This year is the centennial anniversary of the United States' entry into World War I. It also marks the initiation of the transformation of American medicine to the modern era. Twenty-first century healthcare something that Americans take for granted today had its origins 100 years ago on Europe's blood-soaked battlefields.

The United States formally entered the conflict on April 6, 1917, but officials began to prepare the medical aspects a full two years earlier. Necessity became the mother of invention and laid the foundation for future change.

America's involvement in the war required the government to utilize both curative and preventative medicine to the fullest. The variety of health professionals mustered included the usual doctors, nurses and pharmacists. In addition, unlike in previous wars, sanitary engineers, lab techs and doctor specialists of every stripe were added to the medical teams.

Testimony of their collective value came after the war when the statistical record revealed that for the first time in American history, there had been fewer deaths from disease than from battle wounds.

This remarkable accomplishment before the era of antibiotics was achieved by innovations in a number of areas. These included more thorough examination of recruits, education and prophylaxis against venereal disease, and improved enforcement of sanitation and hygiene.

The wounded soldiers were taken to the hospitals from the battlefields in a better system of triage and evacuation. The treatment of the enormous number of causalities employed science-based therapies. In the military hospitals surgeons undertook a far greater variety of complex operations than had their predecessors in previous wars. Doctors used newly developed antiseptic solutions to irrigate injuries and refined a fundamental surgical principal: the removal of all devitalized tissue prior to suturing.

In addition, blood transfusions, which had been used sporadically prior to the conflict, became a reality. A U.S. Army Medical officer showed that blood could be donated in advance and stored using sodium citrate as an anticoagulant. He also developed the first blood bank.

The war saw the debut of the portable x-ray machine. Radium discoverer and Nobel prize winner Marie Curie organized a campaign to turn cars into x-ray vans to radiograph wounds on the front line. This allowed doctors to save lives and prevent disability by detecting broken bones, shrapnel and bullets buried in the flesh.

While many of these medical advances during the conflict dealt with healing the body, there was also treatment of psychological wounds that left many soldiers with the uncontrollable tremors, commonly called "shell shock." This was known as "soldier's heart" during the Civil War and "combat fatigue" in WW II. Shell shock was the forerunner of today's post-traumatic stress disorder.

The war catapulted clinical practice forward. In the half-century between Appomattox and the Treaty of Versailles, the nation's doctors had slowly assimilated the bedrock medical concepts of anesthesia, germ theory, antisepsis, microbiology and pathology. These were the roots of modern medical science.

American medicine immediately after WWI was on the cusp of a transformational leap forward. New higher standards of care were set. The cadre of talented doctors that came back after the fighting stopped would help American practitioners ascend into a position of leadership in the years ahead from which all citizens benefit today.

Stolz is a retired physician with a longtime interest in the history of medicine. He is a regular instructor at William & Mary's Christopher Wren Association.

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War ushered in dawn of modern medicine - Virginia Gazette