in year 1925 an injured Russian soldier completely recovered what is the probability that he was injured in the year 1920-21
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Abstract
The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.
Introduction
The need for surgical care of survivors of accidents or animal attacks is part of the story of civilization, as is the story of medical care of those wounded in that other peculiarly human endeavor, warfare [41]. During the past 250 years, and particularly during the 20th century, developments in military trauma care for musculoskeletal injuries have greatly influenced civilian emergency medicine. The history of military trauma care must be understood in terms of the wounding power of weapons causing the injury and how the surgeon understood the healing process. Improvements in weapons technology forced surgeons to rethink their interventions in their effort to tip the odds of survival in favor of their patient.
Our purpose is to review the evolution of military trauma care during the past two and a half centuries in major conflicts in the West. The major areas of emphasis are medical evacuation and organization; wounds and wound management; surgical technique and technology, with a particular focus on amputation; infection and antibiotics; and blood transfusion.
Medical Evacuation and Organization
Perhaps the most basic problem facing physicians during wartime historically has been whether (and how) to transport the wounded to care or transport the caregivers to the wounded. A secondary problem historically has been how best to organize the delivery of care as modern nations began to dispatch vast armies and navies to fight across vast distances.
For example, Pikoulis et al. [110] reviewed the wounds depicted in The Iliad and determined the arrow wounds such as the one suffered by Menelaus carried a mortality rate of 42%, slingshot wounds 67%, spear wounds 80%, and sword wounds 100%. These high mortality rates suggest surgeons were unable to get to wounded soldiers during the melee, treating only the higher class or those who survived after the battle had concluded. These Greek surgeons, whether they realized it or not, faced the same issues as all future practitioners engaged in wound care: wound management, The Golden Hour (the principle that a victim’s chances of survival are greatest if he receives resuscitation within the first hour after a severe injury), and infection control.
During the American Revolution (1775–1783), the Continental Congress authorized one surgeon to serve in each regiment. Few of the regimental surgeons, mostly trained through the apprenticeship system as there were only two medical schools in the United States (King’s College [now Columbia University] in New York, NY, and the University of Pennsylvania in Philadelphia, PA), had any experience treating trauma. The organization was minimal, and regimental surgeons tended to work for their unit instead of seeing themselves as part of the Hospital Department, which was rendered ineffective by bureaucratic infighting [116].