Battlefield medicine is one subject that I always found interesting. Perhaps just because the idea of trying to heal people and save lives in teh middle of war seems ludicris in many situations, and always seems odd. That said, I know next to nothing about it other than a few anecdotes, and through casual googles never found anything interesting to read or good info about it.

Several stories that I have heard of are:

Napoleon was the first to use ambulances on the battlefield and evacuate the wounded during the battle, I would assume this only refers to field battles, I am sure that wounded would be evacuated to some degree during sieges.

The Crimean war featured the first field hospitals and doctors serving with the troops

During WWII medics were selected pretty much randomly. They didn't volunteer, they didn't start with more knowledge. This seems really strange, I know they wouldn't have been trained doctors, their job was simply to fix a person up so that he either survived the trip to the rear or could go back into the line.

I know that survival rate for wounded soldiers rose substantially during the first half of the 20th century with antibiotics and such, but I remember reading that only a fraction of the German [until they got desperate] and Soviet wounded returned to the front as compared to the Allies. If I recall correctly (or assume correctly), there was a lower mortality rate in the west, but the big difference was in amputations and such prevented by the use of antibiotics.
Another part to this was that antibiotics were rare enough that in a hospital a soldier who revieved them would typically have his urine collected so that the penicillin was filtered out and reused on other people.

I am pretty skeptical on all of these points. And was wondering if anyone knew what the facts were. Or any decent sources that I can access, as this is an aspect of warfare that seems to be almost completely ignored, except by MASH :)

I am pretty skeptical on all of these points. And was wondering if anyone knew what the facts were. Or any decent sources that I can access, as this is an aspect of warfare that seems to be almost completely ignored, except by MASH :)

The Romans were one of the first people to use medics, AFAIK. One source I found says it started under Ceasar Augustus. I wouldn't doubt it as surgical medicine in Roman times was fairly sophisticated. A cable documentary I saw demonstrated that the tools of at least one surgeon were very similar to modern surgical tools, suggesting they had lots of practical experience in those times.

Not sure on a first date for ambulances, but it'd be reasonable to suppose they existed in Roman times, given that they did have a medical corps. An ambulance would be a simple logistical necessity of medicine supporting an organized troops. Just need a cart/stretcher.

I think a resurgence in the use of battlefield medicine can be traced to Napoleonic/American Civil War battles. Surgeons were becoming respected professionals by the 19th C. (I think earlier when they formed their own guild separate from barbers, but I can't recall the exact date---probably late 18th C. at the earliest.). That and the extreme wounds of the 19th C. made battlefield medicine more important again.

The Iliad specifically mentions that Machaon and Podalirius (the sons of Asclepius, the God of Medicine) were medics in the Trojan War, and were among the most important heroes their because of their skill at healing the wounded.


It seems that several of my ancestors at the time of the Civil War were Confederate Army Medics, and I don't think any of them were common soldiers. We still have (a typed copy of) the journal my Great Great Grandfather kept while serving with the Army of Tennessee in the final years of the war. He decided to spend the first few years of the war finishing his medical degree in Philadelphia (in enemy territory) so he could join the confederate army with a higher rank, then stayed at home for a year or two and had a son at the height of the war (I think he actually served as a surgeon at a fort nearby, but this wasn't anywhere near the front lines so he didn't do much), then finally joined the remnants of army after Atlanta had been sacked. I recall that confederate soldiers who wasted their ammunition firing at abandoned rail cars were punished by having their horses given to their company's medic--a punishment that my great great grandfather found particularly just.

I am pretty skeptical on all of these points. And was wondering if anyone knew what the facts were. Or any decent sources that I can access, as this is an aspect of warfare that seems to be almost completely ignored, except by MASH :)

Battfield medicine was rather haphazard until the mid 19th century. Armies generally did not prioritize it, and the staff were not necessarily skilled. Florence Nightengale was responsible for improving the treatment of the wounded after witnessing horrific conditions and a general indifference during the Crimean War. Much of the reforms were in nursing care, such as hygiene and cleaning of wounds and removal of debris, and not so much in medical care. For example, during the American Civil War, doctors did not even know the cause of gangrene and did not understand that infection could be spread through unsanitary conditions, even though Semmelweis had proven this in 1847. They often put down nurses who would tend to their wounds and try to clean them.

Much of the physiology of hemorrhage was not even understood until the 1930's, so many soldiers would often exsanguinate, either externally or internally. By WWII, hemorrhage was often stabilized with plasma transfusions or whole blood transfusions. Also by WWII, penicillin was introduced. It was very hard to come by, so it was often repurified from a patient's urine.

The notion that battlefield medicine existed before 1860 is rather laughable, as it was little more than amputations and prayers.

But prior to the 19th century medicine itself, was basically that, along with a bunch of other superstitious things. I am not worried about how effective the care was, that can be traced through the effectiveness of civilian medical care (but obviously downgraded due to the horrid conditions).

Even through WWI the first course of action if the wound was to a limb was amputation, as if gangrene set in they had no way to control it.

The Iliad specifically mentions that Machaon and Podalirius (the sons of Asclepius, the God of Medicine) were medics in the Trojan War, and were among the most important heroes their because of their skill at healing the wounded.
While this likely indicates that care was given to the wounded during the time, I would assume that this was primarily during lengthy sieges, not during field battles. And even during sieges they waited until after the current engagement ended before bothering to do anything. At least that is how I have seen ancient and medieval battles portrayed.

It seems that several of my ancestors at the time of the Civil War were Confederate Army Medics, and I don't think any of them were common soldiers.
I was thinking more WWII era, specifically coming from Band of Brothers, During the Bastogne episode where Doc Roe says that he was selected for no real overt reason (he says something about his grandmother being a cajun healer).

The Iliad specifically mentions that Machaon and Podalirius (the sons of Asclepius, the God of Medicine) were medics in the Trojan War, and were among the most important heroes their because of their skill at healing the wounded.



Definitely, the Romans' medicine arrived from Greece somewhat. The Romans, in their drive for military organization, probably had the most sophisticated use of battlefield medicine in the ancient world, even having corps of medics.

The notion that battlefield medicine existed before 1860 is rather laughable, as it was little more than amputations and prayers.

By today's medicine, no, but amputations with a survival rate were better than death. And to be honest, most of the ACW battlefield medicine was simply professional amputation. It was an achievement that many lives were saved, regardless.

The guy to check out for the 19th c. invention of battle-field ambulances is M. le Baron Dominique Jean Larrey (1766-1842), Chirurgien de la Garde Impérial de Sa Majesté Napoléon I; 25 campaigns and 60 battles under his belt, from 1792 to Waterloo in 1815.:goodjob:

Larrey was the most honest man and the best friend to the soldier that I ever knew.
- Napoléon I
http://imagecache2.allposters.com/images/pic/BRGPOD/159268~Study-for-a-Portrait-of-Baron-Dominique-Larrey-Posters.jpg
http://www.haciendapub.com/jmag2.html

Larrey made the rather logical assumption that treating wounded soldiers asap tends to provide a better outcome than scouring the battlefield after the end of said battle, picking up the human wreckage still alive. And he had the guts to put the field-ambulance, the "ambulance volant" (flying ambulance) concept into practice, after having watched the French horsedrawn "artillerie volant" in action. He was also farsighted in the sense that the principle of said ambulances was to pick up wounded soldiers, regardless of provenance, on the basis of a need for care. So when applying his ideas in the Penninsular war Larrey and his medics at first had to put up with the Brits taking pot-shots at them as they moved across the battlefield. But that quickly stopped, when the "rosbiffs" realised the French ambulances weren't picking sides. Wellington gave specific orders at Waterloo that Larrey and his ambulances were off-limits.

He also pioneered what's recognisable as "triage", the sorting of wounded in categories of seriousness and gaving the most pressing cases priority, regardless of rank and nationality. "Wetdressing" was also introduced by him, to the betterment of wounded men in general.

Larrey also holds the world speed record in amputations: 200 amputations in 24 hours after Borodino. His survival rate was for the time phenomenal too, 75%. So was the speed of his operations, which helped a lot to reduce the trauma. He is credited with amputating a femur (body's thickest bone, the thigh-bone) in 15 seconds, and an arm in 11. He was reported to occasionally have taken fingers off hapless assistants in the process.

For the care given them the common French soldiers reciprocated by taking very good care of and protecting Larrey and his outfit. The Imperial Guardsmen carried him on their hands across the Berezina during the retreat from Russia.

He's also a pioneer of some pretty amazing high-risk amputations such as the first hip-joint amputation (1803) hitherto considered impossible due to the bleeding control problem involving the huge arteris there. His name is specifically associated with a shoulder-amputation technique.

By today's medicine, no, but amputations with a survival rate were better than death. And to be honest, most of the ACW battlefield medicine was simply professional amputation. It was an achievement that many lives were saved, regardless.
Yeah, the thing about amputations in battlefield medicine is that it wasn't just random butchery, which seems to be what's commonly assumed today. Amputations were in fact necessary to save lives at all. If the bone has been shattered the infection problems that follow are tremendous. Today we can usually fix it through antibiotics, but even now amputations are still occasionally necessary just because healing is problematic.

http://en.wikipedia.org/wiki/Henry_Dunant

By today's medicine, no, but amputations with a survival rate were better than death. And to be honest, most of the ACW battlefield medicine was simply professional amputation. It was an achievement that many lives were saved, regardless.

The way I look at it is that, after 1847, there was no excuse to amputate every wounded soldier in sight, as it was already well proven by Semmelweis that improved sanitation and wound care would prevent infection, which was the cause of gangrene in nearly all cases. It took decades before doctors would accept this simple notion, long after nurses were demonstrating it independently. Even the ancient Romans were aware that cleanliness was tantamount to good health, and would clean wounds, so I would be sooner impressed with Roman battlefield medicine.

The situation on the battlefield often prevented proper care in cleaning and treating wounds, and IF they got infected the soldier was pretty much going to die. Also, if the bone was badly damaged, it would never have healed right because the few doctors helping thousands of wounded could not try and repair a bad break (and battles tended not to result in clean breaks).

In the 19th century, cleaning wounds was pretty standard, and if it was just a flesh wound that is what it got. It the bone was hit they were better off amputating and going on to someone else. Note that not everyone with a torso wound died, and that was from cleaning the wounds.

Even in WWII (and I suspect if the US army doctors suddenly had a couple thousand seriously wounded thrown a them now it would still be the case) it wasn't about the best care possible, it is about the best chance of keeping him alive and allowing you to move on to the next guy in line. The biggest difference being that as of WWII, the Allies at least, could successfully treat infections if they did arise, with minimal time and effort.

The way I look at it is that, after 1847, there was no excuse to amputate every wounded soldier in sight, as it was already well proven by Semmelweis that improved sanitation and wound care would prevent infection, which was the cause of gangrene in nearly all cases. It took decades before doctors would accept this simple notion, long after nurses were demonstrating it independently. Even the ancient Romans were aware that cleanliness was tantamount to good health, and would clean wounds, so I would be sooner impressed with Roman battlefield medicine.

The problem was, Semmelweis didn't communicate it outside of the medical community (where there was politics involved) and didn't publish until late:

In 1858 Semmelweis finally published his own account of his work in an essay entitled, "The Etiology of Childbed Fever".[44] Two years later he published a second essay, "The Difference in Opinion between Myself and the English Physicians regarding Childbed Fever".[45] In 1861, Semmelweis finally published his main work "Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers" (German for "The Etiology, Concept and Prophylaxis of Childbed Fever").

In his 1861 book, Semmelweis lamented the slow adoption of his ideas: "Most medical lecture halls continue to resound with lectures on epidemic childbed fever and with discourses against my theories. […] The medical literature for the last twelve years continues to swell with reports of puerperal epidemics, and in 1854 in Vienna, the birthplace of my theory, 400 maternity patients died from childbed fever. In published medical works my teachings are either ignored or attacked. The medical faculty at Würzburg awarded a prize to a monograph[46] written in 1859 in which my teachings were rejected". [47]

It took Pasteur/Davaine/Lister/Koch to prove it experimentally to the world. Lister's work (phenol on surgical instruments, 1867) is published after the end of the ACW. Davaine advanced Pasteur's germ theory in 1863; It'd have been nice if the connection was made between proven germs and Semmelweis. Pasteur's Germ theory that inspired Lister and Davaine was in 1857; Pasteur might have tried to take his work to practical medicine earlier. Curious if Pasteur was inspired by Semmelweis, and if he was why he didn't try to re-apply Semmelweis's methods to Pasteur's own experiments? But according to this (http://pyramid.spd.louisville.edu/~eri/fos/semmelweis.html) neither Lister nor Pasteur knew about Semmelweis's work until 1865. So really can't blame anyone, except maybe the medical establishment for not having a more scientific mindset, and Semmelweis for being reluctant to publish broadly.

It shows the importance of publishing findings. And regardless, really can't blame medical people of the ACW if the science and protocols weren't in their texts.

What a interesting thread...this is why i get that warm glow when i think about the WH forum.

The situation on the battlefield often prevented proper care in cleaning and treating wounds, and IF they got infected the soldier was pretty much going to die. Also, if the bone was badly damaged, it would never have healed right because the few doctors helping thousands of wounded could not try and repair a bad break (and battles tended not to result in clean breaks).

That's really no excuse. The medical corps of today is extremely rapid and effective, to the point where it has taken the lead in innovations, rather than taking it from civilian medicine. Several months ago, I read a series of papers on this, and was astounded. I believe the difference between today's medical corps and those of the past is that medical care is prioritized today but wasn't in the past. The attitude, as documented by Florence Nightengale, was that that of indifference. If a soldier was mortally injured, it was thought that he was a goner anyway.

In the 19th century, cleaning wounds was pretty standard, and if it was just a flesh wound that is what it got. It the bone was hit they were better off amputating and going on to someone else. Note that not everyone with a torso wound died, and that was from cleaning the wounds.

I'm not so sure about that. Judging by the fact that doctors would perform procedures with the same dirty, ungloved hands on one soldier after another, I have to doubt that they were concerned over cleanliness in wounds.

The problem was, Semmelweis didn't communicate it outside of the medical community (where there was politics involved) and didn't publish until late:

It was announced in an Austrian journal in 1847 in a letter. It was also published as a lecture series in the Lancet (a British medical journal that still exists today, and is a leading medical journal both then and now), in 1848. I'm not sure who else he would report it to besides the medical community. Perhaps the garbage man was interested and didn't get to learn of it first.

Yes, politics then, as now, was often the biggest stumbling block to getting new medical practices adopted. It took decades for his ideas to be widely accepted, in part because he had no explanation for his practices (infection was not an understood notion until Pasteur).

That's really no excuse. The medical corps of today is extremely rapid and effective, to the point where it has taken the lead in innovations, rather than taking it from civilian medicine. Several months ago, I read a series of papers on this, and was astounded. I believe the difference between today's medical corps and those of the past is that medical care is prioritized today but wasn't in the past. The attitude, as documented by Florence Nightengale, was that that of indifference. If a soldier was mortally injured, it was thought that he was a goner anyway.
If he was British soldier anyway, in which case he was more than likely to repeatedly be "guilty of being Irish".;)

One of the criticisms of the British command in the Crimea was that for some reason the French fighting alongside were in fact doing better. And the French had stuff like mobile bakeries, as well as field ambulances and, at least before Flo turning up, better hospitals.

On the note of the need to amputate, here's an interesting little piece on US Civil War surgery:
When a broken bone was exposed outside the skin, as it was when a projectile caused the wound, the break was termed a ‘compound fracture.’ If the bone was broken into multiple pieces, it was termed a ‘comminuted fracture’; bullets and artillery shells almost always caused bone to fragment. Compound, comminuted fractures almost always resulted in infection of the bone and its marrow (osteomyelitis). The infection might spread to the blood stream and cause death, but even if it did not, it usually caused persistent severe pain, with fever, foul drainage, and muscle deterioration. Amputation might save the soldier’s life, and a healed stump with a prosthetic limb was better than a painful, virtually useless limb, that chronically drained pus.

Antisepsis and asepsis were adopted in the decades following the war, and when penicillin became available late in World War II, the outlook for patients with osteomyelitis improved. In the mid-1800s, however, germs were still unknown. Civil War surgeons had to work without knowledge of the nature of infection and without drugs to treat it. To criticize them for this lack of knowledge is equivalent to criticizing Ulysses S. Grant and Robert E. Lee for not calling in air strikes.
http://www.historynet.com/the-truth-about-civil-war-surgery.htm

It was announced in an Austrian journal in 1847 in a letter. It was also published as a lecture series in the Lancet (a British medical journal that still exists today, and is a leading medical journal both then and now), in 1848. I'm not sure who else he would report it to besides the medical community. Perhaps the garbage man was interested and didn't get to learn of it first.


In his support, the British felt that Semmelweis's views supported their own concepts. Perhaps rather than just publish in medical circles, Semmelweis should have sought collaborations with scientists. I don't blame him, just saying that it didn't disseminate well and the idea didn't click enough with other researchers that could have supported him.



Totally agree about modern battlefield medicine taking the lead. Cutting edge medical projects like the new clotting bandages, and remote medicine are because of military spending.

In his support, the British felt that Semmelweis's views supported their own concepts. Perhaps rather than just publish in medical circles, Semmelweis should have sought collaborations with scientists. I don't blame him, just saying that it didn't disseminate well and the idea didn't click enough with other researchers that could have supported him.
Well, which ones?

It's not as if Semmelweis came up with a cut and dried germ theory, never mind how striking his realisation, and the simplicity of the remedy. Contagion was a medical theory old as dirt, and doesn't presuppose germs. It's just that we today are so used to thinking about contagion as germinal we are no longer aware of how it used to work. And dramatic as it was, it was a single example of a diesease, and it wasn't exacty apparent if it could be extended to others.

It's not as if hygiene wasn't an issue back then either. Old Flo in the Crimea was able to cut the hospital death-rate from 40+% to 2-and-a-bit in a couple of month pretty much using the old adage that "cleanliness is next to godliness". Lots of people were crusading for general sanitary reform, busting dirt and dust on the assumption that cleanliness is a virtue, if nothing else, except they were likely to often overlook the right, or focus on the wrong, things, for want of a better understanding of microorganisms.

Early 19th c. hygienists could do amazing feats of sleuthing to work out how disease had spread. But they were still clueless about the exact mechanism of contagion, and ended up making sweeping demands for general large-scale sanitary action that was just fiancially and politically impossible to implement. But they had a very keen sense of the need for sanitation in general. One of the brilliant things about what Pasteur did wasn't just that he identified germs, but that he experimentally worked out how they operate, and then he could prescribe a few simple rules, "gestures", that people could abide by, and in the process kill 90+% of all germs. They got the "full story" about what it was good for and what they were doing in the process of establishing "germs" as real. Semmelweis could only argue that "It works", not the whys and hows.

Science had to work itself up to Pasteur and Koch and the modern germ-theory. Semmelweis is positioned at the inception of that bit of history, but it's not as if he understood contagion better than his contemporaries, or that from his observations about puerperal fever should be drawn universal conclusions.

Though looking at why Pasteur succeeded and Semmelweis failed might be quite instructive.:scan:

On the note of the need to amputate, here's an interesting little piece on US Civil War surgery:

http://www.historynet.com/the-truth-about-civil-war-surgery.htm

That essentially excuses politics as a means to avoid good medicine. It's the same today with Early Goal Directed Therapy, which has been out for some 10 years and yet has little practice, simply because most people either couldn't be bothered or don't understand it. The reason that Pasteur was so successful wasn't because he was more politically or scientifically astute, but that it was a generation later, so all the old doctors who were obstacles to progress were either dead or retired, making room for the next generation. This is how it is in medicine, because it is a very conservative subculture.

The way I look at it is that, after 1847, there was no excuse to amputate every wounded soldier in sight, as it was already well proven by Semmelweis that improved sanitation and wound care would prevent infection, which was the cause of gangrene in nearly all cases.

This is a classic example of putting modern mentalities in the place of those of the past. Using hindsight and being pissed off at the people of the past does nothing to assist in the understanding of history. It's so easy to point fingers and go, "ah, those stupid people should've known" but that really doesn't help. Perhaps try researching into it and understand why they "amputated every wounded soldier in sight" instead of condemning it?

Just because Semmelweis proved it (as you are wont to repeat in every single post) doesn't mean it would be accepted. I did a paper on the history of medicine and society in summer school two years ago, and although I didn't write an essay on battlefield medicine (I wrote on mental institutions) or germ culture, I definitely remember a mention in lecture that Semmelweis was a rubbish orator and was not able to effectively communicate his new ideas. Maybe try reading up on contemp and secondary sources for your hero and try to understand why his idea wasn't taken up while Pasteur was seen as the pioneer of germ culture.

Maybe that way, you would have a better undersatnding rather than just condemning left, right and centre.

That essentially excuses politics as a means to avoid good medicine. It's the same today with Early Goal Directed Therapy, which has been out for some 10 years and yet has little practice, simply because most people either couldn't be bothered or don't understand it. The reason that Pasteur was so successful wasn't because he was more politically or scientifically astute, but that it was a generation later, so all the old doctors who were obstacles to progress were either dead or retired, making room for the next generation. This is how it is in medicine, because it is a very conservative subculture.
Ok, you're spot on about the conservative aspects of medicine of course. Surgery wasn't even part of medicine proper for most of history, but a craft, which operates on the basis on tradition and guild secrecy, i.e. the exact opposite of science. But I still think you're seriously underestimating the complexity of "how to know things" in medicine at the time.:)

But to frame this a little different; antiseptics, germ-theory et al. were all in place by the time of WWI, and arms and legs were still removed in great numbers. How do we account for that?

Small find in the approriate vein.:)
The 1915 "War Surgery" booklet by the French army doctor Edmond Delorme:
http://www.vlib.us/medical/delorme/delorme.htm

"Appropriate vein." I like it. :goodjob:

Also, gives me an excuse for a subscription post. Interesting thread.

Just because Semmelweis proved it (as you are wont to repeat in every single post) doesn't mean it would be accepted. I did a paper on the history of medicine and society in summer school two years ago, and although I didn't write an essay on battlefield medicine (I wrote on mental institutions) or germ culture, I definitely remember a mention in lecture that Semmelweis was a rubbish orator and was not able to effectively communicate his new ideas. Maybe try reading up on contemp and secondary sources for your hero and try to understand why his idea wasn't taken up while Pasteur was seen as the pioneer of germ culture.

Maybe that way, you would have a better undersatnding rather than just condemning left, right and centre.

It was not accepted because it ran contrary to the existing practice of medicine at the time. No amount of oratory skill would've helped Semmelweis' cause. Medicine is the same way today as it was in 1847-- slow to adopt new proven practices. It is a very conservative institution, and always has been. Other fields are not so conservative. For example, many engineering and computer related fields are very quick to adopt new inventions. This is just the nature of medicine. I understand it well, but that doesn't mean that I can't blame them for their stubbornness.

So are you saying that if Semmelweis actually conveyed his ideas properly, it wouldn't have been taken up? Perhaps that's true. But the problem with bad communication is also that no one would know about it. Ask the random guy on the street if they know Semmelweis. Chances are, they won't even know who that is. I didn't know about him till I learnt about the development of germ theory.
How was the world any different when Pasteur put forward his ideas, especially considering not many have even heard of Semmelweis' work?
My argument is, while the conservative medical community may have been a factor in this, they are not the single cause of it not being picked up in 1847.

I don't know about the modern medical community, but the speed of adopting new practices in modern times by engineering and computer fields shouldn't be put onto the 19th century. STOP PUTTING MODERN MENTALITIES ON THE PAST.
I know for a fact that innovations in engineering do not make headway unless there's monetary backing behind it. When it comes to new inventions (I know this in engineering for sure), the term "no money, no talkie" is very very very prevalent. James Watt's engine was slow to pick up until a certain Boulton came along.

Reading a good book on (battlefield) Amputations in the past. Shall I report my findings upon conclusion?

Reading a good book on (battlefield) Amputations in the past. Shall I report my findings upon conclusion?
Why not? Please do!:)

James Watt's engine was slow to pick up until a certain Boulton came along.

Actually I also read an argument that it was slow to pick up because a certain Boulton came along, and bribed/persuaded parliament to extend Watt's patent.

Ok, you're spot on about the conservative aspects of medicine of course. Surgery wasn't even part of medicine proper for most of history, but a craft, which operates on the basis on tradition and guild secrecy, i.e. the exact opposite of science. But I still think you're seriously underestimating the complexity of "how to know things" in medicine at the time.:)

But to frame this a little different; antiseptics, germ-theory et al. were all in place by the time of WWI, and arms and legs were still removed in great numbers. How do we account for that?

Prior to the discovery of antibiotics, antiseptic technique only served to minimize infection, and thereby, gangrene. So it's rather difficult for a soldier to have immediate access to the sort of medical care needed to clean complex wounds in the field. The delays involved allowed gangrene to set in, thereby requiring amputation by the time proper medical care was available.

So are you saying that if Semmelweis actually conveyed his ideas properly, it wouldn't have been taken up? Perhaps that's true. But the problem with bad communication is also that no one would know about it. Ask the random guy on the street if they know Semmelweis. Chances are, they won't even know who that is. I didn't know about him till I learnt about the development of germ theory.
How was the world any different when Pasteur put forward his ideas, especially considering not many have even heard of Semmelweis' work?


By the 1860's, there were young physicians who would've heard of Semmelweis, and were open to his ideas. Rest assured that just because Semmelweis is not a household name, it doesn't mean that doctors never heard of him. There are a lot of names I know of contemporary medical authorities that you've never heard of. Within the medical community, we know who's who. When Pasteur started coming out with his discoveries, doctors of the time were far more open to it.

As I said, it is the same today. Depending on where you practice in the world, or even within the same city, you will find wildly different practices, many of which are woefully obsolete. This is due to political resistance from established vested interests (ie. old doctors who are comfortable in their niche). I have practiced in many parts of the US and have seen this firsthand.

My argument is, while the conservative medical community may have been a factor in this, they are not the single cause of it not being picked up in 1847.

It is the only one. Who else was practicing medicine in 1847? Witch doctors? Midwives? Herbalists? Faith healers?

I don't know about the modern medical community, but the speed of adopting new practices in modern times by engineering and computer fields shouldn't be put onto the 19th century. STOP PUTTING MODERN MENTALITIES ON THE PAST.
I know for a fact that innovations in engineering do not make headway unless there's monetary backing behind it. When it comes to new inventions (I know this in engineering for sure), the term "no money, no talkie" is very very very prevalent. James Watt's engine was slow to pick up until a certain Boulton came along.

That is the same in medicine, but antiseptic technique did not require money.

The reason I put modern mentality on this is because nothing has changed in medicine. Doctors are STILL slow to adopt newly proven practices, with the result that it takes a generation to retire before advances are made.

It is the only one. Who else was practicing medicine in 1847? Witch doctors? Midwives? Herbalists? Faith healers?
All of those for starters. Apothecaries and homeopaths too (the latter particularily big in Germany, still are). And it's also a matter of for instance whether your doctor is a vitalist or a mechanist. What kind of nosological school does he subscribe to? It makes a world of difference as to how he would rationalise and explain disease as an event. It wouldn't matter too much with regards to what he would actually do on the practice level, what therapies, if any, he would prescribe. But it would affect how he would think about illness and disease, and consequently how he would figure they were connected, if at all.
That is the same in medicine, but antiseptic technique did not require money.
No it doesn't, but until you have a decent idea why antispetic techniques work you're still making stabs in the dark, only some of which pay off.

The point is that there was no logical necessity of coupling Semmelweis observations of pleural fever ("cadaverous poisoning") to the extensive experiences of bone shattering wounds, infection rates and survivability with or without amputation. They might as well be regarded as entirely separated medical events. Due to the connection provided by germ theory today we can regard as pretty much the same thing. But is an assumption entirely absent, and with no absolutely compelling argument for it, without that model to frame it. In the mean time the inductive experience of army surgeons about what worked in practice was quite well founded.

Even when having a modern germ theory and antiseptics, the infection problems involving these kinds of wounds were still tremendous (viz. WWI) without resource to antibiotics, making amputations common and apparently necessary.
The reason I put modern mentality on this is because nothing has changed in medicine.
I'm afraid I'm going to have to go with this, that if so, it's rather an artifact of modern medical professionals writing presentist history than of how things worked in the past. Mostly that means ignoring large swathes of medical theory in favour of writing about medical practice, which has historically been amazingly stable (i.e. learning something new and unprecedented in medicine was a very uncommon occurrence before around 1850).

Actually I also read an argument that it was slow to pick up because a certain Boulton came along, and bribed/persuaded parliament to extend Watt's patent.

Don't quote me on this, but I remember Watt was rubbish at marketing - and without Boulton's financial backing and marketing, the engine wouldn't have sold at all.
I would argue that the many lawsuits against copycats by Boulton prove just how successful the design was - and how well Boulton marketed it that it would be known around the world.

By the 1860's, there were young physicians who would've heard of Semmelweis, and were open to his ideas.

And what would they think of a person who can't convey his ideas properly? In my own university, there are some super-geniuses in their field with the awesomest ideas, but because they are lousy lecturers and orators, their ideas are usually seen by the students as rubbish. And it's not like the School of Engineering has mature students.

It is the only one. Who else was practicing medicine in 1847? Witch doctors? Midwives? Herbalists? Faith healers?

You're misreading me. There are other factors behind the non-adoption of Semmelweis - his bad communication skills for example. It may also have screwed things up that he was in Vienna (?), which perhaps could be slightly off the centre of the medical community (this is unverified and could be totally wrong, but is meant to illustrate the point that there are more than just old doctors in the story)

That is the same in medicine, but antiseptic technique did not require money.

Verbose had already covered that point adequately

The reason I put modern mentality on this is because nothing has changed in medicine. Doctors are STILL slow to adopt newly proven practices, with the result that it takes a generation to retire before advances are made.

Nothing has changed? Four Humours and all that. Tell me what you think of say.. osteopathy. I know a good proportion of doctors do not see it as complementary medicine or whatever it is you guys call it - citing lack of proof, etc.etc.
Now, what if osteopathy was actually awesome? At this point in time, we still don't know.
200 years later, some up-and-coming doctor would go "why the hell did those stupid doctors of the 21st century not think osteopathy is good?"

You have to understand that people in the 19th century saw things in quite a different way from how we would see it - and that would lead them to make different decisions. It is NOT because they were stupid, and it certainly isn't as if they had a malicious streak.

And what would they think of a person who can't convey his ideas properly? In my own university, there are some super-geniuses in their field with the awesomest ideas, but because they are lousy lecturers and orators, their ideas are usually seen by the students as rubbish. And it's not like the School of Engineering has mature students.

His skills at oratory aren't relevant. He had proven his practices in an evidence-based format, and there would've been enough bright minds to catch onto this. After a generation, there would be fewer obstacles for widespread acceptance.


You're misreading me. There are other factors behind the non-adoption of Semmelweis - his bad communication skills for example. It may also have screwed things up that he was in Vienna (?), which perhaps could be slightly off the centre of the medical community (this is unverified and could be totally wrong, but is meant to illustrate the point that there are more than just old doctors in the story)

Nothing was wrong with Vienna at the time.

Nothing has changed? Four Humours and all that.

I'm talking about attitude, not practice. The attitude towards innovative and proven practices remains largely the same today as it did in 1847. If it's new, it's largely scoffed at, especially when it goes far against prevailing practices. About the only difference today is that there are large medical authorities that will occasionally mandate certain practices under threat. But that is only occasionally done and with half-hearted effort.

It wouldn't matter too much with regards to what he would actually do on the practice level, what therapies, if any, he would prescribe. But it would affect how he would think about illness and disease, and consequently how he would figure they were connected, if at all.

I rest my case.


The point is that there was no logical necessity of coupling Semmelweis observations of pleural fever ("cadaverous poisoning") to the extensive experiences of bone shattering wounds, infection rates and survivability with or without amputation. They might as well be regarded as entirely separated medical events. Due to the connection provided by germ theory today we can regard as pretty much the same thing. But is an assumption entirely absent, and with no absolutely compelling argument for it, without that model to frame it. In the mean time the inductive experience of army surgeons about what worked in practice was quite well founded.

That is true. However, even his advice regarding puerperal fever was ignored. It was not just a matter of being unable to make the connection between these things. It all comes down to the attitude of the time which was that cleanliness and disease avoidance were not synonymous. The idea that washing one's hands before handling body fluids could avoid disease just made no sense to anyone. There were few open minds enough to accept that maybe there was something to it. That attitude still exists today.

Even when having a modern germ theory and antiseptics, the infection problems involving these kinds of wounds were still tremendous (viz. WWI) without resource to antibiotics, making amputations common and apparently necessary.

Considerably less, mind you. As I said in an earlier post, Florence Nightengale championed nursing to the point where a soldier was in better hands with a nurse than a doctor. WWI was just an extreme, because of the unusual battlefield environment (trench warfare) combined with a larger numbers of wounded. Even today people die of infection, even with antibiotics. Some people still need amputations for gangrene.


I'm afraid I'm going to have to go with this, that if so, it's rather an artifact of modern medical professionals writing presentist history than of how things worked in the past. Mostly that means ignoring large swathes of medical theory in favour of writing about medical practice, which has historically been amazingly stable (i.e. learning something new and unprecedented in medicine was a very uncommon occurrence before around 1850).

That is because for most of history, medicine was more of a matter of opinion than a matter of proven practice. In fact, it was not until about the 1970's that evidence-based medicine even became widely accepted. Now, a doctor's personal opinion doesn't mean anything unless he cites previously published work or verifies it with a confirmatory diagnostic test.