Today, ANZAC Day, represents the 100 year anniversary of the entry of Australia and New Zealand into the battle of the Great War. In many ways, it defined our nationhood and marked the time in history where our two nations stood on their own but also side by side.
There were many lessons learnt over the next 3 years, not least of which were in the medical management of such a large scale conflict.
Colonel Arthur Graham Butler was the first medical officer to land at Gallipoli and was later placed in charge of the Third Field Ambulance. Most importantly, after the war he wrote the three-volume Official History of the Australian Army Medical Services 1914-1918. The original books are now rare but thankfully they have been made available online by the Australian War Memorial. This incredible collection covers areas such as resuscitation, infectious disease, surgical techniques, health promotion, mental health and healthcare systems, to name a few.
In the same way that some of the recent advances in the management of trauma have been born in the Iraq and Afghanistan theatre, Butler’s work describes the new understanding of trauma gained during the Great War. These warrant highlighting today.
Butler’s description of the improvement in understanding of haemorrhage, shock and resuscitation:
One of the most striking features of medical work in the war is to be found in the initial emergence of the pre-war concept ”surgical shock” as a specific and unique syndrome, “wound shock,” and its subsequent gradual resolution in a complex of pathological degradations.
The identification of the causes that might bring about such an impasse, and the detection and exploitation of any opportunity for therapeutic intervention, constitute a remarkable episode in the history of scientific medicine.
The concept of “traumatic shock” emerged from the war an almost crudely clinical one, reflecting on the pathogenic side a curious congeries of causative and contributing agencies and their effects, such as psychic and physiological “pain,” and their reflex effects such as acapnia; “excitement” and fear and their related glandular (hormonic) reactions; haemorrhage, with resulting anoxaemia, and acidosis; thermogenic failure; cardio-vascular failure; neurogenic failure; septic toxaemia: other intoxications as by an “H” substance.
And from the Special Committee for Surgical Shock, this insightful assessmentIn shock without haemorrhage the reduction in blood volume indicates a marked disturbance of the normal mechanism by which the blood volume is maintained. . . . With a certain degree of shock, fluid supplied to the body will cause an increase in the blood volume. But in graver states of shock the smaller vessels of the vascular system are unable to retain an adequate amount of fluid. . . . Further knowledge is needed as to the cause of this alteration in the peripheral vessels, which appears to be a common feature in many shock-like conditions.”
He outlines the constantly changing picture of current practice at the front, culminating in the Manual of Injuries and Diseases of War issued in 1918 in which transfusion of blood is introduced and the treatment prescribed was designed to combat three main conditions:
- loss of body heat
- a low blood pressure
- a decrease in the alkalinity of the blood
Our treatment goals now are not that different, despite a hundred years having passed.
The image above shows a group of twenty six medical officers talking outside a tent at Gallipoli on the effects of gunshot wounds to the head. Captain (at the time) Butler was one of them. His remarkable three volume work showcased these and many more incredible medical staff, some of whom could lay claim to being Australia’s fathers of trauma management.
Butler received the Distinguished Service Order (DSO) with the following citation:During operations in the neighbourhood of Gaba Tepe on 25th April, 1915, and subsequent dates, for conspicuous gallantry and devotion to duty in attending wounded under heavy fire, continuously displaying courage of a high order.