How World War I Revolutionized Medicine

Advances during the “first mass killing of the 20th century” have saved countless lives since.

George Crile, an American physician, with other volunteers from Cleveland's Lakeside Hospital in France, 1915 (

When World War I broke out in France, in August 1914, getting a wounded soldier from the battlefield to a hospital required horse-drawn wagons or mules with baskets on either side.  Incapacitated soldiers would be taken to a railway station, put in the straw of a cattle-car, and sent towards the nearest city with a hospital. No bandages, no food, no water. “One of those trains had dumped about 500 badly wounded men and left them lying between the tracks in the rain, with no cover whatsoever,” recounted Harvey Cushing, the head of the Harvard Unit of volunteer doctors at the American Ambulance Hospital of Paris.

Such pitiful conditions immediately beset the Battle of the Marne in early September, leaving a thousand wounded French soldiers lying in the straw in a village near Meaux. To rescue them, U.S. Ambassador Myron T. Herrick called all his friends with cars, particularly those on the board of the American Hospital, a small expatriate facility that had just refurbished a school building as a military hospital. This impromptu fleet brought back 34 wounded on the first run, and returned for more. It made the difference between life and death, amputation and healing, and it signaled the start of the motor-ambulance corps.

Medicine, in World War I, made major advances in several directions. The war is better known as the first mass killing of the 20th century—with an estimated 10 million military deaths alone—but for the injured, doctors learned enough to vastly improve a soldier’s chances of survival. They went from amputation as the only solution, to being able to transport soldiers to hospital, to disinfect their wounds and to operate on them to repair the damage wrought by artillery. Ambulances, antiseptic, and anesthesia, three elements of medicine taken entirely for granted today, emerged from the depths of suffering in the First World War.

“In the early stages of the war, especially within six weeks, 300,000 French soldiers were wounded—and as competent surgeons were not to be had for more than a minority, an appalling number of needless amputations were made. In strictest confidence, Tuffier told me with tears in his eyes that more than 20,000 amputations had been made,” George Crile, a volunteer physician from Cleveland’s Lakeside Hospital, wrote in his diary in January 1915.

The key dilemma was that doctors had no effective antiseptic to kill the rampant bacteria, such as Clostridium perfringens, which causes the rapid necrosis known as gas gangrene. The soldiers lived in the filth of the trenches, and if they were wounded, their injuries were immediately corrupted with it. Théodore Tuffier, a leading French surgeon, testified in 1915 to the Academy of Medicine that 70 percent of amputations were due to infection, not to the initial injury.

“Professor Tuffier stated that antiseptics had not proven satisfactory, that cases of gas gangrene were most difficult to handle,” Crile wrote. “All penetrating wounds of the abdomen, he said, die of shock and infection. … He himself tried in fifteen instances to perform immediate operations in cases of penetrating abdominal wounds, and he lost every case. In fact, they have abandoned any attempt to operate penetrating wounds of the abdomen. All wounds large and small are infected. The usual antiseptics, bichloride, carbolic, iodine, etc., fail.”

Help was on the way from the Rockefeller Institute for Medical Research in New York. The French physician Alexis Carrel, who had been working at the Rockefeller Institute before the war, had signed up with the French army and was given an abandoned château in Compiègne, near the front, to renovate into a military hospital. He demanded an X-ray machine and laboratories for analysis. When the French Service Sanitaire declined to provide them, Carrel turned to the Rockefeller Institute. They sent equipment, and most important of all, they sent Henry Dakin, a British biochemist who had perfected a solution of sodium hypochlorite, which killed the dangerous bacteria without burning the flesh. Carrel took the new antiseptic and insisted on opening up wounds to thoroughly irrigate them. The technique, which became known as the “Carrel-Dakin Method,” was adopted by doctors across Europe during the war.

An American ambulance in the Verdun sector
(Pierre Machard/SPA/ECPAD)

Over at the American Ambulance Hospital, meanwhile, George Crile was introducing doctors to a method of anesthesia he and a nurse named Agatha Hodgins had developed in Cleveland. In January 1915, their Lakeside Unit had begun a series of three-month rotations in Neuilly. Crile had brought with him 18 large cylinders—3,000 gallons—of nitrous oxide. He gave surgical demonstrations using a nitrous oxide-oxygen mix—just enough to put a patient to sleep, but not into a state of shock—for Carrel, Dakin, and other French surgeons.

“As to nitrous oxid [sic] the progress of opinion among the doctors has been to ‘first scorn, then wonder and admire.’ Miss Hodgins gave it by special request to one of Dr. Du Bouchet’s patients who underwent a prolonged nerve operation. … He was delighted at the result. Today—a final triumph—she was asked to give it for the French service,” Amy Rowland, chief nurse of Lakeside Unit, wrote in a letter in January 1915.

Antiseptics and anesthesia saved lives once they arrived at the hospital, but without motor ambulances and hospital trains to get them there, wounded soldiers stood little chance. From the impromptu rescue of soldiers from Meaux in September 1914, the American Ambulance Field Service grew to number more than 100 ambulances by the end of the first year of the war. Philanthropists such as Anne Harriman Vanderbilt bought cars, as did civic groups from cities around the United States. The Ford Motor Company donated 10 Model-T chassis to be converted into ambulances.

Volunteer drivers arrived from 48 American universities, and the ranks of the ambulance service grew to some 2,500 by the end of the war. Harvard had 55 men in France in 1915, driving in the pitch night on gutted roads to pick up soldiers from field stations just behind the lines. While saving others, 21 of these Harvard men lost their own lives. Richard Hall was the first, struck by a mortar on Bitschwiller Road near Moosch on Christmas Eve, 1915. His fellow driver Tracy Putnam described having driven past the wreck earlier in the evening and not realizing it was Hall’s ambulance.

“[The mortar] struck Dick Hall’s car just behind the front seat; it must have been quite a big one, for it blew the car completely off the road, bent in the frame, smashed to match-wood the light body, flattened out the tins of petrol. Dick was wounded in three places, the head, the side and the thigh, and killed at once. His body lay there, among the wreck of his car, all night. Our merry convoy passed without seeing it. I saw one of the gasoline cans by the side of the road, and stopped to pick it up, wondering who dropped it.”

The service of the drivers, along with the doctors, nurses and social workers who brought the number of American volunteers to the thousands, did not go unnoticed by the French. One of the volunteers, a driver named Leslie Buswell, based at heavily bombarded Pont-à-Mousson in 1915, wrote in a letter home that the stoicism of the wounded French soldiers was remarkable. “When they are unloaded it is a common thing to see a soldier, probably suffering the pain of the damned, make an effort to take the hand of the American helper. I tell you tears are pretty near sometimes.”

Patients on the rooftop terrace of American Ambulance Hospital

What inspired these major advances in medicine? There was a deep need, and people stepped up to find solutions. The new technology of war—heavy artillery, long-range cannons, barrage shelling, and machine guns—rained devastation at unprecedented levels. Medicine had to try to keep up. One good example of this evolution is in facial reconstruction surgery. Soldiers survived having jaws and noses shattered by artillery fragments, so surgeons at the American Hospital and Val-de-Grace Hospital pioneered maxillofacial techniques, and at the same time, brought dentistry into the medical sciences in France.

Just before he sailed back to the United States in March 1915, George Crile organized a day-long conference at the American Hospital for 100 physicians and diplomats to show them the new techniques and methods that had been developed. Alexis Carrel gave a talk entitled: “Science has perfected the art of killing: Why not that of saving?” That evening, at dinner at the Hotel Ritz, doctors gathered from France, Britain and the United States whose work was doing just that, from developing a vaccine for typhoid to figuring out how to defeat sepsis. The war had drawn a framework of urgency around such medical questions, and the doctors stepped up to answer them.

Mary Merritt Crawford, the only woman doctor at the American Hospital during the war, later noted that war brought death and destruction, yet also opened the path to progress: “A war benefits medicine more than it benefits anybody else. It’s terrible, of course, but it does.”