We knew nothing about it at all We knew nothing about it at all. Nothing like it had ever been experienced in South Africa [The Boer War 1899-1902] on the clean, sandy battleground of the veldt, which had been the army’s last experience. Here, on the heavily manured soil of France, it was a different matter. You got this appalling infection with aerobic bacteria and the men just died like flies. We got the casualties straight from Mons and the infection had usually set in by the time they got to us. If they had compound fractures, full of mud, it was an ideal site for the bacteria to flourish, and if the men had been several days on the way, the wound was simply a mass of putrid muscle rotting with gas gangrene. Nothing to do with gas as we knew it later in the war. Even with quite slight wound, when soil and shreds of uniform are carried in by the missile, it starts up. Captain Geoffrey Keynes, RAMC. Quoted in Lyn McDonald’s The Roses of No Man’s Land, p.11

Trench foot was a very real problem especially over the winter of 1914-15. Standing in cold mud and water in tight army boots caused the foot to swell. The skin also began to shrivel and in the worst cases, to rot and to die! The British Army went to war wearing soft caps and there were a lot of head injuries. As a result, steel helmets were introduced in late 1915. Interestingly, this led to an increase in the number of head injuries (16% of all wounds) because more men survived their head wounds because they were now wearing a helmet! Wounds to the arms and legs were the most common injuries, making up 67% of all wounds. These were caused by exploding shells, although these were often recorded as ‘G.S.W.’ – gun shot wounds on a soldiers papers. The wounds were a result of shrapnel or shell fragments and in the worst cases would lead to amputation. Less than 12% of all wounds were to the chest, stomach or back. This is because most soldiers who were wounded in this area died before reaching medical care. For those who did make it, special Casualty Clearing Stations were set up close to the front to deal with these dangerous wounds. Lice affected all soldiers in the trenches. The lived in the seams of the men’s clothes and were almost impossible to remove. As well as being irritating, they could also cause trench fever, which had flu-like symptoms.

The first German gas attack on 22nd April 1915 took the British completely by surprise, and throughout the year the troops were subject to this new form of warfare. Hospital returns for British troops show 12,792 admissions for gas poisoning during 1915, of whom 307 were fatal. The prevention and treatment of this new type of casualty were problems which demanded, and received, immediate attention, not only in 1915 but throughout subsequent development of gas warfare. History of the Great War: Medical Services p.134, published in 1931

Gassed by the war artist, John Singer Sargent, 1918

Gas was the weapons which soldiers feared most Gas was the weapons which soldiers feared most. Contact with the skin caused large, intensely painful blisters filled with a yellow fluid. If more than half the victim’s body was affected, a slow, agonising death after four or five days of suffering was almost inevitable. [However] most gas poisoning was less severe, but nevertheless required several weeks of treatment and convalescence… [I]f mustard gas was inhaled, it would cause bleeding and blistering of the lungs, which if they survived would cause problems later in life. From Lifeline – A British Casualty Clearing Station on the Western Front 1918 by Iain Gordon, p.57

It was at this time, the third week of November 1914, that the serious evil known as ‘Trench Foot’ first made it appearance in the Army in France… The condition is caused by prolonged immersion in water. The condition observed varies very much according to the severity of the case: The feet may be merely very painful and tender. Much more often they are very swollen and cold, with little feeling in them. Frequently the whole foot is like a big ‘chilblain’ and is very hot, red and swollen. Blisters are common in all such feet. The toes may be black and the foot blue. The toes especially, and the foot much more rarely, may die and become gangrenous. Sir John French, Commander of the BEF 1914-15 in his book 1914

The importance of strict attention to sanitation should be impressed on all ranks. Latrines will be constructed in trenches leading to communication trenches. Where the bucket system is emptied, chloride of line or creosol will be freely used. The soil will be removed at night and buried in a deep pit at least 100 yards from the trenches. The commanding officer is responsible for sanitation in his unit, and the medical officer will advise him in sanitary matters, making frequent inspections of latrines, refuse pits and water arrangements. Taken from 4th Division Trench Orders p.4-5