Of Blood Transfusions and Brain Magnets

To say that World War I was gruesome is to understate the obvious. Updated weapons—like the 600-bullets-per-minute, rapid-fire machine gun, with a range of more than 1,000 yards—decimated infantries. Chlorine gas, phosgene, and mustard gas maimed more than killed, but caused devastating lung and skin damage. Hellish flame throwers terrorized troops. Deadly ordinance destroyed armies and landscapes. Even today, buried bombs from the Great War remain a threat in parts of Europe where wildfires have caused them to explode.

Millions of soldiers who survived the onslaught were wounded and maimed. Many suffered from “shell shock,” now better understood and accepted as Post Traumatic Stress Disorder (PTSD). And, for the first time in history, deaths from wounds surpassed deaths from disease.

In response, medicine and medical science innovated. Doctors in the field and hospitals devised new methods to save lives with improved antiseptic treatments. Surgeons learned to reconstruct shattered faces. Dentists rebuilt jaws. Orthopedists created lighter-weight prostheses to replace lost arms, hands, and legs. Blood transfusions, a technique in use prior to the War, became safer and more effective with the discovery of coating the inside of the blood storage vessel with paraffin to delay clotting and preserve supplies. By the end of the War, this enabled wounded soldiers to receive transfusions closer to the front lines, giving them better odds of surviving transport to field hospitals.

Dr. Harvey Cushing

Among the innovators was the American neurosurgeon Harvey Cushing, who came to the American Ambulance Hospital in Paris in 1915. In Line of Flight, Cushing inspires Camilla to follow in his footsteps, after she witnesses him removing shrapnel from a patient’s brain with a giant magnet.

I discovered Cushing’s surgical technique in his diary, From a Surgeon’s Journal 1915-1918 (Little, Brown, and Company, 1936) where he describes the procedure. The magnetic probe was large and cumbersome, and on this particular day, April 29, 1915, Cushing tried several times, unsuccessfully, to draw out a tiny fragment of shrapnel from a wounded soldier’s brain. An assistant had the idea to enhance the probe’s reach by attaching a large wire nail, about six inches long with a rounded tip, to the probe. I’ll let Cushing describe what happened, next:

Well, there was the usual crowd in the X-ray room and approaching corridor, and much excitement when we let the nail slide by gravity into the central mechanism of smiling Lafourcode; for at no time did he have any pressure symptoms, and all of these procedures were of course without an anæsthetic. . .

[After developing the X-ray plate to see if the nail and missile were in contact] we finally traipsed into the first-floor operating room, where Cutler mightily brings up the magnet and slowly we extract the nail—and—there was nothing on it! Surpressed signs and groans. I tried again, very carefully—with the same result. More sighs, and people began to go out. A third time—nothing. By this time I began to grumble . . .

I had taken off my gloves and put the nail down; but then—let’s try just once more! So I slipped the brutal thing again down the track, 3 ½ inches to the base of the brain, and again Cutler gingerly swung the big magnet down and made contact. The current was switched on and as before we slowly drew out the nail—and there it was, the little fragment of steel hanging on to its tip! Much emotion on all sides . . .

Cushing was a gifted writer as well as a pioneer of neurosurgery, and his account of his war experiences is as vivid as this excerpt. Discovering his journal was a gift. He not only inspired one of my lead characters; he inspired me, as well.

Illustration of the magnet from Cushing’s Journal

Top Image: “WWI: nurse and patient outside stationary hospital, Rouen” from photograph collection of Lieutenant Colonel G.J.S. Archer, RAMC. 1914. Via Wiki Commons.

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