Wars cause destruction, devastation and loss, no matter why, when or where they take place, but they also spur faster medical advancements, as health innovators rush to save troops and civilians’ lives.
World War I and World War II had a major impact on 20th century medical developments, with the intensity and scale of the conflicts leading to a long-term relationship between health chiefs and the government and the evolution of new technology.
The treatment of common battlefield injuries led to innovations in medicine that have translated to civilian healthcare in peacetime.
Common battlefield injuries in WWI
There were an estimated 40 million military and civilian casualties globally during the 1914-18 war, including 16 million deaths and 23 million injured military personnel - making it one of the most devastating conflicts in history. The invention of powerful automatic weapons, such as the Browning rifle and machine guns, led to severe injuries to more people, making it hard for medics in war zones to treat them quickly enough.
Loss of limbs was common during WWI, with more than 41,000 soldiers having amputations. More than 700,000 received limb wounds, some leading to debilitating injuries. The biggest killer was losing blood on the battlefield.
Using tourniquets to stem bleeding was practiced during Ancient Roman times, but fell out of favour. It was replaced by more painful methods, such as cauterising wounds. However, medics again began using ligatures on the battlefield, which led to their more widespread use in hospital emergency departments and at accident sites - veins and arteries were commonly crushed, so advances in the repair of blood vessels to restore blood flow to limbs came about as a result of wartime surgical innovations.
WW1 diseases
Much of the conflict took place around the trenches in Europe, where illness was rife. World War 1 diseases suffered by soldiers included dysentery due to poor sanitation and trench fever, spread by lice.
Trenches were damp and usually flooded, causing a painful condition called trench foot, which could cause gangrene and even loss of limbs in serious cases. In addition, fighting on the muddy and dirty battlefields led to open wounds being exposed to bacteria.
Psychological impact of warfare
Injuries weren’t just physical, as the intense battles of the Great War had a dreadful impact on soldiers’ mental health - shell shock was a term coined by Charles Myers, a medical officer, in 1915.
An estimated 250,000 men worldwide suffered shell shock, including around 80,000 British troops. The condition wasn’t understood, as medicine in WW1 was not very advanced, particularly for mental health. Initially, doctors believed it was a physical condition that occurred when the nervous system was damaged during a shell attack.
The symptoms included headaches, tremors, confusion, intense fatigue, nightmares, loss of balance and an inability to focus. Doctors diagnosed shell shock when no obvious cause of illness could be identified.
It became clear that some soldiers who hadn’t been physically injured were suffering from shell shock. After the war, the British Army commandeered more than 20 mental institutions solely to treat victims in 1918. A decade later, 65,000 veterans were still receiving treatment.
In 1980, post-traumatic stress disorder became an official diagnosis for the mental condition, changing long-held medical opinions.
Medical treatments during WWI
Medics were often unable to save severely injured limbs, which were subsequently amputated. Initially, the health service in Britain was not equipped to care for the large numbers of amputees returning from the Western Front. Roehampton House, later known as Queen Mary’s Hospital, in Roehampton, became a centre where veterans were fitted with artificial limbs. Britain called on Allies from the US for help.
American experts travelled to the UK to offer advice and practical help in setting up factories to manufacture prosthetic limbs. As a result, the number of rehabilitation centres increased and the design of prosthetics improved dramatically.
Queen Mary’s became a specialist centre where severely injured soldiers were rehabilitated to live with an artificial limb, which was often made of wood. They were taught exercises to help them adapt.
WW1 facial injuries
Facial injuries were also commonplace during the Great War, with around 280,000 soldiers suffering disfigurement, including shattered jaws and noses. Plastic surgery was in its early stages and surgeons skilled enough to combine functionality and aesthetic appearance were rare.
British surgeon Dr Harold Gillies led a team that reconstructed the faces of many soldiers at St Mary’s, using skin grafts from the patient’s body, a revolutionary procedure and the forerunner of modern plastic surgery.
British sculptor Francis Derwent Wood designed a bespoke prosthetic mask for each soldier whose face was too badly damaged to repair with a skin graft. He used pre-war photographs for reference to make the prosthetic as realistic as possible. Although the masks were uncomfortable, they gave veterans with severe facial injuries a chance to re-enter society.
World War 2 injuries and treatments
During WW2, the most common injuries caused by shells and bullets were penetrating brain wounds and scalp lacerations, which accounted for 60% and 22% of cases respectively. Blast injuries caused by cannons and artillery shells often shattered limbs and bodies, while fractured ribs, hands and feet were common.
Medical care had improved dramatically by the time of the 1939-45 war, with specialist surgical facilities being erected nearer the Frontline and transport for the wounded being by motor vehicle or plane, rather than horse-drawn vehicles.
New antibiotics, including penicillin, also improved survival rates. Scottish physician Alexander Fleming discovered penicillin by accident in 1928, when he left a petri dish containing staphylococcus bacteria in his laboratory before going on holiday.
On returning, he found the resulting mould in the dish prevented bacteria from growing. He researched and developed the product, realising its antibacterial properties and calling it penicillin when he published his findings in 1929. This greatly reduced the number of fatalities from infections during WW2, when penicillin was mass produced. Fleming was knighted in 1944 and won the Nobel Prize as a result.
During WW2, psychological trauma was also better understood, with psychiatrists being based closer to the Frontline to treat soldiers with mental issues. Other lessons learned included the treatment of fragmentation injuries caused by explosions and how to resuscitate casualties even in harsh environments.
Post-war healthcare
The NHS was created in July 1948, revolutionising healthcare and giving the public access to vital services. A greater knowledge of hygiene supplies has also evolved, with the use of nitrile gloves and latex gloves to provide a barrier against the spread of bacteria and germs transforming hospital procedures. Wearing this type of PPE has greatly reduced the risks of contamination in hospitals and other healthcare settings, especially when coming into contact with bodily fluids such as blood.
The NHS has become a global leader in innovative treatments, such as performing the world’s first heart, liver and lung transplant in 1987 and the launch of robotics systems in 2022 to help treat patients with prostate cancer.
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