I’m very excited to host author Jeffrey K. Walker today. You might have read the excerpt of his book, None of Us the Same, that I posted recently. It’s the first novel in a trilogy that revolves around WWI. In this first book, Jeffrey explores how war affects the people who experienced it, even many years after the event.

Jeffrey researched this book extensively before writing it, it is quite apparent. I was particularly impressed by the vivid rendition of the field hospital, which really came to life, for me, in the experience of one of the main characters, Deirdre Brannigan.

A couple of years ago, I helped in the editing of a book by an Italian medical officer who had been in Afghanistan for many months. Something he said really struck me: he wrote that people always ask him how he could be a soldier and a doctor at the same time. He said that where there is suffering, there will be doctors. People often don’t realise that wars actually advance medicine more than we usually think. Horrible as wars are, very often they bring good in the field of medicine.

So I asked Jeffrey if he could expand on this idea since it was clear he knows a great deal of this. This article is the result. I hope you’ll enjoy it as much as I did.

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World War I: a pivotal moment in contemporary history

I’ve been immersed in the First World War and the 1920s for the last year or so. Seems I decided in a delusional moment to write a historical fiction trilogy set 1914-1926, by way of explanation.

Let me say upfront, I totally dig this period. This was the moment when the enormous promise of modernity—industrialization, scientific advancement, unimaginable new technologies—crashed head-on into the worst characteristics of the human race. What people soon discovered was that if we could mass produce Model T Fords and Edison light bulbs, we could just as easily mass produce mountains of bombs and machine guns. The First World War became an assembly line of death and destruction.

Of course, the 1920s as we’ve come to know them could not have happened without passing through the crucible of the First World War. It took the horrendous horror of that 51-month conflict to strip away allegiances to old notions of rectitude and propriety. Into that vacuum rushed jazz and sexual freedom and the avant-garde.

So the First World War, awful as it was, produced unforeseen positive results, too. One of these serendipitous results was a huge leap forward in medical science.

The Golden Hour and the concept of moderm first aid medication

Before the First World War, more soldiers died of diseases and from secondary infections from their wounds than from the direct destructive effects of battle. Although some halting progress was made during the Crimean War (most famously by Florence Nightingale) and by both armies during the American Civil War, military medicine prior to the First World War had been very hit-or-miss… and mostly miss. Part of this was due to a lack of medical knowledge and resources; most was due to a lack of logistics and attention.

Quite early in the First World War, led by the example of the French, the combatant armies developed fairly elaborate systems for getting wounded soldiers off the battlefield and back to some kind of medical facility. The British and French adopted a four-tiered system, beginning in the trenches with battalion-level first aid stations manned by regimental surgeons. They in turn moved wounded men back to Casualty Clearing Stations, the name the British adopted for what we would know today as field hospitals. (Perhaps the most famous of these is the fictional Korean War-era 4077th Mobile Army Surgical Hospital, made famous by the book, movie and television series, M*A*S*H.) These facilities were equipped for surgery and for evacuation. The CCS would then push as many wounded as they could stabilize back to the big Base Hospitals which for the British were clustered around the Channel ports. From there, wounded soldiers requiring ongoing treatment, extended convalescence or discharge from active service were shunted back to an elaborate network of hospitals in the UK.

At each stage of this system, doctors and nurses applied a rigorous—and sometimes seemingly heartless—system of triage. The overwhelming crush of casualties that came in the wake of the big battles led the French to adopt a three-level system of sorting the wounded: those who could be treated in place, those who could be stabilized and moved onward, and those who were beyond saving and could only be made comfortable while they died.

This whole system was held together by dedicated medical transportation: stretcher bearers—often regimental musicians—to remove the wounded from the battlefield to the first aid stations; ambulances—often driven by women—to move the wounded from the first aid stations to the CCS; medical trains and canal boats to move patients from the CCS to the Base Hospitals; and hospital ships to move the convalescent soldiers home to Blighty, as England was known to the Tommies (British soldiers). Although this system often broke down and was inevitably insufficient in the face of huge casualties from the big land offensives, it worked surprisingly well throughout the War, saving countless lives.

The Golden Hour: What Good WWI Gave to Us -Before #WWI, more soldiers died of diseases than from their wounds #history Click To Tweet

Twenty years later, the concept of the “Golden Hour” was conceived—the all-important first hour after a traumatic injury during which an injured person must be gotten medical care—and became ingrained in both emergency civilian and military battlefield medicine. This notion was developed by American trauma surgeons from the extensive data collected by the French Army during the First World War that showed a wounded solider’s chance of survival was much greater if treated within the first hour of injury.

Anesthesia and plastic surgery: how WWI advanced medicin after the trauma

The industrial scale of violence in the War, coupled with the modernized system of medical treatment and evacuation, led to a string of new challenges and solutions. For example, the enormous destructive power of massed artillery firing huge high explosive shells by the thousands resulted in awful wounds from shrapnel. That the medical system could get to these men before they bled out or died from shock on the battlefield led to the problem of how to treat these awful and gaping wounds. The War was fought less than a generation before the antibiotic drug revolution, so infection was an enormous problem. Some of this was alleviated by the new understanding of the importance of antisepsis, particularly in surgery, and the widespread availability of anesthesia to allow for complex surgeries. With microbe-ridden soil often embedded in wounds by shell blasts, gangrene was a persistent horror, but antiseptic and unhurried surgery allowed reasonably safe amputations that most men survived.

The War also saw tens of thousands of men surviving terrible facial wounds from machine gun and rifle bullets that left them horribly disfigured, unable to eat or breathe properly, or with painful scar tissue. This led to great innovations and advancements in what became known as “plastic surgery.” Spearheaded by a New Zealand surgeon, Harold Gillies, a special hospital for reconstructive surgery was established in Cambridgeshire, where Gillies and his surgical teams performed over 11,000 procedures on soldiers with facial gunshot wounds. The techniques they developed to return disfigured soldiers to something like a normal life provided the basis for cosmetic surgery as we know it today.

Shell Shock: how WWI faced PTSD decades before it became a recognised condition

The First World War was also the first conflict in which medical experts recognized and struggled to develop effective treatments to deal with the intense psychological trauma induced by trench warfare. The omnipresence of random death, the percussive effects of sustained artillery barrages, and the subhuman conditions in the trenches all contributed to a wide-spread neurasthenia among enlisted soldiers and officers alike. The colloquial term for this condition was “shell shock” and would be a defining characteristic of the War.

Almost sixty years before “post-traumatic stress disorder” was officially accepted by the psychiatric profession as a diagnosable mental disorder, doctors struggled to treat an often debilitating—and sometimes permanent—condition that may have affected as many as 25% of the soldiers who took the field during the War. The British made some advances, most notably the specialized hospital established for treating shell shocked officers at Craiglockhart, just outside Edinburgh. There was, however, a significant division between the treatment of officers and enlisted men. Generally, a shell shocked officer was considered a gentleman who was simply overtaxed by his duties, exhausted, in need of rest and exercise away from the fighting. Enlisted troops, on the other hand, were considered slackers or, worse yet, cowards. Rather than being allowed convalescent leave or given the more humane medical care afforded officers, the treatment was often military discipline, including courts-martial for cowardice or desertion. By the Second World War, treatment had become more regularized and the condition more widely accepted as a medical disorder rather than a moral failing. Still, as in the famous case of General George Patton slapping a “battle fatigued” soldier, less enlightened attitudes persisted right through to the Vietnam War.

The Golden Hour: What Good WWI Gave to Us – "During #WWI PTSD was first treated as a condition #history of #medicine Click To Tweet

There were many other areas where medical science made leaps forward during the War: gas masks to protect against the new chemical weapons, blood banks and new methods of transfusion, skin grafting to treat burns, custom-fitted prosthetic limbs. The list could go on for pages. The lesson being, I suppose, that even out of catastrophic suffering some good can come. This may be one of the more important legacies of the First World War.

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NONE OF US THE SAME

Fiery Deirdre Brannigan had opinions on everything. She certainly hated the very idea of war in 1914. Childhood pals Jack Oakley and Will Parsons thought it a grand adventure with their friends. But the crushing weight of her guilty conscience pushes Deirdre to leave Ireland and land directly in the fray. Meanwhile the five friends from Newfoundland blithely enlist. After all, the war couldn’t possibly last very long…

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Jeffrey K. Walker

Jeffrey was raised in a dying one-industry town smack in the middle of Flyover Country. He checked out every book in his public library about anywhere other than there. For college, he fled as a refugee to New Orleans then spent his junior year in Scotland, where he learned to drink stout and met his wife.

Father of three children, sticking to a job proved to be a chalelnge. He caromed from stockbroker to bomber navigator to attorney to international consultant to law professor, picking up an assortment of degrees from Syracuse, Georgetown and Harvard along the way. He’s lived in three foreign countries, been to another 70, and still feels he hasn’t seen much.

He’s writing a trilogy set around the First World War and percolating another seven or eight novels and a dozen short stories. He lives in Virginia with his wife where he does a little teaching and law on the side.

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