Medical legacy forged by war

Medical legacy forged by war

Amid the death and horror, combat has also ushered in breakthroughs in the treatment and care of the sick and injured, writes Nicky Phillips.

Life on the Western Front for soldiers in World War I was horrific. Diseases such as foot-rot, gangrene and dysentery were rife. The men were under constant artillery fire and the dead and dying filled the muddy trenches around them.

So when Australian Private Eric Winter was shot in the jaw in late October 1917, leaving nothing but a small fragment of his lower lip and a gaping hole in his right cheek, there seemed little hope he would survive.

Each war has led to improvements treating the wounded

Each war has led to improvements treating the woundedCredit:Reuters

It would be four days before he arrived at Queen's Hospital in London. There a New Zealand surgeon, Harold Gillies, performed what can only be described as a medical miracle.

Taking a portion of cartilage from Winter's chest, Gillies fashioned two tubes of tissue and grafted them onto the private's lower jaw. The innovative technique kept his blood flowing to the skin graft, helping to reduce the risk of infection.

Iraq and Afghanistan..  a war veteran recovers from burns using virtual reality.


A look through war history presents many similar stories of doctors and nurses who, forced by the circumstances of war, invented medical techniques and procedures that we take for granted today.

The Australian military historian Elizabeth Stewart says that, at first glance, war and medicine seem contradictory: the aim of war is to kill, while those who practise medicine strive to heal. However, nations need healthy and fit soldiers. As such, each sizeable war of the past century led to improvements in treating the wounded, many of which have made their way into civilian medicine.

But not all medical advances during the war were applauded and doctors faced the ethical dilemma of whether to use the knowledge gained at experimental hospitals set up at concentration camps during World War II.

Soldiers fighting in wars now often survive injuries that would have killed their counterparts in earlier conflicts, says Stewart, a senior research officer and historian at the Australian War Memorial. She discusses medicine's achievements during warfare in the opening chapter of the new book War Wounds.

Doctors now focus more on giving soldiers who survive horrific injuries good quality of life, she says.

The Great War was the first major war in which more soldiers died from combat than illness. About 8 million people died and a further 21 million were wounded. As military leaders came to terms with a new type of warfare – one fought in trenches using high-powered artillery – the pressure was also felt by medical staff.

However, as the firepower grew more impressive, so did the medical establishment's ingenuity.

Triage, the practice of prioritising patients according to the severity of their wounds, was invented by the French during World War I, Stewart says.

They also began using debridement – a scraping technique that removes dead and damaged tissue from a wound – that is still practised on burns victims today. Debridement resulted in far fewer amputations.

Blood transfusions, the diagnostic use of X-ray machines and reconstructive plastic surgery like that given to Private Winter also have their origins in the clearing stations and field hospitals of the Great War, Stewart says.

The Australian social historian Kerry Neale says facial wounds were extremely common during this conflict, primarily because soldiers' heads were vulnerable when exposed above the trenches. While doctors such as Gillies were forced to come up with innovative ways to treat their patients, many of the soldiers who survived lived with visible deformities, says Neale, who is completing her PhD on the topic.

One of Winter's living relatives, Stewart Campbell, says his great-great-uncle lived for the rest of his life with a black scarf tied around his lower face.

Despite the challenges of dealing with World War I's devastating effect on soldiers' minds and bodies, on the whole, the medical profession rose to the challenge, developing methods used in civilian life before the world's next global conflict encouraged another spurt of advances, Elizabeth Stewart says.

The main advances of World War II came from the development of new drugs, she says. While penicillin had been used since the early 1940s, it took the largest war in history to convince pharmaceutical companies to produce the drug on a mass scale.

Blood products were being deployed throughout field hospitals and the Germans also developed a synthetic version of quinine, which was used to treat malaria, Stewart says.

However, not all medical advances during wars were attained ethically.

The Germans and the Japanese performed barbaric, and at times deadly, medical experiments on prisoners of war in World War II.

The British medical historian Paul Weindling says that at the Ravensbrueck concentration camp in Germany, prisoners' legs were deliberately gashed with splinters and glass shards and infected with tetanus and bacteria that could cause gangrene. The Nazi doctors hoped the experiments would lead to treatments for the many infections that plagued their troops, says Weindling, a professor of medical history at Oxford Brookes University.

While many of the doctors involved in experimentation at Ravensbrueck and Auschwitz concentration camps were convicted of war crimes, civilian doctors faced the ethical dilemma of whether it was appropriate to use the knowledge gained from the experiments, Stewart says.

"Some argued that since the data existed – however unethically it might have been obtained – it was valid to use it, while others doubted whether any use of such tainted data could ever be justified."

In the years that followed, many of the test results were used in medical research, sometimes with the blessing of the victims, who wanted their suffering to benefit others.

By the Korean and Vietnam wars, the big medical advances were more logistical. Mobile army surgical hospitals allowed surgical skills to be brought close to the front line, Stewart says. "The MASH facilities were ideally suited to the rugged terrain and poor roads and railways in Korea."

This war was also the first time armies used aircraft to evacuate wounded patients from near the battlefield. "This was a revolutionary approach to the medical evacuation of soldiers and it saved thousands of lives," Stewart says.

Evacuations were further refined during the Vietnam War, where an injured soldier could be transported from the battlefield to a surgeon's hospital table in 20 minutes, she says.

Medical advances have continued since Vietnam and soldiers wounded in battle today have a 90 per cent chance of surviving, Stewart says.

One of the main afflictions facing soldiers who have served in wars such as Iraq and Afghanistan is post-traumatic stress disorder, a condition that was often diagnosed as shell shock during World War I.

Advances in psychology and neuroscience during the past decade have led to novel ways of treating the disorder, which is common among defence personnel.

Instead of dealing with the trauma, victims tend to suppress their emotions, and psychologists often find it difficult to convince service men and women to seek treatment for such a mental illness.

To overcome this, researchers in the US have developed virtual-reality video games that allow soldiers to work through their anxiety in a safe, controlled environment. And like many other medical advances pioneered during wars, this treatment is also making its way into the civilian world, helping to treat people with depression, anxiety and phobias.

War Wounds, edited by Ashley Ekins and Elizabeth Stewart, is published by Exisle.

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