Medicine in World War I: Reaction, Evolution and Legacy

World War I marked a turning point in the history of civilization, a point that forever changed the future and the promises held within it.

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Unimaginable weapons of chemical destruction were released on men ill-equipped for the horrors of modern warfare; millions lived weeks upon weeks in the mud of the trenches, only to be buried by the barrages of the artillery; airplanes brought warfare to never-before-seen heights, while submarines and dreadnoughts intensified the importance of naval supremacy. In the midst of all of this, it became painfully obvious that traditional methods of medicine and medical treatment were inadequate in dealing with the physical injuries of those on the battlefield and the mental instability that followed.

In the span of a few years during and shortly after World War I, humanity experienced an unparalleled swell in the ability to practice medicine and treat those injured or diseased.

The medical horrors of an industrial war had certainly been felt prior to World War I, such as in the American Civil War; however, World War One marked the introduction of expedited medical treatment such as ambulances and modern military hospitals, expanded the effectiveness of blood transfusions and the resulting medical treatments available for soldiers critically wounded on the battlefield, and catalyzed the development of a variety of other methods of medical treatment, including vaccinations, that benefited both those on the battlefield and those in a civilian lifestyle; therefore World War I was a turning point in the history of medicine that forever influenced the future and the medical possibilities held within it.

The intense battles and enormous amount of injuries and casualties seen on the battlefields of World War I caused many nations to reconsider the methods in which the injured were transported to military hospitals. There were without a doubt existing practice of medicine that were effective in servicing those of World War I; however, it was this new era of thinking that incorporated the products of industry with life-saving speed and accessibility, and it was here that the idea of the ambulance came into existence and provided a never-before seen rapidity in transporting the critically and mortally injured. Ernest Hemingway’s novel A Farewell to Arms entails a historically-based narrative about men serving as ambulance drivers in World War I, and through extensive use visual imagery enhanced by Hemingway’s own service as an ambulance driver during this conflict, the novel conveys to the reader throughout the utmost importance of the ambulance in the brutality of the Frontlines.

As Hemingway describes the chaos that ensues as the Italian Infantry is shelled by the Austrians through the narration of an American ambulance driver named Henry, he details how “stretcher-bearers came in all the time” with critically wounded soldiers, “unloaded them”, and returned to the front to aid others that had become injured, demonstrating the expansive need for treatment in the forefront of this modern war (Hemingway 49). Furthermore, Hemingway details the journey experienced as these soldiers are moved into the ambulances and the severity of their conditions, describing how, as the ambulance moved away from the frontline of the battlefield, another soldier in the ambulance began to bleed “slowly and regularly”, then began to bleed rapidly due to a hemorrhage, only to soon hear the blood merely “drip again” after the soldier bleeds to death (Hemingway 52).

The recollections of Hemingway’s own service as an ambulance driver in World War I serve to shape the stories described within this critically acclaimed novel, and it is directly because of this that this account can be believed with such credibility. As the Austrians begin to shell the Italian infantry, it becomes clear that casualties are catastrophic, as soldiers are continually carried away from the Frontlines into the military hospitals in desperate need, some already dead. However, due to the development of the automobile and its implementation wartime purposes as a military ambulance, many of the wounded were able to be carried safely away from the dangers of the Frontlines, into atmospheres where recovery was more likely. This parallels the story of Henry within the novel, who is seen critically injured in this passage. Henry, himself an ambulance driver whose injury in the chaos mirrors that of Hemingway in reality, is carried via stretchers and later loaded into an ambulance; it is in fact, because of this ambulance that Henry is able to eventually make a full recovery and soon return into the ranks of the Italian infantry, serving once again as an ambulance driver.

Without this, Henry’s story within the novel would have surely been much different; even so, such innovation is still slow to the pace of the war, as Hemingway describes in the second quotation how an Italian within the same ambulance succumbs to his hemorrhage, dying within minutes during transportation. Not all can be saved, but the development of the ambulance proved to save more of the wounded than what had ever been seen before. Additionally, Ellen Hampton’s article in The Atlantic details how, before the introduction of the ambulance, getting “wounded soldiers from the battlefield” to a medical station required “horse-drawn wagons” that would bring those injured to any nearby railway and put them in “the straw of a cattle-car” with “no food, no water, [and] no bandages”, vividly illustrating the primitive nature of the field of medicine in the face of modern technological warfare (Hampton).

These methods of transportation for those injured were likely effective for skirmishes of antiquity, however, there was a clear lack of accommodation for the enormous scale of World War I. Harvey Cushing, the leader of a group of Harvard volunteer ambulance drivers in the Frontlines of Paris, describes in his surgeon’s journal how ineffective medical transportation was at the time, detailing how one of the trains loaded with injured men left five-hundred men “lying between the tracks” in the midst of a rainstorm with “no cover whatsoever”, again supplementing this idea that when the war broke out, the medical field was unprepared to account for the enormity of the war (Cushing). It was likely that a significant amount of these five-hundred soldiers may have been beyond saving at this point; however, nearly all of these soldiers were guaranteed death by being placed in the open with no cover from the elements. Because of this, wounds likely became infected and processes of healing slowed or reversed altogether. Had there been some sort of rapid and effective transportation for these injured soldiers, many would have been saved and could have fought another day.

Both Cushing’s firsthand account and the analysis of Hampton’s article depict greater need for improved medical transportation in this era, and many devoted themselves to meet such a modern war with more contemporary methods of treatment. This is seen clearly by the presence of Cushing himself on the Paris front; an Ivy-League American, Cushing volunteered his services in order to prove the effectiveness of the ambulance in a situation where it was desperately needed. In her article, Hampton continues to detail how an “impromptu fleet” of American volunteers and their cars brought back “34 wounded” on the first run and “returned for more” soon after, making the difference between “life and death”, signaling the beginning of the modern concept of the ambulance (Hampton).

The introduction of persons to new medical fields of profession, such as Hemingway and Cushing, illustrate the beginnings of a new era of medical transportation and rapidity that changed the way that wartime injuries would be addressed and shaped the tide of wars to come. No longer were the disabled left to fend for themselves in the crude surroundings of the horse-drawn cart and the straw-filled railway car.

Modern Industry during this time period provided an innumerable amount of technological innovations that were used heavily on the battlefields of World War One. With such an expansive list of plausible weapons of destruction, however, came an unprecedented list of injuries suffered on the battlefield, and the pains of treatment broke those with even the strongest of wills. The blood transfusion expanded the list of plausible treatments for both the frontline and the home front and laid a foundation in which further medical research and development could take place on, effectively impacting every other existing field of medicine known to man.

Alexander Fleming was a prominent surgeon and bacteriologist whose developments during World War I represent the progression of medical treatments, and he is known for the introduction of the blood transfusion to the front. The blood transfusion exemplifies this idea of medical progression and legacy, as it transformed the medicine of the battlefront and revolutionized the way that civilian medicine was conducted. As described in Fleming’s medical journal, the challenge to the blood transfusion included methods of transferring blood from the donor to the receiver, as well as how to keep it from clotting or causing a toxic reaction from the receiver (Fleming).

When Fleming arrived to serve in the European front, advancements quenching these worries had been developed, and Fleming then used this foundational basis to make the blood transfusion even more effective for those on the battlefront. Fleming simplified the process, enabling it to be effectively used on the front, and at the same time developed a medical paper that was published shortly after the conclusion of the war. Fleming in these papers described the simplified methods of blood transfusion that he innovated, detailing that “the transfusion of blood” could be repeated “as often as necessary” without great worry, and that the blood could be taken “in the most convenient place”, ultimately concluding that the transfusion of citrated blood “saved or prolonged lives” in nearly every case (Fleming). Additionally, the writings of Bertram Bernheim emphasize how the “need for blood” for transfusions was “great and urgent”, and was essential for the survival experienced by millions of injured soldiers (Bernheim).

These quotations illustrate the impact that the blood transfusion had in treating the wounded. A blood transfusion, by definition, is the process in which donated blood is provided to a patient undergoing medical treatment, and is a life-saving procedure which rapidly replaces blood lost due to surgery, amputation, or previous injury. Thus, with the presence of a blood transfusion, surgeons at the front were able to conduct needed surgeries without the risk and worry of killing a patient due to extensive blood loss. Blood transfusions were not invented during World War One, however, it was at this point that they were innovated and simplified to the extent at which they were considered effective for widespread use.

The legacy of this work extends well into the modern day, as the modern blood transfusion stems from the studies and findings published in these papers. One could also conclude that it is because of the works of Fleming and his colleagues that blood transfusions were made possible and effective for all people, rather than the exclusively wealthy. Moreover, Mortimer’s scholarly journal on the actions of Alexander Fleming and his colleagues during World War I detail how, once the case for “indirect transfusion” had been developed, the “relatively static” nature of the war in France allowed for “rapid application” of the blood transfusion at both base hospitals and the front lines, proving that this revolutionary medical treatment heightened the effectiveness of military medicine exponentially (Mortimer). Because of the works and innovations of Alexander Fleming, blood transfusions were widespread throughout the war, and although the author of this scholarly journal admits that this process came too late to absolutely transform recovery rates, it without a doubt enhanced them.

This research also affected other fields of medicine as well, as the journal also details how the transfusion managed trauma, hemorrhaging, and wound infections that saw increased effectiveness due to this leap in medical knowledge (Mortimer). With such a demand for immediate and rapid medical treatment at the battlefront, this innovation made it a reality to save as many soldiers as possible in a timely manner. The effectiveness of these procedures and developments on the battlefield and for the wounded was seen clearly, but the most notable impact of Fleming’s work was the legacy that it carried well into the future. The development of blood transfusions led to the creation of blood banks that save millions of lives in the modern world, and the nature of this period of medical advancement enabled Fleming to develop Penicillin shortly after the war, although there was a significant fallow period before the medical world realized the possibilities of Penicillin.

One could also argue that the study and use of citrated blood by Fleming and his colleagues marked an advancement in the awareness of the sanitary constraints necessary to prevent patients from contracting diseases during treatment or operation. Legacies can be debated, however, direct action and the facts of history cannot be reversed, and the truth of this matter is that medicine during World War One was initially stunned, but quickly received adequate attention and made leaps unparalleled to any other time in recent history. The blood transfusion brought blood into the veins of those who historically would have died, and provide a product of industry capable of facing the effects of a modern war. Most notably, however, is the legacy of these industries, medical developments; such medicine would prove essential in World War II as well as the conflicts of the twenty-first century.

One of the most important innovations during this era was the rapid development and innovation of a variety of general medical procedures and tactics that provide practical not only for those returning from the front lines, but for those of civilian lifestyles as well. It is, in fact, because of these developments that medicine changed into a practice available to a large majority of the general population, whereas it had before been limited to elite members of society and government. One of the greatest examples of this could be the Thomas Splint. The Thomas Splint, like a great deal of medicine characterized by its effective use in World War I, was developed prior to the war; however, it was the systematic use and innovation of this idea that made is a plausible treatment for the Frontlines.

In fact, this could be seen as a universal truth for the medicine of World War One in general; a great deal of it did not suddenly materialize during these four years of conflict, but rather rapidly adapted and altered itself to become practical for extensive use on the front lines. In a BBC News article, Owain Clarke describes how, before the introduction of the Thomas Splint to the medical practices of the military in World War I, “80% of soldiers with broken thigh bones” died directly due to implications from this bone fracture, while after the introduction of the Thomas Splint, “80% of soldiers suffering” from the same situation survived, emphasizing the enormous impact that this relatively simple medical procedure had following its introduction (Clarke).

The Thomas Splint saved the majority of those suffering from broken thigh bones, whereas this majority previously had perished due to the same injury. This form of treatment was not limited to the battlefront, as it was adapted to civilian use soon after the war. It is rare for any individual in a developed nation to die directly from a broken thigh bone when treated, and the sole reason for this is the Thomas Splint. In fact, this introduction was effective enough that it is still used is conflicts despite the changes in the nature of warfare. The information in Clarke’s article is not limited to the Thomas Splint; however, as the author continues to describe how the widespread use of vaccinations and other such treatments developed during this time period saved soldiers and civilians from diseases that had since resulted in certain death (Clarke).

Again, after the vaccination for Typhoid was developed and was implemented into the arsenal of the medical field, millions were saved. This would have changed the tide of a war, as a simple vaccination for each soldier would ensure that medical attention was focused on more serious matters. The concept of the vaccination was not a development sprouting directly from World War I, however, it was here that the profession of medicine made widespread use of vaccinations and marked a turning point in the history of civilization where armies no longer lost a majority of their men to mere disease of the foreign region. This was also made possible by the introduction of antiseptics, intravenous fluids, and antibiotics, all core aspects of modern medicine.

Louise Bell’s online article reinforces this idea, stating that World War I was the first major conflict where more soldiers died “from wounds” than “from disease”, highlighting the fact that these medical developments, such as vaccinations, enabled the field of military medicine to spend greater time focusing on the wounds of the battlefield than the wounds of the immune system (Bell). The idea of the vaccination is a very simple one, yet the effectiveness of it is demonstrated in World War I, and this was likely essential in the characterization of vaccinations as safe and extremely effective. And, with less of a focus on the traditional contraction of the disease, the field of medicine was enabled to expand beyond direct treatment of the physical body to psychological treatment of the mind and the soul of the soldier. One very distinguishable characteristic of World War I is the idea of shell-shock that emerged after the conclusion of the war. With such an extensive scope, millions of troops attempted to adjust back to civilian life, but struggled with symptoms of depression, memory loss, and vivid nightmares.

Tracy Loughran describes in an online article how this new focus on the mental implications of war caused medical professionals to theorize that this shell-shock was a result of “the vibrations of shell explosions” that caused “molecular damage” to the brain, resulting in many doctors who treated this shell-shock with many methods including psychotherapy and hypnosis (Loughran). The quotation demonstrates the particular attention that medical professionals had towards this new concept of shell-shock, however, it hints towards the struggle that was experienced in coping with these conditions. It is absolutely true that there was no precise or fully functional treatment of shell-shock developed during World War I or even remotely after. In fact, this lack of any substantial treatment continues into the modern day. Nonetheless, shell-shock serves as a link between different eras of medicine, for it is only because of the studies following World War I that any modern understanding of Post-Traumatic Stress Syndrome can even exist.

This new focus on mental health developed solely because of the effects of World War I and the symptoms of those who first served within it, and the focus of mental health is undoubtedly one of the leading medical sciences in the modern world as the struggles of depression and anxiety plague populations both old and young. Such a widespread field of conflict proved to be a field fit for the advancement of medicine as well, not only for direct treatment of the wounded, but for civilian use and as a foundational basis for the future of medicine as well. Just as modern industry catalyzed systems of mass production and mass distribution, World War I catalyzed the transformation of medicine from an exclusive practice into a widespread service enabling the flourishing of the human race experienced in the latter 20th century.

The field of medicine has been one of great focus throughout the evolution of humanity; however, because World War I marked the establishment of the ambulance and the creation of expedited medical treatment, because the blood transfusion was adapted to offer a widespread variety of medical treatments that saved millions of lives both during the war and in the future, and because the war transformed the field of medicine through the introduction of new focuses such as mental health and vaccination, World War I therefore marked a turning point in the history of medicine that resulted in the effectiveness and widespread use of medicine that characterizes the modern world.

Often times, adaptation is initiated not by wanting or choice, but by the need to survive in the midst of an atmosphere that threatens and kills. The advancements of medicine during World War I saved the lives of millions of men, yet most importantly, this evolution changed the future profoundly, an impact that define the longevity of modern man and the standard of living of modern nations. Such medical developments would prove essential in World War II, a war of far greater scale and destruction, and transform the basis of man himself.