From Trench to Bedside: Military Surgery During World War I Upon Its Centennial

The views expressed are solely those of the authors and do not reflect the official policy or position of the US Army, US Navy, US Air Force, the Department of Defense, or the US Government. On 11 November 2018, we commemorated the end of the First World War, a social, cultural, political, and military cataclysm that killed an estimated 20 million people. From this carnage emerged few rays of light, but improvements in the care of the wounded represented one effulgence. Over the course of the war, nations developed effective military medical systems that instituted preventive strategies like vaccination, established efficient evacuation chains, and pioneered novel therapeutic interventions to treat the sick and injured. This experience provides particularly relevant lessons for today, given the looming threat of a peer or near-peer conflict. By contrast with World War I, in recent engagements the US has maintained near-total air and sea superiority, facilitating secure and rapid evacuation of the wounded. No enemy assault has seriously threatened to overrun a major American medical unit since the United Nations’ retreat from the Yalu River in 1950. The rate of wounded and killed has markedly slowed over the course of the 20th and 21st centuries. At their most active time, forward hospitals in Afghanistan were treating ~2000 casualties per year – a stark contrast to the ~2000 wounded men deposited on the doorstep of some World War I military hospitals in a single day. The relatively controlled circumstances of recent conflicts enabled high quality care for every injured service member, producing unprecedented results. If America engages with a peer or near-peer enemy (e.g., Russia, China, North Korea), it is highly possible that our military would not benefit from these advantages as adversaries could effectively challenge control of the air/sea, compromise logistical support, and inflict a number of casualties not witnessed in generations. This article, focusing on the Western Front, reviews the military medical experience of the First World War with specific intent on examining lessons applicable to future engagements.