The Great War, 1914-1918 resulted in enormous numbers of casualties
who had sustained filthy contaminated wounds from high explosive
shellfire, bomb and mortar blast, and from rifle and machine gun
bullet. Such wounds were frequently multiple, severe, and almost
invariably became infected. Surgical experience from previous
conflicts was of little value, and it became quickly apparent that
early surgical intervention with radical removal of all dead and
devitalized tissue was absolutely vital to help reduce the chances
of infections, especially the lethal gas gangrene, from developing.
"War Surgery 1914-1918" explains how medical services responded to
deal with the casualties. It discusses the evacuation pathway, and
explains how facilities, particularly casualty clearing stations,
evolved to cope with major, multiple wounds to help reduce their
mortality. There are chapters dealing with the advances made in
anesthesia, resuscitation and blood transfusion, the pathology and
microbiology of wounding, and diagnostic radiology. There are also
chapters dealing with the development of orthopedic surgery, both
on the Western Front and in the United Kingdom, the treatment of
abdominal wounds, chest wounds, wounds of the skull and brain, and
the development of plastic and reconstructive surgery for those
with terribly mutilating facial wounds. Major advances took place
in the surgical management of casualties with all types of wound.
Initially, abdominal wounds were treated by "expectant treatment."
Observations by brilliant clinicians working in a logical and
methodical way resulted in early surgical intervention with
significant improvements in survival. Management of chest wounds
became more aggressive as confidence and experience grew. Major
exposure of combined chest and abdominal wounds through an incision
opening both the chest and the abdomen became standard practice and
these experiences laid the foundations for how these wounds are
managed today. Similarly, application of basic surgical principles
to the vast numbers of soldiers with head injuries saw an active
policy for management of wounds of the skull and brain develop,
with a concomitant improvement in survival, while huge numbers of
facial wounds resulted in the development of plastic and
reconstructive surgery, with complex methods of facial
reconstruction being successfully developed. There is no doubt,
however, that the evolution of orthopedic surgery was one of the
most important developments during the Great War. Described by one
of the most important and influential surgeons of this era, Lord
Moynihan, as "a war of Orthopedic Surgery," because so many
casualties had wounds with serious fractures, in the early stages
of the war the poverty and neglect of Orthopedic training in
surgery before 1914 was all too apparent. The vision and action of
Moynihans surgical colleague, Sir Robert Jones, in establishing the
principles of segregation of patients with orthopedic wounds, unity
of control and continuity of treatment became one of the
outstanding chapters of British surgery in the twentieth century.
This book is firmly aimed at all those with a passion for the
history of this period. While it will be of interest to those in
healthcare professions the editors have ensured that the essays are
accessible and of interest to a non-medical readership. War Surgery
1914-18 contributes greatly to our understanding of the surgery of
warfare. Surgeons working in Casualty Clearing Stations during the
years 1914-1918 laid the foundations for modern war surgery as
practiced today in Afghanistan and elsewhere. REVIEWS 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. " James Daly, Daly History Blog.."..A
most interesting book, both from a World War I historical
perspective and from the major changes in medicine that are so well
outlined."British Journal of Surgery"A most valuable addition to
our knowledge of the war it is also a tribute to the pioneers of
many aspects of surgery - the evacuation may now be by helicopter
and the modern equivalent of the Casualty Clearing Station full of
high-tech equipment, but the basic principles established in the
Great War for the treatment of wounds are just as valid today and
are still helping to save British soldiers' lives in Afghanistan.
Bulletin of the Military Historical SocietyThe writing is clear,
concise, expertly suited to those lacking medical knowledge, yet
not passee to the expert. The book's many well-chosen illustrations
are greatly aided by printing on high quality coated paper.
Although it is far too early to name my Great War book of the year,
I have little doubt that War Surgery 1914-18 will be a major
contender. Very highly recommended. Stand To Journal of the Western
Front Association..".an excellent, well presented and well
illustrated book, printed on good quality paper... very highly
recommended."Mars & Clio -Newsletter of the British Commission
for Military History ..".important reading for anyone involved in
war and conflict injuries." Journal of Plastic, Reconstructive
& Aesthetic Surgery"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."
Royal Canadian Air Force
General
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