Wars in the 19th century were accompanied by a very heavy loss of life from infectious diseases. Typhus fever, dysentery, malaria, typhoid fever and yellow fever caused many more deaths than wounds inflicted by enemy actions. During the Peninsular War, for example, for every soldier dying of a wound, four succumbed to disease. This book examines the development and evolution of surgical practice against this overwhelming risk of death due to disease. It reviews three major conflicts during this time: the Peninsular War, the Crimean War and the Boer War and also considers many minor wars fought by the British Empire in the intervening years, and highlights significant medical and surgical developments during these conflicts. War surgery in the first part of the 19th Century was brutal and it had to be carried out swiftly. It was performed at speed because there were no anaesthetics and the wounded often died during the procedure. Surgeons focussed their attention on wounds of the arms and legs, because limbs were both easily accessible to the surgeon (unlike organs inside the abdomen and chest) and lent themselves well to amputation. This was commonly the operation of choice for many war wounds of arms and legs. Some surgeons performed more difficult surgical procedures to try to preserve the limbs and attempted to repair damaged tissues but these operations took longer and caused greater suffering to the patient. Abdominal and chest wounds were not treated since surgeons did not have the means, the ability, or the understanding, to cut into the abdomen and chest to repair the damaged organs successfully. An important development which contributed to surgery moving forwards was the discovery of general anaesthesia, which became available in time for the Crimean War. However, whilst it certainly rendered operations pain-free, it was associated with significant numbers of deaths during surgery on wounded soldiers because of the poorly understood effects that anaesthetics had, particularly on the heart. As a result, operative surgery did not extend its scope a great deal, and military surgery remained focussed on surgery of the limbs. However, fewer amputations were performed during the Boer War at the end of this period.

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

Wars in the 19th Century were accompanied by a very heavy loss of life from infectious diseases. Typhus fever, dysentery, malaria, typhoid fever and yellow fever caused many more deaths than wounds inflicted by enemy actions. During the Peninsular War, for example, for every soldier dying of a wound, four succumbed to disease. This book examines the development and evolution of surgical practice against this overwhelming risk of death due to disease. It reviews three major conflicts during this time: the Peninsular War, the Crimean War and the Boer War and also considers many minor wars fought by the British Empire in the intervening years, and highlights significant medical and surgical developments during these conflicts. War surgery in the first part of the 19th Century was brutal, and it had to be carried out swiftly. It was performed at speed because there were no anaesthetics and the wounded often died during the procedure. Surgeons focussed their attention on wounds of the arms and legs, because limbs were both easily accessible to the surgeon (unlike organs inside the abdomen and chest) and lent themselves well to amputation. This was commonly the operation of choice for many war wounds of arms and legs. Some surgeons performed more difficult surgical procedures to try to preserve the limbs and attempted to repair damaged tissues, but these operations took longer and caused greater suffering to the patient. Abdominal and chest wounds were not treated since surgeons did not have the means, the ability, or the understanding, to cut into the abdomen and chest to repair the damaged organs successfully. An important development which contributed to surgery moving forwards was the discovery of general anaesthesia, which became available in time for the Crimean War. However, whilst it certainly rendered operations pain-free, it was associated with significant numbers of deaths during surgery on wounded soldiers because of the poorly understood effects that anaesthetics had, particularly on the heart. As a result, operative surgery did not extend its scope a great deal, and military surgery remained focussed on surgery of the limbs. However, fewer amputations were performed during the Boer War at the end of this period. Britain sent observers to several wars in which it was not involved to learn military lessons and to understand the medical and surgical aspects of war. The American Civil War and the Franco-Prussian War were two such conflicts. The Russo-Japanese War resulted in a very significant advance in surgery for abdominal wounds, but Western observers either failed to notice or ignored pioneering work performed by a Russian female surgeon called Vera Gedroits. As a result, when the Great War began in 1914, lessons had to be re-learned by British surgeons, and many soldiers who suffered penetrating abdominal wounds lost their lives when they should have survived. Unfortunately, one of the hallmarks of war surgery is that successive generations of surgeons make the same mistakes as their forebears and the same lessons have to be learned time and again.