War Surgery 1914-1918 - Thomas Scotland and Steven Heys

The information presented was written by Chris Buckham; however, it was published in The Journal of the RCAF. Therefore, the material is reproduced here by the author with the permission of the journal. If you would like to republish this information or refer to excerpts please contact the Editor RCAF Journal (William.march@forces.gc.ca). Website for the Journal is: http://www.airforce.forces.gc.ca/CFAWC/eLibrary/Journal_e.asp

 

Title: War Surgery 1914-18

Author: Thomas Scotland and Steven Heys (editors)
ISBN: 978 1 907677 70 0
Publisher: Helion and Company Ltd
Pages: 288

      Hippocrates said: “War is the best school for surgeons” and while individuals may be uncomfortable with that concept, it is an indisputable fact that marked advancement in all facets of medical practice from intervention and prevention to long term patient care has resulted from major conflict. War Surgery 1914-1918 is a fascinating series of essays drafted to shed light on the impact of the First World War on the field of medicine. The editors, Heys and Scotland (both noted medical practitioners in their own right), have overseen the creation of a book that bridges the gap for the reader between the sometimes arcane world of medical science and health care and the uninitiated reader. Under the overarching thesis of the development of medical support in WW1, the editors have brought together a series of medical experts who have each drafted a chapter focusing on areas such as: anaesthesia, pathology, x-ray development, abdominal wounds, head wounds, chest wounds and plastic surgery. Each chapter is dedicated to outlining challenges, technological developments, impact of experience and successes/failures in each area.  

     At first blush, this subject would suggest a great deal of technical jargon therefore limiting the books appeal to a rather select audience. In reality this is not the case at all. The book is aimed at education of the widest audience possible. Thus, while medical terminology is used it is explained in layman’s terms. This allows the reader a much better appreciation of the nature of the work in which the medical staff were involved.

     The layout of the chapters provide context to the discussion by providing a history of protocols in use at the beginning of the war. Thus the reader is exposed, for example, to the challenges that the medical community faced with regard to legitimacy and respect in the eyes of the professional military. Prior to the war and the massive expansion that this entailed, medical personnel involved in military operations held no official rank and were treated, for the most part, with disdain by military compatriots.  This prejudice resulted in treatments being disregarded that would have saved thousands of lives; the classic example being the military refusing to allow its soldiers to be inoculated for typhus prior to deployment for the Boer War.

     In addition to investigating medical advancement in the physical application of medicine throughout the war, there are also excellent chapters on the technical development of x-ray systems and anaesthesia administration methods. It was determined, for example, that the application of ether via the external ‘drip’ method, resulted in considerable amounts of the chemical escaping into the surrounding atmosphere. This led to an environment resulting in potentially degraded medical team performance and a significant loss of body heat from the patient (as the vaporous ether was 30-40 degrees below the surrounding room temperature). In order to overcome this, a method was developed wherein the ether was warmed through a series of canisters prior to introduction to the patient (called Shipway’s Warm Vapour Apparatus). This allowed for longer surgeries as there was no danger of the ether inducing shock through a lowering of the core temperature of the patient. This is but one example of a number of technical advancements described throughout the book.

     Each chapter has extensive notes associated with them and, while there is unfortunately, no formal bibliography, these serve to provide the reader with a goldmine of information that may be referred to as desired. The book is also replete with photographs, maps and charts that provide outstanding additional sources of perspective and context for the reader. Of particular interest is the fact that the narrative not only focuses on the methodology of triage, surgery and recovery, but also goes into detail about the physical (logistical) method by which patients were assessed and transported through the different levels of care from the front line to the long term care facility. Due to the development of greater understanding and insight into the effects of septic shock, blood loss and trauma, intervention at a level heretofore never experienced before, was undertaken immediately behind the front lines and well within the reach of the enemy’s guns. This resulted in not only a lower mortality rate for wounded soldiers, but also a higher casualty figure for medics and doctors who performed their surgeries at these advanced clearing stations. The authors provide a fascinating outline of the different levels of care and where these took place through both narrative and map representation.

     The production value of this book is very high and the quality of maps, text and photography extremely good. Many of the treatments and protocols that we take for granted now developed out of the trial and error of the wartime period. I recommend this book most highly for those interested in developing a deeper appreciation of the complexity and development of both treatment as well as medical logistics during a time of conflict.