Author: Ioannes Salamanes
Editors: Shannon Tan and Ethan Liu
Artist: Athena Mo
Military medicine is such a unique field and a surprising amount of advances in Medicine have come from innovations on the battlefield. Since tools are often limited and injuries are frequent and serious, the jobs of wartime paramedics, nurses, and doctors are incredibly challenging. In times of war, doctors on the battlefield have to treat soldiers and nurse them back to combat shape as quickly as possible. Considering all of the circumstances of wartime, medics constantly innovate to save the lives of injured soldiers.
William Alexander Hammond was an outspoken reformer and became the Surgeon General of the Union Army during the American Civil War in 1862. He saved many lives through his organizational skills and new medical policies. At the beginning of the Civil War, there were few requirements for becoming an army surgeon or physician. Dr. Hammond changed this when he instituted mandatory training for all Union Army medical officers in hygiene, public health, and surgery. He also promoted “pavilion” hospital architecture, which was a central hub with spokes; these spokes were wards for different conditions and diseases to stop their spread. Although doctors back then may not have known about germs, they did associate fresh air with good health, so, in addition to the pavilion architecture, hospitals were also built with substantial ventilation. Additionally, Dr. Hammond supported Jonathan Letterman in setting up the first ambulance system in the Union’s Army of the Potomac. In August 1862, Dr. Letterman established the Ambulance Corps and instituted a three-step system for evacuating soldiers from the battlefield.
First, wounds are dressed and tourniquets are applied at a field dressing station. Next, they move to a field hospital where doctors perform emergency medical procedures. Finally, patients would move to permanent hospitals away from the battlefields for the remainder of their treatment. This process is still used by the U.S. military to this day. Although beneficial to Union soldiers, some of Hammond’s methods were controversial and caused friction between himself and other battlefield doctors. One of his most controversial moves was banning the use of antimony and mercury-based medications from the army pharmacy on May 4, 1863. These purgative medications did not do anything except make patients vomit and Hammond believed they just cause unnecessary stress to patients’ bodies. Some doctors accepted this change because of the evidence against mercurial medications, but most did not. The opposition against Dr. Hammond grew and he was eventually replaced as the Surgeon General in 1864.
Unsurprisingly, one of the most common surgeries performed during the Civil War were amputations. Surgeons learned two key techniques while working in the field. The first option was to leave wounds open and clean it regularly until the formation of new skin. The other option was to close the wound with a flap of skin. Although the second option was more aesthetically pleasing, it came with the potential of a more painful infection, because it sealed pathogens inside the body, though doctors did not know this at the time. This served as the basis for amputation techniques later on when physicians became aware of germs. The Civil War also brought the emergence of distinct fields of surgery, specifically the development of plastic surgery. Gordon Buck, a New York surgeon, photo-documented a series of facial reconstructive surgeries he performed on Carlton Burgan, a Union private, in 1862. Burgan had taken mercury pills to treat pneumonia, but it had caused severe gangrene, which resulted in him losing his right cheekbone. Buck used facial and dental implants to help Burgan’s face regain his shape. The number of people in need of prosthetics increased due to the Civil War and amputations becoming more common. Most prosthetics were constructed by craftsmen back then, but some veterans, such as James Hanger, tried designing them as well. Hanger was a Confederate soldier who lost his leg in 1861 in the battle of Philippi, West Virginia. Upon his return to Virginia, he designed a prosthetic leg with bumpers made of rubber on the ankle. Later on, he added a rubber foot, which is the basis of modern-day prosthetic legs with solid ankles and soft heels. Hanger patented his design and called it the “Hanger limb”, which was one of the 133 prosthetics that were patented during the 12 year period after the war.
Ambulances, anesthesia, and antiseptics are elements of medicine that emerged from World War Ⅰ. We may take these for granted today, but during the years of the First World War, these were major advances in the field of Medicine. One of the dilemmas that were faced during the war was every doctor’s lack of access to effective antiseptic against Clostridium perfringens, a bacteria that causes gas gangrene or rapid necrosis. Since soldiers lived in filthy trenches, their injuries were prone to becoming infected. Alexis Carrel, a French physician, signed up with the French army and was given an abandoned château in Compiègne to renovate into a military hospital. He demanded laboratories for analysis and an X-ray machine, but his request was declined by the French Service Sanitaire. Carrel then turned to Rockefeller Institute for Medical Research in New York, which he had worked at before the war. The Rockefeller Institute sent the equipment, along with British biochemist Henry Dakin, who had perfected a solution of sodium hypochlorite which killed bacteria without burning flesh. Carrel took the antiseptic and insisted on opening up wounds to irrigate them. This technique, known as the “Carrel-Dakin Method,” was adopted by European doctors during the war. Meanwhile, at the American Ambulance Hospital, George Crile was introducing doctors to a method of anesthesia that he had developed with a nurse named Agatha Hodgins in Cleveland. The American Ambulance Hospital Lakeside Unit began a series of three-month rotations in Neuilly in January 1915. Crile bought 3,000 gallons of nitrous oxide with him and gave surgical demonstrations using a nitrous oxide-oxygen mix for Dakin, Carrel, and other French physicians. Before Crile returned to America in March 1915, he organized a conference that lasted one day at the American Hospital for 100 diplomats and physicians to show them the new models and techniques that had been developed.
Once anesthesia and antiseptics arrived at hospitals, they saved many lives, but wounded soldiers still had little chance if there were no hospital trains and motor ambulances to get them there. By the end of the first year of the war, the American Ambulance Field Service grew to more than 100 ambulances. Volunteer drivers came from 48 American universities. By the end of the war, the ambulance service grew to about 2,500 people. In 1915, Harvard had 55 men in France driving during the nights on gutted roads to pick soldiers up from the field stations behind the lines, but 21 of them lost their lives while saving others. On Christmas Eve of 1915, Richard Hall was struck by a mortar on Bitschwiller Road near Moosch in France and became the first to lose his life.
Progress in blood transfusions can be added to the list of advancements that the war brought. Prior to the war, physicians had been attempting blood transfusions for more than 200 years, but there were finally some breakthroughs when the war broke out. A British born American officer named Oswald Robertson is credited for setting up the world’s first blood depot. The first woman to receive a Nobel Prize, Marie Curie, also contributed to the advancement of medicine during the war. The brilliant pioneer and scientist were appalled by the high number of casualties caused by the war. She was determined to help lessen the suffering. Curie launched a project to provide radiological services to the French army, and thanks to her, x-ray machines were brought closer to battlefields. Aside from the development of medical techniques and machinery, World War Ⅰ was also a turning point for women’s rights. Several movements, such as the Suffragettes, had been calling for more equality and the right to vote for many decades before the war started. Because so many men had to leave their homes to fight in the war, women had to step up and take over the jobs that the men had left vacated. Thousands of volunteer and professional nurses traveled to the Western Front and played vital roles in tending to the wounded. The military relied on nurses from QAIMNS, the Queen Alexandra’s Imperial Military Nursing Service, at the beginning of the war, but it had less than 300 nurses available in 1914. Because the British army was opposed to using female nurses outside of QAIMNS at the time, women who wanted to help had to join the nursing services of the Belgian or French armies. Because of the high number of casualties, the British army eventually relented on its opposition and had over 10,000 nurses in service by the end of the war. Although World War Ⅰ is known as the first mass killing of the 20th century, we should not disregard the amazing medical advances and women’s rights progressions that occurred during that time.
The survival rate for the ill and wounded in World War Ⅱ was 50%, which is commendable compared to the 4% survival rate of World War Ⅰ. This higher survival rate can be associated with the improvement of battlefield medicine during this war. Plasma was the only available substitute for the loss of blood at the beginning of the war, but by 1945, serum albumin was developed. Serum albumin is whole blood, which is rich in oxygenated red blood cells and more effective than plasma. World War Ⅱ also became the first war in which air evacuation for wounded soldiers was available. Surgery techniques, such as removing dead tissue, were improved during this war, which resulted in fewer amputations. The use of metal plates to heal fractures is another one of the advances that occurred during the war. This technique was developed by the German army and was discovered by Allies when examining the X-rays of German prisoners. The recovery time for German troops was cut in half, and to this day, we are still using metal joints and plates. Service members who suffered from post-traumatic stress disorder in World War Ⅱ, which was known as combat fatigue back then, were given a safe place to stay with plenty of food and water, away from the battlefields. This was very beneficial as 90% of patients were able to recover and return to the fight. Service members also received vaccinations for bubonic plague, cholera, smallpox, tetanus, typhoid, typhus, and yellow fever, depending on where they were deployed. Because malaria was a serious threat in the tropical islands of the Pacific, service members who were sent there received a group of medications to protect them against malaria called atabrine. Preventive measures such as crash helmets, flak jackets, and safety belts also received improvements during the war.
Though wars are times of grief and result in the loss of many lives, the advances in Medicine that have originated from them are truly amazing. Many medical innovations that came from the battlefields have been moved to mainstream medicine and have been further developed. It is pretty clear that modern medicine would be starkly different without the events of past wars. We have wartime clinicians to thank for many of the medical procedures and machinery that we take for granted today.
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