Medical Services during WW1

Medical care throughout the First World War was largely the responsibility of the Royal Army Medical Corps (RAMC). The RAMC’s job was both to maintain the health and fighting strength of the forces in the field and ensure that in the event of sickness or wounding they were treated and evacuated as quickly as possible.

Every battalion had a medical officer, assisted by at least 16 stretcher-bearers. The medical officer was tasked with establishing a Regimental Aid Post near the front line. From here, the wounded were evacuated and cared for by men of a Field Ambulance in an Advanced Dressing Station.

The hospitals set up immediately behind the lines were often housed in tents during the First World War, including wards and operating theatres.

This was particularly true of Casualty Clearing Stations, with base hospitals further away from the fighting sometimes making use of existing or more permanent buildings.

A casualty then travelled by motor or horse ambulance to a Casualty Clearing Station. These were basic hospitals and were the closest point to the front where female nurses were allowed to serve. Patients were usually transferred to a stationary or general hospital at a base for further treatment. A network of ambulance trains and hospital barges provided transport between these facilities, while hospital ships carried casualties evacuated back home to ‘Blighty’.

As well as battle injuries inflicted by shells and bullets, the First World War saw the first use of poison gas. It also saw the first recognition of psychological trauma, initially known as ‘shell shock‘. In terms of physical injury, the heavily manured soil of the Western Front encouraged the growth of tetanus and gas gangrene, causing medical complications. Disease also flourished in unhygienic conditions, and the influenza epidemic of 1918 claimed many lives.

Understanding shell shock and its treatments

Post-traumatic stress disorder (PTSD) is an important health risk factor for military personnel deployed in modern warfare. In World War I this condition (then known as shell shock or ‘neurasthenia’) was such a problem that ‘forward psychiatry’ was begun by French doctors in 1915. Some British doctors tried general anaesthesia as a treatment (ether and chloroform), while others preferred application of electricity. Four British ‘forward psychiatric units’ were set up in 1917. Hospitals for shell shocked soldiers were also established in Britain, including (for officers) Craiglockhart War Hospital in Edinburgh; patients diagnosed to have more serious psychiatric conditions were transferred to the Royal Edinburgh Asylum. Towards the end of 1918 anaesthetic and electrical treatments of shell shock were gradually displaced by modified Freudian methods psychodynamic intervention. The efficacy of ‘forward psychiatry’ was controversial. In 1922 the War Office produced a report on shell shock with recommendations for prevention of war neurosis. However, when World War II broke out in 1939, this seemed to have been ignored. The term ‘combat fatigue’ was introduced as breakdown rates became alarming, and then the value of pre-selection was recognised. At the Maudsley Hospital in London in 1940 barbiturate abreaction was advocated for quick relief from severe anxiety and hysteria, using i.v. anaesthetics: Somnifaine, paraldehyde, Sodium Amytal. ‘Pentothal narcosis’ and ‘narco-analysis’ were adopted by British and American military psychiatrists. However, by 1945 medical thinking gradually settled on the same approaches that had seemed to be effective in 1918. The term PTSD was introduced in 1980. In the UK the National Institute for Health and Clinical Excellence (NICE) guidelines for management (2005) recommend trauma-focussed Cognitive Behavioural Therapy and consideration of antidepressants.