WW1 was a new kind of war. It saw the introduction of industrialised weapons on a mass scale, such as heavy artillery, machine guns, poison gas and tanks. As a result, the likelihood of being injured, if not killed was high.
Due to the sheer scale of casualties, medical techniques had to be rapidly developed to cope with the demand for life-saving care. This led to advancements in local and general anesthesia, alongside blood transfusions, improvements in prosthetics, and the dawn of plastic surgery.
Amputations and artificial limbs
As a result of the extensive use of landmines, grenades, and artillery on the Western Front, the risk of losing a limb was incredibly high. Approximately 40,000 British men suffered amputations during WW1, 10,000 of whom lost at least one arm and were entitled to a replacement prosthetic upon returning home.
To care for the thousands of amputees returning from the front, specialist hospitals were established at Roehampton near London and Erskine in Scotland, with additional wards set up in schools and public buildings nationwide. However, in 1914, the British artificial limb industry consisted of only a few small, family-run businesses making heavy, cumbersome prosthetics.
Therefore, to meet the sudden, overwhelming demand of veterans needing prosthetic limbs, new workshops had to be rapidly built and an entire prosthetics workforce trained from scratch.
As WW1 veterans gathered at treatment centers for prosthetic fittings and rehabilitation, a deep sense of community grew from their shared trauma and frustrations.
Out of this mutual support came a desire for collective action. After The Great War, throughout the 1920s, veterans met to discuss their shared hardships and advocate for better support and treatment.
In Glasgow, one group of limbless veterans formed the very first branch of the Limbless Ex-Service Men’s Association. Regional branches eventually united to secure national charitable status, officially founding the British Limbless Ex-Service Men's Association, better known today as BLESMA.
One of the fundamental shifts for amputees after WW1 came with the move from wooden to metal limbs in the 1920s. Having been issued with wooden limbs during the sudden wartime demand for prosthetic limbs, amputees were eager to obtain a lighter, metal design.
Artificial limbs were inevitably subject to wear and tear. Some veterans were highly reluctant to part with their prosthetic limb that had become a major part of their lives. They understandably feared losing a comfortable fit or taking time off work for a new fitting. At the time, workplace absences could cost them their jobs in a ruthless labour market. This vulnerability is precisely why it was so important for limbless ex-servicemen to advocate for their rights.
Loss of eye sight
Thousands of soldiers returned to Britain having lost one or both eyes. Glass eyes were in high demand and quickly became in short supply, as traditionally Germany was a leading manufacturer of glass eyes.
It’s estimated that between December, 1916 and August, 1919, the Army Spectacle Depot supplied over 22,000 artificial eyes to British soldiers.
As the war raged on, the British military tried to prevent horrific injuries, which led to innovations such as the ‘splatter mask’. As an example, British tank crews were supplied with ‘splatter masks’ which were designed to protect them from serious facial wounds caused by explosions and boiling hot shrapnel.
Psychological impact
It wasn’t until WW1 that the devastating psychological toll of warfare was finally formally acknowledged by doctors and the general public. The psychological condition was recognised as ‘shell shock’.
Shell shock manifested itself in different ways – from uncontrollable shaking and trembling to becoming unresponsive, dazed and confused.
The medical term ‘shell shock’ derived from the idea that intensive shelling was the main cause of psychological trauma.
To try and relieve the mental anguish, war veterans with shell shock would sometimes turn to ‘over the counter’ medicines that claimed to heal shattered nerves despite little positive clinical evidence. These included nerve tonics, sedatives and supplements.
Some WW1 veterans who suffered from shell shock recovered or found their symptoms lessened, but many never fully overcame the psychological impact of warfare.
Gas inhalation
During WW1, both sides used poison gas in the trenches to create terror and confusion, which caused soldiers to change positions and flush them out of their trenches.
The first major chemical weapons attack occurred in April 1915 during the Second Battle of Ypres. When German forces released chlorine gas, it caused severe casualties among British and Canadian soldiers and sparked widespread panic among French colonial troops.
Different types of gas were used during WW1 included chlorine, mustard gas, bromine and phosgene.
Chlorine gas was one of the most well known poison gases used on the Western Front, It had a distinctive green colour, and when inhaled would form hydrochloric acid1. This would cause swelling and blocking of the lung tissue, resulting in soldiers choking and potentially suffocating. However, it was actually phosgene gas which was more deadly, as it was colourless and slow to act.
Gas attacks caused approximately 6,000 British and Empire deaths during The Great War2.
While fatalities from poison gas were relatively low, injuries were far more common. Around 185,000 British and Empire service personnel were injured by gas which included respiratory problems, collapsed lungs, severe eye irritations, temporary blindness and painful blisters.
Over time, anti-gas measures were developed by forces to make gas attacks less effective, including the introduction of gas masks on the battlefront.
The dawn of plastic surgery
The likelihood of suffering severe burns and facial injuries increased during WW1. Shells filled with shrapnel were often to blame for facial and eye injuries. During the early twentieth century, facial injuries weren’t easily treated. In some cases, surgeons would have to stitch together a large wound, without taking into consideration the amount of flesh that had been lost.
As the wounds healed, the tightening skin pulled and contorted their facial features into severe, permanent disfigurements.
Otolaryngologist and surgeon Harold Gillies3 founded The Queen’s Hospital at Frognal House in Sidcup; the world’s first specialised facility dedicated to treating facial injuries.
Gillies and other surgeons at Queen’s Hospital reconstructed patient’s faces with skin grafts. It worked for small injuries, however, keeping large grafts alive was a major hurdle until he treated Willie Vicarage, who was left severely burnt during the Battle of Jutland.
While migrating skin from Vicarage's chest to his face, Gillies noticed the tissue edges curling. He decided to stitch the flap into a tube, discovering that this "tubed pedicle" improved blood flow and prevented infection. Once anchored to the face, the tube could be cut from the chest and rolled out over a wide area. This was a pioneering breakthrough that laid the foundations of modern plastic surgery.
Today, 110 years after the Battle of the Somme, Blesma’s work continues. We remain the only national Armed Forces charity dedicated to supporting limbless veterans for the duration of their lives.
Header image: Royal Army Medical Corps stretcher bearers bringing in the wounded. IWM (Q 4175)
1Source: First Usage of Poison Gas - The National World War 1 Museum and Memorial
2Source: How deadly was the poison gas of WW1? - BBC Magazine
3Source: The Birth Of Plastic Surgery - National Army Museum
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