The military surgeon--not least in the crusade

The history of the surgeon in warfare is briefly reviewed. The steady improvement in mortality and morbidity in the major wars of the 20th century has been based on a melding of sound surgical and medical military principles. A number of points are emphasized. Care in the forward area is directed towards those measures that will preserve life and facilitate early and comfortable evacuation to forward surgical hospitals. Triage is vital at this level with criteria for admission to hospital depending at any one time on casualty loads and surgical potential, the remaining patients being sent to large and relatively fixed hospitals in the rear. All selected patients are admitted to a resuscitation ward where, after thorough evaluation, life-saving measures are instituted and blood-volume deficits rapidly replaced before operation. The aim is to debride thoroughly all wounds within 8 hours of injury. The wounds are left open and dressed to be followed by delayed primary closure in 7 to 10 days. Reparative surgery, except to save limb or life, is undertaken only when the wound has healed. The author reminisces about some Canadian military surgeons he has known and relates some surgical vignettes from the two wars in which he participated.