From handmaiden to right hand—World War I—the mud and the blood

AORN Journal,  Oct, 2004  by Victoria L. Holder

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Editor's note: This is the fifth in an ongoing series about the history of perioperative nursing. The first two articles in this series appeared in the September and October 2003 issues of the AORN Journal. The third article in the series appeared in the February 2004 issue of the Journal, and the fourth article appeared in the September 2004 issue of the Journal.

By 1914, the year World War I began, electricity, telephones, motorized vehicles, and airplanes were common. In the field of medicine, physicians were familiar with Louis Pasteur's germ theory (1) and knew of Joseph Lister's discoveries in the fields of bacteriology and antisepsis. (2) They knew how disease was contracted and spread and how to disinfect surgical instruments and wounds with carbolic acid. They also understood the importance of hand washing. Robert Koch, MD, a German physician and chemist, had published a study on certain bacteria, such as anthrax, tuberculosis, and cholera, and the diseases they cause. (3) Karl Landsteiner, an Austrian-born biochemist and pathologist working in the United States, had discovered blood types and the necessity of typing blood for transfusions. (4) As a result of his work, many soldiers wounded during the war, who previously would have been left for dead, were treated and shipped to hospitals for blood transfusions. (5)

Weaponry had advanced in range and accuracy. The weapons of World War I were mass killing machines and antipersonnel weaponry that often did not kill but maimed and crippled. (5) Flamethrowers and poisonous gases had been used in earlier wars, but manufacturers now improved on the methods of delivery. New equipment, such as face masks, were created to help protect against the various gases, but individuals who did not die from the gases often were left with disabling scars.

TRENCH WARFARE

Trench warfare had been used during the Crimean War of 1855 and the latter half of time US Civil War on a limited basis. (6) World War I was fought using trench warfare almost from the beginning because of the increasing sophistication of antipersonnel weaponry. At first, employing this strategy seemed to be the only way to avoid casualties in the open ranges where armies came together, but deprivation and hardship resulted from living and fighting in the trenches. Trench warfare also led to stalemates that triggered even more casualties from vermin and disease. These were insidious enemies against which there was little defense.

Living and fighting in the trenches meant battling rats and lice. The rats were large and showed no fear as they competed for the soldiers' food rations. Lice also were rampant, and clothing was infested with the tiny creatures. The ubiquitous bite marks caused constant itching and scratching. Attempts to destroy the lice usually were unsuccessful. The simplest method was to try to pick them off. More experienced soldiers in the trenches were proficient at using a lighted candle to burn them, without burning their own clothing in the process. (7) "Where possible, the army arranged for the men to have baths in huge vats of hot water while their clothes were being put through delousing machines." (7) This helped temporarily, but it was nearly impossible to remove all the lice eggs, and within hours of putting his clothes back on, an individual's body heat would cause them to hatch.

Along with the constant infestation of lice came the high risk of pyrexia, or trench fever. (7) The symptoms of this disease included "shooting pains in the chin and was followed by a very high fever." (7 p1) Although not lethal, trench fever could incapacitate a soldier, "and accounted for about 15% of all cases of sickness in the British Army." (7 p1)

Trench foot caused by standing and fighting in trenches saturated with water and mud also created a problem in the early years of the war. It did not take long for the cold, wet mud to penetrate boots and socks, causing feet to swell, go numb, turn red and, eventually, blue. If treated quickly, the swelling usually would subside, but not without excruciating pain. If left untreated, toes and sometimes the whole foot could turn gangrenous, requiring amputation. (8 p1)

The only preventive measure for trench foot was to keep feet dry, usually by applying whale oil to help form a protective barrier against moisture and by changing socks frequently. The first winter of the war," ... over 20,000 men in the British Army were treated for trench foot." (8 p1) By the end of the second year, British soldiers were issued three pairs of socks and were given strict orders to change at least twice a day. (8 p1) Despite attempts to prevent trench foot, there were 80,000 cases documented between 1916 and 1918. (9)

Dysentery was another common problem in the trenches. Latrines were pits dug 4 ft to 5 ft deep within the trenches. When they neared capacity, they were supposed to be covered and buried. During heavy fighting, however, men scrambled for cover wherever they could, and that could mean in a latrine. Bacteria from human feces often contaminated the food and water, causing inflammation of the bowel, stomach pains, diarrhea, vomiting, and fever. If left untreated, dehydration occurred, often causing death. In the early stages of the war, supplies of drinking water were insufficient, and the men would resort to drinking contaminated water from shell holes or other reservoirs. It also was not uncommon to look down the line and see a pair of boots or an arm sticking out of the muddy water. (10) In time, chloride of lime was added to the reservoirs to purify the water, but this also caused problems because the taste was not pleasant, and the men were reluctant to use it. (10)