W

artime medicine is an incredibly challenging setting for the doctors, nurses, and paramedics who practice it: Not only are the injuries frequently serious ones, but the tools at hand are often more limited than in a traditional hospital.

Over the centuries, that has meant that battlefield medical personnel have had to innovate. Those wartime practices, in turn, often served to refine medical practice beyond the military.

Here are six cases in which wartime clinicians changed the way medicine is practiced more broadly.

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Tying off

War’s biggest killer has always been blood loss. That’s not a surprise, given the weapons of war over the ages, including swords, bayonets, bullets, grenades, and missiles. But it was a 16th-century Italian war that popularized a means to slow or stop the bleeding. In 1537, a French barber-surgeon named Ambroise Pare went to care for soldiers at the Siege of Turin. Horrified by the many bloody injuries he came across, Pare began fashioning ligatures, and tied them onto the soldiers near their wounds. He wasn’t the first to think of that — Romans and Arabs had also deployed the technique of tying a rope or belt onto a wounded limb — but it had fallen out of favor as doctors adopted other ways to stop bleeding, such as cauterizing wounds with boiling oil.

That method, on a battlefield, was as inconvenient as it was (probably) painful. So Pare was instrumental in getting doctors to reconsider ligatures, or tourniquets, leading to the widespread use of them today — not just on the battlefield but in emergency rooms and at sites of accidents and natural disasters.

Shedding light

Sometimes medical discoveries take an extra-long route from the battlefield to the doctor’s office. In 1862, after the Civil War’s Battle of Shiloh, medical personnel noticed a glow in the wounds of soldiers from that fight. The mysterious light baffled the doctors even more when they noticed that soldiers whose wounds glowed had a better survival rate than those without illuminated injuries. That prompted many at the time to call the phenomenon “the angel’s glow,” indicating that celestial beings had healed the soldiers with heavenly light. It took almost 140 years, a microbiologist mom, and two teenagers to find a more earthly explanation.

In 2001, after learning of the glowing wounds at a history exhibit, 17-year-old Bill Martin asked his mother, who studied bioluminescent bacteria, whether those could be responsible for the glowing wounds of the Battle of Shiloh. And like any good scientist, USDA microbiologist Phyllis Martin told her son to conduct an experiment to find out. So he did. The younger Martin and his friend Jonathan Curtis discovered that the glow came from Photorhabdus luminescens, a bacterium carried by nematodes — small worms which feed on insects. The boys concluded that as the soldiers crawled through mud, their wounds attracted insects, followed by the hungry nematodes. The nematodes’ bacteria not only break down the insect bodies for eating but also kill off competing microbes.

It was the latter function that saved the soldiers. And since that discovery, medical scientists have begun looking into Photorhabdus luminescens as a way to treat antibiotic-resistant infections. Other researchers are using the glowing bacteria to develop a protease inhibitor to treat HIV and other diseases.

Restoring flow

On the battlefield, blunt-force and impact injuries can stretch or crush veins and arteries. So, it’s not surprising that war and its attendant injuries have driven many of the advances in repairing blood vessels.

Much of the progress came during the Korean War, which began in 1950. At that time, Army vascular surgeon Carl Hughes and his colleagues at Walter Reed Army Hospital set out to study the types of vascular injuries Korean War soldiers suffered and how they fared.

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Among the team’s discoveries was that while ligation — tying off or clipping injured vessels — stopped the bleeding immediately, it resulted in amputation far more often than simply taking the time to repair the artery or vein. This realization led to a dramatic drop in the number of wartime amputations from World War II to the Korean War.

The discovery also helped popularize vascular repair surgery more broadly, by familiarizing surgeons with the techniques and with new tools such as the now-ubiquitous Potts clamp. Today those tools and techniques help treat everything from heart disease to varicose veins.

Halting infection

War also brought about the mass production of antibiotics, especially sulfanilamide and penicillin. World War II helped both of them find widespread respect, production, and use.

In 1928, when Scottish bacteriologist Alexander Fleming noticed a weird mold had taken over his Petri dishes and eliminated the bacteria on them, his findings didn’t get much notice. But Fleming continued his research and kept talking up what he called “mold juice” (he didn’t come up with “penicillin” until later), eventually winning a Nobel Prize and attracting the attention of drug maker Pfizer. The company soon began mass-producing the drugs for distribution to medics during WWII, and ultimately, to doctors and hospitals across the country.

In 1932, German biochemist Gerhard Johannes Paul Domagk discovered that the compound sulfanilamide could vanquish deadly strains of bacteria, like the streptococcus in his lab mice and in his first human test subject, his gravely ill young daughter. The wide distribution of so-called “sulfa drugs” began when World War II soldiers carried powdered sulfanilamide in their first-aid kits. By the end of the war, doctors were routinely using these antibiotics to treat streptococcus, meningitis, and other infections.

Saving face

Though plastic surgery is often associated with cosmetic procedures, its origins were in reconstructive surgery. Today, reconstructive plastic surgery helps people with cosmetic concerns resulting from birth defects like cleft lips, physical assaults like acid attacks, and medical conditions like necrotizing fasciitis and other causes of disfigurement. And its origins trace back to 20-year-old Carleton Burgan.

Hospitalized while serving in the Civil War, Burgan was taking mercury pills for pneumonia. They created a gangrenous ulcer on his tongue. Grangrene spread quickly from his mouth to his eye and led to the removal of his right cheekbone.

Desperate, the young man offered up his face to Gurdon Buck, a New York surgeon. With a series of operations, Buck used dental and facial fixtures to fill in Burgan’s missing bone until the Army private’s face regained its shape. Buck also photographed the progress of Burgan’s facial regeneration. Buck went on to perform 32 more facial reconstructions for soldiers disfigured by bullets, bayonets, and musket balls, and he photographed many of those operations. Though primitive by today’s standards, Buck’s techniques planted the seeds of the sophisticated reconstructive surgery we have today.

Getting there

As the Civil War got underway in the 1860s, transport for wounded soldiers consisted largely of a motley collection of vehicles operated by whomever happened to be available. And some of those people weren’t particularly suited for the job because they drank heavily, and/or fled with an empty wagon when the shooting started.

Enter Jonathan Letterman, an Army doctor who developed an efficient and effective ambulance system that ultimately became a model for today’s local systems of emergency transport. At each battle, he set up caravans of 50 ambulances. Each vehicle carried supplies, including morphine and bandages, along with a driver, a stretcher, and two guys to carry it.

Letterman built on his efforts as the war dragged on. He added a lockbox to the ambulances, under the driver’s seat, to prevent bandits from stealing drugs and other supplies. Spring suspensions made for a smoother ride over the uncertain and variable terrain between the battlefield and the hospital.

His ideas led to better, faster recovery from war wounds. Now Letterman’s name graces an award for improving patient outcomes.

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