Emotional memories of war, PTSD, war wounds, facial wounds, plastic surgery, front line procedures and what we "learned" in WWI

Americans today associate PTSD with our Iraq and Afghanistan veterans. Truly, post-war trauma must have always been with us. We are, after all, human and violence of any kind offends us, especially when life and limb are violated. But in the Great War, more men survived the realities of bullets, shrapnel, gas and chemical attacks as well as disease than in any other war. The reason is, of course, that we had organized medical teams behind the lines at the ready.
True that those teams had little in the way of medicines or technology to aid them in rapid response to aiding wounded. But the process of getting aid to a wounded soldier had begun.
What do we know of that process?
1. Speed
We learned that the sooner a medical team sees a man, they can not only bandage him and/or administer first aid, but ease his pain.

The need for speed meant armies developed the concept of stretcher bearers who carried wounded from the line backward to a first aid station. This may have been a TRIAGE station where wounded were assessed for survivability. Triage posts were often served by ambulances, either horse drawn or mechanized. These vehicles ran over rough terrain at slow speeds and men inside often had no morphine or other to ease their pain.

Analysis of wounded men immediately behind

fighting line was often called TRIAGE, or separation

of wounded in to 3 groups. This was: 1. those who

would not live no matter the medical attention; 2. those who needed

immediate attention; 3. those who could wait a reasonable time for attention.

2. Efficiencies
We learned that a proper supply of emergency materials was necessary the closer to the front a medical team operated. This included not only scissors, bandages, splints, gauze, but also fresh sterile water, iodine and other similar sterilizing ointments.

This picture in a church in a Field Hospital shows either
primary or secondary line treatment. This is June 1918 and could
be primary treatment, if behind a rapidly advancing or retreating
front line.

3. Understanding of infection
The Great War occurred during a period when medical researchers were first beginning to understand the process of bacterial infection and how to limit its virulence.  No antibiotics were yet available. So cleansing a wound was a laborious process. Furthermore, the forensics of bullet trajectories and the erratic intrusions of shrapnel made removal of such foreign objects more of a guessing process than a logical one.
X-rays were available but limited in their scope. Furthermore, not every medical team had use of one.


4. Psychological effects of exposure to elements
Not only was a soldier exposed to bombs, bullets, shrapnel, gas and chemicals, he was exposed to the actions and reactions of his comrades to these elements. Add to that the primitive conditions of living and working in knee deep mud, poor hygiene, poor diet and constant pressure to perform menial tasks, and the average soldier suffered physical and social challenges which few current-day non-combatants can identify with.

5. Secondary surgery and recuperative treatments

Often a wounded man required one or more secondary surgeries. Operations performed by medical teams close to the fighting lines were under their own pressures to work quickly. This could mean the wounded had received life-saving treatment but required advanced surgeries to enhance the primary surgery.
To ensure continued care in a more secure area, the US Army (like other armies in this conflict) established hospitals well behind the lines. Americans established a base hospital system, staffed by entire teams from hospitals in the continental US and complemented by others from other area who joined those teams. These base hospitals were approximately 50 to 100 miles behind any front. So indeed a wounded man was transported even farther back of the line to a stationary base from which he could recuperate for an extended period. He was either certified completely recovered and returned to the front lines to fight again or sent on down the line to return home. In the US, he could be treated at another hospital or returned to his civilian home.
No such entity as our current Veterans Administration existed at that time. A man was left to recuperate on his own. The VA was a post World War II entity created by the Congress.

Facsimilie of facial wound prosthetic
Musee de la Grande Guerre, Meaux, FR
Jo-Ann Power photo

6. Rehabilitative services which were new

Torso back brace and amputee of leg prosthetic.
Musee de la Grande Guerre, Meaux, Fr
Jo-Ann Power photo

Physical therapy as a professional service was a new technique offered to amputees and those who had suffered physical incapacities. Much of this kind of therapy included training for new professions, such as weaving and metallurgy.  For those men who were amputees, many were offered prosthetic devices for arms and legs.
For those men who suffered facial deformities, plastic surgery was in its primary stages of development. And while many of these men opted to go into "retirement homes" because they did not wish to re-enter society, many of them volunteered to receive prosthetic masks. Many volunteered to be patients in novel procedures which today form the bedrock of our knowledge about efficacies in plastic surgery.

Arm-shoulder prosthesis
Musee de la Grande Guerre, Meaux, FR
Jo-Ann Power Photo

For more on plastic surgery, visit: http://www.bbc.co.uk/guides/zxw42hv
For more on emotional trauma, shell shock and PTSD, visit: http://armsandthemedicalman.wordpress.com

Frontispiece of Pickerill's text on facial surgery, produced on the basis of his M.S. thesis to the University of Birmingham

Pooches, canaries, pigeons and horses: Animals who served in World War One

Canaries who sang to wounded on hospital trains!

French Blue Cross Hospital for sick and wounded horses.

     We talk so often of the millions who died during la Grande Guerre. Twenty-two million soldiers and pilots. Six million civilians whose homes and farms were shattered, traipsed over, bombed, exploded in mines. Entire towns were obliterated, all  their residents fleeing the carnage. Many of those towns never were reinhabited. In fact, in eastern France, on many hillsides only a placard marks the site of where a prosperous village one stood.

     But animals served the war too. Millions of them. Canaries not only sang to wounded, but also pidgins carried messages. Dogs ran No Man's Land with messages, aiding chaplains whose grim duty was to find the wounded and the dead amid the hideous debris in the killing fields. Horses too served by the hundreds of thousands. These noble animals not only rode in early cavalry charges, but also pulled huge guns and hauled thousands of pounds of shells, bullets, rifles and even food to those in the front lines. One endearing photo here shows the hundreds of ill and wounded horses in the Blue Cross Hospital of the French.
     In the American Army was one extraordinary Sergeant. A terrier named Stubby served first in the Chemin des Dames area in 1917. Yes, he was an American pooch who even captured a German soldier in the Argonne all by his little ferocious self!
     With acute hearing, he warned his comrades about in-coming shells and often ran with men into No Man's Land. For all these feats and more, Stubby earned the Medal of Honor from the American Humane Society. Shown above in his uniform, he wears his medals proudly. After all, a guy must dress correctly when he is to stand in review…or meet the president, as he often did!

TOMORROW, 99th Anniversary of Armistice! Honor the women and men who fought in The Great War and read HEROIC MEASURES

     When the British, French, Americans and Germans and Austrian-Hungarians signed the Armistice agreement November 11, 1918 in Compiegne, France, the world celebrated a cease fire, the end of the slaughter that typied the war.
     Here is the famous picture of those who signed the agreement in the railroad car along the front in northern France.

Photographer unknown. In public domain in EU, UK and USA.

     Millions in tiny villages and large cities across the world came out to mark the end of this tragic conflict. Some danced. Most cried. Millions mourned their loss of  friends and family. For thousands who served, many decried the impairment of their health. Bitter and devastated, the millions who survived had before them an extremely difficult time recovering. Whole towns had disappeared. Home and farms were destroyed. Landscapes were forever altered by huge bombs, tunnels and gas warfare.
    People had to deal with the loss of millions of their loved ones. In Britain, so many young men had been killed that the Government soon developed a program for unmarried women to move abroad so that they might find husbands in the Commonwealth countries. Wounded, largely due to the improvement in medical care, survived by the hundreds of thousands. As amputees, many learned to use prostheses. Others who were facially wounded underwent new skin grafting techniques that were to be the solid basis for the development of plastic surgery.
     Today, the park and forest around Compiegne's treaty site are peaceful sites. Like that day when the Entente military leaders and their German counterparts met in a railroad car, the foliage is thick. And as then, it is so deep you cannot see the sky. On that day, the Entente leaders wanted aerial coverage as protection but the canopy was so dense this was impossible.

Museum at site of Armistice signing.
Inside is Railroad Car, next in sequence of actual car since destroyed in fire.

Aside from this car, the museum houses wonderful panoramic pictures of all aspects of military life.
I estimate ninety percent of these are not duplicated anywhere else.

Outside in the clearing, this statue
to French General Foch
who received the German agreement to the cease fire for 11.11.18.

Memorial to the Heroic Soldiers of France
Defenders of the their country
and the glorious liberators of Alsace and Lorraine.
This stands directly opposite the building in above picture
which houses the replica of the train car where Germans agreed to cease fire.

AEF Operating Rooms, trauma care in WWI France, Nurses take active roles

Accession number	1991.86
Description	Black and white photograph. Hospital scene. Man with leg in traction and having a cast applied. Medical personnel surrounding him, including one nurse. From the service of Lieutenant Colonel Clarence Benjamin Francisco, American Medical Officer, assigned to 1st, 32nd, and 35th Division in France after working at Old Mill Hospital, Aberdeen, Scotland.

Accession number

1991.86

Description

Black and white photograph. Hospital scene. Man with leg in traction and having a cast applied. Medical personnel surrounding him, including one nurse.

From the service of Lieutenant Colonel Clarence Benjamin Francisco, American Medical Officer, assigned to 1st, 32nd, and 35th Division in France after working at Old Mill Hospital, Aberdeen, Scotland.

Archives of National World War I Museum

Accession number	1991.86
Description	Black and white photograph. Operating scene in an operating room. Female nurse and another male assisting doctor while averting eyes away from patient. From the service of Lieutenant Colonel Clarence Benjamin Francisco, American Medical Officer, assigned to 1st, 32nd, and 35th Division in France after working at Old Mill Hospital, Aberdeen, Scotland.

Accession number

1991.86

Description

Black and white photograph. Operating scene in an operating room. Female nurse and another male assisting doctor while averting eyes away from patient.

From the service of Lieutenant Colonel Clarence Benjamin Francisco, American Medical Officer, assigned to 1st, 32nd, and 35th Division in France after working at Old Mill Hospital, Aberdeen, Scotland.

American Nurses in WWI trained in Army camps and marched in parades!

   Women recruited for Army Nurse Corps and for American Red Cross all had field training by the American Expeditionary Forces. Army Nurse Corps recruits were all registered nurses, or the equivalent, having had two to three years professional nurses training. American Red Cross recruits, on average, had only a few months training (and as a result took on lesser responsibility in the wards). But all of them went through medical training specific to the care and treatment of those with wounds, or suffering from trench foot, trench fever, dysentery and Spanish flu.

   Army Nurse Corps recruits went to Army posts for training and many of them had French and British instructors. All were considered contract labor, without rank and yet were expected to act like regular Army recruits, "falling into line."

  They were housed in separate barracks, ate in mess halls separate from officers. When ready to ship out, they were housed in hotels near their embarkation points. A few of these were in Hoboken, New Jersey and others in Manhattan. Sometimes depending on the Navy's warnings of U-boat activities, nurses waited for more than 2 months in these hotels ready to leave at a moment's notice. And what could they take with them? One steamer truck (no larger than 36" wide), one small suitcase and a blanket roll!

   Many were also expected to march in parades. Here is a unit from Houston, Texas, marching together before they ship out!

Accession number	1999.20
Description	Black and white photograph of a Red Cross parade in Houston, TX. From the service of Rose Baker (?), American Red Cross Nurse - Army Nurses Corps.

Accession number

1999.20

Description

Black and white photograph of a Red Cross parade in Houston, TX.

From the service of Rose Baker (?), American Red Cross Nurse - Army Nurses Corps.

 
And here, in dress uniforms, a group of Army Nurse Corps recruits march in France!

A group outside their barracks.

18+ Days in AEF's footsteps: DAY 7, Chateau Thierry and the Second Battle of the Marne

USA Monument to those who fought and fell at Chateau-Thierry
sits atop a hill overlooking the prosperous city.

(River Marne to the left of pix and this road which runs along the river.) 

Sculpture on the Chateau-Thierry Monument
France and USA, holding hands,
Partners in War and Peace

    Chateau Thierry is a lovely town along the Marne River approximately 50 miles east of Paris. In the spring of 1918, the Germans decided to attack their lines in France with great force and hopefully win the war before the Americans could arrive in massive numbers.
   A year had passed since America had declared war and finally, the country had enough recruits, transportation routes and sufficient supplies to convey a million men to Europe, feed, clothe and care for them.
   No small part of this was the need to provide medical care. While a few Base Hospitals (as the primary structure of medical personnel was called by the Army Medical Corps) had arrived in France in spring 1917, they assisted the French and British caring for those nationals.
   Now with the arrival of American men, other based hospital units arrived in huge numbers. Consisting of doctors, dentists, orderlies and pharmacists and nurses, these units could vary in numbers. (In fact, as the Spring Offensives of 1918 proceeded, the US Army called for more recruiting of doctors and nurses. The Army originally thought 50 nurses per Base would be sufficient but soon sought 100 per Base.) While Army Nurse Corps recruits assisted in the Operating Rooms and ran the wards, American Red Cross nurses who had much less training worked as their staff. Usually 50 to 100 nurses worked the Base Hospital wards and surgical units along with 50 or more doctors and dentists. Orderlies and pharmacists (or trained orderlies who did this work) were fewer in number and varied according to location, total force numbers in the area and notice of imminent attack of the enemy.
   Within one mile of the town was a major Base Hospital at Aulnois. Here, the nurses often sponsored dances for their patients. Men who played instruments practiced in the wards and became pick-up bands. These entertainments were welcomed by the staff and the soldiers breaking the tedium of their days and the journey back to health.

One of Operating Rooms, Mars Hospital Center, France*
Note cinder block structure in this OR
as opposed to wooden structures or tents used for Mobile Hospital Units.
Note, too, nurses in grey crepe uniforms with white butcher aprons used in ward duty.
*Mars was composite center far back of front lines and not in Chateau-Thierry sector but farther east near Toul.

Lab at Mars Hospital Center, France
Orderly Mixing Compounds

Memorial atop a hill overlooking the town.
Inscription: "This monument has been erected by the United States of America to commemorate the services of her troops and those of France who fought in this region during the World War. It stands as a lasting symbol of the friendship and cooperation between the French and American Armies."

   Traveling the area around Chateau-Thierry, I easily saw the importance of this town along the Marne. Hold it and any military force could easily attack or defend the river's access to the capital city of Paris.
Do see the picture at the top of this post once more. There on that hilltop, I capture its position which was a disputed territory taken eventually by the American First, Second and Third Divisions. See also views east and west along the Marne, now serene.

Along the River Marne, looking in the same direction
as American Monument

View of the Marne, flowing east, in this lovely city.

American troops crossing the Marne in Chateau-Thierry.

American troops in public square after capture
of Chateau-Thierry,  July 1918.
This square facing Hotel de Ville to the right of picture and Marne to the left is now a parking lot!

Ruins of Chateau-Thierry, in upper right you see Hotel de Ville, City Hall.

American troops clearing a road in Chateau-Thierry.

Aisne-Marne Salient Map on the American Monument high above Chateau-Theirry.