War Surgery and Medicine
First World War
First World War
During the 1914–18 War there was a very marked development in war surgery, particularly in surgery in the battle areas. In France war became static trench warfare, and medical units remained at the one site for considerable periods and were stabilised in well-planned hutments. Only the minimum of surgery was carried out in the Field Ambulances, which acted as evacuating units, arranging only for the first-aid dressing of wounds and preliminary splintage, with active bleeding as the only indication for surgical treatment.
The forward surgical work was concentrated in the CCSs though the New Zealand Stationary Hospital at times acted in the same capacity. A grouping of CCSs often took place behind an active battlefront such as the Somme. The normal establishment of the CCS was found to be insufficient to cope with periods of activity and extra surgeons and surgical teams were attached when necessary. These teams were generally supplied by the base hospitals sited in France and once constituted they as a rule continued till the end of the war. A surgical team consisted of a surgeon, an anaesthetist, a sister, and an orderly, an ambulance being generally utilised for transport. The team was dependent on its host unit for all equipment and supplies.
Nursing sisters were regularly attached to the CCS, both in the operating theatres and in the wards. Evacuation to the Base was generally by ambulance train.
Within the CCS there was often a segregation of cases, such as abdominal injuries, under certain surgeons. There was also segregation of cases to certain CCSs. The New Zealand Stationary Hospital took over from two British CCSs at Hazebrouck for the Messines battle. One of the two CCSs was functioning as the Head Centre for the 2nd Army and our New Zealand hospital continued as the Head Centre. Gask developed chest surgery at page 42 a CCS behind the Somme, and chest cases were steered to his unit. The presence of gas casualties seriously complicated the administration of the operating centre as these cases had to be decontaminated and the chest symptoms relieved. The frequency of anaerobic infection also tended to disrupt ordinary routine as even small wounds would thereby be converted into major problems. At first the wound treatment consisted mainly of incision, removal of foreign bodies, and drainage. The need became apparent for the removal of traumatised tissue, especially muscle, as this acted as a nidus for anaerobic infection. Then followed the ruthless removal of damaged and soiled tissue, especially of muscle, which was cut back till fresh bleeding took place irrespective of destruction of function. The wound was left wide open and drained. Loose bone was removed. Various antiseptic dressings were applied, and salt packs to produce osmosis were used. The hypochlorites were eventually most popular, and the Carrel-Dakin treatment of constant or regular wound irrigation was well established during the latter part of the war. BIPP as a wound treatment was also much utilised for its bacteriostatic effect. In wounds of the head primary suture of the wound was the routine, following careful wound excision, removal of bone fragments, and irrigation of the brain track.
Chest wounds were at first treated conservatively till Gask developed a radical operative approach, including treatment of the lung itself.
Following South African War experience, abdominal surgery was at first not considered advisable, but the younger surgeons quickly demonstrated the possibilities of forward surgery in these cases and they became first priority cases.
Amputations were very frequent, due to the gas infection; and the guillotine type of operation was usually carried out. Extension was applied to the skin to prevent retraction, and short Thomas-type splints were utilised for this. Joint sepsis was severe and drainage was frequently instituted. Transfusions of salines and glucose salines, and at times gum arabic, were used freely for the treatment of shock. Blood was used to some extent towards the end of the war, but only in small quantities, rarely more than a pint.
Anaesthesia was generally in the form of chloroform and ether mixtures, open ether, and gas and oxygen. Shipway's apparatus in some form was popular, as was Boyle's apparatus.
X-ray was not generally available at the CCS level. It will thus be seen that fairly adequate provision had been made for forward surgery in the CCS, and that good accommodation and nursing were available, as well as surgeons. The mobile surgical team acted as a satisfactory reinforcement to the regular staff of page 43 the unit. Casualties were very heavy at times and the battles at periods were almost continuous, giving little rest to the staffs.