Medical Innovations

Credit: Science Museum website. Keynes Flask, blood transfusion apparatus.

(E (AUS) 4623) A ward of the 2nd Australian Casualty Clearing Station at Steenwerke, November 1917. Copyright: © IWM.

The First World War marked a different kind of warfare than had ever been witnessed before.  With new weapons and technology, soldiers suffered injuries of the kind that had rarely been seen before in war, which created great challenges for all the medical staff involved.  This resulted in many medical innovations, which were not only vital in saving lives in the war, but also led to progression in the field of medicine when the war was over.

One of the greatest medical innovations of the war was in blood transfusion.  Though it was not a new or untested idea, WWI improved and popularised the procedure.  Prior to the war, blood transfusions had limited success rates, and were not really trusted.  However, by 1918 transfusions were used extensively, and though there is no exact record of how many took place throughout the war, it is safe to say that they saved the lives of thousands of soldiers.

So, how did this procedure go from one which was rarely used, let alone successful, to one of the main ways of saving lives?  There are three men who are generally credited as pioneers in this, whose innovations led to the widespread and successful use of blood transfusions.

Lawrence Bruce Robertson, of the Canadian Army Medical Corps, encouraged the practice of ‘indirect’ transfusions using syringes and canulae, rather than ‘direct’ transfusions straight from donor to recipient.  He set up the first blood transfusion equipment at a casualty clearing station on the Western Front in the spring of 1917.  Robertson recorded the results of his transfusions and noted the successful results of the indirect method.

Following on from this, an American doctor named Oswald Hope Robertson further improved the process of blood transfusion.  Robertson set up the first ‘blood bank’ on the discovery that blood could be stored for up to 28 days when mixed with a citrate and dextrose solution to prevent clotting, and kept in glass bottles on ice.  He found that using stored blood in transfusions provided the same results as using fresh blood.  Having a stockpile of blood allowed transfusions to take place quickly and easily.  For his efforts, Robertson was awarded the British Distinguished Service Order, in recognition of the lives his innovations had helped to save.

A British surgeon of the Royal Army Medical Corps was also a pioneer in the field of blood transfusion.  Lieutenant Geoffrey Keynes designed a portable blood transfusion kit after observing the methods used by an American medical team.  The Keynes Flask allowed transfusions to take place away from established medical facilities.  Out on the front line, there was no way of refrigerating a stockpile of blood, so direct transfusion was the best option.  Keynes’ equipment contained a special device for regulating blood flow between donor and patient.  This relatively simple innovation contributed to the saving of hundreds of lives and became a standard piece of equipment in the army after the war.

Another of the most significant medical innovations of the First World War was the introduction of the widespread use of the ‘Thomas Splint’ in securing broken legs.  Injuries to the leg were the most commonly recorded types of injury in the war.  At the beginning, around 80% of soldiers who had broken femurs died, but by 1916, 80% of soldiers with this injury survived.  The Thomas Splint is credited as the main cause for this turnaround.

Due to the nature of fighting in the First World War, even ‘simple’ injuries could be lethal.  Debris and shrapnel from shelling tore through skin and bone and caused a great deal of damage, which was very often fatal.  Leg injuries became much more commonplace, and also much more dangerous.  The Thomas Splint was one of the methods of combating this, and its use was popularised by two men, Robert Jones and Henry Gray.

The Thomas Splint was invented in the late nineteenth century by Welsh surgeon Hugh Owen Thomas, but his nephew Robert Jones was greatly responsible for introducing its use on the battlefields of the First World War.  Jones was the director of military orthopaedics from 1916 and directed 20 military orthopaedic hospitals.  One hospital, at Shepherd’s Bush in London, saw the return of 1000 out of 1300 wounded soldiers to fighting.  Jones wanted not just to repair injuries, but to see soldiers returned to the front.  He established a system of rehabilitation, in which soldiers were not immediately discharged if they were injured, but were retrained to see if they could be made fit enough to fight again.  Jones’ advocation of the Thomas Splint and developments in orthopaedic services in the UK were great innovations of World War One.

Henry Gray, an Aberdonian surgeon, also encouraged the use of the Thomas Splint on the field, and further developed orthopaedic services on the Western Front.  He acknowledged the inadequacy of the Liston Splint, which was previously the main way of securing a broken femur.  This method often caused severe pain and blood loss and led to further damage.  The Thomas splint allowed bones to be successfully held in place, which gave the injured a much greater chance of actually making it to surgery.  As well as encouraging the use of the Thomas splint, Gray was also instrumental in the practice of wound excision.  This was radical surgery to clear wounds of dead flesh and filth, in order to prevent infection.  The effects of these two innovations was profound, as shown in the Battle of Arras (1917).  In 6 weeks, Henry Gray took in 1,009 compound fractures to his casualty clearing stations – at the time, it would have taken every hospital in the UK two years to take in that amount of cases!  Before Arras, the mortality rate in clearing stations was 50%, mostly caused by shock due to blood loss.  Amputations were also commonplace, with a widespread belief that the only way to treat compound fractures to the femur was through amputation.  At the Battle of Arras, the Thomas splint was used on all compound fractures.  This resulted in only 5% of wounded soldiers arriving at clearing stations in shock, and the mortality rate was only 15.6%.  Gray’s amputation rate was also relatively low, at 17.2%.  Gray’s encouragement in the use of the Thomas splint and his innovations in wound excision were paramount in treating femur injuries during the First World War.

 

Significant innovations in plastic surgery also arose from the First World War.  Shrapnel was a new consequence of modern warfare. It was the biggest killer on the battlefield and the cause of many significant facial injuries, which could be extremely traumatic for victims, especially on returning to life after the war. Improvements in medical care meant that more soldiers were able to be kept alive, but dealing with these kinds of injuries was a different matter.

The pioneer of treating facial injuries was a New Zealand-born surgeon called Harold Gillies, whose actions and techniques are credited with paving the way for modern-day plastic surgery. He was determined not only to return normal function to patients, but also to achieve aesthetic results and restore the person’s appearance as much as he could. In his efforts to achieve this, Gillies was pushed to more experimental methods, which were not always successful. He learnt that plastic surgery should be carried out in small stages, and should not be attempted in one major operation – a lesson that still informs the field. His greatest innovation in plastic surgery was the ‘tubed pedicle’. This involved using a patient’s own tissue for reconstructive surgery and greatly reduced the chances of infection, which was a major issue in these types of extreme facial injuries. Gillies succeeded in getting the British Army to set up their own plastic surgery unit, and the first modern centre for facial and plastic surgery opened at Sidcup in 1917.  By 1925, Gillies and his team had treated over 5,000 soldiers and had carried out over 100,00 operations.

Another cosmetic innovation brought about by World War I was in the modernisation of prosthetics. At the end of the 19th century, most artificial limbs were wooden and customised to individuals. The First World War created an urgent need for new prosthetics, and lots of them. This led to the widespread introduction of metal prosthetics, and an increased standardisation in manufacturing methods which enable artificial legs to be produced in large volumes. The innovators in this area were the Desoutter Brothers. One of the founders had lost his leg in a flying accident, and his brother (an aeronautical engineer) created a leg for him using an aluminium alloy called duralumin. Duralumin legs were much lighter than wooden ones, and although more expensive they were more durable, and so saved money in the long run. The British government gave the Desoutter Brothers a contract to supply artificial limbs for ex-servicemen – truly modernising the field of prosthetics.

Credit: gilliesarchives.org.uk
Photo of Harold Gillies in 1915

Credit: Science Museum website. Keynes Flask, blood transfusion apparatus.