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The History of Surgery and Anaesthesia

The First World War.

In 2014 we will remember the 100th anniversary of the beginning of the war the likes of the world had never seen before, this war produced statistics that were at the time unheard of for a conflict, thousands of British soldiers had died during the Crimean war 60 years prior, thousands had perished in the Sudan and Boer conflicts, this war however was responsible not for thousands or even hundreds of thousands being killed or injured, the word millions was used for the first time.
The injuries were appalling and disease was once again a greater killer than the initial injury.

We remember with sadness this conflict, the sadness and the madness of sending hundreds of thousands to their deaths in one day, with not a yard gained in response to the slaughter.
We remember the jack ass politicians and power hungry men who led the world into this slaughter of the innocents, may God have mercy on their souls.
It is true however with these tragedies comes some good, and the good which came from this war were the innovations to save lives by improving the surgical and medical techniques.
These innovations were founded on the long suffering of the wounded and the need to end this suffering. In ancient times the physician would end the patients suffering by ending the wounded mans life quickly. It was during this war however when the onus was to get the wounded quickly from the point of injury to the dressingstation where they could receive life saving treatment. This was achieved as a result of the bravery of the many doctors and medics who ventured onto the field of battle to retrieve these poor wretches, the lives of many of these brave medics were lost attempting to save the lives of the wounded.

The bravery of the medics matched and in many cases exceeded those others, many medics both doctors and ordinary stretcher bearers won awards for bravery beyond the call of duty with hundreds being awarded the Military Medal or cross, several posthumously, and fewer but still several who were awarded the highest award of al, the Victoria Cross and of the three people throughout history to win a bar to the Victoria Cross, two were medics and both won their second during this horrific conflict.

It is also noting that all three winners of this award are connected in one way or the other. Captain Noel Chavasse (top right) died of his abdominal wounds in August 1917 it is said at one stage he was tended by Lt Col Martin-Leake,(bottom right)who was the first person to be awarded the bar to his VC. Second Lieutenant Charles Upham, from New Zealand,(Left ) was awarded his VCs for outstanding leadership and courage in the battle of Crete in May 1941 and then in North Africa in July 1942, he is relatedto Noel Chavasse on his mother’s side.

The First World War was to be called at the time, a war to end all wars or the Great War, how wrong they were. The politicians obviously never learnt the lesson from this barbaric conflict, as they were back for more 20 years later.
The Second World War came along. The First World War brought with it several inventions that allowed man to kill man in greater numbers more efficiently. The machine gun, long-range artillery, aircraft, mortar fire and the grenade all done their job efficiently.
The Second World War added to that the mass slaughter of civilians, the rocket and the ultimate weapon of mass destruction the Atomic bomb.

During the ww1 however one of the biggest killers was of course were the Generals, who for example at the Battle of the Somme ordered the men to Walk casually toward the enemy positions as opposed to charge.
The result of this was thousands upon thousands were killed on the first day more being killed than were killed by the A-bomb on Hiroshima on the first day, with many more wounded, and this slaughter of young men continued throughout the campaign.

The injuries were horrific, in a lot of cases death was a merciful exit from the world of agony both physical and mental.
The loss of so many men to death and injury forced changes in the civil society they grew up in, women were recruited to undertake work that were previously male dominated.
Once these women established themselves they were allowed to continue post war if simply because they were paid a lot less than their male counterparts.

So the war  to end all wars caused such a change in society that was never to be reversed.
However with all major wars, comes inventions of new weapons and ways to kill and maim a human being, a typical example of the First World War was the use of the aircraft and the  airship to strafe and bomb, also the use of chemical warfare that produced a new type of injury.
It is then in reaction to these new weapons of mass destruction that the medical services start to produce a range of different treatments and counter reactions.
With technology to destroy, comes also invention of new medical techniques and surgical techniques to deal with a different wounds that are a result of this new modern warfare.

Most are aware of Harold Gillies and Henry Tonks the team who charted using art, a series of surgical operations of disfigured faces of several First World War injured. The artists pictures (Tonks) portrayed the treatment stages of the plastic surgeon (Gillies)
This of course was at the time a new innovation the idea of reconstructing facial disfigurement was new.
This war also brought with it a new approach to wound control. It was common at the beginning to give each soldier their own bottle of iodine, however the strength of this iodine was eventually to cause  problems as it was too strong, it resulted in the destruction of the crucial white cells required for healing. Other substances were eventually  put in place EUSOL  was a typical example.
It was also a time for research, the first stages of Flemings' theories of antibiotics were formulated during this war, maggots were used to good effect on the wounded. The ambulance service improved as did the nursing service. The building of a great many hospitals was undertook, also specialist hospitals for plastics (Sidcup) and for those who had battle shock (Post Traumatic shock ) Netley.
Innovations in surgery were preceded with the innovations in anaesthetics with the likes of McGill and Rowbotham. New anaesthetic machines were being developed  by Boyle to take the place of the mask and lint.
The use of endotracheal tubes were amplified with the designs that McGill produced. Surgery was able to progress simply because of the elimination of the need to work expeditiously, the surgeon could now feel as though there are no time restraints put on him.
The war also showed the country that there is a need for a National Health Service, the work investigated by Bertram was the template for the Future NHS.
The country also was put to the test as post war Britain and the world  suffered from a outbreak of Spanish Flu that killed more people worldwide (some say as high as 50 million) than the bullets and bombs of the entire war did.
The French introduced x-Rays into medicine in 1918, although very crude, they were seen as useful by some doctors and useless by others.
The blood transfusion service was really set up during the Great War. This was accomplished by trial and error but the idea and the practice was perfected  between the wars.

There's also the fact that more people died as a result of disease and infection during the First World War than by bomb and bullet. However it is also the case that health and hygiene took great steps forward during this war.
One of biggest improvements in practice during the First World War was the development of the ambulance service This service was mechanised and patients were reaching hospital far quicker than they had in previous wars. On occasions it was only possible to use horse-drawn ambulances especially on the fields of Flanders  as mud stopped any mechanised vehicle in its tracks. The boats and trains transported the battlefield wounded quickly to their allotted hospitals.
With the mud and with so many dead bodies and body parts littering the battlefield, The rats and the vermin increased. The cases of gangrene increased with many losing life and limb to his deadly bacteria. Because there were no antibiotics at this time amputation was also common on the battlefield however the other big killer was disease which was as a result of the filth of the battlefield.

New methods were tried to eradicate this disease on open wounds, maggots for instance were seen to be extremely helpful in keeping wound clean.
So the First World War was a cause of so much misery, heartache and grief.

It was a result of the First World War that so many different forms of medical research were followed; for example:

  1. Antibiotics
  2. X-rays
  3. The modernisation of the health services
  4. Better hospitals
  5. Better techniques in anaesthesia and surgery especially plastic.

It also was responsible for the way hospitals are now staffed with nurses taking the primary role for patient care prior to this the doctors ruled the roost and nurses were subject to them and did not question the most cases what they were told to do.
In the operating theatres staff were being replaced with women who were trained as nurses, with the only place effectively open for the men, was as an anaesthetic assistant as at this time either chloroform were the main agents in anaesthetised patients and as patients go to sleep after being gassed down they tend to struggle and fight a bit, the strength of the male assistant was needed.

This however does not justify war in any form under any circumstances, politicians are to blame for war as they were unable to keep the peace. There are regimes throughout the world who do not deserve power as the abuse that power and terrorise their citizens. We have United Nations and organisations that can put these regimes under the severest pressure economically and diplomatically, this should be the main way to defeat an irresponsible leader, sending troops to destroy this organisation just creates more violent groups.

That however will happen in a perfect world, this world is far from perfect and will never be perfect. Until then we must maintain research funding into better treatment for the wounded on the battlefield which would then be passed over to the civilian populace for general use and benefit all mankind.

It is now been 100 years since the start of that senseless war which cost the lives of millions and affected the lives of millions more. After the war there was unemployment and many, many soldiers returned to no job at all. These jobs are been taken up by women or had ceased to exist because most of the jobs at that time were involved in arms and munitions manufacturing and shipbuilding.

Later on in the 20s came the great depression in which thousands upon thousands lost their livelihoods within a week.

10 years after that, the Second World War started and with it more death and destruction and debilitating injuries. And there were of course, modifications within the hospitals in surgery, medicine and in rehabilitation which advanced these specialities.

It is important for us never to forget all those who died or were injured during this war, the first of a new form of warfare were in most cases they did not see their enemy as the shells fired from the cannons were miles away or the bombs that fell from the sky, that rained the shrapnel of death, instead of the water of life.


Lest we forget.



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