Treatment of War Wounds: A Historical Review

Abstract

The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.

Appendices

Appendix 1

The Wound-Dresser

By Walt Whitman (1819–1892)

From Drum-Taps (1865)

1

An old man bending I come among new faces,

Years looking backward resuming in answer to children,

Come tell us old man, as from young men and maidens that love me,

(Arous’d and angry, I’d thought to beat the alarum, and urge relentless war,

But soon my fingers fail’d me, my face droop’d and I resign’d myself,

To sit by the wounded and soothe them, or silently watch the dead;)

Years hence of these scenes, of these furious passions, these chances,

Of unsurpass’d heroes, (was one side so brave? the other was equally brave;)

Now be witness again, paint the mightiest armies of earth,

Of those armies so rapid so wondrous what saw you to tell us?

What stays with you latest and deepest? of curious panics,

Of hard-fought engagements or sieges tremendous what deepest remains?

2

O maidens and young men I love and that love me,

What you ask of my days those the strangest and sudden your talking recalls,

Soldier alert I arrive after a long march cover’d with sweat and dust,

In the nick of time I come, plunge in the fight, loudly shout in the

rush of successful charge,

Enter the captur’d works–yet lo, like a swift-running river they fade,

Pass and are gone they fade–I dwell not on soldiers’ perils or

soldiers’ joys,

(Both I remember well–many the hardships, few the joys, yet I was content.)

But in silence, in dreams’ projections,

While the world of gain and appearance and mirth goes on,

So soon what is over forgotten, and waves wash the imprints off the sand,

With hinged knees returning I enter the doors, (while for you up there,

Whoever you are, follow without noise and be of strong heart.)

Bearing the bandages, water and sponge,

Straight and swift to my wounded I go,

Where they lie on the ground after the battle brought in,

Where their priceless blood reddens the grass the ground,

Or to the rows of the hospital tent, or under the roof’d hospital,

To the long rows of cots up and down each side I return,

To each and all one after another I draw near, not one do I miss,

An attendant follows holding a tray, he carries a refuse pail,

Soon to be fill’d with clotted rags and blood, emptied, and fill’d again.

I onward go, I stop,

With hinged knees and steady hand to dress wounds,

I am firm with each, the pangs are sharp yet unavoidable,

One turns to me his appealing eyes–poor boy! I never knew you,

Yet I think I could not refuse this moment to die for you, if that

would save you.

3

On, on I go, (open doors of time! open hospital doors!)

The crush’d head I dress, (poor crazed hand tear not the bandage away,)

The neck of the cavalry-man with the bullet through and through examine,

Hard the breathing rattles, quite glazed already the eye, yet life

struggles hard,

(Come sweet death! be persuaded O beautiful death!

In mercy come quickly.)

From the stump of the arm, the amputated hand,

I undo the clotted lint, remove the slough, wash off the matter and blood,

Back on his pillow the soldier bends with curv’d neck and side falling head,

His eyes are closed, his face is pale, he dares not look on the

bloody stump,

And has not yet look’d on it.

I dress a wound in the side, deep, deep,

But a day or two more, for see the frame all wasted and sinking,

And the yellow-blue countenance see.

I dress the perforated shoulder, the foot with the bullet-wound,

Cleanse the one with a gnawing and putrid gangrene, so sickening,

so offensive,

While the attendant stands behind aside me holding the tray and pail.

I am faithful, I do not give out,

The fractur’d thigh, the knee, the wound in the abdomen,

These and more I dress with impassive hand, (yet deep in my breast

a fire, a burning flame.)

4

Thus in silence in dreams’ projections,

Returning, resuming, I thread my way through the hospitals,

The hurt and wounded I pacify with soothing hand,

I sit by the restless all the dark night, some are so young,

Some suffer so much, I recall the experience sweet and sad,

(Many a soldier’s loving arms about this neck have cross’d and rested,

Many a soldier’s kiss dwells on these bearded lips.)

Appendix 2

Wound management in Homer’s Iliad

From the translation by Samuel Butler, 1898

Wounded Eurypylus made answer, “Noble Patroclus, there is no hope left for the Achaeans but they will perish at their ships. All they that were princes among us are lying struck down and wounded at the hands of the Trojans, who are waxing stronger and stronger. But save me and take me to your ship; cut out the arrow from my thigh; wash the black blood from off it with warm water, and lay upon it those gracious herbs which, so they say, have been shown you by Achilles, who was himself shown them by Chiron, most righteous of all the centaurs. For of the physicians Podalirius and Machaon, I hear that the one is lying wounded in his tent and is himself in need of healing, while the other is fighting the Trojans upon the plain.”

“Hero Eurypylus,” replied the brave son of Menoetius, “how may these things be? What can I do? I am on my way to bear a message to noble Achilles from Nestor of Gerene, bulwark of the Achaeans, but even so I will not be unmindful your distress.”

With this he clasped him round the middle and led him into the tent, and a servant, when he saw him, spread bullock-skins on the ground for him to lie on. He laid him at full length and cut out the sharp arrow from his thigh; he washed the black blood from the wound with warm water; he then crushed a bitter herb, rubbing it between his hands, and spread it upon the wound; this was a virtuous herb which killed all pain; so the wound presently dried and the blood left off flowing.