|Tuesday, 11 January 2011|
Michael Crumplin, Pen and Sword Military, 2010, ISBN-13: 978-1848842458, RRP: £19.99
To anyone who has an interest in military surgery, Guthrie’s War is a fascinating read. Michael Crumplin, surgeon, archivist at the Royal College of Surgeons of England and well-known military historian has traced Guthrie’s career from being the youngest to pass the examination for Membership of the College at 16 years through his career to a short appreciation of his three terms as President of what was then the Royal College of Surgeons of London.
Those who already are students of the Peninsular War and Wellington’s campaign will acknowledge the detail of the various units which Guthrie supported as the reader is taken very rapidly from campaign to campaign, but throughout there are well described clinical vignettes which bring out the care which Guthrie had for individual casualties and how he developed his principles of managing the horrific injuries faced with huge numbers of casualties, understaffed, lacking in resources and often without senior support. It is the number and detail within these case recordings, which illustrate the problems, which Guthrie faced and make this book so relevant.
Guthrie was one of the first to appreciate the essential need to collect data, subject it to audit and alter his approach. His contributions in trauma management will strike a cord with those who currently deal with such injuries. He recognised the need for early amputation of limbs when the limb was clearly unsalvageable, yet conservative management where feasible; in vascular surgery where compression was preferable to the immediate application of tourniquet, isolation of bleeding vessels was preferable to merely ligating the feeding artery proximal to a wound and decompression of swollen limbs; the need to remove debris and clothing taken into wound by bullets, or later drain the inevitable abscesses. If only he and colleagues had audited the results of the widespread habit of ‘bleeding the patient’, maybe many more lives would have been saved.
Crumplin seeks to elevate Guthrie to the status of Baron Larrey, Napoleon’s surgeon, the ‘father’ of military surgery whom Guthrie never met. There may well be justification in this but we are two centuries further on. What an exchange of views there could have been had there been an international military surgical conference in the early 1980s!
With such a background, it is not surprising that Guthrie found it difficult to settle in peacetime to the more gentile surgical practice in London, but publications and teaching followed and he was elected onto the Council of the RCS of London at 39 years, overcoming prejudice and driving through reforms as its President. This book can unequivocally be recommended for anyone interested in the history of surgery.
Michael F Smith