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Bulletin of the History of Medicine 74.2 (2000) 291-316



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The Obscure Object of Knowledge: German Military Medicine Confronts Gas Gangrene during World War I

Derek S. Linton *


Among the results of the recently revived interest in the medical aspects of World War I have been reexaminations and reassessments of claims about the contributions of war-related research and experiences to medical progress. 1 The official medical histories trumpeted the accomplishments of scientific medicine and argued that the war had significantly advanced medical knowledge. Thus, for example, the official German history contrasted Germany's defeat in the war with the triumphant medical achievements in the field that vindicated the international reputation of German physicians and medical researchers. 2 More recent accounts have been divided over this issue, with some medical historians contending that the war contributed little of lasting value in terms of [End Page 291] either organization or specific knowledge that was carried over into peacetime, whereas others have reaffirmed contemporary assertions that the war constituted a kind of gigantic in vivo experiment that led to significant breakthroughs. 3 Given the variety of wounds and the range of infectious diseases treated during the war, it is doubtful that this issue can be decided globally. Rather, it will have to be evaluated in terms of specific fields of research and medical specializations.

In this article I will examine the German medical corps' difficulties with diagnosing and treating gas gangrene, as a case study of the problematic relation between medical research conducted during World War I and medical progress. There are several reasons for doing so. First, immediately following the war some medical writers proclaimed gas gangrene research, especially research on etiology and antitoxin sera, to be an example of the achievements of scientific medicine--a claim that has recently been echoed by a leading German medical historian. 4 Second, the two central medical concerns of the war, the treatment of wounds and the control of infectious disease, intersected in cases of gas gangrene, as did two leading medical specializations, bacteriology and surgery--thus making gas infections a major focus of military medical research activity. Third, in the early twentieth century, German medical research in both of these specializations was arguably preeminent and hence set the international standards.

Without completely discounting the achievements of German bacteriology and scientific medicine, I will argue that gas gangrene research and treatment were far from being unequivocal successes. Instead, because of a well-established horizon of expectations, the German medical corps entered the war ill prepared to cope with gas gangrene. Wartime conditions, [End Page 292] although offering a vast amount of experience with gas infections, posed insuperable impediments to effective medical research on these disturbingly intractable and highly lethal wound complications. Throughout the war, often-vituperative polemical debates abounded among bacteriologists and surgeons over the etiology, diagnosis, clinical picture, and therapy of gas gangrene--debates that in many instances continued unabated and unresolved. Moreover, physicians often had to resurrect procedures previously regarded as superseded, thus undermining prevailing notions of linear medical progress. Finally, as in many areas of military medicine, limitations on resources and personnel militated against the widespread implementation of expensive and labor-intensive but promising therapies.

Earlier Experience and Research

When war broke out in 1914, strong reasons could be adduced for believing that the risk of fatal wound infections was minimal, especially from anaerobic bacteria. The first reason was the apparent success attained by introducing aseptic wound management and therapy, as championed by the eminent surgeon Ernst von Bergmann since the 1880s and confirmed by subsequent experiments, clinical experience, and extensive evidence accumulated in small-scale colonial wars. Bergmann, a Baltic German, publicly renowned as Kaiser Friederich III's surgeon during the emperor's terminal throat cancer in 1888, had served as a military surgeon during the Austro-Prussian War of 1866, the Franco-Prussian War of 1871, and the Russo-Turkish War of 1877-78. 5 Although an early follower of Joseph Lister's antiseptic principles, during the latter...

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