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Wednesday 26 November 2014

Wine and Warfare part 8: Battlefield medicine

3rd January, 2014 by Rupert Millar

An arm and a leg 

war wounds

The doctor will see you now. An illustration from a book on field surgery by Hans von Gersdorff in 1517

War tends to lead to the development of many things which are then absorbed into civilian practice.

Medical progress in particular has been driven by warfare: as weapons evolved so too did the medical nous to deal with the resulting wounds.

Anyone who’s broken a bone or suffered some sort of physical trauma or even required plastic surgery can thank techniques developed through centuries of conflict for their recovery – and alcohol has a part to play here too as both anaesthetic and disinfectant.

Wounds on the battlefield inflict disgusting perversions on human flesh no matter what the age in which they were or are inflicted.

Weapons now cause horrendous injuries but some of those used in the past were just as bad if not worse as they were often crude and designed to cause trauma that was quite simply catastrophic.

Swords, pikes, billhooks, maces, bayonets, large calibre bullets, solid iron cannonballs weighing up to 24lbs, napalm and shell fragments the length of a man’s forearm; it is little wonder that casualty clearing stations are described as charnel houses.

Worse still, until the end of the 19th century, hygiene, anaesthetic and good patient care were all virtually non-existent. Until the advent of ether and later penicillin, the only way to clean wounds or render a patient as immune to pain and infection as he was likely to get was alcohol.

Battlefield surgery from the ancients into the 19th century was a brutally simple affair – in fact you were probably better off being treated by a Roman medic than most European doctors after them who were usually little better than butchers.gersdorff_pfeil

The soldier came in and the doctor or more likely an assistant would check what needed to be done. If the number of wounded was great and the nature of the wound too unnecessarily complex the soldier might simply be left to die.

A lack of surgeons was a real problem in many conflicts. At the beginning of the American Civil War (ACW) the US army and navy had just 100 trained physicians, none with battlefield trauma experience and 30 of them joined the Confederacy at the outbreak of the conflict.

Problems were greatly increased by the introduction of gunpowder weapons. In the Middle Ages when cutting, stabbing and blunt force trauma were the main cause of wounding, major surgery was actually quite rare.

Trepanning to relive pressure on the brain was one of the most complex surgeries but that would only be practised on the most important kings or commanders and there couldn’t possibly be time for it as screaming casualties descended on the medics during a battle.

Most soldiers would have to make do with their wounds being cauterised or stitched up and at most an arrow that hadn’t gone all the way through might be pushed out to help its removal or it would have to be cut out.

Dead flesh would also have to be removed sometimes by using maggots to eat the dead tissue, other times cut out with a knife – a process known as debridement and one potentially noted as far back as Homer who seems to describe something like it in the Iliad.

From the 15th century onwards though, as guns became more common and then as explosives made an appearance on the battlefield, surgeons were confronted with new injuries and the practice of amputation became much more common.

Until the advent of chloroform which was first used extensively in the Crimean War, the only pain killer available to both doctor and patient was alcohol.

As seen in Part 2, soldiers often started drinking before the battle had begun so there was a chance a wounded man might be slightly anaesthetised when he arrived. One often reads accounts of soldiers who were relieved to find they had some rum or brandy in their kit as they lay wounded on the field.

On the other hand, the shock of injury and the rush of adrenalin would probably have sobered him up. Either he or whoever brought him in might have more alcohol on them and, as time went on, doctors would keep a stash handy too.

There would be no time for the patient to drink himself insensible though. A good, fortifying slug of rum or brandy would be it and then a bit would be placed between the teeth and he’d be held down as the doctor went to work.

Unless he passed out he would be conscious for the whole procedure as the doctor incised his flesh to the bone and then sawed off the limb, which would be flung onto a quickly growing pile, and bandaged him.

Manual003

Instructions for amputating limbs from an American manual

The whole thing could take less than a minute or two. The French surgeon Baron Dominique-Jean Larrey, who actually helped pioneer modern battlefield surgery and the method known as triage, is supposed to have performed over 200 amputations personally after the Battle of Borodino in 1812 and many doctors would pride themselves in their ability to whip off a limb quickly and cleanly.

On the other hand it could be drawn-out agony. Major George Napier of the 52nd (brother to the famous historian who also served in the Peninsular War) was wounded while commanding one of the storming parties at the capture of Ciudad Rodrigo in 1812.

A musket ball shattered his right elbow and and his arm had to be amputated. Unfortunately it took the doctor 20 minutes to take his arm off as his instruments were so blunt from previous amputations.

The other patients had drunk all the rum too so there was none to dull the pain and poor Napier remembered cursing the surgeon “like a trooper” until it was over at which point he thanked him politely and went to find warm fire to sleep by for the night.

He retired a full general in 1854 having been governor of Cape Colony for five years and died in 1855 aged 71.

In The Recollections of Rifleman Harris, the author, Benjamin Harris (who served in the 95th Rifles), recalled a man who even asked the doctor to bring his amputated arm back before it was thrown away so he could shake its hand!

Despite this unbelievable sang-froid, patients could still die of shock and even if they survived, post-operative infection rates were monstrously high as surgeons were renowned for using instruments covered in the blood and filth of previous patients. Throw into the mix campaigns in disease-ridden areas or (as in the First World War) water contaminated by rat urine or decaying flesh and sometimes a wound was the least of your worries.

Disease has followed armies throughout history and it is thought that as many as two thirds of the 620,000 men who died during the ACW died of disease. In hospitals meanwhile gangrene and erysipelas were rampant and carried off terrifyingly high numbers of patients or put them through more procedures which were completely unnecessary if they’d been looked after in the first place.

Bacteria and how it caused infection and illness wasn’t fully understood until later in the 19th century despite being discovered in the 17th. Doctors instead attributed the cause of sickness to nebulous sounding “vapours” or “humours” wafting on the breeze.

As alcohol was generally held to be good for you it was therefore dished out as a preventative. The West Indies in particular had a frightening reputation for virulent diseases and were commonly referred to as the “white man’s grave”.

A posting there was tantamount to a death sentence for most soldiers. Rum, which became the army and navy’s drink when the islands were colonised, was thought to help prevent the spread of diseases such as yellow fever.

In 1761 Colonel Andrew Rollo reported from Dominica that: “The excessive heat hath putt me under the Necessitie of giving a Gill (a quarter of a pint) of Rum per day to each private Man … the care of the Mens health is the grand object of my attention.”

When the science behind infection and disease was better understood, the cleansing (and stinging) powers of alcohol could be used to better treat wounds and clean surgical instruments.

Although advocated by Hippocrates, the use of alcohol on wounds in more modern times was first supposed to have been observed at the Battle of Harlem in 1776 during the American War of Independence. US surgeon Charles Gillman accidentally spilled rum on the infected hand of a soldier and saw the infection recede.

The practice was not widely adopted however although in the same war, wine was apparently used to treat minor burns by both sides and the use of alcohol in various experimental rubs and ointments would continue throughout the 18th and 19th centuries.

Alcohol was so vital to medical personnel as the 19th century progressed that it was not uncommon for medicinal supplies to be looted during the chaos of a retreat or by the pursuers because the men knew they contained booze of some kind.

Indeed, alcohol rubs remain important in hospitals military or civilian to this day. An interesting and much deeper look at changes to military medicine over the centuries can be found here.

Next time: How the wine ration kept the French army going during the slaughter of the First World War.

Previously: The vivandières - women on the battlefield

One Response to “Wine and Warfare part 8: Battlefield medicine”

  1. Damien Chase says:

    I remember reading that the Knights Hospitaller just outside of Toulouse housed wounded Crusaders there, where dogs would lick the wounds since their saliva has some antiseptic qualities. The wines drunk to alleviate suffering were what we now call those from Fronton, mainly Negrette grape variety. Producers like Chateau La Colombiere produce some fine examples today.

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