Eisha Rao

Mrs. McMennamy
Capstone - Period 5
21 September 2016
History of Military Medicine
Throughout history, the main three issues facing wounded soldiers in combat have been
hemorrhage, infection, and inadequate surgical procedures. However, due to the advancements in
military grade weapons that cause a multitude of different injuries, the manner in which doctors
treat soldiers injured on the battlefield has continued to develop throughout history. Some of the
key innovations in the field of military medicine include improved control/clotting systems,
antibiotic compounds, and regenerative medicine.
A lack of control over hemorrhaging accounts for a large number of killed in action and
died of wounds deaths. However, treatment for open wounds has become much more refined in
recent years. For a large part of history, debridement, or the removal of damaged tissue and
debris from a wound, was considered the most effective method for containing bleeding.
Hippocrates, considered the father of medicine, is credited with keeping wounds sterile and
irrigating the site of the injury with clean water and wine.12 This ideology has remained fairly
similar in the present day, though the medium that is used for debridement has varied. For
example, when guns were popularized in warfare, the Italian surgeon Giovanni da Vigo proposed
pouring boiling oil into the wound in order to prevent poisonous gunpowder from harming the
patient.12 In the modern era, saline solution and alcohol are used to clean wounds and prevent the
spread of any debris into the wound.12 However, simply irrigating the field is not enough to fully
prevent death by hemorrhaging. Starting in the Civil War, traditional tools such as tourniquets

and compression dressings were used in order to stop blood flow to a particular area so that a
doctor could operate with clear view of the field.12 While tourniquets and compression dressings
are practical for use when the wound is located on one of the limbs, they fall short when
hemorrhaging occurs in a harder to reach area, such as the groin or armpit. In such cases, a
soldier often bleeds out en route to a treatment facility due to a lack of control over the bleeding.
For this reason, many innovations in hemostatic agents have been made in hopes of finding a
simple and quick method for controlling hemorrhaging until someone can undergo surgery.
These include HemCon, a poly-N-acetyl glucosamine (P-NAG) based dressing that can control
bleeding from minor injuries and QuikClot, a dressing made of mineral zeolites, which adsorbs
water to promote the concentration of platelets and clotting.1 Both of these devices have been
deployed in Iraq and Afghanistan and have been found to decrease mortality dramatically.1 As a
whole, the prompt control of hemorrhaging is an essential part in preventing deaths in the
military.
The spread of infection in an open wound also causes a significant amount of military
deaths. Despite the deadliness of infection, advancements in this field have only happened in the
last century or so due to a misguided interpretation of the symptoms of disease throughout
history. In the 1700s, many doctors did not attempt to treat infection because they associated the
disease with an imbalance of the humors (This follows the humoral theory, in which an
imbalance of the bodily fluids of blood, phlegm, black bile, and yellow bile were attributed to
sickness).8, 12 This concept was later proven to be false, yet due to inconsistencies in determining
the source of infection, doctors did not actively prevent its occurrence. This is most notable in
the Civil War, during which wounded soldiers were brought to unsanitary camps in order to be
treated. In fact, soldiers were more likely to be killed during this time because of the bacteria and

viruses at the campsite than because of their injuries.12 Though by the time of the First World
War, advances in bacteriology were made, similar spreads of infection occurred because soldiers
were grouped closely together in trenches.12 This trend changed during World War II when
penicillin was first administered to soldiers.13 This antibiotic proved to have a significant impact
on the health of soldiers; because the threat of infection was controlled, soldiers were able to
recover more quickly from their wounds. This can be seen through the results of a 1972 study
conducted on US Marines in Vietnam by Myron J. Tong. Immediately after a soldier was
wounded in battle, Tong collected cultures of the bacteria growing at the infection site. These
cultures showed a mix of both pathogenic and nonpathogenic bacteria. Within two to five hours
of the injury, soldiers who were not treated died of infection whereas soldiers who received
targeted surgery and antimicrobial treatments, particularly penicillin, were more likely to survive
and show negative cultures five days after the injury.13 These uses and advantages of penicillin
are consistent with how military personnel are treated today. Despite the many benefits of
treating individuals with antibiotics, the overuse of antibiotics can cause the selection of more
resistant strains of bacteria, thereby reducing the effectiveness of penicillin in curbing infection.13
For this reason, research is still being conducted today to determine the most permanent and
effective method for treating infection in the military.
Although many soldiers are stabilized on the battlefield, they often die at or in transit to a
hospital due to a limited capacity to deal with injuries of this nature. The ability of hospital staff
to adequately treat wounded soldiers is improving, as are the treatment options for veterans with
long standing injuries. Blood transfusions were particularly complicated in the past. The first
time that this method was tried by the British Army, 15 out of the 19 subjects died.12 However,
this practice has become more streamlined, and it is now possible to complete a blood

transfusion in the field in order to stabilize a wounded soldier. Likewise, amputations were
increasingly common for soldiers in previous eras because doctors simply did not understand
how to adequately treat many wounds. Although they are still fairly common today, veterans
with amputations have more opportunities for learning to live without a limb than before. For
example, U.S. Army Staff Sergeant Robbie Doughty, who lost his leg in Iraq, uses a C-leg, or a
prosthetic limb, which allows him to continue to participate in many civilian activities that he
was able to do with his leg.7 Additionally, the field of regenerative medicine in relation to the
military is greatly advancing. Scientists are able to grow ears and noses, both of which can be
used for burn victims.18 As this research continues to progress, individuals who have lost larger
organs will likely be able to regenerate them.
War produces an interesting paradox: though it is a terrible thing, it creates a need for
advancements in a variety of fields, thus serving as an accelerant for progress. Military medicine
is a dynamic field that has had to evolve as war related technology has become more destructive.
Through history, the treatment options both in the field and after war have become more
advanced and effective in thoroughly healing a wounded soldier.

Works Cited
1. Alam HB, Burris D, Dacorta JA, Rhee P. Hemorrhage Control in the Battlefield:
Role of New Hemostatic Agents. Military Medicine. 2005;170(1):63-69.
doi:10.7205/milmed.170.1.63.
2. Ferber D. Soldiers of fortune? Popular Science.
http://www.popsci.com/scitech/article/2005-01/soldiers-fortune. Accessed September 13,
2016.
3. Manring MM, Hawk A, Calhoun JH, Andersen RC. Treatment of War Wounds: A
Historical Review. Clinical Orthopaedics and Related Research Clin Orthop Relat Res.
2009;467(8):2168-2191. doi:10.1007/s11999-009-0738-5.
4. Murray CK, Roop SA, Hospenthal DR, et al. Bacteriology of War Wounds at the
Time of Injury. Military Medicine. 2006;171(9):826-829. doi:10.7205/milmed.171.9.826.
5. Underwood A. Military medicine: The war on wounds. Newsweek. May 10, 2008.
http://www.newsweek.com/military-medicine-war-wounds-90119. Accessed September
13, 2016.
6. Four Humors - And there's the humor of it: Shakespeare and the four humors.
Nlmnihgov. 2016. Available at:
https://www.nlm.nih.gov/exhibition/shakespeare/fourhumors.html. Accessed November
11, 2016.