The Great War and the Birth of Modern Medicine

by Thomas Helling

A startling narrative revealing the impressive medical and surgical advances that quickly developed as solutions to the horrors unleashed by World War I.

The Great War of 1914-1918 burst on the European scene with a brutality to mankind not yet witnessed by the civilized world. Modern warfare was no longer the stuff of chivalry and honor; it was a mutilative, deadly, and humbling exercise to wipe out the very presence of humanity. Suddenly, thousands upon thousands of maimed, beaten, and bleeding men surged into aid stations and hospitals with injuries unimaginable in their scope and destruction. Doctors scrambled to find some way to salvage not only life but limb.

The Great War and the Birth of Modern Medicine provides a startling and graphic account of the efforts of teams of doctors and researchers to quickly develop medical and surgical solutions. Those problems of gas gangrene, hemorrhagic shock, gas poisoning, brain trauma, facial disfigurement, broken bones, and broken spirits flooded hospital beds, stressing caregivers and prompting medical innovations that would last far beyond the Armistice of 1918 and would eventually provide the backbone of modern medical therapy.

Thomas Helling’s description of events that shaped refinements of medical care is a riveting account of the ingenuity and resourcefulness of men and women to deter the total destruction of the human body and human mind. His tales of surgical daring, industrial collaboration, scientific discovery, and utter compassion provide an understanding of the horror that laid a foundation for the medical wonders of today. The marvels of resuscitation, blood transfusion, brain surgery, X-rays, and bone setting all had their beginnings on the battlefields of France. The influenza contagion in 1918 was an ominous forerunner of the frightening pandemic of 2020-2021.

For anyone curious about the true terrors of war and the miracles of modern medicine, this is a must read.

Genres: History, Nonfiction, Medicine, Science, World War I, Audiobook, Medical

496 pages, Hardcover

Published March 1, 2022

Reviews

[Stefan Mitev · Rating 3 out of 5]

Според един историк, Първата световна война е "бащата на модерната медицина". Според друг, тя е спасила повече животи, отколкото е отнела. Звучи парадоксално, но за четири години между 1914 и 1918 г. науката и медицината в частност претърпяват невиждан прогрес. Ужасът на окопите води до революция в разбирането за травматичен шок и асептична грижа за замърсени рани. Започват масово да се използват мобилни рентгенови апарати за диагностика. Създава се прототипът на съвременните банки за кръвни продукти. "Линейки" извозват ранените до полеви болници. Фрактурите на кости се обездвижват за правилно зарастване с иновативни методи, като шина на Томас. Разпознават се механизмите, водещи до състоянието, известно днес като посттравматично стресово разстройство, а в миналото наричано "умора от битката" или "гилзов шок".

Известният автор Джаред Даймънд отбелязва, че през ХIX век историята е разглеждана като "прогрес от дивачество към цивилизация". Първата световна война слага край на тази наивна идея. Жертвите на химичните оръжия, използвани под формата на газове, са невиждани дотогава. Бактерията Clostridium perfringens причинява безбройни случаи на газова гангрена, налагаща ампутация на крайници. "Испанският" грип взима повече жертви, отоколкото оръжията на бойното поле. Учените отхвърлят теорията, че грипът се дължи на бактерия (H. influenzae - бацил на Пфайфер) и започват масови мерки за карантина и изолация.

Първата световна война е първият истински индустриален военен конфликт, в чиито ужас се ражда модерната медицина.

[RageSheep · Rating 2 out of 5]

The history itself was interesting enough to get me through to the end of the book, but it was hard in a few places because of how the author addressed women through the book.
I'm not, of course, referring to the fact that the involvement of women in the medical efforts of nearly every combatant country was largely ignored. That is, frankly, par for the course in military histories.
But nearly every time a woman was mentioned, the author felt the need to actively attack her and her character. For example, after having spent almost no time on any one player's personal history in the first half of the book, the author felt the need to bring up the fact that Marie Currie had an extra-marital affair after her husband's death, just so he could work in calling her a whore.
Later on, when discussing a particular Dr who joined a volunteer hospital because he was too old to join a military hospital, even as a Dr, he went on to claim that the woman who founded said hospital was just looking for a distraction to get her out of London because she was bored with her marriage.
An unnecessary tangent at its absolute best. It's almost like he took personal offense at the fact that they created a situation where he couldn't ignore them without leaving noticeable gaps in his history.
I normally think it's annoying at best when people feel the need to accuse military histories of being sexist because they have a prominent male focus. For the most part, it doesn't seem entirely inappropriate, but this author really just took it too far.
I'm curious what the editor and publisher were thinking, too.

[Ashley · Rating 2 out of 5]

At its base, this is an interesting book that covers various aspects of medicine that were impacted by the Great War. It's organized such that each chapter covers a different topic--poison gas, in one, or the treatment of facial injuries in another. These are arranged in a somewhat chronological order as possible, though of course most cover a period starting before the war and continuing through its conclusion.

My real complaint with this book is the writing style, which is unnecessarily florid. Whole paragraphs might be devoted to a semi-poetic description of blood, and truthfully the chapters dealing with the less literally bloody varieties of war wounds are stronger for their lack of this.

The overall approach also has a strong tendency toward the Great Man--one pioneering doctor does one thing that lays the groundwork for all future progress. I don't know enough about the history of medicine to know whether these assertions are true, and trust that Dr. Helling does know--but simultaneously, I'm not sure that Marie Sklodowska-Curie having an affair after her husband's death is actually that relevant to the topic at hand, especially when the book doesn't generally discuss the love lives of the male doctors, surgeons, etc. profiled.

This approach also has a tendency to highlight the impact of various developments on the trajectory of medicine as a whole, but spends relatively little time considering the impact on the lives of the injured men it was used to treat. This makes sense, given the intent of the book is to profile the impact of the First World War on the development of modern medicine and not to profile the impact of medicine in the First World War on the people who experienced it. Nevertheless, it contributes to a somewhat strange effect where weapons and injuries are acknowledged as having been considered terrifying at the time, and yet are described as essentially not nearly as bad as they were believed to be because the overall death rate was relatively low and instances where it seems like the acknowledgement that the injuries described were on actual people comes as something of an afterthought.

Again, I don't mean to suggest that the author did a poor job or that he doesn't know his subject matter--he very clearly does know what he is writing about. Rather, my issues with the book are largely a matter of a combination of stylistic choices and somewhat unfortunate implications that probably could have been largely circumvented with different editing.

[Kumail Akbar · Rating 5 out of 5]

"A war benefits medicine more than it benefits anybody else. It’s terrible, of course, but it does."

This was an absolutely fantastic read. I had heard of Florence Nightengale as a child, and of the development of modern healthcare practices in and after the World Wars, but the actual story of different health care practices and how they emerged during what was possibly the most brain dead war of the entire 19th and 20th centuries is truly something. Strongly recommend this as a must read to everyone.

[Jeff Burket · Rating 3 out of 5]

Almost only a 2-star for me, but there is enough interesting information that I'll keep it at a 3. It genuine does a decent job of describing how the origins/early life of many fields of medicine spring from or were heavily influenced by WWI - chemical warfare, hemorrhagic shock and transfusion, surgical techniques, radiography, infectious disease, and more; and you meet many of founders of modern medicine and lore that lived during this time.

However, the book falls well short of its potential in many ways: thematically, 1) it doesn't do much to truly connect the origins of these many fields to current practice; and 2) it far too much focused on individuals and their apparent "genius" but hardly all on how systems and organizations must have played roles in the advancement of various knowledge and techniques (academic centers, journals, government and military agencies, etc). But the biggest shortcomings are more editorial and in the writing: there is far too much repetition about the "horrors" of the war - as we the reader are repeatedly subjected to unnecessarily and unhelpfully gruesome descriptions of the carnage along with each new character of history we meet. Far too much of the narrative consists of various anecdotes the author seemed to have found in his research but arent that relevant to the topic and mostly lead him to make assumptions about the mindset and motivations of the main figures -> should have just left so much of it out. And finally a critique of the audio version: much of the book centers around French physicians and scientists (which is fine). But the heavily accented (and I presume correct) pronunciation in french of all individual names, the referring to so many of the hospitals/organizations/etc in french (and not just translating to English), and particularly the sometimes length quoting of scientific findings or journal entries was simply annoying and not-helpful, it actually made it harder sometimes to understand the throughiline/point the quote was trying to make.

[Nancy · Rating 4 out of 5]

The quotation that opens Dr. Helling's final chapter, "And After the Dying," summarizes this book well: "A war benefits medicine more than it benefits anybody else. It’s terrible, of course, but it does." - Mary Merritt Crawford, only woman physician to serve at the Ambulance Americaine in Neuilly-sur-Seine, working there for one year as an anesthesiologist.

This book delves deeply into the horrors of the first modern war, modern because the weaponry was so advanced that casualties were plentiferous and catastrophic, and the destruction the war wrought upon its players - the soldiers on both sides - became an opportunity for medicine and science to devise ways to treat the injuries, both physical and mental, the conflict wrought.

The need for battlefield surgery, prompting the creation of mobile ambulances. The dilemma of traumatic shock, necessitating ways to measure blood pressure and to treat with blood transfusions. The vile horror of gas gangrene - antiseptics. Gas warfare. The diagnostic utility of x-rays and creation of mobile x-ray units. Neurosurgery to treat the catastrophic head injuries caused by shrapnel and explosive concussions. Maxillofacial plastic surgery advances to ameliorate the disfigurations caused by battlefield injuries. Advances in orthopedic splints to better treat broken femurs and allowing for ventilation and wound treatment. The recognition of "shell shock" and its need for treatment (which was spotty 100 years ago). And the profound impact of the 1918 Influenza Epidemic that killed so many soldiers and medical personnel, but especially on the German side, weakening its ability to continue the battle.

I sometimes had quibbles with author Helling's writing style, which could seem florid or prolix, but on balance I found this to be a valuable history that enhanced my knowledge both about that terrible conflict and also about medicine.

[Kristi Thielen · Rating 5 out of 5]

The importance to medicine of blood transfusion, shock treatment, mobile surgical units, x-rays, reconstructive surgery, sterile conditions and even the humble splint, has been established for a century. But it was World War I which saw them first proposed, opposed, refined and finally established as standard medical care.

When the Great War began, medical professionals still thought of battlefield damage as what was inflicted by previous war’s weaponry: gunshot wounds, to be left largely untouched until the wounded could be gotten to a hospital far away. But the advanced weaponry of 1914 – principally machine guns, grenades and poison gas – did hideous damage never seen before. Medicine had to change and quickly.

In Thomas Helling’s ably written book, he details the history of the war through the eyes of medical personnel and how they came to accept and utilize vitally important new procedures. As he tells the story, Helling also provides rich details about the conflicting (and often egomaniacal) personalities that played a role in the Great War’s evolving medical treatment. And it should come as no surprise to a reader that, often, treatment that was proposed and how quickly it was adopted was a matter of politics and power, not care for the wounded and dying.

The book is an excellent read for any student of World War I and of the remarkable history of medicine.

[Lance Hillsinger · Rating 4 out of 5]

Dr. Thomas Helling’s, The Great War and the Birth of Modern Medicine is a painful read. The horrors of war, especially in the pre-antibiotics era where amputations were common, do not make for an easy read. That said, Helling’s book is worth reading.

Helling is a good historian. In places, he deftly goes back to the mid-19th century to the story of the first great war of the 20th century. His writing is descriptive without being flowery. Helling has a journalist’s nose to digger deep, not just into events, but the personalities and mindsets of the various doctors who were prominent in the care of the wounded in WWI.

Just a few minor criticisms, in the first few chapters, there are too many quotes. Quotes that the author translated from French. Also, the first few chapters, accurately, relate how injured soldiers went hours, even days without treatment, and amputations to prevent gangrene were needed. (Other chapters focus on facial injuries, shell shock, etc.). There is just so much of the horrors of war the reader can take in an evening’s read before bedtime.

Still, with a doctor’s insight, a historian’ grasp of history, and a journalist’s eye for the larger truth, The Great War and the Birth of Modern Medicine deserves a strong four stars.

[Grace Harmon · Rating 3 out of 5]

An informative and relatively condensed summary of how the WW1 battlefield-turned-laboratory led to medical innovations and practices we take for granted today. I appreciated the structure and readability as someone untrained in medicine. However, I docked two stars because of the author’s treatment of Marie Curie in comparison to other men of the book. The only mention of other male figures’ relationships are whether a spouse died, and a few lines about the men’s general disposition and stature. Whereas Marie Curie, despite her genius, is attributed to flirting her way into funding of her X-Ray mobiles. Is that not networking? Are her romantic affairs and physical beauty relevant to her scientific work? It made me wonder if all a woman can be, is attractive to men, despite Marie Curie’s invention of two fields of science. Second, I respect that this author sought to give a subjective view of military medical history, but I don’t love the lack of recognition of the moral gravity and/or dissonance of this scientific innovation as a result of this new, barbaric warfare. It was overall a good read that helped me make connections, but left me perturbed and unsure of the author’s perspective on women and the destruction of human beings.

[Brian Thorson · Rating 4 out of 5]

World War I provided a unique and challenging environment for medical professionals, forcing them to develop innovative techniques and technologies to treat the unprecedented number and severity of injuries. As the military medicine community prepares for the next “great” war, we would be wise to gain an appreciation for how medical professionals prepared for, learned from, and adapted during this war.

The advancements during WWI were impressive. Representative of the totality of advances, here is a sampling: new surgical techniques, including the use of antiseptics, blood transfusions, and improved anesthesia; the establishment of specialized hospitals and medical units to deal with specific medical conditions; X-rays for diagnosing injuries; the development of mobile surgical units for immediate treatment; prosthetics; the emergence of psychiatric care and the understanding of post-traumatic stress disorder (PTSD) during and after the war; public health campaigns; and blood transfusions.

[Karen Vincent · Rating 5 out of 5]

Science teachers never tire of the subject even when they are retired. This is a really interesting book about how war, though a terrible thing, brings about many advances in science. WWI truly was the beginning of modern science - neurology, surgery, anesthesiology, plastic surgery, oral surgery, blood transfusions, bacteriology, immunology - the list is endless! I found it fascinating especially to hear about some of my heroes like Marie Curie and how they contributed to modern medicine because of the situations created by advanced armaments in WWI. It's long but so worth reading. If I was still teaching I would have a copy in my classroom library because the students need to understand how we got to where we are today.

[Forrest G · Rating 5 out of 5]

The cost?.

The irrational process of invasion on another’s sovereignty and the horrid consequences of the soldiers is the slap in the face of this historical novel! Medicine and science innovations were funded by ignore governments to placate their embarrassments and slaughter of their young. Thankfully, the gifted scientists, researchers, and physicians of the period willing stepped in to the chaos of maiming and death to adapt and learn.
War benefits industry, perhaps science but destroys the soldiers. This book is miss titled. It should be the horrid killing fields of France and knee jerk of governments and science that resulted in the birth of modern medicine.

[Patrick Pilz · Rating 4 out of 5]

Prior World War 1, the odds of visiting a doctor and returning with better health was about 50:50. The tremendous amount of violence and the resulting number of casualties triggered a lot of creative approaches to healing which converged with the emerging sciences of x-rays, germ theories, epidemiology, immunology and others, so that by the end of World War 1, the odds of patients significantly improved.

If you want to know how these 4 years leapfrogged medical treatments, you will love this book!
!

[Sara Suleski · Rating 5 out of 5]

If you would like an overall look into the various medical advancements that came about amidst turmoil and chaos, then this is the book for you. Each chapter focuses on the history and evolution, so if you are interested in one of them, you could read it by itself and skip around. I listened to the book and it felt like each chapter was an episode in a morbidly curious podcast.

Some medical highlights include: Rontgen's Rays (X-Rays), Ambulances, Field Hospitals, Bone Fractures and Splints, Invention of Plastic Surgery, PTSD and Shell Shock, and the Influenza Pandemic of 1918.

[Marci · Rating 2 out of 5]

While the material was interesting and I learned a lot, the book suffered from overly florid prose, a lack of good editing: “his death was so sudden he was dead by the morning”, and some disappointing sexism in the chapter on Marie Curie. Too bad because the concept of the book was interesting, it was just not really well written.

[Patrick · Rating 4 out of 5]

I enjoyed it. I skipped around a bit and didn't read the whole thing. It's written in such a way that you can do that without getting confused. Parts are pretty gruesome which tbh is what I was looking to read. I learned some very interesting things reading this, for example, even at this time they were doing pretty remarkable facial reconstruction surgeries.

[Caleb McDaniel · Rating 4 out of 5]

Fascinating read about all the medical knowledge derived from the horrific atrocities of war at the beginning of the 20th century. The book discusses chemical gas warfare, gas gangrene infections, neuro surgery, radiology, various wound management, and the Spanish flu epidemic that happened at the same time.

[Ben · Rating 5 out of 5]

Great read about how war drove advancement and change in medicine. Being in military medicine currently, I can now see why the army does what it does, from PTSD screening to yearly influenza vaccinations.

[Daniel · Rating 4 out of 5]

How the man made hell of the Great War, the war to end all wars led to some of the most brilliant of findings leading to many of the medical advances of the next century. Some descriptions not for the fainthearted.

[Jacob Walkinshaw · Rating 3 out of 5]

- Interesting overview of treatments and advancements made in various areas of medicine during WW1.
- Some descriptions seemed a bit lengthy/poetic.
- Was hoping for more scientific detail, less story telling.

[Killthehumans Savetheforest · Rating 2 out of 5]

Barely a skim of the subjects. It's a fine book, I just want to be drowned in technical detail.

[Shawn · Rating 5 out of 5]

Utterly fascinating, broad-ranging, and exquisitely written

[Arianne · Rating 3 out of 5]

3.5 stars

[Laura✨ · Rating 4 out of 5]

Although I have read tidbits of medical history surrounding gas masks, shell shock, blood transfusion and more within other WWI books and articles, this was the first time I encountered a book bringing all the fields together. The book is informative, weaving together the different strands of medical history into a cohesive and engaging story that highlights how the Great War served as a catalyst for the birth of modern medicine. It is a valuable read for anyone interested in the intersection of history, medicine, and the indelible impact of war on society.

[John Hewlett · Rating 4 out of 5]

Highly recommend. Helling may be a trauma surgeon but he also exployees a skilled literary flare. WWI saw innovations in two notable realms, aviation and medicine. This book covers the latter in a VERY readable form. War may be hell but the world certainly benefited greatly in its aftermath and this book explains how.

[Peter Hawkeye · Rating 3 out of 5]

Interesting, though I thought it excluded a lot of pertinent information relating to many revolutionary ideas that were also instilled within this sad monumental time within humanity's history.

[jeffrey · Rating 5 out of 5]

I read the hard cover version of this outstanding book. In graphic and fascinating detail the author recounts the development of treatment for a variety of horrific injuries and diseases suffered primarily by soldiers of the Great War. Highly recommended!

[Michelle Kim · Rating 5 out of 5]

Very graphic and well detailed on how certain treatments and medicines were formed during WW1 and the crucial roles that physicians played. Very intriguing overall.