting technique, using tissue from another part of the body to repair an injury
He developed a new technique using pedicle tubes. A narrow layer of skin was lifted from the body and stitched into a tube at one end. This allowed the blood to circulated as the skin was still attached to the body. The healthy skin would grow, and when long enough would be attached to where it was needed, then cut free at the base.
Gilles kept records, including drawings of the injuries and reconstructions he created

16. Pedicle Tubes Plastic Surgery
A narrow layer of skin was lifted from the body and stitched into a tube at one end. This allowed the blood to circulated as the skin was still attached to the body. The healthy skin would grow, and when long enough would be attached to where it was needed, then cut free at the base.

17. Prosthetic Limbs
The First World War left behind a generation of mutilated and disabled men.
It was not uncommon for men to return from the war with an arm or a leg missing, sometimes two or all four.
Between 1914 and 1921 over 41,000 men in the British Armed Forces lost a limb.
Developments using light metal alloys and new mechanisms allowed some of those limbs to be replaced and a chance of a return to normality.
However there was a huge waiting list, and patients needed training to use them properly.

19. Getting you thinking… Draw out a table in your book as shown below.
Think about the things you have learnt today, and also in previous lessons, such as the discovery about storing blood.
Complete the table with as many ideas as you can.
Examples of war ACCELERATING developments in surgery
Examples of war leading to NEW developments in surgery
Your answers here….
Your ideas here….