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Thanks to the MASH series devoted to the adventures of American doctors and nurses serving in a military field hospital during the Korean War, the struggle for health and life on the front line became a topic that lived on TV audiences for many years. Meanwhile, the Lazarets are almost as old as the wars themselves. They have saved countless troops and have come a long way from gloomy places of agony to air-conditioned facilities with the most modern equipment.
- The origins of military lazarets date back to ancient times
- Over the centuries, treating the wounded in battle was reminiscent of scenes from a horror movie, where blood and amputated limbs were daily bread, all surrounded by the ubiquitous infectious diseases passed from one wounded to another.
- «They are carrying two dead, bloodied men up the stairs. In the open living room on the table, a man undergoes a leg amputation. Two bloody legs were abandoned at the door »- this is a description of the field hospital from the times of the Civil War
«The officer gave the order to retreat. I was backing away when suddenly something stabbed my hand. I fell, blood spurted. My colleagues disappeared from my sight. I was left alone … I heard pieces of lead whistle around my head. I crawled into the enormous bullet hopper and began to sink into the mud. All stained with goo, I fled to hide behind a hedge which, by God’s grace, remained there. Nobody around… Looking around, I saw a crashed tank half-tilted. Sweat flooded my face. And then, in this great expanse of mud and barbed wire, I noticed a little flag with a red cross sticking out of the ground. I felt safe again ».
These are the words of Private Alfred Willcox of the Royal Sussex Regiment, one of 310. of the casualties of the British Expeditionary Forces in the Battle of Ypres in 1917. To him and millions like him, the “red cross on a little flag” – the emblem of the members of the medical corps who took care of the wounded with dedication – meant life.
It started in ancient Rome
Military medicine has come a long and arduous road since the introduction of organized care for the sick and wounded by the Roman army.
In the time of the Republic, only wounds were treated in the Roman army. The more seriously wounded soldiers were placed in the homes of patricians, where they recovered. The situation changed when the legions began fighting in remote provinces of the empire. By order of Emperor Octavian Augustus, a system of hospitals was created – valetudinaria – located along the main routes, and today considered the greatest Roman innovation in the field of medicine.
Valetudinaria were an integral part of military camps and forts all over Europe. There were, among others, surgical operations, as indicated by tools found during archaeological excavations. During the Empire, the hospitals of Octavian Augustus were ready to accept up to 10 percent. the composition of the legion.
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The legacy of Rome was taken over by the Byzantine Empire. Traditional Roman military hospitals functioned there, and during the reign of Emperor Maurice (582–602), when the army was modernized, the nature of the medical service changed. Each regiment had a medical unit, consisting of a doctor and surgeon, and a stretcher. However, medical facilities for the army were located only in cities and wounded and sick soldiers were treated there.
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The Kingdom of Jerusalem
The Crusaders were at war with neighboring Muslim states for almost 200 years. We owe them the creation of military orders, the first of which, the Order of the Knights Hospitaller (Maltese), was called to care for the sick and poor pilgrims to the Holy Land. His greatest achievement was founding a hospital in Jerusalem. It served the army and the population as a general hospital. After the Battle of Tel Geze in 1175, 750 Christian knights were admitted there, which means that the Crusaders did not set up field hospitals.
Średniowiecze
The first traces of the existence of a field hospital can be found in the chronicles of the siege of Granada – the last Muslim stronghold in Spain – in 1484. Establishing a field hospital for wounded soldiers was the idea of Queen Isabella. The ruler sent six large tents to the camp with equipment, doctors, surgeons, paramedics and medicines. She ordered no fees to be collected from the injured, as she would pay for everything. Behind the Catholic army, there were about four hundred wagons covered with awnings, known as the Queen’s Hospital. Everything needed by doctors and surgeons was found there. Given that Islamic medicine was at a much higher level at the time, some suggest that Isabella borrowed the idea of the hospital from the Moors.
Her grandson, Charles V, continued her grandmother’s policy. In his army, sick and wounded soldiers were taken from the battlefield and placed in tents forming a kind of hospital, where doctors and surgeons took care of them.
Renaissance and the times of religious wars
During the religious wars of the 1597th and XNUMXth centuries, some steps were taken towards better organization of military medicine. The first was initiated by Prince Sully, minister of Henry IV, during the siege of Amiens in XNUMX. He established a field hospital that moved with the fighting armies.
On the other hand, in Germany, military hospitals were organized for the Catholic League by order of Elector Maximilian I in 1620. They were stationary, but were located close to the battlefields and therefore were called field hospitals. They were aimed at providing the necessary medical assistance to the casualties in combat and enabling them to be evacuated further to a permanent military hospital.
In the XNUMXth century, the command of the Spanish army of Flanders concluded that if disease and injuries were not handled properly, they could push soldiers into desertion. This led to the creation of field hospitals to provide initial treatment to combatants and then transport them to the hospital in the rear.
The development of military medicine in England began with the creation of a standing army. Each regiment had a surgeon and an assistant surgeon. The task of these specialists, supported by soldiers, was to heal 40 sick on the battlefield, and then to transfer them to the rear. Field hospitals only appeared in 1690 during the campaign in Ireland. They were to accompany the troops and therefore were called “marching hospitals” or “flying hospitals”. They were logistically independent, consisted of 12 horse-drawn carriages carrying 25 tents. Their main task was to service the victims as close to the front line as possible, and then to evacuate them. From such a hospital, located beyond the reach of enemy cannons, the wounded were transported by carts to permanent facilities. The “marching hospital” could accommodate up to 200 patients and the necessary surgical equipment. The staff consisted of 17 staff officers: one physician, one surgeon, eight surgeon’s assistants, a chief apothecary and three medication assistants, and three suppliers.
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XNUMXth century
Firearms have been improved, while advances in surgery have increased the chances of survival of the wounded. The growing size of the army forced the governments to provide soldiers with appropriate medical care. Medical services and regimental hospitals were established – small units that provided immediate help to the victims in combat. Some armies even had field hospitals with qualified personnel.
During the War of the Austrian Succession, the British medical service treated the wounded directly on the front line, where surgeons performed surgeries. On the other hand, more severe cases were transported to hospitals in nearby towns.
Napoleonic wars (1792-1815)
Thanks to the new tactics and the massive use of artillery, the death toll grew rapidly. The wounded soldiers were left unattended on the battlefield for long hours, and the transport to hospitals far from the front took more than 24 hours, which resulted in high death rates.
Pierre-François Percy created a corps of trained paramedics in the French army; their task was to collect the wounded and transfer them to the nearest aid station. He also introduced horse carts as a means of transport. Each of them housed surgeons and teams that looked after the injured on the battlefield and during transport to the rear.
Dominique Jean Larrey, the chief surgeon of the Napoleonic army who had been involved in most of the campaign, commissioned a volante ambulance, a “flying ambulance” – a horse-drawn carriage that carried the wounded from the battlefield. Until now, victims have only been evacuated after the battle was over, and Larrey realized that the sooner treatment begins, the better the prognosis.
This meant operations on the battlefield and even under fire. It was also then that triage was used for the first time, guaranteeing access to treatment due to the severity of the injuries, not the rank. What is standard procedure today was a radical solution at the time. Larrey was also a supporter of the immediate amputation of the injured limb, rather than waiting to see if gangrene would develop. He decided that time to intervene was of paramount importance, becoming the father of emergency medicine.
The flying ambulance consisted of 340 people, divided into three divisions of approximately 113 people. The chief surgeon, 15 surgeons, and five members of the quartermaster’s corps were there. The cast also included people whose task was to carry surgical instruments and prepare dressings. Each division had 12 light and four heavy cars.
In the following years, military medical care followed one pattern. The stretchers picked up the wounded from the field and took them to a dressing point located just outside the range of enemy small arms fire. Such a point was equipped with all the necessary things, which, for example during the Civil War, included: bandages, chloroform (if available), morphine, opium and whiskey.
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The Civil War hospital was a dangerous place mainly due to lack of sterilization and widespread infections. Not only combat wounds were treated there, but also dysentery, typhus and measles. Besides, it was them, and not the wounds suffered in battle, that caused as many as two-thirds of the deaths of soldiers. Houses near the battlefield were also converted into hospitals. A description of one of them has survived: “Two men are carrying blood on the stairs. In the open living room on the table, a man undergoes a leg amputation. Two bloodied legs were dropped at the door … In the opposite room there are ten dying or wounded men, one has gangrene on his thigh, the smell is terrible. In the next room there are five soldiers, one is dying, the father is sitting next to him … Downstairs about forty men in different states, blood is flowing on the floor, the smell is overwhelming. No words can describe it ».
And one more message, this time describing the field hospital near Gettysburg: “The soldiers were in a terrible condition. They were lying right on the damp ground, and the lucky few on a handful of straw or rags. Many amputations were performed here, and the cut stumps were placed on the ground. Surgeons are overworked, they lack helpers…. Badly injured, they are constantly screaming and calling for help … Without clothes, many almost naked, covered with dirt, lying in the mud without food … ».
Under these conditions, the surgeon’s task was to stop the haemorrhage and prevent shocks until the injured were moved beyond the front line.
The XNUMXth century brings changes
In the early 1914s, the US Army Medical Department and the British Army Royal Medical Corps (RAMC) were perhaps the best trained medical units in the world. Both armies learned a lesson from the wars with the Spaniards and Boers, in which they lost the most soldiers due to … typhus. However, could they prepare for the catastrophe that awaited the world in XNUMX?
World War I was something that had not been seen before. The Allies and the Central Powers mobilized about 65 million soldiers, of which over 37 million (about 57%) were killed, wounded or missing. Treating so many victims was a gigantic challenge.
RAMC had three work zones: the wounded collection zone (closest to the battlefield); an evacuation zone (located along communication lines with vehicles for transporting the injured to the rear) and a distribution zone (locations of base hospitals).
The first key link in this chain was the regimental medical officer (MO). His help desk was located a short distance from the main trench. The trenches were about half a meter wide at the bottom, one meter at the top and 1,5 meters deep. The cramped conditions made it difficult to maneuver the stretcher, which sometimes had to be moved in the open. This was generally done under cover of night, unless the wound was severe. Then the soldier was transferred under fire.
At the regimental aid station, the priority was to clean the wounds (remove dead tissue, pieces of clothing or foreign objects), wash them with an antiseptic solution (Dakin’s solution) and bandage them, keep the soldier warm and prevent shock. Broken limbs were stiffened. Since the wounds were usually contaminated with trench mud, soldiers were routinely administered tetanus toxoid. Then a field ambulance took them to a dressing point. They were sent to another universe: “Electric lighting was working two miles from the front line, there were clean bandages and steaming tea.”
A selection was carried out in the dressing room. The injured were classified into three categories: those with less severe wounds that could be treated and then referred to a field hospital for further treatment, requiring immediate attention, and “hopeless cases” who received palliative care such as morphine or chloroform.
The field hospitals or emergency stations at the RAMC were, in the words of a 1917 medical textbook: “real hospitals, despite the fact that some are only about six miles from the battle line… Patients are cared for by trained nurses; for the most severe cases there are hospital beds; operating rooms usually have four operating tables… electric lighting… some proprietary x-ray machines (invented several years earlier)… laboratory tests are performed by mobile laboratories for them ».
The operation of the field hospital in 1918 is described by a British surgeon who volunteered to work in France: “The number of injured people is rapidly increasing. So fast the tent fills up soon. Many are pale and cold, lie still, do not respond and those who do are laconic … I have not been given instructions on how to proceed, but I realize I need to quickly examine and sort them and then send them to one of the tents hospital … It was 7 am when I finished my work, and at 10 o’clock I should start operating for the next twelve hours! ».
«The emergency tent was a terrible place. Dying people who would not have survived the operation were sent there. They were given warm beds or had blood transfused. The effect of the transfusion was miraculous in some cases. I saw men who were pale and faint, resembling corpses with no pulse and barely perceptible breath, who, two hours after the transfusion, were sitting in bed, smoking cigarettes and telling jokes ”.
Much has changed in military medicine; while the death rate after amputation during the Civil War was 25%, it was 5% during World War I. Not only has the number of deaths from wounds decreased, there have also been fewer victims of infectious diseases.
World War II started the era of sulfonamides and penicillins. The synthetic antimalarial drug Atabrine was used extensively in the Pacific after the Japanese occupation cut off quinine supplies. The plasma separation method, improved in the 30s, gave medics the ability to stabilize the wounded when whole blood was unavailable. Morphine, used for decades in field hospitals, became available in individual doses that could be injected immediately. As a result, only 4,4 percent died in this war. injured, compared to 8,1 percent. in the previous.
The US Army began experimenting with mobile medical facilities to create a Mobile Military Surgical Hospital (MASH) in late 1945. MASH units were first used on a large scale in Korea. The first three, between July and December 1950, were moved as many as 50 times, and one of them during the Battle of Busan took over 5. patients.
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