The Weekly Dose: What modern medicine owes to World War II
Here are the stories of three medical innovations which we now take for granted, but which were devised and perfected during the resource-limited, high-pressure, high-stakes period of World War II.
On this day, 74 years ago, representatives of the defeated German forces and the victorious Allied troops signed the Instrument of Surrender, formally marking the end of World War II in Europe. Between 70 to 85 million people – 3% of the world’s population – perished in the war. Many who survived owed their lives to path-breaking advances in medicine, made or popularised during these war years. Some – such as the widespread use of the antibiotic penicillin – are well known. Here are the stories of three other medical innovations which we now take for granted, but which were devised and perfected during the resource-limited, high-pressure, high-stakes period of World War II.
Cardiac surgeries - which patients survived
In the aftermath of the D-Day landings in France which turned the tide of the war against Germany, Dr. Dwight Harken was brought a dying soldier with his chest blown open. Poring deeper into the injury, he found shrapnel from an explosion that had buried itself in the young man’s heart.
Leaving it in place meant the soldier would die of an infection or embolism. But at the time, surgeons were apprehensive about operating on the heart; most were willing to incise the sac covering it to remove accumulated pus or release constrictions, but none would touch the heart itself, because almost all patients died after, or during cardiac surgery.
After placing sutures around the shrapnel’s site of entry, Harken used an instrument to grip the piece of metal protruding out of the man’s heart, which bobbed with each heartbeat. He tugged, and the still pumping heart spurted blood towards the ceiling. Harken quickly tightened the sutures, and temporarily closed the gap with his finger. A surgical needle and thread were deftly inserted into the heart wall, passed under his finger, and brought out on the other side, repeatedly, to sew the wound shut. “The only moment of panic”, confessed Harken, “was when we discovered that one suture had gone through the glove on the finger that had stemmed the flood. I was sutured to the wall of the heart!”
Harken went on to operate on over 130 soldiers, all of whom had shrapnel or bullets lodged near, or in the major blood vessels or heart. Amazingly, all survived. Bear in mind that he achieved this while performing surgeries in temporary huts, on already infected wounds, without the aid of a heart-lung machine to keep his patients alive. They had to be administered massive doses of the then-new drug penicillin to control post-op infections, as well as receive up to 1.5 litres of transfused blood every minute!
But his patients lived, paving the way for surgeons to devise and perform hitherto impossible cardiac surgeries in peacetime, for other conditions like valve replacement. As Harken concluded, "We discovered that the heart wasn't such a mysterious and untouchable thing after all."
The rod and the bone
When American prisoners of war with fractured femurs returned home from German internment camps, X-Rays revealed steel rods in their thighs. No one had seen anything like it; the soldiers were suspected to have been victims of a cruel Nazi human experiment. They were subjects of an experiment, by a pioneering, humane, German doctor who devised the now-common technique of inserting rods into fractured bones, to help them heal faster and better.
While broken bones were treated with splinting, Plaster of Paris casts, and bed rest, all attempts at using artificial contraptions to bring the shattered ends of the fracture into close contact had failed. When introduced into the body, foreign materials were rejected, or broke, or brought in infection with them.
Some years earlier, Dr. Gerhard Küntscher had figured out a way to stabilise fractured long bones like the femur by inserting a long, stainless steel nail into the marrow of both halves of the bone, binding them together. But his successful results were not taken seriously, and during the war, he was deputed to work at a remote war front in Finland. There, he implemented his technique on injured soldiers from both sides of the enemy line. Since the rod was introduced into the bone from a small incision at a point far from the fracture site, the risk of infection was minimised, blood loss reduced, and the natural healing process undisturbed.
In 1945, a Time magazine article titled ‘Amazing Thighbone’ created waves in America’s medical community by describing how Küntscher’s patients had regained full mobility and were back on their feet within weeks, instead of the expected months of convalescence. Orthopaedic surgeons owe their expertise to nails that were ‘smuggled’ across the Atlantic in the thighs of injured soldiers during World War II!
How to ‘bank’ blood?
In 1940, American Dr. Charles Drew received an urgent cablegram from his former teacher, asking for 5,000 containers of human plasma (blood without cells) to be sent to Britain, to help treat the thousands wounded by German bombs. Drew had just submitted his doctoral thesis about how to safely collect blood, prevent it from coagulating and becoming unusable, and transport it intact to the place of transfusion. Based on his credentials, he was appointed the director of the ‘Blood for Britain’ program, in which he applied modern techniques of blood collection at a mass production level, creating the first ever blood bank.
While whole blood had a shelf-life of only a week and was easily damaged during transport, donated plasma could be transfused for up to two months, in larger doses, and not just through veins but also into the muscle or under the skin. This was especially useful in war-time for wounded patients who had lost a tremendous amount of blood, and who needed emergency transfusions and surgery.
Drew devised the strict rules for blood donation that are still implemented today: screening potential donors for infectious diseases, accurately and consistently documenting their blood groups, and ensuring a strict chain of paperwork to prevent the horrible complications of a mismatched transfusion. He also developed something that is a common sight today: a mobile blood bank. In just a few months, Blood for Britain collected over 14,000 American blood donations and dispatched over 5,000 litres of plasma to a grateful England.
History is not without irony or tragedy. The American Red Cross prohibited African-Americans from donating blood. Drew – who headed its blood bank and pioneered the very concept – was black, and never permitted to donate himself. Some years after the war, he was grievously injured in a car crash and taken to an all-white hospital in one of the more racist American states. Its blood bank supplied him with an emergency blood transfusion – to no avail. Drew died.