In the first part of the history of military medicine of the First World War, special attention was paid to the incorrect strategy of treatment and evacuation of the wounded. Throughout the war, the vicious doctrine of "evacuation at any cost" prevailed, which cost the Russian army many lives of soldiers and officers. The command believed that the accumulation of "crippled soldiers" in the front-line zone would hamper the movement of troops. This was not a feature of the Russian army alone - a similar ideology prevailed in many countries. However, already at the end of 1914 in France, doctors realized that evacuation to the rear hospitals would lead to unjustified losses. As a result, the Paris Surgical Society came up with an initiative to organize an early surgical intervention. Since 1915, the French in the front-line hospitals began to practice a previously unheard-of - laparotomy (opening of the abdominal cavity) for penetrating wounds of the abdomen. Actually, it was in France that the concept of the "golden hour", new for military medicine, was developed, according to which patients with multiple wounds should be treated within the first hour. As a result, the conservative treatment of gunshot wounds in the armies of the Entente gradually came to naught by the end of the war. In the Russian army, progress in this work began to be observed only in the fall of 1916 - mobile detachments of front-line surgeons-consultants appeared, mobile X-ray machines appeared, as well as dental offices.
A separate problem in the Russian army was infections, which were not dealt with in the best way even before the war. So, in 1912, on average, out of 1000 soldiers and officers, 4, 5 were sick with typhoid fever; typhus 0, 13; dysentery 0, 6; smallpox 0.07; gonorrhea 23, 4 and scabies 13, 9 personnel. The abnormally high proportion of patients with gonorrhea, typhoid fever and scabies is clearly visible. By the way, by that time there were opportunities to vaccinate the troops against most of these diseases, but the leadership did not take steps in this direction. Naturally, with the beginning of the war, the proportion of infectious patients increased sharply - for example, at the end of 1914, 8,758 people of the Russian army were sick with cholera near Warsaw. The reaction was not long in coming - sanitary and hygienic detachments appeared in the corps, and divisions and brigades had one disinfection and epidemiological detachment each. What were these units like? Usually, a senior doctor was at the head of the sanitary unit, his deputy was an ordinary doctor, then 4 sisters of mercy, 2 disinfectants, 10 orderlies and 9 transport orderlies. Transport support was in the form of 3 steam-horse chariots, 6 carts with 18 draft horses, 2 riding horses and a field kitchen. The main advantage of such a unit was mobility, autonomy and responsiveness. In addition, the detachments could be reorganized into large stationary epidemic points, as well as reinforced with disinfection detachments and highway divisional detachments.
Despite this, during the war, the tsarist army saw a steady increase in many infectious diseases. In 1915, there was a repeated outbreak of cholera, in the winter of 1915-1916 - relapsing fever, and on the Romanian front in 1917, 42, 8 thousand soldiers were sick with malaria. Statistics on epidemics in the tsarist army indicate 291 thousand.infectious patients, of which 14, 8% died. Among them there were 97.5 thousand people with typhoid fever, of which 21.9% died, typhus - 21.1 thousand (23.3%), relapsing fever - 75.4 thousand (2.4%), dysentery - 64, 9 thousand (6, 7%), cholera - 30, 8 thousand (33, 1%), smallpox - 3708 people (21, 2%). The notorious "evacuation at any cost" aggravated the situation with the spread of infections. Despite the existence of the "Instructions for the triage of infectious patients and their transport in military ambulances", the combat officers responsible for the evacuation, often violated the prescribed rules. The infection spread both inside the hospital train and among the civilian population in the rear of the country. Only from the beginning of the war to August 15, 1914, 15, 3 thousand infectious patients proceeded to the rear of the country, including 4085 - with typhus, 4891 - with typhoid, 2184 - with relapsing fever, 933 - with dysentery, 181 - with smallpox, 114 - with diphtheria, 99 - with cholera, 5 - with anthrax. Efim Ivanovich Smirnov, head of the Main Military Sanitary Directorate of the Red Army during the Great Patriotic War, wrote about this practice:
"… this fact can rather be called not a fight against infectious diseases, but its spread throughout the country."
Water, corpses and lice
A wartime novelty was the leadership's special concern for the quality of drinking water at the front. The reason for this was typhoid fever and dysentery, which regularly flared up in the front line. Mobile laboratories appeared in the army, providing an express analysis of water supply sources (of course, adjusted for technologies and methods of the early 20th century). There were attempts to eliminate the illiteracy of the soldiers regarding the simplest hygiene and the prevention of intestinal infections. The instructions spoke of the need to protect the sources of drinking water, pour only boiled water into flasks, do not lie on the damp ground with your stomach and wash your hands regularly. In addition, the sale of kvass, vegetables and fruits was banned at railway stations.
Throughout the war, the leadership of the Main Military Sanitary Directorate did not solve the problem of transferring infectious diseases from the civilian population to the army personnel. This was largely due to the actual lack of sanitary supervision over the civilian population - for example, in December 1915, 126,100 people were sick with various infectious diseases (primarily typhus) in the Russian Empire. Isolation of the places of deployment of troops from contacts with civilians was poorly carried out as one of the most effective ways to fight infections at the front. By 1916, the first ideas appeared about the nature of anti-epidemiological work in the combat zone. The well-known domestic military epidemiologist K. V. Karaffa-Korbut wrote on the basis of military experience in healing:
“… Sanitary measures in the area of military operations of the army should extend… to the civilian population; to manage the anti-epidemic business, it is necessary to train specialists-epidemiologists, and to carry out the appropriate measures, have regular sanitary and epidemiological institutions; reliable anti-epidemic “filters” should be in place on the routes of supply and evacuation; identified infectious patients should be treated on the spot, without their evacuation to the rear”.
Unfortunately, the words of Karaff-Korbut were heeded only by the end of the war and only in terms of organizing anti-epidemiological filters along the escape routes. But the sanitary and epidemiological service of the Red Army during the Great Patriotic War took into account the blunders and failures of the tsarist army.
And, of course, the main and, probably, the most disgusting sign of any war - mountains of corpses, which became breeding grounds for dangerous infections.
“The few remaining corpses, decaying more and more, began to give such a terrifying smell, poisoning the air that it became more and more difficult both physically and mentally to withstand it,”
- wrote about the terrible pictures of the war of the soldiers of the Russian army N. V. Butorov. But the timely burial of the bodies of the dead was not established, especially in winter. Situations were not uncommon when hundreds of dead enemy corpses remained under the snow, which by the spring decomposed and became sources of pathogens of serious diseases carried by meltwater and insects. Moreover, even if the dead were buried in winter, it was only a few tens of centimeters, which did not save the situation.
A major blunder of the command of the tsarist army was the lack of attention to the personal hygiene of servicemen in the early years of the war. Lebedev A. S. in his work "On the work of technical detachments in the forefront: the construction of baths, laundries, exterminators and others" in 1915 writes terrible things:
“We had to see in the trenches and for those wounded who were taken to the infirmaries, the following: people were literally dressed in“human shirts”, everything was covered with lice, the body was covered with bark of mud, the underwear had a brown protective color, everything this, taken together, gave off such a strong specific smell that at first it was difficult to get used to it, and especially to that heap of lice that instantly covered pillows, blankets, sheets and even sisters' robes. From the questioning of the soldiers, it turned out that they had not washed for about 4-5 months."
It should be noted separately that the author of the material met such a thing only in the memoirs of a military doctor of the Wehrmacht when describing a hospital for German prisoners of war near Stalingrad. What was done to solve the current disaster?
First, since 1915, mass vaccinations have been organized using, among other things, new products - anti-typhoid and anti-tetanus sera. Pilot vaccinations against typhoid fever were carried out on an experimental basis in May 1914 on 5700 soldiers and officers of the Turkestan Military District. The results turned out to be very positive and on the basis of the "imperial command" that followed on August 14, 1915, as well as the order of the Minister of War No. 432 of August 17 of the same year, vaccination was to become a mass phenomenon. Despite the fact that in many divisions this news was treated negligently, the incidence of typhoid fever in the tsarist army by 1916 decreased from 16.7% to 3.13%. Secondly, the Main Military Sanitary Directorate has declared a real, albeit belated, war against lice. There were preparations such as mylonfta, technical cresol, insectivore, helios and hygiene. For decontamination of clothes, we used paroformalin and sulfur, sulfur dioxide and ordinary steam. Bedbugs with lice were also taken out in the traditional ways - by wearing two shirts, the top of which was soaked in a 10% solution of tar, as well as by wetting the hair with gasoline, kerosene and mercury ointment. Thirdly, the army significantly expanded the staff of baths, each of which had a capacity of 30-40 people. They drowned them "in black", since the construction and operation of such a bath was much cheaper.
Stationary bath from the First World War
Bath train built at the expense of residents of the Kursk province
The classic army bath from the First World War consisted of a changing room and a soap-steam room, as well as an adjacent laundry room and (if possible) a disinfection chamber. The consumption rate of soap for soldiers was about 90 grams per person. Unfortunately, the soldiers of the Russian army could use such baths only in moments of trench warfare - there were no mobile baths in the state. However, historical sources indicate at least one bath train, built at the expense of residents of the Kursk province. The train consisted of 19 carriages, two huge water tanks and a steam generator. In such a train with a capacity of 1,200 people per day, the soldiers washed themselves as follows: they undressed in one of the first carriages, then went to the baths themselves, and after washing they got into the dressing car, where they received a set of clean linen and their own clothes for free, which in addition time managed to be disinfected. The remaining carriages housed a dining room, a tailor's and shoemaker's workshops, and a shop.
All of the above led to a noticeable improvement in the sanitary and epidemiological state in the tsarist army: parasites and skin diseases immediately decreased by 60%. Not to mention the general improvement in the well-being of soldiers and officers.
