Forged in War
As Dr. Rosset reminded us, with the specter of war so intertwined with the 20th century, we must ask, “How much did war accelerate our knowledge of orthopedics?”
WWI was still raging when the organizers of the French Surgical Societymet in October 1918. Aware of the need to harness the power of science to the lessons of war, Dr. Kirmisson brought several colleagues together to form a new organization whose charter was to focus on an obscure corner of medicine—the study and treatment of musculoskeletal injuries and disease.
But the origins of orthopedics in general and the French contribution go back much further.
“During to the 1870 French war with Germany, the main problem for the soldiers was disease not the bullet wounds,” says Dr. Rosset. “During the first several weeks of WWI, because of new weaponry, the surgeons saw wounds they had never seen before.”
The horrific trend accelerated in WWI.
Bogged down in trench warfare, the emerging science of industry rolled out ever more destructive mechanizedweaponry—combat aircraft, tanks, machine guns and bombs—to break the armies loose.
Notes Dr. Rosset, “Before WWI, the practice was to bring wounded soldiers away from the front lines and into the city for surgery. But physicians in WWI were quickly overwhelmed with so many infections, amputations, and deaths that they began to think that there must be a better way. The war began in August; by the end of September they knew they were getting things wrong.”
“It became clear that instead of bringing the soldiers to the treatments, the treatments would have to go to them. Operating rooms, X-rays, etc…all was then brought as close as possible to the front lines. This was the time when debridement began. Previously, doctors would administer the dressing and send soldiers to the city and they would get an infection. Debridement and lavage gained a footing here; surgeons learned the importance of enlarging the wound area in order to have proper visualization. This way they could do a better job of removing the necrosis, the bullets, and the accompanying dirt.”
And the result, says Dr. Rosset, was that the rate of amputation at the beginning of the war decreased by roughly 3x.
