War Surgery 1914-18 edited by Thomas Scotland and Steven Hays

How many military historians – people for whom writing about death and injury is part of their vocation – actually have anything more than a rudimentary understanding of battlefield medicine? Nope, me neither. And for somebody who has been specialising in war casualties, that is something I really should remedy.

Therefore I was intrigued to receive this book looking at war surgery in the First World War. It is actually edited by a pair of medical professionals who also have an interest in military history, which for me is crucial. Medicine is such a specialist field, that to be honest I think only medical professionals can really do it justice. But this isn’t just a scientific, geeky look at things that the layman would never understand. It is structured very sensibly, beginning with a basic introduction to the First World War and the Western Front, and also to the history of battlefield medicine.

A very interesting chapter looks at the manner in which wounded soldiers came into contact with medical help – namely, the evacuation chain. Wounded soldiers were treated immediately by their Regimental Medical Officer, aided by a team of stretcher bearers. Men were then taken to a Field Ambulance, usually by ambulance wagons and cars. Lightly wounded might be sent to an advanced dressing station to be patched up and sent back. More seriously wounded would be passed on to a Casualty Clearing Station by motor convoy. From there the wounded would be despatched to a stationary base hospital, usually in French coastal towns such as Rouen, Etaples, Le Havre of Boulogne. Men who did not respond to treatment might be shipped back to England for further care. With much of the war being fought in a stationary, almost siege-like manner, evacuation trains could be implemented, even incorporating river transport.

Obviously, many wounded were in shock, and in need of stabilising and resucitation. And with thousands of men requiring treatment almost on a daily basis, it was an ideal proving ground for medical officers to establish best practice. Anaesthetic had been discovered and pioneered in the later years of the nineteenth century, and with many men requiring operations, anaesthesia was also a key consideration in the treatment of many.

Something I had not really though of is the varying pathology of warfare. Men wounded on the Western Front – in cold, wet and muddy conditions – were very vulnerable to infections, and the heavily fertile Flanders mud was an ideal breeding ground for bacteria. And with a large proportion of open wounds, the early onset of infection was a serious problem. By contrast, men serving in warmer climes were at threat of other illnesses, notably Dysentery in Gallipoli and Malaria in Mesopotamia. As in previous centuries, a large proportion of deaths were to illness rather than wounds received in action.

As with Anaesthesia, X-rays had been pioneered relatively shortly before 1914. Gradually X-ray facilities were established at base hospitals, and a few locations further forward in the medical chain. X-ray machines were relatively large, unwieldy and expensive, and being so far back behind the lines it took time for men to reach them. Another consideration was the quality of imaging, and the ability of medical officers to interpret them and consider an appropriate course of treatment.

With many men suffering broken bones – in particular due to gunshot wounds – orthopaedic surgery was important. a large proportion of broken bones were suffered in the form of fractured femurs. As a major bone, a frature of the femur could be catastrophic, and poorly healed might cripple a man for life. The newly-invented Thomas splint helped medical officers on the front line to immobilise a man quickly, and radically improve their chances of recovery. A great example of how war prompted a remarkable medical innovation.

Throughout military history abdominal wounds had often been regarded as particularly troublesome, as to a lesser extent had penetrative chest wounds. Any wounds in these areas might threaten vital organs, and hence chances of recovery were often very low. Performing delicate operations on vital organs were particularly trying, and not something that could be performed easily in makeshift facilities. Also, the risk of infection was ever-present.

Something I had not ever thought of was the development of plastic surgery during the First World War. As with any way, men suffered horrific scars. I had always thought that plastic surgery was first developed during the Second World War with burnt aircrew, but some of the images of Great War Soldiers having their faces gradually rebuilt with flaps and the like are staggering. The Great War was possibly the first war in which cosmetic injuries were taken seriously.

Something else that really impressed me is the manner in which the medical services expanded to take on what was an unbelievable burden. The Royal Army Medical Corps was tiny in 1914, as was the British Army as a whole. With each Regimental-level unit needing an MO, and countless other medical units needing staffing, where did all these extra doctors come from? It was a considerable balancing act to make sure that there were adequate doctors at the front, but that there were also adequate doctors at home in Britain too.

I’ve got the utmost respect for doctors who serve on the front line. They deal with some of the most traumatic injuries, in trying circumstances and with scant resources. When faced with overwhelming casualties they have to take on an unbelievably tragic method of triage – which casualties have the best chance of success with the resources available? Those deemed unlikely to survive are left to their fate.

This is a brilliant book. Considering that the editors and contributors are medical professionals, it reads incredibly well as a history book – much more readable than many a military history text! I recommend it wholeheartedly to any historian of the Great War who wishes to develop a broader understanding of battlefield medicine. It has certainly helped me to broaden mine, and I must confess, I now think that researching casualties of war without looking at surgery in war is simply inadequate.

War Surgery 1914-18 is published by Helion

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