SH05 THE CONTRIBUTION OF THEODORE BILLROTH TO THE MANAGEMENT OF WAR WOUNDS IN THE FRANCO‐PRUSSIAN WAR 1870–1

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The outcome of war wounds until the late 1800s was dismal, with most significant wounds showing “putrefication and suppuration” prompting surgeons to employ a high rate of amputation. At this time a “spontaneous generation theory” was popular – wound infection being attributed to toxins released by dying tissues. Pasteur's Germ Theory was yet to be published.Billroth spent a summer vacation as a military surgeon during the Franco‐Prussian war (1870–1), a campaign that marked the birth of Germany as a nation. By then Billroth, aged 41, was Professor of Surgery in Vienna, and had already published a book on gunshot wounds in which he had advocated primary closure.He was posted behind the frontline in military hospitals, first in Weissenburg and then in Mannheim. His wartime observations included missile projectiles, prevention of suppuration, removal of bullets, and the impact of a fracture on the risk of infection. On arrival in Mannheim, the incidence of erysipelas had been alarming, but he reduced infection rates by simple hygienic measures, adopting, but modifying, some of Lister's principles of anti‐sepsis. For amputation, he stressed haemostasis, approximation of layers, but allowing open drainage and healing by secondary intention. In October 1870 he had almost 100 patients transferred from Weissenburg to Mannheim so he could study their progress. There was only once case of gangrene.Conclusion: Billroth's involvement in the Franco‐Prussian war resulted in progress in the treatment of war wounds. He changed his original management, established without much experience in Zurich, to advocate cleansing, dilute antiseptics, and open drainage.