MEDICINE, WORLD WAR I

The Great War was a staging ground of carnage, diseases, and psychological disorders on scale that dwarfs suffering in peace time. Millions of people who otherwise would have escaped such ravages were killed, maimed, and scarred for life. While the extent and devastation of the war affected battlefield care and post-combat treatment, loss of relatives, crippling injuries, impaired health, and psychological disorders also had a profound effect on social attitudes and culture after the war ended.

The First World War was the first in which battlefield fatalities outnumbered deaths by battlefield disease. Heavily armored tanks, machine guns and gas warfare replaced the antiquated cavalry and cannons of past conflicts. Great advances in prostheses were made. Gunshot wounds were now irrigated with antiseptic fluid (Carrel-Dakin treatment), which helped prevent gangrene. Most importantly, hygiene became an ever-present issue.

Throughout the war, soldiers fought, ate, slept, washed, and relieved themselves in narrow trenches surrounded by dead, decomposing bodies and hungry diseased rats. To make matters worse, the body louse, also known as the "chat," was rampant. Since lighting fires on the front lines was prohibited because they would attract sniper fire, soldiers often had to huddle in close groups in cold weather, thus enabling infestation. Besides being a vector for diseases like typhus fever, which killed millions of German and Russian troops on the Eastern Front, the body louse can spread very quickly, producing up to twelve eggs per day. When conditions allowed, soldiers made social events of picking off these lice from clothing hair, and skin; these events were often called "chats" or "chatting up."

Although lice were bothersome, and on occasions deadly, they may have saved many lives. Louse feces caused "Trench Fever," also known as the "Five Day Fever," marked by high-grade fever, aches, and rashes. Soldiers suffering from Trench Fever had to be evacuated from the lines. However, rarely did anyone die from this condition.

Trench Foot, another ailment facilitated by bad hygienic conditions, was the result of prolonged periods in wet soggy boots in cold, water-filled trenches. Feet swelled, blistered, and caused intense pain. Though this was not usually deadly, if it was not treated gangrene could set in, necessitating amputation. To avoid Trench Foot, soldiers were required to change socks and wash feet whenever possible.

The outbreak of venereal diseases in wartime France increased because many women, whose husbands had been killed, became prostitutes for financial and other reasons. During the war the control of licensed prostitution, which had been enforced by the "police de moeurs," became less rigid. According to one U.S. Navy physician, 50 percent of prostitutes were infected with syphilis in its primary and secondary stages. All of these women were infected with gonorrhea. To protect soldiers the U.S. military used measures such as semi-monthly inspections of troops, warnings, prophylaxis, and in some cases, loss of pay for illness.

Shell shock, later called war neurosis and now known as post-traumatic stress disorder (PTSD), was a popular label for neuropsychiatric casualties of the war. Victims of this condition, who were initially believed to have suffered from concussions due to exploding shell blasts, often exhibited starry-eyed looks, violent tremors, expressions of terror and sometimes blindness and paralysis. Although the treatment of this multi-symptom condition varied, Americans such as U.S. Army psychiatrist Dr. Thomas Salmon developed a program consisting of rest, food, access to a warm shower, and assurance that victim was neither cowardly nor ill. Many victims suffered from the psychological damage caused by the war for the remainder of their lives.

TRIAGE

From the French word trier "to sort out," triage means to sort casualties of war or other wounded persons according to the seriousness of their injuries, the need for immediate treatment, and the availability of a place for treatment. This medical prioritization system was developed during World War I, when there were usually not enough doctors or medical supplies at field hospitals. Physicians and support personnel had to balance time-consuming and high-intensity treatment against treating the lightly wounded in order to send them back to their military units. Later The Geneva Convention for the Protection of War Victims: Armed Forces in the Field, one of the four Geneva Conventions of 1949, would stipulate: "Only urgent medical reasons will authorize priority in the order of treatment to be administered." Triage procedures are also used today in hospital emergency rooms and in disaster relief situations.

One might say that the war ended with a cough, not a bang. In 1918, the year of the Armistice, more people

died from Spanish Influenza than from combat. Of course, "Spanish flu" was a misnomer for the pandemic that wreaked havoc across the world. It is believed that the disease began at a Kansas army training facility in 1917, spreading throughout North America, and was brought to the European front by American troops. Somewhere along the line, as a result of increasing human antibodies, it mutated. By the time it reappeared in the United States in the fall of 1918, influenza brought on the added complication of pneumonia. Health providers could treat only the symptoms. By 1919, after a reign of terror that killed between 22 and 40 million people worldwide and over 675,000 Americans, the virulent form of flu simply vanished. Today's virologists are still unlocking the mysteries of the virus.

During the war 4.7 million Americans were mobilized; of these, about 4 million were in the Army, 600,000 served in the Navy and 79,000 were Marines. In total, 116,708 American servicemen died during the war, including 53,513 killed in battle. These statistics do not reveal the stories of the many survivors who became physically and/or psychologically impaired from the toll of war. However, the medical community gained new understanding of military medicine, leading to preparation for the onslaught of the next major conflict of the century just twenty-one years later.

bibliography

Armstrong, James F. "Philadelphia, Nurses and the Spanish Influenza Pandemic of 1918." Navy Medicine, March-April 2001: 92.

Jones, Franklin D. "Psychiatric Lessons of War." In War Psychiatry, edited by Franklin D. Jones, et al. Falls Church, VA: Office of the Surgeon General, U.S. Army, 1995.

Keegan, John. An Illustrated History of the First World War. New York: Alfred A. Knopf, 2001.

Miller, M.G. "Of Lice and Men: trench fever and trench life in the AIF." Paper presented at the Second Anzac Medical Society meeting, France, October 1993.

Surgeon General, U.S. Navy. Annual Report to the Secretary of the Navy. Washington, DC: Government Printing Office, 1918.

André B. Sobocinski

See also:Medicine, World War II; Red Cross, American.