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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 19 th 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 20 th century. Indeed, conservative treatment was officially adopted by the Russians at the outset of the Russo-Japanese War (1904-1905).
... She then arranged a marriage of convenience to a friend, Nikolai Belozerov, to change her name, obtain a passport, and escape to Switzerland to pursue medical studies. 14,15 She graduated from Lausanne University in 1898 with honors, achieving almost perfect marks. 11 Following her graduation, Gedroits was supervised by Professor César Roux as senior assistant. ...
... "In this war [Boer War], a man wounded in the abdomen dies if he is operated upon and remains alive if he is left in peace"-Sir William MacCormac, c1900 14,18 Despite the development of antiseptics and improved anesthetic methods, nonoperative management of PAWs dominated at the time of the RJ War. 14,18 One influential proponent of the conservative approach was Paul Reclus, a French surgeon, based on gunshot experiments in dogs. ...
... "In this war [Boer War], a man wounded in the abdomen dies if he is operated upon and remains alive if he is left in peace"-Sir William MacCormac, c1900 14,18 Despite the development of antiseptics and improved anesthetic methods, nonoperative management of PAWs dominated at the time of the RJ War. 14,18 One influential proponent of the conservative approach was Paul Reclus, a French surgeon, based on gunshot experiments in dogs. 14,18 This principle would be supported by results from the First Sino-Japanese War (1894-1895), the Spanish-American War (1868), and the Anglo-Boer War (1899-1902). ...
The 1904–1905 Russo-Japanese War was the first “modern” conflict, using rapid-firing artillery and machine guns, fought over imperial ambitions in Korea and Manchuria. During the war, Princess Vera Gedroits pioneered early laparotomy for penetrating abdominal wounds with unprecedented success. Her techniques were then adopted by the Russian Society of Military Doctors. However, Allied forces took 10 years to adopt operative management of penetrating abdominal wounds over conservative management. Gedroits was later appointed in Kyiv as the world’s first female Professor of Surgery. Kanehiro Takaki, a Japanese Naval surgeon, showed in 1884 a diet of barley, meat, milk, bread, and beans, rather than polished white rice, eliminated beriberi in the Japanese Navy. Despite this success, the Japanese Army failed to change the white rice rations until March 1905. During the 1904–1905 Russo-Japanese War, an estimated 250,000 Japanese soldiers developed beriberi, of whom 27,000 died. Japan’s 1905 defeat of Russia sowed the seeds of discontent with Tsar Nicholas’ rule, culminating in the 1917 Russian Revolution. Although the Russian Navy was destroyed, Japan ceded North Sakhalin Island to Russia in peace negotiations, and Russia seized Manchuria, South Sakhalin, and the Kuril Islands in 1945. We highlight the contributions of Gedroits and Takaki, 2 intellectual prodigies who respectively pioneered rapid triage and surgical management of trauma and a cure for beriberi. We aim to show how both these surgeons challenged entrenched dogma and the cultural and political zeitgeist, and risked their professional reputations and their lives in being ADOPTERs of innovation during a crisis.
The Russo-Japanese War illustrates how the normal evolution of modern warfare affects the medical branch of military service. This book presents a series of reports by U.S. Army Assistant Surgeon-Generals attached to the Russian Army as observers in the Russo-Japanese War. Special attention is given to changes that have occurred in military medicine over time and to changes in wounds caused by the weaponry of modern warfare. The observers record statistics of deaths casualties and scrutinize the increasing importance played by the relatively new Red Cross Societies. They also study how the climate and terrain affect soldiers' health and medical personnel's ability to evacuate and hospitalize the wounded. The book includes detailed descriptions of life in Russian Army hospitals, and photographs and descriptions of ambulances and wheeled litters used to transport the wounded. This volume, Part II, contains the observations of Colonel Valery Havard and Colonel John Van R. Hoff. Colonel Havard's observations focus on the following topics: the unique characteristics of the Russo-Japanese war; the Manchurian climate; winter quarters and heating; the effects of cold on soldiers; clothing, uniforms, and equipment; medical vehicles and tents; food and rations; the ambulant kitchens; casualties and deaths; casualties from artillery fire; bayonet and sword wounds; medical corps; hospital corps; organization of medical corps at the front; first aid; field hospitals; base hospitals; disinfection stations; hospital trains; projectile and gunshot wounds; wound infections; disease and hygiene; the history and development of the Russian Red Cross Society; and the Society's role in the Russo-Japanese war. Colonel Van R. Hoff's report focuses on the Russian Army's medical statistics; sanitation, medical, and veterinary departments; medical personnel; division lazarets; field hospitals; evacuation procedures; prevalence of disease; dysentery; and surgical suggestions.
Mandatory surgical exploration for gunshot wounds to the abdomen has been a surgical dictum for the greater part of this past century. Although nonoperative management of blunt solid organ injuries and low-energy penetrating injuries such as stab wounds is well established, the same is not true for gunshot wounds. The vast majority of patients who sustain a gunshot injury to the abdomen require immediate laparotomy to control bleeding and contain contamination. Nonoperative treatment of patients with a gunshot injury is gaining acceptance in only a highly selected subset of hemodynamically stable adult patients without peritonitis. Although the physical examination remains the cornerstone in the evaluation of patients with gunshot injury, other techniques such as computed tomography, diagnostic peritoneal lavage, and laparoscopy allow accurate determination of intra-abdominal injury. The ability to exclude internal organ injury nonoperatively avoids the potential complications of unnecessary laparotomy. Clinical data to support selective nonoperative management of certain gunshot injuries to the abdomen are accumulating, but the approach has risks and requires careful collaborative management by emergency physicians and surgeons experienced in the care of penetrating injury.
The book of Revelation describes the 4 horsemen of the Apocalypse, conquest, death, famine, and war as the hardships that human kind must endure before the end of the world.1 The hardships of war have been evident throughout history and are now illustrated for us at least twice a day on the morning and evening news. Not so obvious have been the benefits derived from surgical experience during war, or the benefits derived from the application of new knowledge and new technology to the treatment of combat casualties. These benefits have been most conspicuous in the realm of wound care, the recorded history of which begins by best estimate 3605 years ago.
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