The treatment of wounds during World War I

The First World War was a huge tragedy for mankind, but, paradoxically, it represented a source of significant progress in a broad series of human activities, including medicine, since it forced physicians to improve their knowledge in the treatment of a large number of wounded soldiers. The use of heavy artillery and machine guns, as well as chemical warfare, caused very serious and life-threatening lesions and wounds. The most frequent causes of death were not mainly related to gunshot wounds, but rather to fractures, tetanus and septic complications of infectious diseases. In the first part of this article, we describe the surgical procedures and medical therapies carried out by Italian physicians during the First World War, with the aim of treating wounded soldiers in this pre-antibiotic era. Antibacterial solutions, such as those of Dakin-Carrel and sodium hypochlorite and boric acid, the tincture of iodine as well as the surgical and dressing approaches and techniques used to remove pus from wounds, such as ignipuncture and thermocautery or lamellar drainage are reported in detail. In the second part of the paper, the organization of the Italian military hospitals network, the systems and tools useful to transport wounded soldiers both in the front lines and in the rear is amply discussed. In addition, the number of soldiers enrolling, and those dying, wounded or missing during the Great War on the Italian front is estimated.

[Technological innovation and humanitarianism in the transport of war wounded: Nicasio Landa's report on a new elastic suspension system for stretchers (Pamplona, May 29, 1875)]

In May 1875, in the midst of a bloody civil conflict in Spain known as the Third Carlist War, Nicasio Landa, a medical officer with Military Health, wrote a report requesting authorization for the Spanish Red Cross, of which he was Inspector General, to adopt a new elastic suspension system for stretchers that he had designed, developed and tested. Intended above all for use in farm wagons - still the most widely-used method of transporting the wounded at the time - it was an inexpensive, sturdy mechanism that improved patient comfort and could also be installed in ambulance carriages, railway carriages and hospital ships. An annotated version of the report is included, preceded by a presentation of its contents.

[Organization of medical support for troops, defending Leningrad and the people of the blockaded city]

The data on the composition of forces of medical services and organization of medical-evacuation support for troops defending the blockaded Leningrad are presented. The information about the health losses among the population of Leningrad as a result of bombing, shelling and disease is given. Extremely high rates of morbidity and mortality in residents were associated with hunger, hypothermia and emotional stress. The clinical picture of some diseases has different peculiarities because of alimentary dystrophy background. The city health service suffered huge losses: 482 medical institutions were destroyed, only about 300 people from 1.5 thousand of medical personnel in 1942 saved working capability. The health care service of the local air defense played an essential role in delivery of medical aid. The contribution of civil and military health workers in saving residents lives in the blockaded Leningrad was appreciated.

[Medical support of the 65th Army during the East Prussian offensive operation performed by the 2nd Belorussian Front]

Prussian offensive operation performed by the 2nd Belorussian Front. An activity of the medical An activity of the medical service of the 65th Army during the East Prussian offensive operation performed by the 2nd Belorussian Front is a typical example of the medical support of troops during the final stages of World War II. Forms and methods of medical support management, which were developed during the war, haven't lost their importance in modern conditions. These methods include the establishment of specialized surgical and therapeutic field hospital, establishment of medical institutions in the Army, which worked on the evacuation directions and reserve of mobile hospitals and transport, timely extension of the first echelons of the hospital base front to change institutions hospital deployed the army base. A research of experience in organizing medical support of the offensive operations performed during the last year of World War II provides the material for the development of the theory of modern medical support operations and ability to provide on this basis, the continuity of the hospitals, the continuity of qualified and specialized medical care, improve the performance of diagnostic and treatment work.

[Treatment organization for patients with gunshot wounds of the maxillo-facial region evacuated during the military operations in the Far East (1938-1939) and the war with Finland (1939-1940)]

This article describes the path of the maxillo-facial surgery to becoming an independent part of the general surgery. We will look closely at the experience, gained y field surgeons during the events at Lake Hasan and Halkin-Gol river. The war with Finland, that enabled the surgeons to develop the system of specialized dental help for the gunshot wounds, to create standarts of specialized equipment, examples of splints, etc, which were widely used during the World War II.

[From South Tyrol to Württemberg: the "resettlement" of South Tyrolean psychiatric patients within the Germano-Italian Option Agreement of 1939]

Object of this article is the procedure of the transport of South Tyrol patients to the South Wuerttemberg asylums Zwiefalten und Schussenried as well as to some extent to the former asylum of Weissenau near Ravensburg in 1940 and 1942. Attention is focused on the pioneering state pre-negotiations, the so-called option treaties between the German Reich and Fascist Italy as part of the general aspect of National Socialist bio-Politics.The treatment of these South Tyrol patients in the asylums themselves, as well as their fate will be put into the context of the resettlement actions at the margins of the "Third Reich", which started in 1939 and widely affected the European continent. By presenting the abuse of medical patients in the aim to solve the political problems having occurred after bio-political goals had been set into practice, this study offers new material to the history of National Socialist psychiatry, as well as to National Socialist Foreign Policy in the case of Italy.

[Experience in development of deployment tools of medical evacuation stages]

Paper is devoted to the history of creation of various types of field installations of the tent, mobile medical units and facilities, the experience of their usage in combat. An analysis of approaches to medical support of troops and equipment of the medical service in accordance with the changing nature of military operations in the XX-XI centuries is performed. Description of several generations of means taken to supply is given.

[Providing medical care in the Leningrad hospitals during the Soviet-Finnish war of 1939-1940]

Leningrad Health Care was assigned a central role in medical care of wounded and sick during the Soviet-Finnish war during 1939-1940. The outbreak of war in Leningrad and its suburbs, as well as a number of settlements adjacent to the front-line rear areas, was deployed hospital bed net hospital base of the front. Medical institutions of Leningrad, serve the needs of the army and navy, were not uniform in its structure. They had different departmental subordination, as well as the nature and scope of tasks. During the period from December 1, 1939 to September 1, 1940 in Leningrad, has received 167 915 persons. In the City there was a range of institutions, where the wounded and sick have finished a course of treatment, as well as rehabilitated.

[Role of the 33rd distributing evacuation station in medical-evacuational support of the troops during the Great Patriotic War]

This article is concerned with the arrangement of formation of the administration of 33rd distributing evacuation station and organization of its evacuation work of casualties from hospital bases of West front lines to the hospitals in back land and also the main tasks of its subunits and units. The way of hospital trains performance, the amount of the hauls during the years of the work, average duration of one haul and average speed in kilometers, the amount of transferred casualties including litters.

The history of organized medical transport in Minneapolis: 1867-1930

When Minneapolis officially became a city in 1867, there were no hospitals or ambulance services within its limits. Four years later, in 1871, the first hospital in the city, Cottage Hospital, opened its doors to the public, shifting medical care from the family home to the hospital. The need then developed for organized medical transport. The period between 1880 and 1890 marked the beginning of limited ambulance service in Minneapolis. Over the next 40 years, many public and private institutions developed their own transport services. During that same time, skilled medical transport in which physicians and/or nurses went along on calls began, and the transport of patients transitioned from horse and wagon to motorized ambulances. These developments would set the stage for future innovations in Minneapolis' emergency medical system and ultimately improve patient care and survival.

Evolution of the intensive care unit as a clinical center and critical care medicine as a discipline

This article discusses the history of the ICU and critical care medicine (CCM). It also discusses the certification of critical care nurses and allied health professionals, as well as CCM societies and congresses, education and board certification, evidence-based CCM, research and publications, and future challenges to the field.

[Brazilian Army nurses and transportation of the wounded: a challenge faced during World War II]

This historic-sociologic study aims to analyse the challenges faced by the Brazilian Expeditionary Force's Air Transportation Nurses of the Army with the Theatre of Operations on the course of World War II. The primary source was comprised of a photograph from this time period and oral testimonies of those who participated in the conflict. Ideas by sociologist Pierre Bourdieu support the discussion. Results suggest that Brazilian nurses were challenged to transport the wounded without medical advice. We conclude that the challenge to fulfill the task imposed, which led to independent decision-making, gave confidence and autonomy to the ones already responsible for the transportation of the wounded.

Aeromedical evacuation in the "Luftwaffe" from its origins until 1945

Prior to WWII, Germany had little experience in aeromedical evacuation (AE) of the sick and wounded. The need for a specialized AE organization was recognized, organized, and used extensively on all fronts during WWII. Nearly 2.5 million casualties were transported by regular troop carriers and 11 specialized AE Units, which concentrated on the intensive care air transport of the seriously wounded, especially those with injuries of the brain, eyes, or jaw, thoracic or abdominal wounds, or gun-shot fractures. The AE Units were commanded by medical officers, most of whom were pilot-physicians, who had command jurisdiction over flying and line personnel as well as medical service personnel. The AE Units were equipped with both Junkers Ju-52s, which could carry up to 12 litter patients plus 3 to 5 ambulatory patients each, and with Fieseler Fi -156s (STOL "Stork" for 1 or 2 litter patients), ambulances, as well as the personnel needed for operating and maintaining the vehicles and materiel. The AE Units of the Luftwaffe--the Sanitaetsflugbereitschaften--made an outstanding contribution to military medical care in achieving this significant number of casualties evacuated under the humanitarian symbol of the Red Cross.

A Tribute to William B. Long, Jr., and William B. Long, III: A Celebration of Their Revolutionary Contributions to Trauma Care

An emergency medical system for trauma care has been conceived in our nation in an effort to improve delivery of emergency care to the accidentally injured patient. There are an estimated 20 million disabling injuries in our nation that should be cared for in trauma centers each year. This report has been written to acknowledge Dr. William Long, Jr., as well as Dr. William B. Long, III, for their unique contributions in establishing the Maryland Statewide Trauma System. Dr. William Long, Jr., played an instrumental role in working with Dr. R Adams Cowley to verify the life-saving value of the Maryland State Police helicopter system. In addition, Dr. Long, Jr., crafted a plan with Dr. R Adams Cowley that allowed Dr. Cowley the autonomy from the University of Maryland Medical School to develop a separate and distinct trauma facility, which is recognized throughout the world. It is indeed fortuitous that Dr. William B Long, III, experienced these landmark changes in trauma care in Maryland, which provided a catalyst for his future career that included extensive training in general surgery in Edinburgh as well as training in trauma surgery with Dr R Adams Cowley. These unique experiences convinced him to expand his training into cardiothoracic surgery. During these academic adventures, he became an international authority on the mathematics of trauma scores, cardiothoracic trauma resuscitation, and the components of a Level I trauma center. These empowering experiences became a catalyst for Dr. William Long, III, to undertake the scientific and clinical studies that would allow him to develop the only American College of Surgeons Committee on Trauma (ACSCOT) Verified Level I Trauma Center in the Pacific Northwest. This report describes in considerable detail Dr. William B. Long, III,'s Trauma Center at Legacy Emanuel Trauma Center (Portland, Oregon) as well as to outline his plans to further improve trauma care in the state of Oregon so that it remains a legacy for his academic career. His dreams for having a comprehensive trauma system in the Pacific Northwest are described in detail so that it an be replicated in our nation and our world.Dr. Long became the Trauma Medical Director for Emanuel Hospital in the Fall of 1983. He began building Emanuel's trauma program by establishing an infrastructure that would support technically advanced ways of restoring life and function. His trauma center consisted of the following components: trauma registry, trauma resuscitation nurse program, direct to operating room policy with unstable trauma patients, anesthesia as part of the trauma resuscitation team, massive transfusion protocol, mobile surgical transport team, outreach to rural communities, recruitment of specialists with interest in trauma care, development of a new trauma physical facility, and the Physician Assistant educational program.

[Function of observation posts and squads escorted wounded transports in the Great War]

In autumn of year 1914 more and more epidemic cases were observed from the eastern front-line. The infected wells, the lack of cleanliness and the health were the reasons, and the home territory was also in danger because of transportation of the wounded soldiers. For the sake of defence the sick soldiers were transported as a closed detachment, then "saving zones" were established with ill-observation posts. The posts were ruled by two leaders. The commissioner of the Minister for Home Affairs prevented spread of contamination, the commanding officer of the military squads organized order and subordination. There were squads escorted the wounded detachments; they worked in two areas: from the border railway stations to the observation posts and at these posts. They worked as escorts, supervisors of the sick soldiers. The posts were barracks; they consisted of an entrance room, operating rooms, laboratories, barracks of infecting and non-infecting ills etc. The soldiers were quartered into 5 groups, infecting ills, non-infecting ills, people contacted infecting ills, wounded men, other ills. The staff of posts consisted of 57-64 people.

[Experience with passenger motor ship re-equipment used for evacuation of the wounded and sick]

In September 2002 the mobilization headquarters training was conducted on the base of Volga-Baltic steamship. During this training the passenger motor-vessel (the project 301) was re-equipped into sanitary-and-transport ship. The sanitary treatment coast post and the elements of evacuation receiving-room were developed by the personnel on the shore near the mooring wall. On the 3rd day the ship's sanitary treatment post, medical department (60 beds) with the wards for psychic patients (4 critical patients/ward), post for nurse on duty, room of physician on duty, dressing room, drugstore, autoclave room, clinical laboratory and collective defense post were created in the re-equipped rooms of the ship. The training has confirmed the advantages of casualty and patient transportation using the inner water-ways over the other types of transport. The following defects should be noted: the season work of river transport; frequent discrepancy of river trend with evacuation ways; comparatively low rate of transportation; different types of river ships used for medical evacuation.

[The sanitary support for military operations in putting out of combat some detachments of the Algerian ALN who had jumped over the electrical fences on the Tunisian border in 1958-1959]

General Forissier, MO deals with a very particular problem which occurred within a short time period: the sanitary support units involvement in the large operations which took place in the semester back in 1958, during which the parachutists were opposed to units which were violently attempting to jump forcibly over a barrage which was still under construction. The article focuses on the respective losses inflicted on the forces involved and on the manner in which the evacuation of the wounded was undertaken.

[Brief history of the hospital bed]

Start as simple litter for several patients in the Middle-Age, the hospital's bed had progressively change to the first mechanical beds in the XIX century.

Operation Homecoming: 25 years later

Following an end to U.S. involvement in the Vietnam War in early 1973, approximately 600 Army, Navy, Air Force, and Marine personnel, the great majority aviators, were released from captivity in North and South Vietnam and Laos. Their initial medical evaluation was performed at USAF Hospital, Clark Air Base, Republic of the Philippines, between February and April 1973. The author describes the events of those memorable days.