PROGRESS IN MEDICINE AND SURGERY DURING THE FIRST WORLD WAR

(For source see WEBOGRAPHY below)

 

INTRODUCTION

Advances in medicine during the First World War went hand in hand with new developments in weaponry, particularly in artillery, as 70% of the injuries and deaths in the conflict were due to mortar shells, which also caused new pathologies and types of wounds.

 

In this context, medicine adapted quickly, making remarkable progress in treatment techniques as well as in logistical organization (first-aid stations, triage of the wounded, evacuation to hospitals behind the lines, and training of personnel). 

 

PROGRESS IN MEDICAL IMAGING

 

In 1895, German physician Wilhelm Röntgen discovered ionizing radiation and developed X-ray imaging.

 

In 1914, scientist Marie Curie went to the front with the Union des femmes de France after the First Battle of the Marne, and with the help of the Red Cross, equipped several hundred vehicles with X-ray machines, creating a veritable radiological ambulance service for soldiers wounded at the front. Heavy use was made of these ambulances, which were rapidly nicknamed “petites curies.” In 1918, there were approximately 300 of them, manned by 400 radiologists. Over the duration of the war, one million wounded men had been helped by this technology.

​

X-rays machines were also set up in hospitals, and radiology has since been used for the benefit of millions.

PROGRESS IN TREATMENT

​

Infections were very numerous and difficult to control due to a lack of hygiene in the urgency of war, the large number of injuries of all kinds, and the wide range of hard-to-treat conditions that grew out of this situation. Heinous infections weakened the injured soldiers, making them more vulnerable, particularly to death from gangrene.

​

In consequence, there was a crying need for improvements in antisepsis. During the war, French surgeon Alexis Carrel and English chemist Henry Drysdale Dakin developed the Carrel-Dakin chlorine-based antiseptic. It was effective in disinfecting traumatic wounds, as was “verdunization,” a simple technique using diluted bleach (sodium hypochlorite).

​

Generalized vaccination against contagious diseases, one of the major inventions of the 20th century, became indispensable during the First World War. The vaccines developed before and during the conflict made a great difference in the lives of the soldiers: up until then, epidemics (along with gangrene, typhus, etc.) had been one of the main causes of death in wars. A law of March 28, 1914, made the typhoid vaccine obligatory for the whole French army, and for good reason: in the first 14 months of the war, 100,000 cases of typhoid fever were declared, with a mortality rate of over 20 percent. The tetanus vaccine was also used; it had been developed for Canadian troops by the University of Toronto Antitoxin Laboratories (renamed Connaught Laboratories in October, 1917), founded by physician and teacher John FitzGerald.

​

CRUCIAL PROGRESS IN BLOOD TRANSFUSION

​

The Great War was also characterized by a revolution in emergency-care techniques. The progress in blood transfusion methods is a shining example of this. From the very beginning of the war, army doctors carried out blood transfusions (this had been done since the 17th century, with mixed success, as the knowledge of human blood groups only dates from 1900). However, there was great difficulty in applying direct transfusion techniques. Canadian surgeon Bruce Robertson initiated new transfusion techniques during the war, but what revolutionized this vital process was the addition of citrate to blood for its anticoagulant properties. Thanks to this technique, used in transfusion for the first time by Belgian doctor Albert Hustin in 1914, it was possible to conserve and transport blood. Army doctors developed simple but effective devices to carry out transfusions at the front, considerably augmenting the chances of survival and recovery of seriously wounded soldiers and bringing about a major advance in first-aid and emergency care.

​

REMARKABLE PROGRESS IN SURGERY TECHNIQUES

​

To bring about progress in medical care, particularly in surgery, much effort was expended during the war on improving anaesthesia methods. Success in this area meant that operations hitherto considered impossible could be carried out thanks to the development of less toxic, morphine-derived anaesthetic agents, and above all, new devices that facilitated the process and made it much more reliable. The Camus and the Ombredanne ether inhalers (the latter created in 1908) dominated anaesthesiology in Europe during this period.

​

In reconstructive surgery, the first grafts were carried out to help the large number of soldiers whose faces were mutilated in trench warfare—the men known as gueules cassées in France. The main types of grafts were skin grafts and bone grafts.

​

To repair disfigured faces, osteoperiostic grafts, Dufourmentel (tissue transfer) grafts, and the Italian graft procedure were practised.

​

 First World War infantrymen whose faces had been mutilated in trench warfare. They were known as the “gueules cassées”.

​

These innovations were accompanied by the development of aesthetic surgery per se. One noted practitioner was Suzanne Noël, considered the world’s first female plastic surgeon, and who is said to have also operated on actress Sarah Bernhardt.

​

Emergency surgery made spectacular progress during the war with the systematic use of pre-emptive suturing to avoid the immediate amputation much practised in past wars, and laparotomies to save soldiers with abdominal wounds.

​

Parallel to the progress in reconstructive surgery were improvements in prosthetic devices, not only for the replacement of amputated limbs and extremities—a leg, an arm, a hand—but also in cases of facial disfigurement where surgery had its limits, and recourse to nasal, ocular or other prostheses was occasionally necessary.

​

In addition, a number of devices to accelerate rehabilitation were invented during the First World War. Among these were 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.

​

PROGRESS IN THE TREATMENT OF PSYCHOLOGICAL DAMAGE

​

Finally, in direct relation to the First World War, progress in neuropsychiatry was made, notably through the work of American psychiatrist Thomas William Salmon, who pressed for the immediate treatment of shell shock in solders and the maintenance of psychiatric units close to the front. Canadian army doctors were aware of the psychological troubles afflicting soldiers. Torn between the military authorities’ desire to keep these men at the front at all costs, where they were seen as “fakers” bent on avoiding combat, and concern for the real syndromes that affected them, the doctors divided these soldiers into two categories: those suffering from shell shock, who were deemed capable of returning to combat after a period of rest, and in some cases, treatment, and those considered irreparably insane. The latter became the guinea pigs of a new science of the soul, psychiatry, and likely remained wards of the Canadian government for the rest of their lives[1].

​

BIBLIOGRAPHY / WEBOGRAPHY
•    Geneviève Allard, Névrose et folie dans le Corps expéditionnaire canadien (1914–1918), Outremont: Athéna, 2012.