Sir William Osler on Military Medicine – Part The Final (3)

In two previous posts (here, and here), I discussed medicine’s beloved William Osler’s thought on military medicine in his early and middle years. In these times – up to about 1905, when he moved to Oxford to become the Regius Professor of Medicine – his concern was largely about individual workers and their work to discover and characterize diseases found throughout the world. Only lately (after 1900) had he come to write about the role of armies in their “public health” function of carrying out successful mass immunization programs against smallpox and, later, typhoid.

In 1914 speech to soldiers and officers (1), Osler – ever the internist’s internist – still keyed his thoughts to disease and its prevention. He said:

What I wish to urge is a true knowledge of your foes, not simply of the bullets, but of the much more important enemy, the bacilli.
In the wars of the world they have been as Saul and David—the one slaying thousands, the other tens of thousands. I can never see a group of recruits marching to the depot without mentally asking what percentage of these fine fellows will die legitimate and honourable deaths from wounds, what percentage will perish miserably from neglect of ordinary sanitary precautions ?

But, four months into the war, he noticed something which was to him remarkable. In a letter to the U S medical community published in the Journal of the American Medical Association (2) he wrote, “The outstanding medical feature of the campaign in France and Belgium is that wounded, not sick, are sent from the front. So far, disease has played a very small part and the troops have had wonderful health, in spite of exposure in the trenches.” In the same letter, he actually took notice of combat injuries, commenting that wounds from artillery weapons (shrapnel) were more dangerous than bullet wounds because the shrapnel was usually contaminated with mud and dirt. And the dirt and mud of this fertile region were heavily populated with bacterial pathogens. As Osler put it, “The surgeons are back in the pre-Listerian days and have wards filled with septic wounds.”

1915 appears to be the last time Osler spoke about war medicine, in a speech “Science and War”, given early in October. Here he acknowledged that science had, in the early 20th century, made the waging of war “more terrible, more devastating, more brutal in its butchery”. But Sir William Osler, non-surgeon, Professor of Medicine and honorary Colonel in the Oxfordshire Regiment, saw – perhaps only dimly – the future of combat medicine, also a product of science: “[an] enormous number spared the misery of sickness, the unspeakable tortures saved by anesthesia, the more prompt care of the wounded, the better surgical technique…”. Add effective shock management, antibiotics and modern imaging, and we have the picture of modern combat casualty care as practiced nearly 100 years later.

William Osler survived the war, but died at age 70 of pneumonia, in 1919. It is said that he never recovered from the loss of his only son, Edward Revere, an artilleryman  who succumbed to shrapnel wounds sustained at Ypres in August 1917.

(1) Osler, William, “Bacilli and Bullets” , Oxford Pamphlets, Oxford Press, 1914. Accessed online at http://ia600307.us.archive.org/5/items/bacillibulletsby00osle/bacillibulletsby00osle.pdf, 02 November 2012.
 
(2) Osler, William, “Medical Notes on England at War”, correspondence, in JAMA, vol LXIII [63], No 26, December 26, 1914, p 2303 ff
 
(3) Quoted in Cushing, Harvey, “The Life of Sir William Osler”, Vol 2, pp 492 – 495, Oxford, Clarendon Press, 1925.
 
©2012 Thomas L Snyder
 
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