When British Forces went over the top of the trenches on July 1, 1916, no one could have predicted the outcome. As the Sun set on that first day of the Battle of the Somme, some 57,000 British men lay dead, wounded or dying on the battlefield in northern France. To mark the centenary of the beginning of the Battle of the Somme, the Science Museum in London, has opened a new exhibition that brings together objects that highlight not only how deadly the First World War was, but also the innovation and advancement in technology, science, and medicine.

“The scale and severity of wounding in the First World War was totally unprecedented,” explains Vikki Hawkins, curator of the exhibition Wounded: Conflict, Casualties and Care, to IFLScience. “The medical collections give a slightly untold story, so rather than the people who lost their lives, it looks at those who were wounded and had to continue to live with their wounds and what happened to them in the years after they returned home.”

^{Blood transfusion kit from the First World War. Science Museum/SSPL}

As troops were faced with weapons they had never experienced before, doctors and medics where conversely having to treat wounds of an unprecedented nature and scale. Due to the mechanization of warfare, they were often in uncharted territory. Even if the men survived the trauma of slashed muscle and splintered bone, they then had to contend with blood loss and infection. Some of the most basic techniques, such as applying pressure and a tourniquet to stem the bleeding, were often the first line of treatment, but some doctors were trying to develop more advanced, long-term treatments.

While blood transfusions had been around beforehand, it was really during the First World War that the technique was refined and pioneered. “Blood transfusion was not at the level that it would be able to provide a real difference until about 1917,” says Hawkins. “We’ve got an example of one of the first 1917 blood transfusion sets, and for the first time by mixing the blood with sodium citrate, the medics were able to prevent the blood from clotting.” This proved to be an invaluable advancement, as it meant that blood could be banked and stored in preparation for the casualties from major battles, and as a result save countless lives.

The importance of blood transfusions during warfare is something that has remained unaltered in the 100 years since the Battle of the Somme. “It is fascinating how important blood transfusion is,” explains Hawkins. “How in the First World War they were trying so hard to get blood transfusions closer and closer to the front line to give it to people as soon as possible.” Now, doctors have “intraosseous drills” - which inject blood and fluid directly into the bone - and coupled with a huge amount of blood stored on the helicopters, this allows medics to provide transfusions literally as soon as they are off the battlefield. “The principles are exactly the same, it’s just the technology that has changed.”

But doctors were not only having to treat injuries of unparalleled scale, they were also forced to deal with those never before seen in battle. In April 1915, chlorine gas was first used on the Western Front. Taken by complete surprise, the medical staff were unsure what to do as patients arrived vomiting, coughing, and initially dying in high numbers. Within days of the attack, which terrified the soldiers who had never experienced anything like it, the British Army sent scientist John Scott Haldane to the front line to help identify the gas and how best to treat its effects.

^{Haldane's oxygen apparatus adapted for four people to use. Science Museum/SSPL}

“He actually discovered what the gas was from looking at somebody’s button that had just been on an officer’s uniform. It had just been polished the day before and was now completely tarnished,” explains Hawkins. “As a scientist he was aware that that could be because chlorine was present.” Haldane returned to London where he started experimenting with a team, often using themselves as test subjects, gassing the corridors, and digging trenches in the university’s grounds to allow them to see how the gas dispersed.

After conducting these experiments, Haldane realized that the most effective way to treat men who had been gassed was to increase their blood oxygen concentration. This all resulted in him producing “Haldane’s oxygen apparatus”, a life-saving piece of equipment that was eventually stationed near the front lines to treat soldiers as soon as possible. The one on display shows one of these apparatuses adapted for use by four separate people, and would have been attached to a cylinder of oxygen.

Yet it wasn’t just the visible wounds that soldiers were suffering from. In what was originally called “shell shock”, countless men during the First World War were impacted by what we now know to be Post Traumatic Stress Disorder (PTSD). When this first manifested itself on the battlefield, often as symptoms including paralysis, muteness, vomiting, and tremors, there was little done to help the men and little sympathy given. In fact, many men who are now thought to have been suffering from shell shock were appallingly executed during the war, accused of cowardice and treason.

And when those who survived returned to England with these “invisible wounds”, as the exhibition calls them, some of the men weren’t necessarily treated any better. “Because there was no standard treatment for men who had been exposed to war and who suffered shell shock, some of them sadly were sent to asylums,” says Hawkins. But out of the dramatic rise in patients suffering PTSD – some 32,000 war pensions were given to those suffering shell shock – came the groundwork for modern mental health practices that informs much of how people are treated today.

^{Artificial eyes were in great demand from those who lost their sight. Science Museum/SSPL}

The exhibition culminates with a short film looking at how modern soldiers have coped with PTSD. Created in collaboration with the organization Combat Stress, which itself started as a charity founded to help First World War men suffering from shell shock adapt to life back home, the men featured are all veterans from the recent conflict in Afghanistan. The film brings home how, despite the technological advances in the last 100 years, the impacts inflicted on men and women who serve has not.

“The men in the film have really felt that this experience of helping us curate that part of the exhibition is a way of continuing their talking cure, that talking about their experiences is really good therapy for them,” explains Hawkins. So rather than only remembering those who made the ultimate sacrifice for King and for country, we should also take a moment to remember those millions of men who returned from the horror of the Great War with injuries both visible and invisible.

^{Amputees being rehabilitated with their artificial legs, 1915-1918. Science Museum}