Medical Aspects of Chemical Warfare (2008) - The Black Vault

History of the Medical Management of Chemical Casualtiesbodies and human excreta. The ground behind is fullof excreta and dead bodies. 10(pp235–238)The French army’s structure was responsible forthe unsanitary state seen by the arriving Canadians.The French medical service was part of the only WorldWar I combatant army whose medical officers (MOs)were not organized in a separate corps. The absenceof an independent medical service meant that medicalissues were under the auspices of the French combatarms leadership and maneuver commanders. Fieldsanitation and troop hygiene were lower prioritythan tactical matters. Almost all water supplies wereinfected by Salmonella typhi. The French army experienced50,000 cases of typhoid in the first 3 years ofthe war. 17,18 Because the French medical service wasplagued with problems, the Americans arriving onthe western front looked to the British Royal ArmyMedical Corps as a template for medical organization.During the early part of World War I, the US Armysurgeon general assigned a number of MOs to act asobservers within the French and British armies. Reportson the medical aspects of the European conflict,including the diagnosis and treatment of chemicalcasualties, were received by the surgeon general from1916 onward.Royal Army Medical CorpsThe Royal Army Medical Corps had three mainresponsibilities during the war: (1) sanitation (physicaland environmental hygiene), (2) patient transport(evacuation of the sick and wounded), and (3) hospitalization(the medical management of the sick orwounded). Chemical warfare impacted all three (Figure3-6). Chemical casualties had to be managed in abattlefield creviced with trenches of varying depths.Some had flimsy dugouts that protected troops fromthe elements but not from artillery shelling. In mostplaces the trenches did not run in a continuous line,but were instead made up of groups of shallow fireand support trenches. 10Collecting, Evacuating, and Distribution ZonesThe Royal Army Medical Corps provided supportfor itself and for its attached forces. Its managementscheme divided the battlefield into the collecting zone,the evacuating zone, and the distribution zone. Thecollecting zone was the first or forward area to whichthe wounded were evacuated from the battlefield(Figure 3-7). The middle area, known as the evacuatingzone, encompassed the roads, railway lines, andcanals along which casualties were transported tothe distribution zone. The evacuating zone occasionallycontained a medical supply unit or “stationary”hospital for receiving casualties who could not beadvanced to the distribution zone (see Figure 3-7).The distribution zone contained the various facilitiesneeded for definitive medical treatment, staffed bylogistical and service support units dispersed in a reararea of operations of indeterminate size, includingmainland Great Britain. Stationary hospitals out oftheater in Great Britain were called “home hospitals,”and those outside of Great Britain were called “overseas”or “base hospitals.” 19Gun Miscellaneous*War GasShrapnel †Rifle BallsShellsBombsGrenadesBayonetsPistol BallsSabersUnknownChemical WeaponsConventional Weapons* Penetrating missiles, sources unknown†Majority of casualties were wounded by fragmentsof explosive munitions; only a fraction were injured bytrue shrapnel0 5 10 15 20 25 3035Fig. 3-6. Hospitalized casualties in World War I, in percentages by causative weapon (224,089 casualties).Adapted from: Gilchrist HL. A Comparative Study of World War Casualties from Gas and Other Weapons. Chart 7. EdgewoodArsenal, Md: Chemical Warfare School; 1928:19.85