Military Field Surgery

a medical discipline dealing with the study of combat injuries and their clinical course and the solution of problems related to organization and the means and methods of treating the wounded and injured in various combat situations. Surgery, on the one hand, and the tactics of the medical service, on the other, make up the theoretical foundation of military field surgery. The main task of military field surgery is to render highly skilled surgical care in any combat situation. The need to care for a large number of wounded and injured requires constant readiness to organize surgical activity in new places and under new conditions and to deploy medical installations close enough to the troops so that the wounded and injured can be brought there in the shortest time possible.

To provide correct and adequate care, the wounded are “sorted” into those requiring emergency attention and those who can be treated later. During combat action surgical treatment has to be combined with evacuation of the casual-ties. Uniform principles are followed in directing and performing surgery in order to ensure the continuity of treatment of each wounded soldier in all the evacuation stages.

Military field surgery is one of the most ancient branches of medicine. The troops of ancient Egypt had facilities resembling dressing stations. The Scythians (seventh century B.C.) provided care on the battlefield. Army doctors were found among the troops of ancient Greece. The ancient Roman troops had authorized medical installations to take care of five or six legions. Teams of eight to ten unarmed deputies (scribes) carried the wounded from the battlefield; the wounded were then evacuated to cities. Among the troops of ancient Rus’ there were doctors (called lekari) to take care of the wounded. Under laroslav the Wise (11th century) the soldiers carried kerchiefs in their quivers to bandage wounds and used tourniquets to stop bleeding. The service lists of 1616 contained the names of regimental doctors. Military commanders allocated money for medical expenses. The army doctors had knives, saws, tourniquets, splints, waxed threads, syringes, lint (fuzz scraped from a clean cloth), mandrake “potion,” and opium (morphine). The wounded were carried from the battlefield to tents set up far behind the lines and as close to water as possible. After firearms came into use, military field surgery was largely transformed into gunshot wound surgery. The unusual severity of gunshot wounds was ascribed by military surgeons (known as wound doctors in the 15th to 17th centuries) to poisoning by gun-powder. To control this poisoning, the wounds were cauterized with a red-hot iron, covered with boiling oil, and even cleaned by mechanical devices.

As medicine progressed, the methods of treating the wounded changed. N. I. Pirogov played a special role in forming military field surgery into a separate medical discipline. In his book Principles of General Military Field Surgery (parts 1-3, 1865-66) he formulated its general concepts. By the 19th century surgeons had correctly determined the structural characteristics of gunshot wounds, but they operated only to amputate limbs. The antiseptic method of treating wounds suggested by J. Lister greatly influenced the development of military field surgery. Antiseptic methods had been in use in the Russian Army even before; they were described in detail in the official “Instructions for the Prevention and Termination of Hospital Gangrene” (1848). However, already by that time, in addition to antiseptic methods, Pirogov believed it was necessary to remove blood clots and crushed and bruised tissues from the wound. In 1847, Pirogov was the first to use general ether anesthesia in war and then chloroform, demonstrating the possibility of using general anesthesia under field conditions. This paved the way for introducing active surgical methods into military field surgery. Its subsequent development was marked by the application of the achievements of surgery, bacteriology, asepsis, antisepsis, and so on.

During the wars at the end of the 19th and beginning of the 20th century, the number of wounds inflicted by fragments steadily increased. These wounds were characterized by a large zone of nonviable tissues that were treated surgically (by excision). During World War I (1914-18) wounds were treated surgically in combination with the use of antiseptics. In the Russian Army, active methods of treating gunshot wounds were publicized by V. A. Oppel’, N. N. Burdenko, and N. A. Veriaminov. However, the tsarist army’s system of medical evacuation of the wounded failed in many respects to meet the needs of active surgical tactics (delays in the admission of the wounded into surgical installations). Hence active methods of treating gunshot wounds did not become very widespread. The new system proposed by Oppel’ whereby evacuation was combined with treatment in the evacuation stages was employed only in the Red Army. During the Great Patriotic War (1941-45) stage treatment became the basis of a new system of treating wounded Soviet Army soldiers. The objectives of each stage of medical evacuation were defined, and surgical care was brought as close to the troops as possible, thereby greatly reducing the time required for the wounded to reach a medical facility. Regimental medical posts provided initial medical care, division medical posts and mobile frontline field hospitals provided skilled medical care, including treating the wounded for shock and replenishing lost blood, and general hospitals at the rear of the front provided specialized treatment for certain types of wounds. There were hospitals in the armies and at the fronts to treat the slightly wounded who were not evacuated to the rear and, after a short period of treatment, were returned to a field unit. All these things helped greatly to reduce mortality from wounds and increase the number of those returned to duty. Standard methods of treatment were used under the direction of leading army and front hospital surgeons. All the advances of surgical science were widely employed during the Great Patriotic War.

After the war the development of new types of weapons with new destructive capabilities confronted military field surgery with new problems, which surgeons in peacetime are now trying to solve.