War Surgery 1914 18

“A most interesting book, both from a World War I historical perspective and from the major changes in medicine that are so well outlined.” —British Journal of Surgery The First World War resulted in appalling wounds that quickly became grossly infected. The medical profession had to rapidly modify its clinical practice to deal with the major problems presented by overwhelming sepsis. Besides risk of infection, there were many other issues to be addressed including casualty evacuation, anesthesia, the use of X-rays, and how to deal with disfiguring wounds—plastic surgery in its infancy. This book focuses closely on the human aspects of the surgery of warfare, and how developments in the understanding of combat injuries occurred. Ten essays covering a wide variety of topics, including the evacuation of casualties; anesthesia, shock, and resuscitation; pathology; X-rays; orthopedic wounds; abdominal wounds; chest wounds; wounds of the skull and brain; and the development of plastic surgery. All material is supported by an extensive number of figures, tables, and images. Those with a passion for the history of this period, even if they have no medical training, will find fascinating information about those surgeons who worked in Casualty Clearing Stations between 1914 and 1918—and laid the foundations for modern war surgery as practiced today.

This work sets out to show how tremendous progress was made in the treatment of wounded soldiers during the Great War which significantly improved chances of survival. It describes ground breaking advances in resuscitation, anaesthesia and surgery which established the foundations of modern war surgery. It stresses the importance of blood transfusion. In 1914, definitive management of wounds took place at base hospitals after a journey which sometimes took days. Resuscitation was practically non- existent, anaesthesia was poor and surgical methods were hopelessly inadequate. Many soldiers developed catastrophic wound infections and died as a result of overwhelming sepsis when they should have survived. During the Second Boer War, surgeons followed the teaching of Joseph Lister who had introduced antiseptic surgery in 1867. Antiseptic dressings were applied to prevent harmful organisms gaining access to wounds which were considered sterile. Results were satisfactory, but the Boer War was fought in dry grasslands of the Transvaal and Orange Free State and most wounds were caused by rifle bullets fired from long range and of relatively low energy. The Great War on the Western Front was fought in richly manured fields of France and Flanders and wounds were caused by high energy shell fragments or bullets carrying potentially lethal organisms into their depths. Many wounds were sutured, and antiseptic dressings applied in dressing stations of field ambulances, before patients were transferred to base hospitals for definitive surgery. Results were appalling. Two pioneering surgeons challenged established doctrine and introduced new surgical methods against much opposition and hostility from clinicians who lacked vision to see beyond existing methods of treatment. Resuscitation and anaesthesia were transformed as knowledge increased and by 1917 blood transfusion became very important in improving survival. From May 1918, Field Ambulance Resuscitation Teams were employed by Australian medical personnel to deliver resuscitation and surgery to wounded soldiers within a very short time, saving limbs and lives. When hostilities were over, it was hoped by many that lessons learned during the conflict would be applied subsequently to civilian practice. Professional jealousy and rivalry sometimes prevented this from happening.

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Wars in the 19th Century were accompanied by a very heavy loss of life from infectious diseases. Typhus fever, dysentery, malaria, typhoid fever and yellow fever caused many more deaths than wounds inflicted by enemy actions. During the Peninsular War, for example, for every soldier dying of a wound, four succumbed to disease. This book examines the development and evolution of surgical practice against this overwhelming risk of death due to disease. It reviews three major conflicts during this time: the Peninsular War, the Crimean War and the Boer War and also considers many minor wars fought by the British Empire in the intervening years, and highlights significant medical and surgical developments during these conflicts. War surgery in the first part of the 19th Century was brutal, and it had to be carried out swiftly. It was performed at speed because there were no anaesthetics and the wounded often died during the procedure. Surgeons focussed their attention on wounds of the arms and legs, because limbs were both easily accessible to the surgeon (unlike organs inside the abdomen and chest) and lent themselves well to amputation. This was commonly the operation of choice for many war wounds of arms and legs. Some surgeons performed more difficult surgical procedures to try to preserve the limbs and attempted to repair damaged tissues, but these operations took longer and caused greater suffering to the patient. Abdominal and chest wounds were not treated since surgeons did not have the means, the ability, or the understanding, to cut into the abdomen and chest to repair the damaged organs successfully. An important development which contributed to surgery moving forwards was the discovery of general anaesthesia, which became available in time for the Crimean War. However, whilst it certainly rendered operations pain-free, it was associated with significant numbers of deaths during surgery on wounded soldiers because of the poorly understood effects that anaesthetics had, particularly on the heart. As a result, operative surgery did not extend its scope a great deal, and military surgery remained focussed on surgery of the limbs. However, fewer amputations were performed during the Boer War at the end of this period. Britain sent observers to several wars in which it was not involved to learn military lessons and to understand the medical and surgical aspects of war. The American Civil War and the Franco-Prussian War were two such conflicts. The Russo-Japanese War resulted in a very significant advance in surgery for abdominal wounds, but Western observers either failed to notice or ignored pioneering work performed by a Russian female surgeon called Vera Gedroits. As a result, when the Great War began in 1914, lessons had to be re-learned by British surgeons, and many soldiers who suffered penetrating abdominal wounds lost their lives when they should have survived. Unfortunately, one of the hallmarks of war surgery is that successive generations of surgeons make the same mistakes as their forebears and the same lessons have to be learned time and again.

Excerpt from Abstracts of War Surgery: An Abstract of the War Literature of General Surgery That Has Been Published Since the Declaration of War in 1914 The preparation of these abstracts, in common with many of the other early war activities, was an emergency war measure. Much of the excellent surgical work which had developed as a result of French, English and Italian effort had to be appropriated by our medical personnel at a time least favorable for quiet mental effort. To meet the needs of the situation, the Division of General Surgery of the Surgeon Generals Office prepared, collected and arranged abstracts of the important general surgical papers bearing on war surgery; and, after having them mimeographed, distributed one hundred of them to various surgical instructors in the Army Surgical Schools, and to the surgical chiefs of the war hospitals. This limited issue of one hundred so far failed to meet the demand that we have acceded to the request for a wider distribution in printed form. The volume must of necessity be regarded merely as a condensed text for ready reference. Most of the abstracts have been used through the courtesy of Surgery, Gynecology and Obstetrics, the Journal of the American Medical Association, the Medical Record, the Military Surgeon, and the New York Medical Journal. Some articles in the British Medical Journal and in Surgery, Gynecology and Obstetrics were so fundamental that they were abstracted with a minimal amount of paraphrase. To all these journals and to any others that through inadvertence may not have been mentioned, we express the sincere thanks of the Surgeon General. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.

Excerpt from Abstracts of War Surgery: An Abstract of the War Literature of General Surgery That Has Been Published Since the Declaration of War in 1914 Wound Infections: Some New Methods for the Study of the Various Factors Which Come Into Consideration in Their Treatment. A. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.

This is a curated and comprehensive collection of the most important works covering matters related to national security, diplomacy, defense, war, strategy, and tactics. The collection spans centuries of thought and experience, and includes the latest analysis of international threats, both conventional and asymmetric. It also includes riveting first person accounts of historic battles and wars.Some of the books in this Series are reproductions of historical works preserved by some of the leading libraries in the world. As with any reproduction of a historical artifact, some of these books contain missing or blurred pages, poor pictures, errant marks, etc. We believe these books are essential to this collection and the study of war, and have therefore brought them back into print, despite these imperfections.We hope you enjoy the unmatched breadth and depth of this collection, from the historical to the just-published works.