The Day the Universe Changed - James Burke [100]
New techniques were also developed for handling fractures. Early in the war much of the fighting had taken place on the Franco-German border near the Val d’Ajol in the Vosges mountains. There, the local rebouteurs, or ‘quacks’, were expert in treating the effects of falls and taught the surgeons the value of alcohol as a means of inducing stupor and relaxation so as to make manipulation easier. They had also solved the problems of poisoning associated with the use of nicotine in surgery on the abdominal area. The patient was given oils of nicotine which were supposed to relax and anaesthetise the abdomen so as to make hip and pelvic setting possible. The poisonous nicotine often killed the patient. The rebouteurs inserted a cigar into the patient’s rectum to the same effect and without risk of intoxication.
Battlefield surgeons learned that the old idea of operating immediately was wrong and that the patient should first be treated for shock. Trepanning was also discarded. The operation had been popular in cases of skull fracture, when holes were drilled in the skull to relieve pressure. In battle, without such drilling instruments, little trepanning could be done. As a result, more patients survived without the operation than had previously been saved by it.
Bandaging and the use of splints, from an eighteenth-century Italian manual of anatomy.
Amputation in the field. This early nineteenth-century illustration shows the surgeon about to make the first incision with a curved knife, while his helpers prepare to restrain the patient. On the table to the left, a hacksaw lies ready to be used on the bone.
Amputation techniques changed too. The surgeons no longer waited as long as possible before cutting off the limb. Three years after the beginning of the war the rule was to cut within twenty-four hours or not at all. With insufficient supplies of needle and thread it was found that two flaps of flesh laid against each other would heal united; an ordinary bandage would hold them in place. Skin grafting was tried as a treatment for burns, as well as the use of simple soothing oils and lint.
The strangest discovery involved the condition known as ‘wind death’. Many soldiers had been found dead, with no external marks on their bodies. It was thought that this was due to the wind of a passing bullet drawing out all their breath and causing them to suffocate. After a time, the frequent opportunity for dissection due to the plentiful supply of corpses revealed cases of severe internal damage which had produced no external symptoms.
During the revolutionary wars both physicians and surgeons were given the new rank of ‘health officer’. Gradually both sides of the profession became accustomed to working together. Both took up posts in the new post-war hospitals. The mass of casualties from armies hundreds of thousands strong urgently needed treatment. In January 1793 the National Convention began moving veterans out of the Invalides and replacing them with war wounded. The Val de Grace monastery in the Rue St Jacques was commandeered for hospital work. It took 1200 men. Soon there were too many patients to handle, so hospitals all over Paris were expanded and redesignated as specialist hospitals for fever, skin diseases, venereal disease, the wounded, and so on.
An illustrated guide to the hospitals and hospices of Paris, in 1818 the medical centre of Europe. Note the new School of Medicine, top left.
In 1794 all hospitals became state property and the expansion of facilities continued. By 1807 Paris hospitals alone offered over 37,000 beds. In the whole of Britain at the same time, hospitals had room for less than 5000 patients. The reorganisation of 1794 was to make Paris the world capital of scientific medicine, attracting visitors and students from all over Europe and America.
In the new Ecole de Santé the surgeons were now in charge. Of the twenty-two professional chairs, twelve were occupied by surgeons: