Download Medicine in World War I, 1917

Medicine in World War I, 1917
Preparation
By the time the United States entered World War I in April 1917, improvements in the previous
decade in medical education, medical skills, and medical resources meant that the country was
far better prepared to grapple with the problems that would arise. In 1916 President Woodrow
Wilson appointed a Council of National Defense which included a medical division headed by Dr.
Franklin Martin of Chicago. With the cooperation of the American Medical Association and the
American College of Surgeons, Dr. Martin organized the medical profession for the war effort.
Once war was declared, much of the work of the medical division was planned and controlled by
its executive committee, which included the three surgeons-general of the Army, Navy and the
U.S. Public Health Service, together with noted physicians from major medical centers throughout
the country.
Poor Health and Death from Disease
The physical examinations of U.S. recruits for the war revealed a startling amount of general poor
health. More than one-third of the young men drafted were rejected on physical grounds. Many of
these rejected men had problems that could have been corrected had they had timely and proper
medical attention. For those who were healthy enough to enter military service, disease
contracted in one of the military's thirty-two training camps threatened health more than battle
wounds or injuries. Sixty-three thousand soldiers and sailors died from disease, nearly ten
thousand more who died as a result of combat wounds. The camps were lethal because they
mixed together some thirty to forty thousand recruits, including many rural men previously
unexposed to the contagious diseases more commonly found among city dwellers.
Communicable Diseases
Although the camps would turn out to be breeding grounds for disease, the medical personnel
attending the troops were better prepared than ever before. Typhoid fever was kept in check by
monitoring sanitation procedures and water supplies and through the routine use of typhoid
vaccine. Venereal diseases among the troops in the camps and in Europe were a serious
problem, but the availability of arsphenamine for treating syphilis made its long-term effects less
damaging than they might have been. But doctors and planners were not prepared for the men's
vulnerability to unanticipated disease threats. Measles, a minor childhood disease for most,
presented one of the major health threats in the camps because it reduced resistance to other
bacterial infections. Complications arising from measles included laryngitis, tracheitis, and
brochopneumonia, the most common cause of death where measles occurred. Thousands of
soldiers came down with measles; some camps experienced 100 to 500 cases a day. Of every
1000 men with measles, 44 developed pneumonia and 14 died. Large outbreaks of mumps and
of cerebrospinal (meningococcal) meningitis had a high mortality rate, but pneumonia, either as a
primary disease or as a complication of other diseases, was the main cause of death. In the
winter months of 1917 to 1918, 13,393 cases of pneumonia led to 3110 deaths. The high
mortality from disease was largely due to the influenza epidemic that struck U.S. camps in the fall
of 1918. When the epidemic entered the camps, the cases of pneumonia rose to 61,199 with
21,053 deaths. Had it not been for influenza, the death rate from disease in the military forces
would have been unusually low.
Combat Wounds
Of the 1.4 million United States military men who saw active combat service, 53,400 were killed
outright or died of their war injuries while 204,000 survived their wounds. World War I saw a
major improvement in the treatment of combat wounds as a result of better surgical methods and
antisepsis, the use of X-rays, tetanus antitoxin and blood transfusions, and the more rapid
evacuation of the wounded by motorized ambulances to hospitals. Although surgical methods
were greatly improved over earlier wars, many of the wounded died of shock. The nature of shock
was not then adequately understood, and its treatment consisted mainly of first-aid measures.
The casualty was given hot sweet tea to drink, wrapped up, and kept warm by stoves under his
stretcher during the hours of waiting. Ambulance journeys aggravated shock by increasing the
anxiety, hemorrhage, and pain of the wounded. The result was sometimes fatal when broken
bones were allowed to grate together.
Transfusions
Blood transfusions were given to replace lost blood, but the procedure did not always go
smoothly. The concept of blood types was known, but problems from incompatibility were still
encountered. Blood was transfused in insufficient quantities by a form of syringe technique
directly from donor to recipient. Three-quarters of a pint was considered a large transfusion. If the
patient died, a condition of "irreversible shock" was diagnosed, rather than inadequacies of the
transfusion technique. One major problem was the clotting of the donor's blood in the syringe or
in the tubing through which the blood was injected. This was solved when it was discovered that
the addition of a citrate solution to the blood would prevent clotting. By 1917 the citrate method of
anticoagulation was sufficiently developed and standardized to save thousands of lives.
The Fight Against Infection
Nearly 90 percent of combat wounds were caused by shell fire, and shrapnel carried particles of
mud-caked clothing and equipment deep into wounds. Surgeons who had been trained in "clean"
surgery performed under aseptic conditions were faced with war casualties with terribly
contaminated wounds. In the improvised operating theaters there was no possibility of adequate
asepsis. Tetanus and gas gangrene were two types of infection that often complicated wounds,
especially when battles were fought over fertilized farm lands. The incidence of tetanus in 1914
was 1500 to 3000 per 10,000 wounded, and the mortality rate was generally higher than 60
percent. With the introduction of tetanus antitoxin injections towards the end of 1914, the infection
rate fell to about 7 per 10,000. Gas gangrene was a serious condition, and it was necessary to
remove all dead and dying tissue from wounds. In 1916 it was discovered that the gas produced
by the infection would show up on X-rays, and when this was seen, surgical intervention, with
possible amputation, was urgent. Toward the middle of the war, an anti-gas gangrene serum was
introduced that greatly improved the chances of those infected, although it did not replace early
and adequate surgery as effective treatment. The search for a suitable antiseptic for wounds led
Alexis Carrel and Henry Drysdale Dakin to create an irrigation treatment of wounds with Dakin's
antiseptic solution. The Carrel-Dakin treatment of wounds became the preferred antiseptic for the
next twenty years.
Poison Gas
Medical personnel during World War I also had to contend with the first large-scale poison gas
attacks in history. The most dramatic accounts of gas use came from Ypres on 22 April. Both
British and French soldiers noticed a curious blue-white mist--the tear gas xylyl bromide-- rising
from the parapet of the German trenches and drifting before them. The sentries were the first to
begin to cough and choke. The tear gas xylyl bromide sank into the Allied trenches and soon
soldiers were streaming to the rear, tearing at their collars, vomiting and gasping for breath. The
Germans also bombarded the Allies with a variety of poison gases in artillery shells marked with a
yellow (mustard gas), blue (the arsenical compounds), or green (phosgene) cross. Mustard gas
and phosgene were the most widely known poison gases used during the war. Mustard was an
oily liquid that at average temperatures produced enough evaporation to create a gas that
severely blistered and burned the skin and was a deadly cell poison. Damage to lung cells by
mustard led to a rapid loss of fluid from the blood, which flooded into the lungs and caused
severe edema and often death. Phosgene also acted on the lungs and could also have lethal
effects. Prevention, using gas masks, was the most effective solution against gas attacks, but
artificial respiration devices were also used to treat victims.
Base Hospitals
Hospitalizing the wounded was one of the most difficult problems the military faced. Base
hospitals, organized and staffed by medical schools and civilian hospitals in the United States,
evolved to meet the need. The local communities of the parent civilian hospitals were proud of
them and held large fund-raising campaigns to provide equipment. One such base hospital was
#18, organized by the Johns Hopkins Hospital and Medical School. All of its surgical dressings,
operating gowns, sheets, pillowcases, and towels were made by Baltimore women volunteers,
and a group of Baltimore businessmen raised $30,000 to further equip the unit. Base Hospital
#18 took over a 1000-bed hospital from the French, and in September and October 1918 gave
primary surgical care to the wounded who arrived at the hospital by ambulance after receiving
first-aid treatment at the front. Several medical students who had volunteered as enlisted men
toward the end of their third year were awarded their M.D. degrees while the unit was still in
France. Two of these degrees were awarded posthumously since one student died of scarlet
fever and another died of typhoid fever.
Medical Advances
Although the devastation of World War I was unprecedented, in the long run, according to Major
George A. Stewart of the War Demonstration Hospital of the Rockefeller Institute for Medical
Research, "The war .... taught us how to save more lives than the war .... cost." He believed that
medicine and surgery took giant strides and that the science of medicine advanced half a century
in the four long years of war. The use of chlorine and the development of the "Carrel-Dakin"
method of treating infected wounds by periodic irrigation with Dakin fluid (a non-caustic
hypochloride) marked an advance in the treatment of infection. The lessons learned in surgery, Xray work, in the knowledge of the gas bacillus, in the serum treatment for prevention or cure of
such diseases as typhoid fever, lockjaw, pneumonia, and meningitis were some of the
compensations for the tragedy of war.
Source Citation: "Medicine in World War I, 1917." DISCovering U.S. History. Online Edition.
Gale, 2003. Student Resource Center. Thomson Gale. 31 August 2006
<http://galenet.galegroup.com/servlet/SRC>