Wartime medicine is incredibly difficult for doctors, nurses and paramedics who practice it. but the tools available are often more limited than in a traditional hospital.
Over the centuries, battlefield medical personnel had to innovate. These war practices, in turn, often served to refine medical practice beyond the military.
Here are six cases in which war clinicians have changed the way medicine is practiced more widely.
Knotted
The greatest killer of the war has always been the loss of blood. This is not a surprise, given the weapons of war through the ages, including swords, bayonets, bullets, grenades and missiles. But it's a sixteenth century Italian war that has popularized a way to slow down or stop bleeding. In 1537, a French surgeon-hairdresser named Ambroise Pare went to take care of the soldiers at the Turin headquarters. Horrified by the many bloody wounds he encountered, Pare began shaping ligatures, and tied them to the soldiers near their wounds. He was not the first to think about it - the Romans and Arabs had also deployed the technique of attaching a rope or belt to a wounded limb - but the doctors had adopted other means to stop them. bleeding, such as cauterizing wounds. with boiling oil.
This method, on a battlefield, was as troublesome as it was (probably) painful. So Pare has been instrumental in getting doctors to reconsider ligatures or tourniquets, leading to their widespread use today - not just on the battlefield but in emergency rooms and on sites. from accidents and natural disasters.
Projection Light
Sometimes medical discoveries take an extra-long route from the battlefield to the doctor's office. In 1862, after the Shiloh battle of civil war, medical personnel noticed a glint in the wounds of the soldiers of this fight. The mysterious light further confounded the doctors when they noticed that soldiers whose wounds shone had a better survival rate than those without wounds. This prompted many at the time to call the phenomenon "the light of the angel", indicating that celestial beings had healed the soldiers with the heavenly light. It took nearly 140 years, a mother microbiologist, and two teenagers to find a more earthly explanation.
In 2001, after learning of the incandescent injuries of a history exhibition, Bill Martin, 17, asked his mother, who was studying bioluminescent bacteria, whether they could be responsible for incandescent wounds of the battle of Shiloh. And like any good scientist, USDA microbiologist Phyllis Martin told his son to conduct an experiment to find out. So he did it. The young Martin and his friend Jonathan Curtis discovered that the glow came from Photorhabdus luminescens, a bacterium borne by nematodes - small worms that feed on insects. The boys concluded that when soldiers crawled in the mud, their wounds attracted insects, followed by hungry nematodes. Nematode bacteria not only destroy insects for food but also destroy competing microbes.
This is the last function that saved the soldiers. And since that discovery, medical scientists have begun to look at Photorhabdus luminescens as a way to treat antibiotic-resistant infections. Other researchers are using luminescent bacteria to develop a protease inhibitor to treat HIV and other diseases.
Restoration of the stream
On the battlefield, blunt injuries and impact injuries can stretch or crush veins and arteries. It is therefore not surprising that the war and the wounds that accompany it have led to many advances in the repair of blood vessels.
The Korean War, which began in 1950, was one of the major advances. At that time, Army vascular surgeon Carl Hughes and his colleagues at the Walter Reed Army Hospital were studying the types of vascular injuries suffered by Korean War soldiers. they got away with it
Among the team's findings is that ligature - lashing or cutting of injured vessels - immediately stopped bleeding, but resulted in amputation much more often than simply repairing the artery or the vein. This awareness led to a dramatic drop in the number of wartime amputations from the Second World War to the Korean War.
The discovery also helped to popularize vascular repair surgery more broadly, familiarizing surgeons with techniques and with new tools such as the now pervasive Potts clamp. Today, these tools and techniques help treat everything from heart disease to varicose veins.
Stopped infection
The war also resulted in massive production of antibiotics, particularly sulfanilamide and penicillin. The Second World War helped them to find widespread respect, production and use.
In 1928, when the Scottish bacteriologist Alexander Fleming noticed that a strange mold had invaded his petri dishes and eliminated the bacteria on them, his discoveries were not very noticed. But Fleming continued his research and continued to talk about what he called "mold juice" (he did not find "penicillin" later), eventually winning a Nobel Prize and attracting the manufacturer's attention of Pfizer medications. The company quickly began mass-producing drugs for distribution to doctors during the Second World War and ultimately to doctors and hospitals across the country.
In 1932, German biochemist Gerhard Johannes Paul Domagk discovered that the sulfanilamide compound could overcome deadly strains of bacteria, such as streptococcus in his laboratory mice and in his first human test subject, his young daughter seriously ill. The broad distribution of the so-called "sulfonamides" began when World War II soldiers carried powdered sulfanilamide in their first aid kits. At the end of the war, doctors commonly used these antibiotics to treat strep, meningitis and other infections.
Saving a Face
Although plastic surgery is often associated with cosmetic procedures, its origins were in reconstructive surgery. Today, reconstructive plastic surgery helps people with aesthetic problems resulting from congenital malformations such as cleft lips, physical assaults such as acid attacks and medical conditions like necrotizing fasciitis and pain. other causes of disfigurement. And its origins go back to Carleton Burgan, 20 years old.
Hospitalized while serving in the civil war, Burgan was taking mercury tablets for pneumonia. They created a gangrenous ulcer on his tongue. Grangrene spreads quickly from her mouth to her eye and leads to the removal of her right cheekbone.
Desperate, the young man offered his face to Gurdon Buck, a surgeon from New York. With a series of operations, Buck has used dental and facial devices to fill the missing Burgan bone until the face of the private army regains its shape. Buck also photographed the progress of Burgan's facial regeneration. Buck then performed 32 other facial reconstructions for soldiers disfigured by bullets, bayonets and musket bullets, and he photographed several of these operations. Although primitive by today's standards, Buck's techniques have planted the seeds for the sophisticated reconstructive surgery we have today.
How to get there
As the Civil War began in the 1860s, the transportation of the wounded consisted essentially of a motley collection of vehicles operated by anyone who was available. And some of these people were not particularly good at work because they drank a lot and / or escaped with an empty cart at the start of the shootings.
Enter Jonathan Letterman, an army doctor who has developed an efficient and effective ambulance system that has finally become a model for local emergency transportation systems. ; aujourd & # 39; hui. At each battle, he installed caravans of 50 ambulances. Each vehicle was carrying supplies, including morphine and bandages, as well as a driver, a stretcher and two men to transport it.
Letterman relied on his efforts as the war dragged on. He added a trunk to the ambulances, under the driver's seat, to prevent the bandits from stealing drugs and other supplies. The spring suspensions allowed a smoother ride on the uncertain and variable terrain between the battlefield and the hospital.
His ideas led to a better and faster healing of war wounds. Now, the name of Letterman is receiving an award for improving the results for patients.
Reissued with permission of STAT. This article was published on November 10, 2017
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