32. Relearning in military surgery: The contributions of Princess Vera Gedroits

Abstract

It is a well known truth that knowledge is often forgotten and has to be relearned. In medicine, this unfortunate trend is especially prevalent in the history of military surgery. The story of a Russian Princess, military surgeon, and poet, Dr. Vera Gedroits is one such forgotten story. Dr. Gedroits’ largely unrecognized contribution to military surgery was the adoption of laparotomy for penetrating abdominal wounds (PAWs).
 In the latter half of the 19th Century, the treatment of PAWs was controversial. However, the results of the Spanish-American (1898) and Boer (1899-1902) Wars and the outspoken opinions of prominent experts unified medical opinion; conservative treatment was clearly established as the treatment paradigm for PAWs at the birth of the 20th Century. Indeed, conservative treatment was officially adopted by the Russians at the outset of the Russo-Japanese War (1904-1905). 
 During this war, the bold surgical practices of Dr. Gedroits would seriously challenge this standard of care. Dr. Gedroits performed operations in a converted railway car in a Red Cross hospital train. Despite these suboptimal conditions, she performed laparotomies on victims of PAWs with unprecedented success. These results, which were largely due to strict surgical indications and technical skill, effectively demonstrated the importance of laparotomy in the treatment of such wounds. As a result, the Russians adopted operative treatment as the new standard of care. Interestingly however, no other countries seemed to take any notice. Dr. Gedroits’ results were barely remarked upon and quickly forgotten. Indeed, contemporary Western observers of the Russian medical outfit, and historians since, have interpreted the surgical results of the war to support conservative management. It was not until WWI, ten years later, that surgeons relearned the utility of laparotomy. The story of Dr. Gedroits, both before and after her innovative treatment in the Russo-Japanese war, deserves remembering.
 Bennett J. Princess Vera Gedroits: military surgeon, poet, and author. British Medical Journal 1992; 305(6868):1532-1534.
 Harvard V, Hoff J. Reports of Military Observers Attached to the Armies in Manchuria during the Russo-Japanese War. London: HMSO, 1908.
 Wallace C. War surgery of the abdomen. Lancet 1917; 189(4885):561-5568.