How did trench warfare affect injuries and treatment?
These teachers notes can be downloaded as part of our Teachers Pack PDF. (7.2 MB)
Both these collections of original sources Part 1 and Part 2 can be used to support GCSE thematic modules which cover ‘Medicine through Time to the present day’ and the ‘historical context of the British sector of the Western Front’. Teachers have the flexibility to download and create their own resources from these documents, to develop their pupils’ understanding of how to work with sources and prepare and practice for source based exam questions. Each collection includes a wide range of sources to encourage students to think broadly when exploring these topics.
With each collection we have suggested 5 tasks based on some of the documents. The tasks can be completed individually or in groups.There is a downloadable pdf of questions (0.02 MB) to help working with sources. All documents are provided with transcripts. We hope that exposure to original source material may also foster further document research. The following themes covered by the documents in Part 1 include:
- Type of injury which resulted from trench warfare.
- Medical treatments received by injured soldiers and some of the medical developments that came with the First World War.
- Dangers faced by soldiers caused by exploding shells, grenades, shrapnel, gas, personal combat, flooding, noise, acute stress.
- Type of medical services from transport to hospitals. (For the injured, this could involve initial treatment and transport by a Field Ambulance unit and return to duty or movement to a Casualty Clearing Station. From here injured soldiers could be moved to a Base Hospital before transportation to a British military/civilian hospital at home via hospital ship. Transport itself ranged from stretcher bearers, horse-drawn ambulances, motor vehicles, boats or ships.)
- Included here also is the personal War Office record of war poet Wilfred Owen (one of a specific record set of notable high-ranking officers in the British Army).
Working with these sources:
It is fundamental when using sources that students get to grips with what they are looking at! What type of source is this? What is being said? How is it being said? For example, if looking at an army medical card, a superficial view response might be that it contains, by its nature, only limited information or only provides answers to generic questions. Encourage students to “look behind the source”. The army records included here infer a huge amount of planning and record keeping and can suggest the scale of a particular problem. Some of information contained may be limited but this suggests that the purpose was to gather statistics for medical authorities/government. Other sources, such as medical case sheets, unit war diaries, reports and pension records can be highly detailed. It is possible to understand a huge amount about how patients were assessed, examined and treated, how their cases progressed and how their treatment continued after the war. Whilst the emphasis of the sources in Part 1 centres on injuries, treatment and medical services, these also provide invaluable information about the nature of trench warfare, its organisation and impact. Part 2 includes sources which focus more specifically on the nature of trench warfare, but also documents relating to the experience of women at the front and further sources covering injuries and treatments during wartime.
When working with the photographs in these collections, students should always consider why has the photograph been taken? Does it show some kind of development or system of organisation? Can you tell if the photograph is posed, or an official war photograph? Remember too, a photograph can be selective in choice of subject or could it have been cropped? Is there an original caption linked to the photograph? Captions can add meaning to a photograph and add a particular message. They are added after the photograph was taken, therefore we must not necessarily take them on face value. It is also useful to know that many soldiers used photography to record their experiences and some carried small Vest Pocket Kodak cameras which were banned after 1915, but many continued to carry them regardless and some such photographs have survived, although examples are not included here. Finally, other soldiers were employed as official photographers during the First World War as well as newspaper photographers.
The big question when working with sources is: how can the evidence provided within the source be considered useful for a particular enquiry question? Therefore, encourage students to consider both the ‘witting’ and ‘unwitting’ testimony a source may reveal. Part of this evaluation is to consider if there are any gaps in the evidence or issues of accuracy in authorship. Why would we trust/not trust this source? What other sources might be needed to provide additional information/context? Does the document support other knowledge that you have already for a certain line of enquiry?
Always pay attention to the origin of the source. Ask students to look at the document reference. Do they know what that means? The record series/government department can contribute a whole layer of meaning to the interpretation of a given source. What does the type of record tell you (see below) about the content of the source?
General source guidance questions:
The purpose of these questions is to help students to analyse, evaluate and understand documents in order to develop their own interpretations and conclusions. Teachers may wish to print these out from pdf download and discuss them with the students before they look at the sources.
- What is the date of the source?
- Who wrote/created it?
- Do you know anything about the author?
- What type of source is it? (Letter, report or newspaper, war diary, pension record, medical record, map, diagram, photograph.)
- What is the source saying/showing?
- Check the meaning of any words you are unsure about.
- How useful is this information, does it support what you know already?
- What can you infer (information which is not directly stated)
- What type of enquiry would be this record be useful for?
- Does the document show the writer’s opinions/values?
- Are there any clues about the intended audience for the document?
- Why was the document created?
- Does it have any limitations or gaps?
- Does it link to other sources in this group?
- Does it share the same ideas, attitudes and arguments?
- How would you explain any differences between these documents?
Records of the medical services during the First World War reveal a great deal about the experiences of those working in the field and the soldiers they treated for a variety of injuries and diseases on the Western Front, and indeed further afield. Soldiers were exposed to many dangers from gunshot, shellfire, gas and personal combat as well as the psychological threats to their mental well-being brought on by anxiety and stress. Again conditions in the trenches brought their own health hazards. The industrial nature of the war with its new weapons and technology resulted in vast casualties. In total, medical services treated two million men in France or at home in England.
The journey from battlefield to care for a wounded soldier on the Western Front varied greatly depending on the injuries sustained. The majority of the wounded would pass through a regimental aid post, and/or an advanced dressing station. Some made their own way there, and others would be collected by the stretcher bearers from the Field Ambulance. Minor injuries would be assessed here and some minor treatments, such as the cleaning and bandaging of wounds might be carried out here. More serious injuries or significant illness would be transferred in to the Main Dressing Station which was set up to deal with a variety of medical issues. Then a man might be transferred to a Casualty Clearing station, where a triage assessment would be undertaken. The least serious cases, that needed a brief period of recovery, would be returned to duty after some rest and recuperation. Any man whose injuries were serious, but who was still fit to travel would be transferred back to base hospitals, usually known as the General Hospitals, subsequently via some form of ambulance (be that a lorry, a barge or a train) to a hospital further back beyond the lines. The most seriously ill or injured and those in need of urgent treatment would be retained at the C.C.S. until such time as their treatment was completed and their condition was stable enough to allow them to be transferred back to a General Hospital.
Casualty Clearing Stations were central to the whole process of evacuating the wounded away from the Western Front and it was in this setting that a number of significant medical innovations, such as the development of transfusions, began to be shaped. During 1915, the Director General of Medical Services approved the movement of surgical services in the C.C.S. and over the course of that year it became routine for the most serious wounds to be sent straight to the CCS, bypassing the other sections of evacuation from the front lines. During 1916, there was a move to bring the C.C.S. even closer to the frontline, in order to try and reduce deaths amongst the most severely injured men, who might bleed to death whilst waiting for transfer. During the latter years of the war, it was common for C.C.S. to be located near railway lines, but during the spring of 1918, the C.C.S. were judged to be at risk of direct enemy action and were moved back. C.C.S. included surgical theatres, preparation spaces, resuscitation wards, and in some units, x-ray equipment. The C.C.S. were managed by the Royal Army Medical Corps (RAMC) and staffed by the Queen Alexandra’s Imperial Military Nursing Service (QAIMNS), sometimes supported by nurses from the Territorial Forces Nursing Service (TFNS) and members of the Voluntary Aids Detachment (VAD). You can find some examples of these nursing service records in our second collection of documents (Part 2).
Over the course of the war, new treatments and methods for rehabilitation were refined and developed. The Roehampton centre at Queen Mary’s Hospital for example, forced in part by the scale and frequency of those who lost limbs, became a specialist limb fitting unit. Artificial limbs were made and fitted and patients would learn how to use them using hospital the gymnasium and workshops. Pioneering work was made too in the treatment of facial injuries. These were not easily treated on the front line. Surgeons would often have to stitch a wound quickly but did not take into account the amount of flesh that had been lost. Harold Gillies, a New Zealand surgeon after serving in France, saw the absolute need for specialist hospitals to deal with facial wounds and set up The Queen’s Hospital in Sidcup in 1917, the first dedicated treatment hospital of its kind.
St John in the First World War – with a particularly good film telling the story of a fictional VAD nurse: http://museumstjohn.org.uk/research/projects/st-john-first-world-war/
Students could consider British Pathe film sources as interpretations of the First World War in relation to these documents on trenches, injuries and medical treatment: https://www.britishpathe.com/
Oral testimony online
Students can explore some of the oral testimonies and eyewitness accounts available from the Imperial War Museum Sound Collections alongside the written and photographic sources available in this collection: https://www.iwm.org.uk/collections/search?
First World War Digital Poetry Archive: http://www.oucs.ox.ac.uk/ww1lit/
Other useful links
The National Army Museum’s Birth of Plastic Surgery resource: https://www.nam.ac.uk/explore/birth-plastic-surgery/Back to top