Wednesday, February 8, 2017

Combat Medicine: Battlefield Surgery

By Becker Staff, 10-20-10

The demands of treating the many wounded and sick during military conflicts have put great pressure on caregivers, physicians, and surgeons in every age. The unique difficulties and situations of wartime medicine, however, have sometimes led to important medical advancements. Surgery, especially, has developed remarkably from work being done on combat wounds since the time when Galen advanced his knowledge of human anatomy by studying the gladiatorial injuries he treated. Paracelsus also found his time spent traveling with various armies across Europe to be essential for his education in surgical techniques. In the Rare Books Collection of the Bernard Becker Medical Library are numerous books in which surgeons describe how their work with wartime casualties helped lead to the development of better surgical care for everyone.

The library’s books on wartime surgery reveal tremendous advancements in surgical technique, often spurred on by the conditions of military conflict, but they also make it clear that modern war has continued to become more destructive.

In fact, the man who helped to make surgery a respected medical specialty in the 16th century worked out many of his most important techniques on injured soldiers. In his first book, which discussed treatments for gunshot wounds, the French surgeon Ambroise Paré described how he had discovered that the contemporary method of cauterization with boiling oil led to more pain, infection, and amputation than simply cleaning wounds with a turpentine-based solution. Paré would go on to develop arterial ligatures and many techniques for securing shattered limbs. His work and writings brought him great fame, so that he ended up serving the kings of France and his books on surgical techniques were published many times. The library has several early editions of his collected works.

Surgical techniques continued to improve over the next two centuries, but little was done to ensure the delivery of effective medical care during combat even as armies became larger and their weapons more horrific. Only when the French Republic put together a huge force of citizens did military administrators seek to improve surgical conditions on the battlefield. Dominique Jean Larrey stands out as the organizing genius of this period of war across much of Europe. He created a force of quick ambulance carriages for the French that delivered the wounded to military field hospitals as close to battles as possible, where a triage system determined who needed the most immediate care. Since surgeons still had to deal with the tremendous risk of infection from bullets and shrapnel, the most frequent surgery remained immediate amputation, a procedure that Larrey helped to perfect. The Becker Library holds several editions of these memoirs of his years spent improving medical care during the Napoleonic Wars.

Military medicine and surgery continued to improve over the course of the nineteenth century, especially after the international disasters of the Crimean War encouraged further development of medical institutions. Surgery still had to be quick and infection remained the major killer, but surgeons now had an effective infrastructure of field units and hospitals to care for the wounded. By the time of the American Civil War, surgeons often used chloroform as an anesthetic to allow them to perform precise surgeries on unconscious patients, while the use of morphine helped to ease the pain of injuries. Frank Hamilton wrote a short pamphlet on modern surgery at the beginning of the war to advise surgeons. After his experiences over the course of the conflict, he followed that up with a huge text in 1865, highlighting all the advances in medical practices for the battlefield including the transport of the wounded, specific surgical techniques, and methods of effective bandaging to ensure proper healing. Hamilton would go on to become a famous surgeon who attended presidents.

In 1861, the renowned Philadelphia surgeon, Samuel D. Gross also produced an important manual on military surgery for the army’s use in the coming conflict. His guide proved invaluable to surgeons in the field. Their work clearly had become an essential part of the war effort, for in 1862 the Confederate government in Richmond, Virginia ordered a pirated copy of the Gross book to be produced for their military doctors. And then they demanded another reprint a year later. Like the Hamilton book, this text discusses the use of chloroform for battlefield surgery and describes the best techniques for ligation and amputation to deal with the dreadful wounds of modern warfare that were likely to lead to infection and gangrene.

By the 1870s, a new understanding of what causes infection led to the development of aseptic surgery. Reducing the risk of infection through aseptic surgery and antiseptic wound cleaning revolutionized surgery by making it much safer. So, the development of anesthesia and aseptic operating rooms meant that surgeons could perfect difficult, detailed procedures for work on specific conditions. Soon afterwards, x-ray imagery offered a guide to the surgeons’ hands before any operation had even started. The Boer War witnessed the first applications of these new technologies which had dramatic results for battlefield medicine. Now wounded soldiers had much better chances of surviving and making it home in one piece. This book shows the new level of care being given with x-rays that showed every bullet fragment and surgeries that allowed perforated intestines and fractured skulls to be repaired.

During World War One, the force of the new artillery and the unsanitary conditions of trench warfare made the work of surgeons and other medical caregivers on the frontlines very difficult. And while advancements such as motorized ambulances and transfusions meant that more lives could be saved, surgeons also had to deal with new concerns such as trenchfoot, gas poisoning, and flamethrower burns. De Tarnowsky’s book was meant to be a field manual for all of the medical situations one would face at the front, so it includes discussions of complicated bladder surgery under anesthetic and the best methods to stitch up a wounded face for later plastic reconstruction, as well as gunshots and fractures.

* Please note: Becker Briefs pages may contain links, email addresses or information about resources which are no longer current.

Image 1: Frank Hastings Hamilton. A Treatise on Military Surgery and Hygiene. New York: Bailliere Brothers, 1865. xxWO 800 H217t 1865

Image 2: Confederate States of America. A Manual of Surgery: Prepared for the Use of the Confederate States Army, by Order of the Surgeon-General. Richmond: Ayres & Wade, 1863. xxWO 800 C748m 1863



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