Museum Notebook: Anaesthesia in World War I made massive changes to medicine

A British Army surgeon removes a bullet from a soldier's arm in a field-ambulance tent on the Gallipoli Peninsula. The patient has a cloth over his face and has been given chloroform by the orderly on the right. Source: Kable 2016

Anaesthesia developed rapidly during World War I. The impact of better anaesthesia for wounded troops had a long-lasting impact on civilian anaesthesia.

At the start of the war, anaesthesia was usually provided with chloroform.

This was first introduced in 1847 and doctors came to prefer it to ether because of its faster onset. It was usually given by a nurse or orderly by dripping it on to a mask over the patient's face. This often resulted in an overdose. The correct dose of chloroform is about 3 per cent but via an open drop mask it can reach 30 per cent. For all that, even this rudimentary anaesthesia saved many lives.

Its first use in a major conflict was in the American Civil War. The Union Army recorded 90,000 chloroform anaesthetics, usually for amputation, cutting the operative death rate from about 75 per cent to 25 per cent. The British continued to use chloroform during the South African (Boer) Wars (1899 to 1902).

Anaesthesia at Gallipoli, again often for amputation, was also by chloroform. There are few direct references to this in New Zealand histories.

As the New Zealanders moved to the Western Front, they benefited from the developments in anaesthesia pioneered by the British Army.

Early experience with chloroform raised concerns about mortality in shocked soldiers. Dr Geoffrey Marshall was ordered to improve anaesthetic care, and eventually he designed a system that delivered oxygen, nitrous oxide and ether at a controlled rate. Anaesthetic mortality fell, and chloroform was abandoned.

Marshall's system remains the basic method of delivering anaesthetic gases and oxygen today, albeit in a much-modified form. Anaesthetists seldom use nitrous oxide now, and ether has been replaced by safer, less explosive agents.

There were other anaesthetic developments in World War I that had major and ongoing impact in civilian healthcare. Blood transfusion became widely adopted in the wounded. It is interesting that during the Vietnam War there was a move away from blood to the use of other intravenous fluids, basically salty water. In modern warfare, there has been a move back to blood, "reinventing the wheel" from 100 years ago.

The advent of issuing steel helmets for frontline troops led to significantly increased survival rates for soldiers with horrific facial wounds.

The treatment of these wounds at Queen's Hospital in Sidcup in the United Kingdom posed major challenges for anaesthetists, as they had to keep the patient asleep and oxygenated while the surgeon operated on the face. The surgeon pioneering this work was a New Zealander, Sir Harold Gillies.

Many soldiers required multiple operations and, to avoid using tracheostomies, the technique of placing a rubber tube through the nose or mouth into the trachea was developed and refined by Dr Ivan Magill. These tubes are still called Magill tubes, and the technique of endotracheal intubation is now a basic anaesthetic skill. It is also used in intensive care and by paramedics for patients suffering cardiac arrest or major trauma.

Tourniquets were widely used to stop bleeding from limbs. They were officially abandoned in 1946 as they were considered too dangerous. Later experience in the Afghanistan conflicts showed the value of tourniquets, and they are now part of a soldier's basic life-saving medical kit.

Would these innovations in medical care have occurred in the absence of warfare? The answer is probably yes, but at a slower pace. Despite the benefits of medical advances made during conflict, one thing remains true. War is hell.

• Dr Graham Sharpe ONZM FANZCA RNZAMC is a consultant anaesthetist.

Acknowledgment: This article was originally published in The Great War Times Issue 7, August 2017. Permission to republish this article was granted by the Publications Committee of the Great War Times 2014-2019.