“It was that awful butchery of humans that led to the true foundation of modern medicine.”

By Thomas S. Helling, MD

AT THE DAWN of the 20th century, the world was poised on the brink of a new era. With the closing of the Gilded Age and the marvellous final years of the 19th century, medicine had advanced from supposition to science, from bedside to technology.

Foul diseases and the sinister unworkings of the human body were almost within reach of dismantling, correcting and reassembling. The new disciplines of physiology and microbiology had uncovered mechanisms of pathology heretofore unknown. The magic X-rays of Wilhelm Röntgen astounded clinicians with their ability to literally see through the human frame. Surgical advances of asepsis and general anesthesia had opened avenues of tinkering with internal organs unimagined just a generation before. Even rearrangement of flesh, bone, and muscle – a talent soon to be called plastic surgery – had been tried on frightful facial malformations.

Despite this, many clinicians languished in the comfortable traditions of the past. Modern medicine was reserved for the few academicians and the well-heeled of Paris, Berlin and London. Even Röntgen’s X-ray machines sat idle in hospital storerooms. Inaccessible to many practitioners of the countryside, technological changes escaped the health concerns of common people and the small communities of Europe. Progress, so wonderful in universities, was slow to penetrate those socioeconomic barriers of the underprivileged.

It would soon change. The conflagration known as the Great War would provide the impetus for implementing medical discoveries of the newfound experimentalism.

Hell had indeed been unleashed in 1914. The unbelievable devastation of modern weapons felled humans by the tens of thousands. Shrapnel from powerful new high explosive artillery shells tore through muscle and bone. Rapid fire machine guns cut down advancing troops who marched to the enemy in parade-ground fashion of times long gone, the victims literally falling in heaps.

Casualties cleared from the battlefield often suffered from injuries beyond imagination: tissue and limbs torn asunder with open wounds immersed in the mud and manured dirt of French battlefields.

Casualties quickly mounted, outstripping the best efforts of the various armies’ medical services to evacuate the legions of injured, treat the devastating wounds and house patients as they recovered. Doctors were overwhelmed, hospitals swamped and traditional battlefield care proved woefully inadequate.

In a mad dash for solutions, an expansive networking of scientists, funded by governments, took on the challenge. The work of researchers like François Magendie, Claude Bernard, Louis Pasteur and the talents of the great surgical masters of England, France and Germany were hurriedly extrapolated to battlefield medicine. Amid the panic and chaos, dissemination of knowledge occurred at a much brisker pace as combat medical teams on both sides eagerly shared achievements to forestall the evils of industrialized warfare.

Innovations including the provision of early surgical care right on the frontlines, often within earshot of the gunfire, proved to be life-saving.

Mobility also was decisive. The faster the wounded could be brought to treatment – the more quickly the bleeding could be stopped and wounds cleaned – the better the odds of survival and recovery.

Even Röntgen’s mysterious rays were made mobile and used at the front lines to diagnose injuries and guide surgical exploration.

Microorganisms studied by Louis Pasteur and William Welch — rarely encountered by doctors in peacetime — now festered in pulped limbs until putrid decay rotted victims to death. Surgeons took lessons from the laboratory and applied them in field hospitals to rid flesh of the fetid pathogens, a process known as gas gangrene, and rescued these horribly suffering individuals.

Elsewhere, unbelievable developments in brain surgery made head wounds treatable. Doctors were able to probe deep in the gelatinous substance of mentation itself to stop bleeding, remove shrapnel and eradicate infection.

And the treatment of massive blood loss, native to battlefields time immemorial, finally made sense. That elusive ailment of shock could be explained by physiologic principles discovered decades before and now could be applied almost at the instant of injury. Treatment with precious blood transfusions – a seeming logical solution to shock and, at first, so dramatic as to be likened to resurrection – by the end of the war was almost commonplace.  

Added to these miraculous developments was the reconstruction of mangled features, frightfully abundant in trench warfare, brought disfiguring wounds to the realm of functional and cosmetic suitability and allowed these “broken faces” to re-enter society.

Even those with invisible wounds — soldiers suffering from trauma to the psyche — were gradually recognized not as malingerers or cowards, but casualties. Compassionate physicians would come to understand the toll such brutality took on sanity. So began a systematic approach to dealing with what was then called “shell shock” but now we recognize as post-traumatic stress disorder.

Warfare would never be the same again; modern ballistic technology had seen to that. The ability to kill and maim combatants had reached new levels of inhumanity and would never regress. Yet at the same time, medical care would change in response.

The Great War was sadly the catalyst for scientific progress. “A war benefits medicine more than it benefits anybody else. It’s terrible, of course, but it does,” wrote pioneering woman surgeon Mary Merritt Crawford at the conclusion of the conflict. But it was that stimulus, that awful butchery of humans, that led to the true foundation of modern medicine. In all its evil, the Great War furnished mankind with an improbable redemption.

Thomas Helling, MD, is the author of The Great War and the Birth of Modern Medicine. A professor of surgery and head of General Surgery at the University of Mississippi in Jackson, he has vast experience in military medicine, trauma and critical care. With this clinical experience and understanding of the evolution of military surgery, Helling lends a unique perspective to twentieth century combat casualty care. He lives in Jackson, Mississippi.