Before the 18th century, injured soldiers were left to their fates on the battlefield. But as the art of modern warfare became more advanced, evacuating and treating patients quickly and efficiently became a priority. From the earliest ambulances to portable hospitals, this is how emergency medicine has evolved in the past 200 years.
The evolution of war-zone medicine
Words by Sonia Zhuravlyova
- In pictures
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As Chief Surgeon under Napoleon, Baron Dominique-Jean Larrey observed how wounded soldiers were treated. Often abandoned, or carried on slow-moving wagons, many would not live long enough to receive medical attention. His solution? The ‘flying ambulance’, a nimble horse-and-cart combo used for quick evacuation. He also pioneered rapid amputation and triage – treating men according to the severity of their wounds, rather than rank, class or even nationality.
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In the course of his career, Larrey organised and built military hospitals in Egypt, Sudan, Syria and Palestine. The flying ambulances (ambulances volantes) were normally specially equipped horse-drawn wagons. When horses weren’t available, a local alternative would have to take their place – in this case a camel. Special side-panniers were designed for the camel ambulance, used in Egypt in about 1798.
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Drawn by two or more horses, this two-wheeled carriage could move quickly across the battlefield. It had space for two stretchered patients, who would be transported to field hospitals just outside the battle zones. The sheltered carriage was also used as a place to perform emergency surgery. Larrey organised an ambulance corps of surgeons and orderlies, and equipped them with first-aid supplies, which has served as a blueprint for modern medical battalions ever since.
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The provision of mobile hospital huts became important in the course of modern warfare. The Ducker Portable House company was founded by William M Ducker of New York and according to the 1888 catalogue, its timber buildings were “light, durable, well-ventilated, warm in winter, cool in summer, healthful and cheap”. The buildings – which could be transported by horse and wagon – were made up of flat-packed wooden frames, hinged together and covered with a special waterproof material.
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Captain Doecker of the Royal Danish Army first patented his portable building system in 1880. It required sections roughly a metre square (3ft x 3ft), which could be fastened together with iron hooks and studs, allowing for dismantling and re-erecting on another site. What’s more, it could be built by unskilled workmen in just a day, and its roof, walls and floor were made up of panels that could be easily disinfected by giving each separate part a good wash.
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Navigating the narrow, winding and often muddy trenches was extremely taxing during World War I, and men would usually have to wait until the cover of darkness. British surgeon George Herbert Colt devised this bendable stretcher as a possible solution. The wounded soldier would lie semi-upright in the canvas sling, suspended underneath poles, and be carried out by two stretcher-bearers. The design allowed them to deal with sharp corners with more ease. Sadly, this remained a prototype – it was never put into production.
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Medics were eager to carry out blood transfusions close to the frontline in World War I, but it was near impossible to store blood on the Western Front, so a patient-to-patient method was preferred. This portable apparatus, with a special device in the flask for regulating blood flow, was designed and pioneered by Lieutenant Geoffrey Keynes of the Royal Army Medical Corps.
The British army on the Western Front, 1914-1918. © IWM. Attribution-NonCommercial 4.0 International (CC BY-NC 4.0).
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In 1916 a Canadian-American mining engineer designed a prefabricated steel structure that was to become the famous Nissen hut. A steel frame and a half-cylindrical corrugated steel skin deflected shrapnel and bomb blasts, and instead of glass, windows were made out of oiled cloth. It took just four hours to assemble and could fit into a three-tonne army wagon. Not only were they built to house troops, but they were also used as stables, hospitals, ammunitions shelters, mess rooms and churches. They continued to be used throughout World War II and some have even survived to this day.
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In anticipation of enormous casualties during World War II, more than 600,000 steel stretchers were mass-produced by Steelway in Wolverhampton to be used by air-raid protection officers. They consisted of a wire mesh and two steel poles, while two kinks at either end of each pole allowed the stretcher to be rested on the ground and picked up easily. Despite high casualties, authorities were left with stockpiles at the end of the war, which were then welded together to serve as railings at postwar housing estates, since railings across London had been removed to aid the production of munitions.
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As war became ever more sophisticated, ambulances took on a form that we could recognise today. The nippy ‘Sympathy’ is the Order of St John’s oldest ambulance and dates back to 1929. This hard-working ambulance, built at the Ford factory in Old Trafford, was used to rescue casualties from bombed-out buildings during the Blitz on London’s East End. It received a handy upgrade for the task – a high-output dynamo ensured it always had reliable lighting at night.
About the author
Sonia Zhuravlyova
Sonia Zhuravlyova is a journalist based in London. Her focus is urbanism and architecture – and she's especially keen on the history of post-war prefabs.