Advances in Medicine From the Frontlines

[Richard Wigle MD FACS]

Steve,

You have touched on an area that I have had quite an interest in over the last years. The military has contributed many things to medicine over time, some of which you wouldn't expect. On the other hand, many things you would think would have been military in origin turn out not to be

Everyone knows about Larrey and the ambulance although most people don't realize that the term ambulance (ambulancia) is several centuries earlier and referred to a field hospital- what Larrey contributed was the "ambulance volante"(spell??) or "flying ambulance" which was an equipped wagon which took the hospital and surgery to the wounded but could also transport them to the rear. These were part of one of the first organized medical corps (Wellington at Waterloo believed that medical personnel just got in the way and the British seemed to more or less continue to feel that way right up the Crimea snd Florence Nightingale)

The Letterman plan during the Civil war was a direct derivative of Larrey's ambulance corps in it's organization and although  multiple designs were tried two came to predominate. The first civilian medical service in the US was organized by  Dr Dalton (I've forgotten his first name) in New York about 1868 and initially used surplus army ambulances although they rapidly switched to a design modified from the army vehicles 

First Aid is of military origin and surprisingly recent. In the 1870's Esmarch in Prussia wrote a text "Erste Hilfe" to teach soldiers to treat each other on the battlefield. The first civilian first aid course was in England at about the same time and was developed and taught to factory workers by a military surgeon, name of Roberts I think, who was posted to the area. It proved immensely popular and was rapidly copied, many small first aid books were published  which often taught useful skills such as splinting extremities with the bayonet or rifle that I guess factory workers were supposed to carry. Anyway they got the point across

The first air transport has been given as being by balloon out of the Paris siege during during the commune although this is disputed. Air transport was proposed during WWI although never, as far as I know, actually took place, being forbidden by the command. In the immediate post war years the first transport used a military fixed wing although civilians were transported. The first helicopter transport occurred during the Korean conflict

These are some of the major prehospital contributions. Obviously one would also have to mention Ambrose Pare and the treatment of wounds, Larrey's many surgical contributions as well as his aforementioned organizational pieces of genius, the work on shock during WWI by Crile and many others, early abdominal surgery for penetrating injuries during the Russo Japanese conflict by a female Russian surgeon whose name escapes me (who operated in a specially equipped RR car) and of course the work on burns during and after the Korean conflict by Dr Basil Pruit and others at the Army surgical research unit. And, despite the fact they are not surgical or trauma, Walter Reed and yellow fever and the Russians (that's right)and PTSD.

Something else to look at is the Knights Hospitabler (sp?) or the knights of Malta which one continues to see not only as a worldwide NGO but also as the Johannes Rutter or Maltesers in Germany and St John's Ambulance in Britain and Australia.


These are the things that most rapidly come to mind, sorry some of the facts are a bit vague but I don't have access to either my library or PowerPoints at present. If anything strikes you or there is any other area that comes to mind I'll at least be able to get at my PPt slides and pictures in a day or two. Apologies for all the misspellings.


Dick Wigle 
LTC (ret) USAMC
Dept Surgery, LSU Shreveport



--- On Sun, 7/13/08, Stephen Richey <stephen.richey at gmail.com> wrote:

> From: Stephen Richey <stephen.richey at gmail.com>
> Subject: Advances in Medicine From the Frontlines
> To: trauma-list at trauma.org, ccm-l at ccm-l.org
> Date: Sunday, July 13, 2008, 1:26 PM
> I am in the process of writing a short article for a
> newsletter about
> advances in critical care and emergency medicine based upon
> military
> medicine.  I have a basic idea for most of the topics I
> want to touch upon,
> but I would appreciate hearing what everyone thinks are the
> most important
> contributions to arise out of military medicine- at any
> time, not just
> recently.  Please feel free to contact me off-list.
> 
> Thank you in advance.
> 
> 
> Sincerely,
> -- 
> Stephen L. Richey, CRT
> Aviation Injury Research Project Leader
> Saginaw Valley State University
> Phone: 248-366-4452
> --
> trauma-list : TRAUMA.ORG
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