Part 10: Casualties of War

 The profession of nursing descended from war.

Deeply affected by what she experienced tending to the wounded during the Crimean War in the late 1850s, Florence Nightingale founded the first school of nursing at London’s St. Thomas’ Hospital in 1860.

In the U.S., Clara Barton began attending wounded soldiers quartered at the U.S. Senate chamber in the Capitol during the first days of the Civil War. She founded the American Red Cross in 1881.

Louisa Parsons, who had studied under Nightingale, founded the University of Maryland School of Nursing in 1889, making it one of the oldest schools of nursing in the country.

The Civil War was a pivotal point in trauma medicine. Although Civil War-era medicine has a reputation as brutal, surgery was comparatively sophisticated by historical standards. Anesthetic agents had been used since Boston dentist William T. G. Morton demonstrated ether at Massachusetts General Hospital in 1846.

While Louis Pasteur was making discoveries about microbes in Europe, it was years before his germ theory was understood and not until WWII that antibiotics were available. Many soldiers survived amputations – by far the most common surgical procedure done during the Civil War – only to die from infection.

The ambulance was introduced by the U.S. Army in 1862. Napoleon’s physician, Domnique-Jean Larrey – regarded as the father of military trauma medicine – developed the ambulance volante or “flying ambulance” to rush wounded soldiers from the battefield. Prior to 1862,transport of the wounded was relegated to the quartermaster, who delivered casualties along with routine delivery of supplies.

The idea of evacuating the wounded from the front lines to field hospitals caught on, and was expanded during WWI. Also introduced during the Great War was the concept of first aid training.

During WWII, antibiotics and blood transfusions were among the most recent innovations, along with the use of helicopters to evacuate the wounded.

Air evacuation was further developed in Korea, as well as the concept of bringing definitive care closer to the front lines through Mobile Army Surgical Hospital (MASH) units. In Vietnam, trained non-physician medics began treatment before and during air evacuation, contributing to a combat-related mortality rate that steadily declined since the Civil War.

Through the Maryland Institute of Emergency Medical Services Systems (MIEMSS) and the Shock Trauma clinical center, R Adams Cowley took the tactics and strategies that saved the lives of troops on the battlefield and applied them to the state of Maryland, creating the first statewide, wall-to-wall trauma system in the U.S.