History of Infections Associated With Combat-Related Injuries

Abstract

Despite the innumerable variations in war-making throughout the millennia, wounds have always been characterized by devitalized tissue, the presence of foreign bodies, clots, fluid collection, and contamination by microorganisms. Even in the postantibiotic era, infections of these wounds remain a significant contributor to both morbidity and mortality. Shifts in causal organisms and their resistance profiles continue to challenge each new generation of therapeutics. This article reviews the history of war wound infections, with an emphasis on wound microbiology and combat casualty management during US conflicts from World War I through the end of 20th century.

Treatment of War Wounds: A Historical Review

“…If a wound had to be closed, a piece of onion was placed in the cavity before closure, and the wound reopened in 1 to 2 days. As in the past, Colonial physicians saw the development of pus a few days after injury as a sign of proper wound digestion [96].…”

“…John Hunter (1728-1793), surgeon general of the British army, directed physicians to resist aggressive débridement in smaller wounds. Wine was applied topically to minor burns, and hog lard to full-thickness burns [96]. John Jones (1729-1791), a veteran of the French and Indian Wars (1754-1763) and Professor of Surgery in King's College, New York, advised surgeons to delay primary wound closure and apply:…”

“…Patients frequently sustained multiple wounds from bursts of automatic fire or booby traps. Surgeons could receive patients as early as 1 to 2 hours after wounding [60,96], although in reality conditions during combat often delayed evacuation and resulted in an arrival time of 4 to 6 hours after wounding. On arrival, the patient was infused with Ringer's lactate and antibiotics.…”

“…Physicians did not agree on the cause or treatment for erysipelas, which carried a mortality rate of 8%. The battle against hospital gangrene and its 60% mortality rate [96], however, produced one of the rare antiinfection victories of the war. In 1863, the Union medical officer Middleton Goldsmith (1818-1887), stationed in Louisville, KY, reported the results of a treatment protocol that called for débridement of all necrotic tissue and application of a mixture of bromine, bromide of potassium, and water applied to dressings.…”

“…Bromine was used widely thereafter to treat gas gangrene, although surgeons were never sure if it was effective [104,116]. Carbolic acid and sodium hypochlorite also were used to treat established gangrene, but not as prophylaxis [96].…”