Wednesday, 4 June 2014

Wine and Warfare Part 8 : Battlefield Medicine

By Rupert Millar

An illustration from a book
on surgery from 1517
War tends to lead to the development of many things which are then absorbed into civilian practice. Medical progress in particular has been driven by warfare: as weapons evolved so too did the medical nous to deal with the resulting wounds. Anyone who’s broken a bone or suffered some sort of physical trauma or even required plastic surgery can thank techniques developed through centuries of conflict for their recovery - alcohol has a part to play here too as both anaesthetic and disinfectant.

Swords, pikes, billhooks, maces, bayonets, large calibre bullets, solid iron cannonballs weighing up to 24lbs, napalm and shell fragments the length of a man’s forearm; it is little wonder that casualty clearing stations are described as charnel houses. Worse still, until the end of the 19th century, hygiene, anaesthetic and good patient care were all virtually non-existent. Until the advent of ether and later penicillin, the only way to clean wounds or render a patient as immune to pain and infection as he was likely to get was alcohol.

Battlefield surgery from the ancients into the 19th century was a brutally simple affair – in fact you were probably better off being treated by a Roman medic than most European doctors after them who were usually little better than butchers. The soldier came in and the doctor or more likely an assistant would check what needed to be done. If the number of wounded was great and the nature of the wound too unnecessarily complex the soldier might simply be left to die.

Problems were greatly increased by the introduction of gunpowder weapons. In the Middle Ages when cutting, stabbing and blunt force trauma were the main cause of wounding, major surgery was actually quite rare. 

Most soldiers would have to make do with their wounds being cauterised or stitched up due to the availability of resources and medical skill. Dead flesh would be removed by using maggots or other times cut out with a knife in a process known as debridement. From the 15th century onwards, as guns and explosives became more common, surgeons were confronted with new injuries and the practice of amputation came into fashion. 

Until the advent of chloroform which was first used extensively in the Crimean War, the only pain killer available to both doctor and patient was alcohol.

As seen in Part 2, soldiers often started drinking before the battle had begun so there was a chance a wounded man might be slightly anaesthetised when he arrived. Accounts of soldiers exist who were relieved to find they had some rum or brandy in their kit as they lay wounded on the field. However, the shock of injury and the rush of adrenalin would probably have sobered him up. Either he or whoever brought him in might have more alcohol on them and, as time went on, doctors would keep a stash handy too.

Instructions for amputating limbs

from an American manual
There would be no time for the patient to drink himself insensible though. A good, fortifying slug of rum or brandy would be it and then a bit would be placed between the teeth and he’d be held down as the doctor went to work. Unless he passed out he would be conscious for the whole procedure as the doctor incised his flesh to the bone and then sawed off the limb. Surely no amount of alcohol could help here!

The whole thing could take less than a minute or two and many doctors would pride themselves in their ability to whip off a limb quickly and cleanly. On the other hand it could be drawn-out agony: Major George Napier, wounded at the capture of Ciudad Rodrigo in 1812, endured 20 minutes of suffering to take his arm off as the instruments were so blunt from previous amputations - the other patients had drunk all the rum too!

As alcohol was generally held to be good for you it was therefore dished out as a preventative to disease. The West Indies in particular had a frightening reputation for virulent diseases and were commonly referred to as the “white man’s grave”. A posting there was tantamount to a death sentence for most soldiers. Rum, which became the army and navy’s drink when the islands were colonised, was thought to help prevent the spread of diseases such as yellow fever.

In 1761 Colonel Andrew Rollo reported from Dominica that: “The excessive heat hath putt me under the Necessitie of giving a Gill (a quarter of a pint) of Rum per day to each private Man … the care of the Mens' health is the grand object of my attention.”

When the science behind infection and disease was better understood, the cleansing (and stinging) powers of alcohol could be used to better treat wounds and clean surgical instruments. Although advocated by Hippocrates, the use of alcohol on wounds in more modern times was first supposed to have been observed at the Battle of Harlem in 1776 during the American War of Independence. US surgeon Charles Gillman accidentally spilled rum on the infected hand of a soldier and saw the infection recede.

To this day, alcohol rubs remain important in military and civilian hospitals alike.

* Please note: this article first appeared on on 3rd January 2014 and is reproduced with the permission of the author. There has been some minor editing of the original by Alex Crawford.

The series so far...

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