Born on the Battlefield: Celebrating the Centennial of the Discovery of Epidural Anesthesia

ABSTRACT The year 2021 marks the 100th anniversary of the discovery of epidural anesthesia by Spanish military surgeon Major Fidel Pagés. The idea for the technique was born from Pagés’ experiences in forward military hospitals in North Africa and Austria and would go on to revolutionize the fields of surgery and obstetrics.

Saving private W. H.: The surgical experiences of Dugald Blair Brown (1847–1896): Lieutenant-Colonel, FRCS, Edin., AMD

Dugald Blair Brown, a military surgeon and Fellow of the Royal College of Surgeons, Edinburgh, published twelve papers containing 77 case studies of gunshot wounds that he had treated in the Anglo-Zulu War of 1879 and in the First Anglo-Boer War of 1880–1881. Brown devised a “conservative” method of surgery, the early development of which had been influenced by Thomas Longmore (1816–1895), Joseph Lister (1827–1912), F. J. von Esmarch (1823–1912), and Carl von Reyher (1846–1890). During these conflicts, Brown reacted to surgical practices unsuited to the battlefield and not in the interest of the wounded. One such practice was “expectant” surgery, the practitioners of which dangerously substituted natural healing for immediate wound resection. Brown also criticized “operative” surgeons who, when faced with gunshot wounds of the extremities, expeditiously amputated limbs. Viewing each case as diagnostically unique, Brown tried to salvage limbs, to preserve function, and to accelerate recovery. To achieve these objectives, he used debridement, antisepsis, drainage, nutrition, and limited post-operative intervention.

Joe, the Combat Medic

This chapter tells the story of a combat medic named Joe, who served for many years in Iraq, Afghanistan and other war zones. As a result of his job, Joe developed a severe case of PTSD. He comes to the park at the request of a friend, and slowly begins to heal. He becomes one of Patrick’s super volunteers, eventually becoming so good that he lectures visitors. Over time, he feels better and begins working in a hospital as a military surgeon.

The Hudson Brace technique for emergency burr holes, an aide-memoire for the front-line military surgeon

Traumatic brain injury is the leading cause of death in conflict and early surgical intervention achieves better outcomes. The British Army surgical kit includes a Hudson Brace and bit and Gigli saw for decompression of the cranial cavity. Here we demonstrate the Hudson Brace technique for non-neurosurgeons.

Evaluation of a fellowship abroad as part of the initial training of the French military surgeon

IntroductionMilitary surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment.MethodsThis study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents’ first foreign deployment.ResultsSixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10.ConclusionA fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees’ feedback confirms its relevance.

Dr. Vladan Djordjevic, the first Serbian military surgeon-operator and the first medical colonel of the Serbian army, chief of its medical care in the three wars it fought in the second half of the 19th century (1876, 1877/1878 and 1885), military writer and historian of the Serbian military medicine - a military part of his life

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