The need for better medicine frequently arises from wars since the times of antiquity.
Hippocrates, the father of medicine, once said that one who wishes to be
a surgeon should go to war and his words ring true even in modern times.
The Great War of 1914 to 1918 is one of the most crucial periods of recent human
history for advancement in both weapon development and advancement in medicine.
Welcome to Nutty History and today let’s find out how the first world war changed medicine for good.
In 1914, an elimination of a prince spiraled into a chain of events that led to the inevitable war,
and history witnessed the horrors of warfare like never before. For the first time the world
saw over 30 nations declare war, using all available resources and prioritizing warfare
over non-combatant needs. There was no limit on the type of weapons used, and more innovations
in terms of biological, chemical, and other weapons were all imminent. Death and Decay ran
rampant across Europe and many other parts of the world as the war for imperial supremacy raged on.
Infirmaries and Medical camps too experienced war in an unfamiliar
fashion this time despite being tethered to each other for centuries. The challenges posed
by this war for medicine were like strangers encountering each other for the first time.
With most of the fighting set in the trenches of Europe and with the unexpected length of the war,
soldiers were often malnourished, exposed to all weather conditions, sleep-deprived, and often
knee-deep in the mud along with the bodies of men and animals prone to all kinds of diseases.
War casualties increased significantly due to the armament race between
enemy countries. In the wake of the mass slaughter, it became clear that the only
way to cope with the sheer number of casualties was to have an efficient administrative system
that identified and prioritized injuries as they arrived. This was the birth of the Triage System.
The triage system was a means to classify wounds and injuries endured on the battlefield
into three broad categories, trivial, treatable, and terrible. Keeping soldiers at the front line
was a huge priority so those with minor or trivial wounds were treated first and the
aim was to send them back to the battlefield with a quick patch-up as soon as possible. Those who
had severe but treatable injuries and wounds were next in line. The terrible category included those
who had grave wounds and were less likely to make it out of the infirmary to join the battle again.
It does sound apathetic to a degree but the triage system helped to bring order and efficiency to
urgent medical care and after the first world war, the system was established as standard practice in
military medicine. The triage system also played a vital role in regulating the spread of trench foot
or immersion foot syndrome, a terrible gift of the first world war to humanity. Trench foot was a
direct consequence of trench construction. Dug-in land near or at sea level left the men standing,
eating, and sleeping in puddles of water. The symptoms included swelling, numbness,
and discoloration of the feet. By the end of the war, a total of seventy-four thousand Allied
troops are believed to have suffered from the condition. Until then amputation was a common
practice in military medicine to reduce the chances of death by gangrene but thanks to
the triage system trench feet were treated as soon as possible by cleaning and drying feet
as often as possible and also changing socks. Other methods involved rubbing whale oil into
their feet, and even a ‘stamping drill’ of stomping and rubbing their feet in unison
to get the blood flow going. Soldiers also tried digging drainage ditches and laying duckboards
through communication trenches to avoid flooding. But it is also true that the Triage System,
though effective, could only do so much. The poor sanitary conditions in trenches led to infections,
infections led to indomitable pressure on the triage system, and the indomitable
pressure caused the delay in treatment of medical practices such as amputations to prevent gangrene.
As a consequence of the infection epidemic, there was a crying need for improvements in antisepsis.
French surgeon Alexis Car-rel and English chemist Henry Drysdale Day-kin saved the day by
developing Carrel-Dakin chlorine-based antiseptic effective in disinfecting traumatic wounds. The
“Carrel-Day-kin” method or verdunization involved opening the wounds to thoroughly irrigate them
with a Sodium Hypochlorite solution. This was instilled by means of small rubber tubes closed
at the end and perforated with 6-8 holes at half-inch intervals. While the method may have
come about in time, the war necessitated rapid developments in medicine and medical practice.
It allowed doctors to work on a large scale of patients all suffering from the same disease.
Antivenin, a fascinating and marvelous invention of the early 20th century,
also heroically helped save men against contagious diseases that were common to spread in stuffed and
unhygienic trenches. France, ever so wisely, made the typhoid antivenin obligatory for its
entire army on March 28, 1914. The war proved them correct as within the first 14 months of the war,
more than a hundred thousand cases of Typhoid fever were declared and the mortality rate
due to fever was as high as twenty percent! University of Toronto Antitoxin Laboratories,
later renamed Connaught Laboratories, developed antivenin for tetanus for Canadian troops. Germany
made sure to get their troops on the Russian front the antivenin against cholera as well.
The US Army’s intervention in the war proved the most pivotal in advancing the process of blood
transfusions. It delivered more physicians to the front lines with broader knowledge,
especially English-born medical scientist Oswald Hope Robertson. When deployed to the front lines
in France, Robertson developed plans for what would become the first blood bank. Previously,
all blood stored near the front lines was at risk of clotting. By implementing anticoagulant methods
such as adding citrate or using paraffin inside the storage vessel he made the blood preservable
for 26 days. Robertson also used transportation via ammunition boxes packed with sawdust and ice,
meaning that blood could be transported faster for being used on the front-line. These processes
were adopted throughout the war as soldiers were issued standardized transfusion kits,
allowing the procedure to occur before reaching a casualty clearing station. This was a huge
advancement because at this age injured men on the battlefield were still being transported by cattle
car to the nearest city. The whole process of blood transfusion was archaic as well,
the original process of blood transfusions relied on both the donor and patient lying next to each
other, with both blood vessels exposed, connected by rubber tubing. This led to many complications
such as clotting, patient self-restraint, and inability to measure how much blood was passing
between the two individuals. While it was not an innovation of war, thanks to Oswald Hope Robertson
the process of blood transfusion was greatly refined during World War I. Consequently,
the First World War introduced transfusion methods to more doctors and in more standardized
procedures that might have occurred in peacetime and convinced them of its benefits. After the war,
these results and practices were promoted to a new status in civilian medical practice.
In surgery, the anesthetic process was in dire need of an overhaul when the first world war
commenced and much effort was expended on this particular field during the war. Thanks
to the development of less toxic, morphine-derived anesthetic agents, surgeries became more reliable.
More importantly, the development of new devices such as the Camus and Ombredanne ether inhalers
facilitated the process of anesthesia. This allowed surgeons to perform operations that
were considered impossible! Emergency surgery made spectacular progress during the war with the
systematic use of pre-emptive suturing. It avoided the need for immediate amputation much practiced
in past wars. It also enabled quick laparotomies to save soldiers with abdominal wounds.
Reconstructive surgeries also advanced as they became more and more important during the war.
Before the first World War, plastic surgery wasn’t practiced as a specialism like it is
being done today. Usually, work was undertaken by whichever surgeon received the case. But from the
Battle of the Somme onwards, there was a huge rise in facial mutilations, and as a result, a separate
medical field was developed focusing on treating such injuries. Thanks to improvements in asepsis
and again, general anesthetic, the risk of life in reconstructive surgeries was substantially reduced
as well. A New Zealand-born surgeon Harold Gilles and Auguste Charles Valadier, a French-American
dentist, came together in France to tackle the challenge of helping the large number
of soldiers whose faces were mutilated in trench warfare. Gilles focused hard on the aesthetic part
of the surgery, he also wanted to help patients regain their original physical features as much
as possible. With his work, Gilles became famous for his use of the tubed pedicle technique, in
which he would only partially remove tissue from its original site so it retained a blood supply
during transfer to another site. This practice reduced the risk of infection to a great degree
and allowed large quantities of still-living skin to be transferred from one section of the body
to another. Parallel to the progress in reconstructive surgery were improvements
in prosthetic devices. When the war broke out, the making of prosthetic limbs was a small industry.
Thomas Splint was a revolutionary invention by Hugh Owen Thomas in orthopedics, reducing death
by broken thigh bones by 80%! Yet, injuries from new weapons were still causing a lot of men to
return home with physical disabilities. Production of artificial limbs had to increase dramatically
and there was also the need for improving designs and techniques so these unfortunate souls can
still live a life as close to normal as possible. One of the ways this was achieved was by employing
men who had amputations to make prosthetic limbs, they learned the trade alongside established
tradespeople. Not only did it help them to give their input as being on-site target customers,
but also helped them to make a living because of their disabilities. As it wasn’t easy for them to
find work elsewhere. Soon, not only replacements for amputated limbs such as legs, arms, and
hands were being manufactured at the war level. Extremities such as facial disfigurement where
surgery had its limits, were also being aided with prostheses such as nasal and ocular necessities.
In addition, a number of devices to accelerate rehabilitation were invented during the war.
Among these was a mouth-opener that promoted the recovery of muscle elasticity in jaw injuries,
a strapped-on mouth-guard that supported or replaced jawbones,
and the Darcissac helmet that immobilized the face for the treatment of fractures.
No other medical term is often associated with the First World War as Shell Shock. Previously,
any individual showing symptoms of neurosis was immediately sent to an asylum and consequently
forgotten. As World War I made its debut, it brought forward a new type of warfare that no
one was prepared for. With the introduction of new weapons, a new psychiatric disorder came
to light known as Shell Shock. Coined in 1915 by Charles Myers, Shell Shock was a direct catalyst
for psychological medical advancement in war as it provided hundreds of test subjects in which these
symptoms could be seen. Close-range bombings, lack of sleep, malnutrition, and emotional
distress from witnessing mass death caused physical and mental damage lasting a lifetime.
At first, the severity of the situation was handled poorly by the authorities because the
assumed soldiers were malingering. Many soldiers would face death for their incapability to follow
orders when these men were just struggling with severe mental issues. Stanley Kubrik’s
Path of Glory is a phenomenal representation of negligence towards shell shock in army culture
during the first world war. That is why, in direct relation, progress in neuropsychiatry was made,
notably through the work of American psychiatrist Thomas William Salmon.
Salmon pressed for the immediate treatment of shell shock in soldiers and the maintenance
of psychiatric units close to the front. While authorities were still pressing to
keep these men at the front at all cost while simultaneously labeling them fakers, the doctors
divided shell-shocked affected soldiers into two broad categories. Those suffering from shell shock
were deemed capable of returning to combat after a period of rest, and in some cases, treatment,
and those who were considered irreparably insane. Unfortunately, the latter became the guinea pigs
of a new science of the soul, psychiatry. However, their sacrifice was not in vain as mental health
issues were recognized and accepted in militaries across the world after the first world war. Also,
hypnosis, electro-shock therapy, and many other practices learned from the conflict were carried
out in the post-war era and shaped psychiatric care as we know it today. One may say that the
introduction of modern warfare in the first world war paved the path for modern medical advancement
but you have to ask yourself, was the cost worth it? Does medicine really need war to progress?
Tell us in the comments what you think? And as always thanks for watching Nutty History.