Antiquity During the 4th century BC,
Alexander the Great (July 356 BC – June 323 BC) ran a lengthy military campaign, creating one the largest empires in history. During his military campaigns,
tourniquets were used to slow the bleeding of wounded soldiers.
Romans used them to control bleeding, especially during amputations. These tourniquets were narrow straps made of bronze, using leather only for comfort. In the 1st century BC, the Roman army used
spider webs and honey-soaked bandages as
field dressings. Wounds were packed with webs before being wrapped in honey-soaked bandages. The webs served as a natural
fungicide while
the honey staved off bacterial infection. Field healers provided wounded soldiers with amulets associated with their circumstances. This appears to have been effective for the combatant's mental health. In 3rd century China,
bamboo slips from the
Han dynasty (202 BC – 9 AD) list injuries sustained by soldiers on the
front line and from
infighting. Illnesses related to the
digestive and
respiratory systems were also included. Medical treatment was limited and comprised such treatments as
acupuncture, applications of plaster, and drugs, the latter being the most common. The practice of
cranioplasty, or skull repair surgery, may have originated in pre-Incan Peru. Skulls with evidence of cranioplasty have been found more commonly in military burial grounds than residential ones, and primarily in male skeletons, suggesting the practice was mainly performed as a result of traumatic battle-related injury. Various materials were used to graft skull injuries, including non-natural materials like gold and silver plates, and organic materials like shells and coconut.
Middle Ages The
Middle Ages saw further developments in battlefield medicine.
The Crusades allowed for significant development of
trauma surgery and military medicine. In 1112, the first king of the Crusaders ordered a hospital to be built. This hospital was shown to have military medicine uses after 750 patients were admitted in a 24-hour period after a battle in November of 1177. This hospital utilized medicinal traditions from
Schola Medica Salernitana, a prominent medieval medical school located in
Salerno, such as examining the urine. The practices at the hospital were also influenced by
Byzantine and
Islamic methods. Despite these hospital systems and the recent invention of the tourniquet, most soldier fatalities on the battlefield were due to
a fatal loss of blood. In order to return deceased crusaders' bodies home, practices like boiling the body to remove the bones,
dissecting out important organs like the heart, and packing the body with salt were all common practices. This practice of dismemberment for transport occurred across Europe until a decree banning it was issued in 1299 by
Pope Boniface III. However, it continued illegally after. Notably, crusaders performing such preservations learned a significantly better
anatomical knowledge of the human body. As more soldiers were brought into the Crusades, more medical interventions for fatal blood loss were introduced. For example, texts from Islamic Spain describe an early cauterization method to stop
arterial bleeding. This method involves using a hot olive
cautery, a metal rod with an olive-shaped tip, to burn the artery shut. Performance of this procedure would be complicated by blood filling the site and making both the vessel and instruments slippery. Another notable innovation with a modern counterpart is an early
stretcher, likely made from wicker over a frame. This stretcher appears in a manuscript from . Simple stretchers were commonly used in militaries through the middle of the 20th century.
Ambulances as well were first used by Spanish soldiers during the
Siege of Málaga in 1487, a part of the campaigns to seize control of southern Spain. Authorized by
Isabella I of Castile, the ambulances were largely ineffective, though they were perceived as critical to Spanish
morale. Battlefield medicine also appears in classical medieval texts such as
Wolfram von Eschenbach's (1160/80 – c. 1220)
Parzival, first published in 1210. Wolfram von Eschenbach was a German knight, poet and composer, regarded as one of the greatest German writers in national history. A scene in the book describes a wounded soldier with
internal bleeding in his chest. The book explains that the soldier was thrown from his mount after being struck by a
lance that pierced his shield. After, a procedure similar to a modern-day
thoracostomy, inserting a tube into the chest to release blood or fluid, is described. A similar procedure done for an accumulation of pus in the chest was described as early as 460 BC, by
Hippocrates, (460 BC – 370 BC) an influential medical figure from
Kos.
Galen (129 – 216 AD), another influential medical figure, describes the procedure roughly 500 years later again for pus and not blood.
Early modern period , showing a variety of wounds from the ('Field Manual for the Treatment of Wounds') written by
Hans von Gersdorff in 1517 and illustrated by
Hans Wechtlin.The early modern period brought several large changes to the conduction of warfare, which in turn brought major developments to medicine. For one, political changes like the formation of nation-states meant that armies were now national institutions, and military medicine became an established professional field. Political conflict between emerging nation-states meant more organized warfare and larger conquests, both in duration and number of soldiers, thus requiring more surgeons and physicians to accompany. Social and cultural trends also impacted medicine and medical advancements. At the beginning of the 16th century, it was generally not socially accepted to alter the human body away from its natural form, even if that meant danger, or even death.
Amputation was only accepted in cases of
necrosis. Over the course of the 16th and 17th centuries, this convention gradually faded, allowing for more and more alterations to the body for the sake of health, including a gradual accepting of amputation as a lifesaving practice. Organized armies brought army surgeons along on their conquests; these surgeons were more specialized and more highly respected than civilian barber-surgeons, and they were trained to the same battle standards as soldiers, but better paid. Surgeons' social status grew significantly during this time, as the practical skills and handiness with tools was far more useful than a physician's knowledge of internal ailments in situations of dire injury. Further, guns enabled soldiers to become more accurate shots in shorter training times, leading to an increase in head injuries as soldiers aimed to cause maximal damage to their enemies' forces. With amputations becoming more common,
prosthetic limb development also become more common. Notably, only among members of society with considerable wealth. An early modern German knight,
Götz von Berlichingen (1480–1562), wrote a series of memoirs describing the aftermath of the loss of his right hand in 1504 when a piece of his own sword, shattered by a culverin (small handgun) wedged itself into his wrist, effectively severing it At the same time in Europe, Italian Catholic anatomist
Gabriele Falloppio (1522–1562) was also gaining experience with cranioplasty. He stated that a bone replacement is possible only if the
dura mater (a thick protective membrane surrounding the brain) is not affected by the injury. if it is, the entire injured bone should be replaced with a gold plate. During the
American Civil War,
Jonathan Letterman modernized medical organization on the battlefield for the
Union. Following his appointment as the Medical Director of the Army of the Potomac, Letterman founded an ambulance corps staffed with permanent and trained attendants which was later compounded in efficacy by the organization of hospital echelons and tent hospitals in the war's eastern theater. His contributions led to his being recognized as the "father of battlefield medicine". During this time, the Relief Society for Wounded Soldiers, forerunner of the
International Committee of the Red Cross (ICRC) was founded in 1863 in
Geneva. The ICRC advocated for the establishment of national aid societies for battlefield medical relief, and stood behind the
First Geneva Convention of 1864 which provided neutrality for medics, ambulances, and hospitals. In the late 19th century, the influence of notable medical practitioners like
Friedrich von Esmarch and members of the
Venerable Order of Saint John pushing for every adult man and woman to be taught the basics of first aid eventually led to institutionalized first-aid courses amongst the military and standard first-aid kits for every soldier.
20th and 21st centuries in World War II. • Advances in
surgery – especially
amputation – during the Napoleonic Wars and
First World War during the
Battle of the Somme. • Medical advances also provided kinder methods for treatment of battlefield injuries, such as antiseptic ointments, which replaced boiling oil for cauterizing amputations. • Advances in understanding of
Germ Theory and
Asepsis as well as the introduction of
High Explosive Artillery and
Machine Gun filled
Trench Warfare lead to conditions primed for better battlefield wound care. One such advance was the
Carrel-Dakin Technique . This was developed by many but namely involved
Alexis Carrel. This involved initial cleaning/
Debridement of the wound, followed by irrigation with
Dakin's Solution (Essentially dilute
Aqueous Sodium Hypochlorite a solution developed by
Henry Dakin ). This cleaned the wound of dead tissue and pathogen contaminated soil, as well as aided in drainage of
Pus etc. • "During the Battle of Champagne in 1915, 80% of the wounded were infected with gas gangrene bacteria. A year later, when surgeons applied the Carrel-Dakin technique during the Battle of the Somme, that number was 20%" • During the
Spanish Civil War there were two major advances. The first one was the invention of a practical method for transporting
blood. Developed in Barcelona by
Duran i Jordà, the technique mixed the blood of the donors with the same
blood type and then, using
Grifols glass tubes and a
refrigerator truck, transported the blood to the front line. A few weeks later
Norman Bethune developed a similar service. The second advance was the invention of the mobile
operating room by the Catalan
Moisès Broggi, who worked for the
International Brigades. • The establishment of fully equipped and mobile
field hospitals such as the
Mobile Army Surgical Hospital (MASH) was first practiced by the United States in World War II. It was succeeded in 2006 by the
Combat Support Hospital. • The use of helicopters as ambulances, or
aeromedical evacuation, was first practiced in Burma in 1944. The first MEDEVAC under fire was done in Manila in 1945 where over seventy troops were extracted in five helicopters, one and two casualties at a time. • The extension of
emergency medicine to pre-hospital settings through the use of
emergency medical technicians. • The use of
remote physiological monitoring devices on soldiers to show vital signs and biomechanical data to the medic and MEDEVAC crew before and during trauma. This allows medicine and treatment to be administered as soon as possible in the field and during extraction. Similar
telemetry units are used in crewed spaceflight, where a
flight surgeon at the Command Center can monitor vital signs. This can help to see issues before larger problems occur, such as elevated
carbon dioxide levels, or a rise in body temperature indicating a possible
infection. == History of Tactical Combat Casualty Care (TCCC) ==