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 anesthetics and the wounded often died during the procedure. Surgeons focused 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 anesthesia, 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 anesthetics had, particularly on the heart. As a result, operative surgery did not extend its scope a great deal, and military surgery remained focused 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.
Heys, Steven: - Steven D Heys was born in Accrington in Lancashire and educated in England, Australia and Scotland. He graduated in Medicine from the University of Aberdeen in 1981 and undertook surgical training in the North-East of Scotland. He is a Fellow of the Royal Colleges of Surgeons in England, Edinburgh and Glasgow and underwent research training at the Rowet Research Institute in Aberdeen, obtaining a PhD in 1992. He specialised in general and breast cancer surgery for many years before latterly concentrating on breast cancer surgery together with his research interests in the role of nutrition in the causation of cancer, and has responsibilities for medical education both locally and nationally. He has published more than 200 scientific papers and written many book chapters on different aspects of surgery and played many national and international roles in surgery and the provision of surgical services. His interest in the Great War was sparked by the stories of the Accrington Pals and the Lancashire Fusiliers; by his time as a member of the RAMC (V), serving for six years in the 51st Highland Brigade; and by Tom Scotland's famous cycling tours around the Western Front where he has the dual role of bicycle mechanic, and because he is a keen bagpipe player, has been appointed as Piper to the tours! He is also co-author of the two books War Surgery 1914-1918, and Understanding the Somme 1916.
Scotland, Thomas: - Tom Scotland was born in St. Andrews and brought up in the East Neuk of Fife, and was educated at Waid Academy in Anstruther. He graduated in Medicine from the University of Edinburgh 1971, becoming a fellow of the Royal College of Surgeons of Edinburgh in 1975. He developed his interest in the Great War whilst a student, when there were still many veterans alive. He trained in orthopaedic surgery in Aberdeen, and after spending a year as a fellow in the University of Toronto, returned to take up the position of Consultant Orthopaedic Surgeon with Grampian Health Board and Honorary Senior Lecturer at the University of Aberdeen. His particular interests were knee surgery, paediatric orthopaedics and tumour surgery, and for three years was lead clinician for the Scottish Sarcoma Managed Clinical network. Over the years he has been a frequent visitor to the Western Front, and has found cycling the best way to visit different places. He has explored many areas of the Western Front with family and friends and since retiring from the National Health Service in 2007 has kept in touch with former colleagues by leading cycling expeditions to the Western Front. He has pursued his interest in the Great War by making a particular study of Aberdeen surgeon, Sir Henry Gray, who played a pivotal role in the development of surgery on the Western Front, and has given various lectures on the development of surgical services during the Great War. In retirement he has completely re-invented himself as a cycling orthopaedic historian. He is also co-author of the two books War Surgery 1914-1918, and Understanding the Somme 1916.
