The destination for history

Changes to medical practice from 1914 - 1918


At the Order of St John hospital in Etaples patients received the highest possible standards of care. Medical staff of the Order were also at the forefront of medical research. The first Commanding Officer Colonel James Clark established the Etaples Medical Society on 18 August 1915, and members convened a few days later on 1 September.

Astute enough to realise that newly emerging medical problems could only be overcome by research and innovation Clark argued that war presented doctors with a God given opportunity to make exceptional contributions to physiology, surgery and neurology. Henceforth his medical team were involved in several research programmes and their findings were published in medical journals such as The Lancet.

The British Director of Gas services also stated:

We have in the theatre of war itself a vast experimental ground….Human beings provide the material for these experiments on both sides of no man’s land.

Scientists and physiologists became expert advisors to the British government and the military; alongside industrial and business experts. These medical-industrial relationships intensified as new methods of warfare both prompted and accelerated research programmes. However, much as they viewed soldiers as a means of testing medical innovations physiologists were not averse to self-experimentation. John Scott Haldane for instance, inventor of the first box respirator, used to sit in specially modified sealed chambers and breathe in a variety of harmful gases whilst recording the effects of such gases on his own body. Haldane had spent some considerable time working with the mining industry, but when German forces unleashed the first large scale gas attack on 22 April 1915 he was summoned to the British War Office and asked to investigate the nature of this new chemical warfare. Haldane travelled to France, identified the gas as chlorine and subsequently assisted the War Office in developing the first effective British gas mask. Further research into the effects of chemical warfare resulted in the introduction of oxygen therapy for those affected by poisoned gas.

In many respects the changing nature of warfare dictated substantial changes in medical practice. From the use of magnets to extract shrapnel from soldiers brains, to the development of controversial wound therapies for gas gangrene and other seriously infected wounds, a series of medical ‘firsts’ were performed and documented during the war years. Furthermore, certain areas of medical expertise such as orthopaedics gained greater prominence and prestige within the medical community as a result of war; and changes often yielded dramatic results. Before the introduction of the Thomas splint for instance, eighty per cent of soldiers with compound fractures of the femur died. Once the splint became an accepted method of stabilising these fractures the mortality rate dropped below ten per cent. Advances in blood transfusions, dental care and plastic surgery also improved the lot of patients. 

At the Order of St John’s hospital considerable research was conducted within the field of bacteriology and cardiology. Major Houston published several research papers on bacteriology and Dr Macllwaine published research material related to the value of electro-cardiograms. Thanks to Macllwaine, the hospital was the only establishment within the British Expeditionary Force with a cardiograph machine. It was installed next to the x-ray department and electro-cardiograms (E.C.Gs) quickly became an important diagnostic tool. Within medical circles generally, the value of (E.C.Gs) was heavily disputed, with some doctors claiming they were of little or no use. By conducting his own meticulous research Macllwaine and his assistant Captain Alan Brunwin produced several medical papers on the subject of E.C.G.s which confirmed both diagnostic and monitoring benefits of cardiograms.

By 1916, in addition to coping with medical and surgical cases hospitals were admitting an increasing number of shell shock (neurasthenia) victims. Soldiers suffering from the condition exhibited widespread body tremors, muscle jerking and facial expressions of terror. Sometimes they spoke gibberish, other times they were catatonic. They were usually placed at far corners of wards in the hope that rest and gentle nursing would improve their condition. Initially doctors believed that shell shock was organic in origin. They surmised that soldiers who were very close to exploding shells suffered from small haemorrhages in the brain which rendered them semi-conscious and traumatised. When post mortems failed to substantiate this theory doctors were at a loss as to how to treat the condition. Henceforth, patients suffering from shell shock were often accused of malingering. For those who were diagnosed as neurasthenic treatments varied considerably, and usually depended on the social class of victims. Officers with the condition were encouraged to rest, listen to music, write poetry and read books, whilst other ranks were subjected to aversion therapies and tortuous medical examinations. As the number of victims continued to rise dramatically however, new psychological theories and therapies were developed. The medical field of psychology and psychiatry expanded as a result. Subsequently shell shock has been become known as battle fatigue or post-traumatic stress disorder.

As the war drew to a close and Allied forces were making good progress on the Western Front, another more sinister battle was being lost on the medical front. A virulent strain of influenza was spreading across the globe, killing twenty million people in the first six months of the outbreak. Back in Britain, by the end of October 1918 an average of 4,500 British people were dying from flu every week. For medical and nursing teams on the Western Front who had fought valiantly to save men from the ravages of war, the fact that thousands upon thousands of people were now dying of influenza was a cruel twist of fate. As bodies piled up outside mortuary blocks, doctors debated the unusual nature of this pandemic. A virus that did not target the young, the old, or the vulnerable but attacked all those between the ages of eighteen and thirty five. Between 1918 and 1920 over five hundred million became infected with influenza and over fifty million died as a result. Despite all the medical advances gained as a result of wartime research and experimentation, medical teams were rendered helpless in the wake of this global pandemic.

By Penny Starns

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