WAR SURGERY 1914-18
Author: Thomas Scotland & Steven Heys (eds.)

The Great War, 1914-1918 resulted in enormous numbers of casualties who had sustained filthy contaminated wounds from high explosive shellfire, bomb and mortar blast, and from rifle and machine gun bullet. Such wounds were frequently multiple, severe, and almost invariably became infected. Surgical experience from previous conflicts was of little value, and it became quickly apparent that early surgical intervention with radical removal of all dead and devitalised tissue was absolutely vital to help reduce the chances of infections, especially the lethal gas gangrene, from developing.

War Surgery 1914-1918 explains how medical services responded to deal with the casualties. It discusses the evacuation pathway, and explains how facilities, particularly casualty clearing stations, evolved to cope with major, multiple wounds to help reduce their mortality. There are chapters dealing with the advances made in anaesthesia, resuscitation and blood transfusion, the pathology and microbiology of wounding, and diagnostic radiology. There are also chapters dealing with the development of orthopaedic surgery, both on the Western Front and in the United Kingdom, the treatment of abdominal wounds, chest wounds, wounds of the skull and brain, and the development of plastic and reconstructive surgery for those with terribly mutilating facial wounds.

Major advances took place in the surgical management of casualties with all types of wound. Initially, abdominal wounds were treated by "expectant treatment". Observations by brilliant clinicians working in a logical and methodical way resulted in early surgical intervention with significant improvements in survival. Management of chest wounds became more aggressive as confidence and experience grew. Major exposure of combined chest and abdominal wounds through an incision opening both the chest and the abdomen became standard practice and these experiences laid the foundations for how these wounds are managed today. Similarly, application of basic surgical principles to the vast numbers of soldiers with head injuries saw an active policy for management of wounds of the skull and brain develop, with a concomitant improvement in survival, while huge numbers of facial wounds resulted in the development of plastic and reconstructive surgery, with complex methods of facial reconstruction being successfully developed.

There is no doubt, however, that the evolution of orthopaedic surgery was one of the most important developments during the Great War. Described by one of the most important and influential surgeons of this era, Lord Moynihan, as "a war of Orthopaedic Surgery", because so many casualties had wounds with serious fractures, in the early stages of the war the poverty and neglect of Orthopaedic training in surgery before 1914 was all too apparent. The vision and action of Moynihan`s surgical colleague, Sir Robert Jones, in establishing the principles of segregation of patients with orthopaedic wounds, unity of control and continuity of treatment became one of the outstanding chapters of British surgery in the twentieth century.

This book is firmly aimed at all those with a passion for the history of this period. While it will be of interest to those in healthcare professions the editors have ensured that the essays are accessible and of interest to a non-medical readership.

War Surgery 1914-18 contributes greatly to our understanding of the surgery of warfare. Surgeons working in Casualty Clearing Stations during the years 1914-1918 laid the foundations for modern war surgery as practiced today in Afghanistan and elsewhere.

“… this volume … should be in the hands of all whose concern is with injuries of war and conflict … No reader of this book will fail to realise the impact of the lessons of surgery in the Great War on the progress and advance of the science and art of Surgery itself.” Colonel Michael P M Stewart, CBE, QHS, MBChB (Abdn), FRCS, FRCS Tr & Orth L/RAMC, Honorary Surgeon to H.M.The Queen

"This is a brilliant book. Considering that the editors and contributors are medical professionals, it reads incredibly well as a history book – much more readable than many a military history text! I recommend it wholeheartedly to any historian of the Great War who wishes to develop a broader understanding of battlefield medicine. It has certainly helped me to broaden mine, and I must confess, I now think that researching casualties of war without looking at surgery in war is simply inadequate. "  James Daly, Daly History Blog

"... a most interesting book, both from a World War I historical perspective and from the major changes in medicine that are so well outlined." British Journal of Surgery

"A most valuabe addition to our knowledge of the war it is also a tribute to the pioneers of many aspects of surgery - the evacuation may now be by helicopter and the modern equivalent of the Casualty Clearing Station full of high-tech equipment, but the basic principles established in the Great War for the treatment of wounds are just as valid today and are still helping to save British soldiers' lives in Afghanistan." Bulletin of the Military Historical Society

 "The writing is clear, concise, expertly suited to those lacking medical knowledge, yet not passée to the expert. The book's many well-chosen illustrations are greatly aided by printing on high quality coated paper. Although it is far too early to name my Great War book of the year, I have little doubt that War Surgery 1914-18  will be a major contender. Very highly recommended." Stand To! Journal of the Western Front Association

"...an excellent, well presented and well illustrated book, printed on good quality paper... very highly recommended." Mars & Clio (Newsletter of the British Commission for Military History)

"...important reading for anyone involved in war and conflict injuries." Journal of Plastic, Reconstructive & Aesthetic Surgery