Old Tricks for New Dogs? John Caddy and the Victorian Origins of TCCC

The success of Tactical Combat Casualty Care (TCCC) in reducing potentially preventable combat deaths may rely on both specific interventions (such as tourniquets) and the systematized application of immediate care. Essential elements of a combat care system include clear specification of immediate care priorities, standardized methodology, and inclusion and training of all nonmedical personnel in early response. Although TCCC is fairly recent, the construct is similar to that first suggested during the mid-nineteenth century by John Turner Caddy (1822-1902), a British Royal Navy staff surgeon. Although naval warfare engagements at the time were relatively infrequent, casualties could be numerous and severe and often overwhelmed the small medical staff on board. Caddy recognized that nonmedical personnel properly trained in the fundamentals of combat injury management would result in lives saved and greatly improved morale. The novelty was in his attempt to make procedures simple enough to be performed by nonmedical personnel under stress. However, Caddy's guidelines were completely overlooked for nearly two centuries. The principles of best practice for managing combat trauma injuries learned in previous wars have often been lost between conflicts. Understanding the historical roots of combat first responder care may enable us to better understand and overcome barriers to recognition and retention of essential knowledge.

[The tourniquet of Jean-Louis Petit]

In the early part of the 18th century the mechanization of Petit's tourniquet is one of the most outstanding medical inventions. During more than a century that tool without any noticeable change was in the surgical boxes in all countries. As the mechanic Peron has been intensely working to handcraft the device with the utmost urgency Petit's tourniquet could have become that of Petit and Peron.

Chapter 9 prehospital tourniquets: review, recommendations, and future research

The tourniquet is a simple device that has been used since the Middle Ages. Although different variations have been designed throughout its history, the simplicity of design has remained. The history of tourniquets follows two distinct paths--the operating room and the prehospital setting. From the earliest recorded history, tourniquets have been used for surgical procedures which were originally to amputate war-ravaged limbs and then to create a bloodless field for routine limb surgery. This history has continued uninterrupted since the early 1900s with continued research to foster advances in knowledge. The history of tourniquets in the prehospital setting, however, has not progressed as smoothly. The debate regarding the use of a tourniquet to save a life from excessive limb hemorrhage began in the 1600s, and continues to this day. This chapter will explore the prehospital use of tourniquets, which may shed some light on where this debate originated. The current state of the knowledge regarding tourniquets will then be discussed with a focus on prehospital use, using the operating room literature when needed to fill knowledge gaps. The chapter will conclude with recommendations for prehospital tourniquet use and some areas for future research. Tourniquets are used for operative procedures within accepted clinical guidelines throughout the world as the standard of care. Current science supports a similar stance for the use of prehospital tourniquets within clinical guidelines.

Cushing's clips

Together with Sir William Macewen (1848-1924) and Sir Victor Horsley (1857-1916), Harvey Cushing (1869-1939) is recognised as one of the triumvirate of founders of the speciality of neuosurgery.

Esmarch's bandage

Over the centuries, surgeons have battled with the problem of blood loss in trauma and surgery. In major limb surgery, amputation for example, the assistant would apply digital pressure over the artery or a tourniquet would be used – a pad over the arterial pressure point would be bound down with a bandage, tape or rope tied around the limb. However, this had a tendency to slip and the limb could not be exsanguinated efficiently.

[From the collection of instruments at the Museum of medical history. Tourniquets and compressors]

This article calls attention to the extensiveness of our collection of instruments we have chosen to publish a description of the tourniquets and compressors. The era of these instruments is limited, that is to say from the discovery by Morel in 1674 to Esmarch about 1870. The many different types mentioned in the literature are richly represented. They are named after the originators, who were the great surgeons and instrumentmakers at that time. In the oldest existing list of the instruments dated from 1760 more of the tourniquets are recorded, others are included in a protocol dated 1875. A hand-written book with lecture-notes from 1860 shows evidence of the level of education in surgery.