Many of history’s transformational medical innovations were born on the battlefield.
The history of human conflict inevitably calls to mind battlefields strewn with the dead and dying. In the earliest clashes warriors brutally hacked and slashed their way through the ranks, leaving behind their injured with little hope of help from any quarter. Later, as gunpowder and machine-tooled weapons boosted killing power, soldiers sustained devastating injuries from projectiles that ripped open flesh and shattered bones. Those who died fast were the lucky ones, as survivors often suffered disfigurement and lifelong pain.
It is a terrible mercy, then, that the wounding of untold millions in armed conflict has triggered major advances in the fields of combat and, by association, civilian medicine. Military medical personnel have long struggled to find effective ways to help their injured comrades. Their solutions have led to miraculous innovations in such disciplines as trauma, surgery and prosthetics.
From Ambroise Paré’s artificial limbs and Dominique Larrey’s “flying ambulance” to Clara Barton’s nursing regimen and Walter Reed’s bacteriological research, dozens of healing techniques and medical advances were spawned in the horrific cauldron of war.
Dr. Ambroise Paré (1510–90)
Ambroise Paré rose from humble parentage to serve as surgeon to four French kings. He was also an anatomist, an inventor of surgical instruments and an author of surgical textbooks. During the 1536–38 Italian War, Paré revolutionized wound care by replacing the usual salve of scalding oil with an ointment made of egg yolk, rose oil and turpentine. In 1564 he published his technique, imploring surgeons to abandon “the old and cruel way of healing.”
His second great innovation was to tie off blood vessels rather than cauterize them, thus allowing more successful amputations. In his time amputation became the most common treatment for limb wounds, since it converted a ragged, irregular wound into a simpler, neater wound that was easier to manage with the medical resources of the period. His new methods proved less painful for the soldiers he treated, making him resolve, “never so cruelly to burn poor men wounded with gun-shot.”
Paré also made important contributions in prosthetics, which he designed literally from head to foot, including artificial eyes and legs. His above-knee prosthesis included a kneeling peg, a suspension harness and a prosthetic foot, all major innovations.
The field of limb prostheses has advanced considerably since Paré, with improvements such as carbon-fibre composites, silicone-based compounds, improved joint sockets and advanced microprocessors.
Sir John Pringle (1707–82)
Sir John Pringle was appointed physician general to the British army in 1745 and saw service in England and Flanders. Through his efforts opposing armies mutually recognized field hospitals as neutral territory, thus anticipating the Geneva Conventions by more than a century. In another sign of his humanitarian nature, Pringle demanded foot soldiers be given blankets for use in the field.
In 1752 he published his Observations on the Diseases of the Army in Camp and Garrison, a landmark paper in military medical history. It contained the first scientific description of human-to-human disease transmission, noting that more men died in encampments and hospitals than on the battlefield. Pringle pointed the finger at appalling sanitary conditions, including overcrowding, poor ventilation and inadequate waste disposal. Determined to improve the situation, he advised fellow doctors to improve conditions, which would decrease the high mortality rates.
Pringle also had an intuitive sense of the germ theory of disease. He proposed that “hospital fever” and “jail fever” were the same illness, now known as typhus, and coined the term “antiseptic,” which he recommended as another means of decreasing the spread of infection in hospitals.
Today every public health unit and hospital infectious disease committee traces its origins to the writings of this pioneer of military medicine.
Captain James Lind (1716–94)
In the 18th century scurvy debilitated and killed thousands of seamen. Afflicted sailors exhibited bleeding gums, loose teeth, weak muscles and extreme fatigue. In 1747 Captain James Lind, a Royal Navy surgeon aboard HMS Salisbury, separated a dozen seamen with scurvy into six pairs. He gave each pair different supplements to their regular diet—cider, seawater, elixir of vitriol, vinegar, a purgative mixture, and oranges and lemons. While those given cider showed some improvement, those given citrus fruit improved dramatically and returned to good health.
This was the first such clinical trial in history and a landmark in naval medicine. In 1753 Lind published his findings as A Treatise on the Scurvy. He continued his work with sick and wounded sailors as physician in chief of the Royal Naval Hospital Haslar at Gosport. In 1795, largely due to Lind’s work, the Admiralty ordered a daily ration of lemon juice for all sailors, and scurvy no longer posed a problem in the Royal Navy.
The active ingredient in citrus juice was later named ascorbic acid or vitamin C. Today the Military Nutrition Division of the U.S. Army Research Institute of Environmental Medicine develops its own nutritional products, including MREs (meals, ready-to-eat) and FSRs (first strike rations), which are enriched with vitamins and nutrients that meet the specific requirements of an active combat force.
Dr. Dominique-Jean Larrey (1746–1842)
Among the more colorful medical pioneers was Dominique-Jean Larrey, Napoléon Bonaparte’s surgeon in chief. Larrey invented the flying ambulance, a two-wheeled horse-drawn cart specifically designed to retrieve wounded soldiers from the front and transport them to aid stations and field hospitals. His invention saved countless lives and also improved morale, as soldiers came to realize that being wounded in battle was not necessarily a death sentence. Larrey’s flying ambulance has its modern-day counterpart in frontline medical evacuation systems, which effectively and rapidly transport injured soldiers to emergency surgical facilities.
Larrey further determined that amputations of grievously wounded limbs should be performed as soon as possible, before potentially fatal infection set in. His particular skill at amputations was legendary; it is said that at the 1812 Battle of Borodino, Larrey performed 200 amputations in a 24-hour period.
Larrey also originated the concept of battlefield triage (from the French verb trier, “to sort”), in which doctors prioritize wounded soldiers according to the severity of their injuries, a concept that remains in use on battlefields and in emergency rooms worldwide.
Clara Barton (1821–1912)
Clara Barton began her life of service at age 11 when, for two years, she cared for her brother, who suffered serious injury in a fall from a barn. She became a teacher and later worked at the U.S. Patent Office in Washington, D.C., but when the Civil War broke out, Barton found her true calling.
In April 1861 she assisted the 6th Massachusetts Regiment troops based in Washington, giving them clothing, food and supplies. Eventually she gained permission to work behind the front lines, bringing her own supplies and tending to hundreds of wounded soldiers. As superintendent of Union nurses, Barton worked selflessly during such vicious battles as Antietam, Fredericksburg and Charleston. She became known as the “Angel of the Battlefield.”
After the war Barton proposed the establishment of a national cemetery on the site of the notorious Confederate prison camp at Andersonville, Ga., and she assisted in identifying the graves of nearly 13,000 Union prisoners of war.
In 1870, at the outbreak of the Franco-Prussian War, Barton worked with members of the International Red Cross, which inspired her to establish the American Red Cross in 1881. Barton served as its first president, holding that office for 23 years. In 1904 she founded the National First Aid Society. Today the American Red Cross continues to aid victims of disasters nationwide in the selfless spirit of its compassionate founder.
Major Walter Reed (1851–1902)
In 1875 Virginia-born Walter Reed was appointed a first lieutenant and an assistant surgeon in the U.S. Army. In his early career he served at frontier outposts in Indian country, including Arizona, where he cared for Geronimo and other Apaches, and the Dakotas, where he treated Sioux survivors of the Wounded Knee Massacre. After being promoted to major, Reed traveled to Washington, D.C., at the behest of Surgeon General George Miller Sternberg. Sternberg later appointed Reed head of the Typhoid Fever Board, established to investigate an outbreak among U.S. troops at the onset of the Spanish-American War in 1898. The board determined the main cause was human-to-human spread by contact with bodily excretions contaminated with typhoid bacteria. Finding that this rapid spread was intensified by deplorable conditions in the encampments, the board made several recommendations to cut down the incidence of this devastating disease.
A greater challenge was yellow fever, which had been killing American civilians for decades and more recently U.S. troops in Cuba. Reed was put in charge of a Yellow Fever Commission to find the cause and mode of transmission of this horrific illness. The commission conducted several experiments with Army volunteers to prove Cuban Dr. Carlos Finlay’s suggestion the disease was mosquito-borne. Acting on the commission’s findings, Major William Gorgas carried out an intensive program to eradicate yellow fever from Cuba and subsequently the Panama Canal Zone, thus facilitating construction of the waterway.
Reed died of a burst appendix at age 51. He was buried at Arlington National Cemetery. In 1951 the Walter Reed Army Medical Center was named in his honor—a fitting tribute to one of the finest of military physicians.
Sir Alexander Fleming (1881–1955)
Alexander Fleming was born in Lochfield, Scotland, and followed his brother’s career path into medicine by training at St. Mary’s Hospital, London, where he developed an interest in microbiology.
When World War I broke out, Fleming served as a captain in the Royal Army Medical Corps on the Western Front in France. After watching numerous soldiers succumb to the severe bacterial infections that accompanied their war wounds, Fleming was inspired to find a cure.
“Surrounded by all those infected wounds,” he later wrote, “by men who were suffering and dying without our being able to do anything to help them, I was consumed with a desire to discover something which would kill those microbes.”
Fleming realized combat wounds were particularly susceptible to contamination by bacteria-laden foreign matter. He recommended field doctors aggressively clean out all such matter in a process known as debridement. He also understood that the common use of antiseptics in these situations was largely ineffective, as they could not reach the deeper layers of the wounds and were also interfering with the body’s normal immune response against infection.
After the war Fleming continued his research and by chance discovered a mold he named penicillin that was very effective against several types of bacteria, including those complicating war wounds. What was a hunch in World War I became a reality in World War II, as penicillin saved the lives of thousands of soldiers. Alexander Fleming shared the Nobel Prize in medicine in 1945.