Abstract
Medical services in WWI had to face enormous new problems: masses of wounded, most with devastating wounds from artillery splinters, often involving body cavities, and always contaminated. Tetanus, gas gangrene, wound infections were common and often fatal. Abdominal wounds were especially a problem: upon entering the war the commanders of all medical services ordered to avoid surgery, based on dismal experiences of previous wars. Surgical community divided into non-operative and operative treatment supporters. The problem seemed mainly organizational, as the wounded were rescued after many hours and treated by non-specialist doctors, in inadequate frontline settings or evacuated back with further delay of treatment. During initial neutrality, Italian Academics closely followed the debate, with different positions. Many courses and publications on war surgery flourished. Among the interventionists, Baldo Rossi, to provide a setting adequate to major operations close to the frontline, with trained surgeons and adequate instruments, realized for the Milano Red Cross three fully equipped, mobile surgical hospitals mounted on trucks, with an operating cabin-tent, with warming, illumination and sterilizing devices, post-operative tents and a radiological unit. Chiefs of the army approved the project and implemented seven similar units, called army surgical ambulances, each run by a distinguished surgeon. Epic history and challenges of the mobile units at the frontline, brilliant results achieved on war wounds and epidemics are described. After the war they were considered among the most significant novelties of military medical services. Parallels with present scenarios in war and peace are outlined.
Highlights
The outbreak of World War I, in August 1914, found all Armies unprepared
Once conquered the Bainsizza, the Zagora section again moved to Ravne, another “hot” site”, and for a couple of months was the only specialized surgical unit in the entire plateau, deserving a warm tribute by the famous British historian Trevelyan, who was in command of the local British Red Cross Motor Ambulances and a direct witness of medics’ courage in Ravne [21]
Baldo Rossi and collaborators published a book on the Città di Milano’s 5497 operations, which became a war surgery reference textbook [18]
Summary
The outbreak of World War I, in August 1914, found all Armies unprepared. Army medical services were still oriented to past trends: military doctors had a general medical training, and the organization, following a hasty dressing in the field, aimed mainly at rapidly evacuating the wounded. Soon the conflict turned into a horrific war of position. Thousands of men holed up in the trenches awaiting to go “over the top” to attempt breaking through enemy lines, despite barbed wire fences and machine-gun fire. Bayonet wounds were relatively infrequent, and gunshot wounds were a minority; the vast majority were devastating lacerations from artillery splinters or machine gun blasts. The onset of infection, tetanus or gas gangrene was often fatal [3]
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