Today is Memorial Day, the day we set aside to honor Americans who died in active military service. War is always horrible, but historians tell us that the attempt to save many lives during wars has always led to innovative technologies and new skills that have helped all of us. So, I am in the frame of mind to tell you a few stories about surprising medical advances during wartime. And you know me; I want to tell you about people and situations you have never heard of.

We all know the Civil War was the first war during which anesthesia (ether and chloroform) was widely available. So, surgery, like amputations, evolved from rapid-fire, hold-the-patient-down events to deliberate delicate surgery, with time to tie off blood vessels, make skin flaps and inflict much less pain on the patient. But you’ve probably never heard of Dr James Bean, a Tennessean who was the single most important dental surgeon of the Civil War. He moved to Atlanta after the outbreak of the war, and established, for the Confederacy, what became a famous hospital for head, neck, and oral injuries. He developed an oral splint that successfully held together portions of an injured jaw until it healed, leading to much better jaw alignment and less facial disfigurement than before. Made of vulcanized rubber with metal attachments (Imagine a bulky rubber Invisalign retainer.), the “Bean splints” were a significant improvement and were quickly adopted by other Confederate dentists.

In fact, Thomas Gunning, a Union dentist, used the exact same technology in 1867 when he treated the fractured mandible of William Seward, the Secretary of State under Abraham Lincoln. How did he know about Bean’s splint? Bean had given a presentation to the Confederate Medical Board in Richmond, where a Union spy was in attendance. The spy then spirited a copy of the circular passed around at the meeting to his Union connections. It is interesting to think about medical technology as a spy secret, isn’t it? Luckily, Seward also had old-fashioned metal splints around his jaw because several days after Lincoln’s assassination, one of John Wilkes Booth’s collaborators, Lewis Powell, attempted to murder Seward. His stabbing attempts were mostly blocked by the metal jaw splint and Seward survived.

Gunning went on to make many more craniofacial innovations and publish widely. Bean’s and Gunning’s innovations revolutionized the treatment of jaw injuries. Much less was written by the original inventor, Bean. He had long collected specimens for the Smithsonian, a hobby of his, and went with nine companions (sponsored by the Smithsonian) to the Alps, just after the Civil War. He and his fellow hikers all perished in a week-long snowstorm near the peak of Mont Blanc. He was just 36 years old.

During World War I, blood transfusions were pioneered. Mobile field hospitals and ambulance corps were also developed (See my story about Marie Curie and her mobile x-ray units here.).

Innovations continued during World War II. Femur fractures, a common wartime injury, were problematic. Wires, metal plates and screws for complex fractures had been experimented with for many years. Doctors were limited, in the 1800s and early 1900s, by constant post-operative infections. Once the germ theory was understood and Lister’s influence on antisepsis spread, treatment for fractures became more successful. However, corrosion of the metal was a limiting factor, as well as loosening of screws. Enter Dr. Gerhard Kuntscher, a German orthopedic surgeon. In 1939, he developed the Kuntscher intramedullary nails, stainless steel rods used for fixation of long bones. These nails were different, as they went into the marrow of the bone, the long way, and held the two bone fragments together from the inside, like a popsicle stick inside a popsicle. This technique was an important military advantage for the Germans, as previous treatment of femur fractures required 6 weeks of bed rest, casting, and traction. With the Kuntscher nail, soldiers were up and walking days after surgery, and back on duty in half the time compared to normal healing. This was a closely held secret during wartime. The word began to get out when Allied doctors, examining captured German prisoners who needed x-rays, sometimes found healing fractures held together by these unusual long nails. Also, Kuntscher had been assigned to a Luftwaffe hospital outside of Berlin and Luftwaffe POWs were treated there. So, captured American paratroopers who had broken femurs while landing near Berlin, were often treated by Kuntscher; they, too, had the new innovative intramedullary nails. Once home after the war ended, these soldiers with intramedullary rods did well, and American doctors were fascinated. This technology was rapidly adopted by the American and British medical community. Intramedullary rods remain a mainstay of fracture care to this day.

The Allies had their own medical military secret during World War II: penicillin. We all know the story of Alexander Fleming and the discovery of penicillin in 1928. There is so much more to it than you’ve heard! Fleming had neither the resources nor the chemistry background to isolate the active ingredient in the penicillium mold. He sent his mold around to any other scientists who wanted to work on it. Efforts by others floundered over the next several years. Then, in 1938, Dr Howard Florey at Oxford read Fleming’s paper on the penicillium mold, and assembled a team to try to purify and test the active ingredient. So, Florey, a pathologist, and two biochemists, Ernest Chain and Norman Heatley, began to experiment. By 1941, they knew how to make penicillin and knew it worked. But think of what was happening in England in 1941. These scientists were working under terrible wartime conditions, with bombings, minimal funding, and primitive facilities. Their ability to make sufficient volume of mold and purify the antibiotic was severely restricted. In fact, Florey smeared the penicillium mold on his coat, so he would still have it if his whole lab were destroyed by bombing!

In 1941, Florey and Heatley flew to the United States, meeting with American scientists to develop a means to mass produce penicillin. Modifications led to much greater productivity and the ability to manufacture large quantities of penicillin. The US entered the war in December of 1941; at that point, the government took over penicillin production. Initially, there was not enough to treat one patient. By the end of 1943, more than twenty companies were working round-the-clock on penicillin; there was enough penicillin in stock to take care of the Allied Forces’ needs.

Of course, other countries heard about it and tried to produce it. German officials in occupied Paris learned the Pasteur Institute had begun efforts to produce penicillin. They demanded more be produced; the French lab gave them a false strain of mold that did not produce any penicillin. The same thing happened in the Netherlands. Again, a false strain was given to the occupying Germans, while underground efforts continued to surreptitiously produce active penicillin (under the false name Bacinol) at a lab in Delft. By 1944, the Nazis themselves succeeded in making penicillin. However, Allied bombing raids prevented mass production. Germany relied on the previously developed sulfa antibiotic, which, although revolutionary, was less effective. Hitler, in fact, was treated on a few occasions with penicillin, most notably after the 1944 failed assassination attempt. He had some minor injuries after a bomb detonated near him. His physician had penicillin, most likely confiscated from downed Allied bomber pilots who routinely carried it in their medical kits. Ironic that Hitler may have been helped by Allied penicillin.

In the war, penicillin proved its worth. Throughout history, the major killer in wars had been infection rather than battle injuries. It has been estimated that 100,000 or so men benefited from penicillin treatment in the European Theater between D-Day and the final German surrender. Penicillin also saved thousands of lives during the last year of combat in the Pacific. My mother, a young nurse during World War II, never forgot the drama of the first dose of penicillin she gave. “We stood there and watched him stop dying,” she remembered. Many other people had similar stories.

So today we mourn and thank those who died for our country. Let us also thank the researchers, doctors, and others who braved the odds, tried new things, and advanced science.