Future – The princess who transformed war medicine – BBC News

By | April 25, 2019

Vera Gedroits knew she was in a race against time. She had to escape. Overnight, gunfire from the battlefront had grown ever nearer and only now, at 02:00, was it beginning to die down. As the train’s wheels creaked and the vehicle lumbered tentatively into motion, it cut a shadowy silhouette across the nocturnal landscape. All lights had been put out to try and prevent the train from being spotted by enemy gunners.

As a mobile hospital, it shouldn’t have been a major target in any case. But now that it was in motion, shells nevertheless began to rain down in its direction.

Gedroits looked around at some of the patients on board. In all, there were about 900, many of them lying in terrible pain on stretchers fixed to the walls. There were some horrific battlefield injuries among them. Infections. Open wounds. Gedroits didn’t have a moment to lose. During the next few hours, she and her team performed operations and provided whatever treatment they could as the train rumbled away from the front. About 12 hours later, it finally reached a safe distance.

Two weeks later, on 10 March 1905, the battle ended with the Russian army defeated. Before long, the war itself was lost.

This was a turning point for Vera Ignatievna Gedroits – a descendant of Lithuanian royalty, a gifted surgeon, an odd-ball, a polymath. Princess Gedroits, as she may rightfully be called, was an extraordinary figure – and yet today she is largely unknown in the West. As a pioneer of battlefield medicine, Gedroits made contributions that some think could have saved thousands of lives during WWI had they been better understood at the time.

“When I first heard about the story, I still remember my comment at the time was, ‘Why hasn’t this been a movie?’,” says Melanie Stapleton at the University of Calgary.

It’s a good question. But who exactly was Vera Gedroits and why have we forgotten her?

Even the first key bit of information about Gedroits – the year of her birth – has been a matter of debate. Many articles about her state that she was born in 1876, but she appears to have corrected this in her personal papers. She was actually born six years earlier in 1870, in Kiev.

Not much detail in English is available about her early life, but we know that she was from a wealthy family and studied at home before attending finishing school in St Petersburg. When she was 16, she was arrested for taking part in revolutionary activities organised by a left-wing faction. She returned home but soon escaped to Lausanne in Switzerland. It was there that she studied medicine. Gedroits would have been one of a few thousand woman who studied medicine in Switzerland in the late 1800s and early 1900s. The country was unusual in that period because its universities regularly welcomed female medical students.

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By 1901, Gedroits had returned to Russia, where she would later pass her medical exams and officially take the title of doctor. Her medical career began not on the battlefield, but an industrial estate. She was appointed surgeon at the Maltsov Cement Factory in the district of Zhizdrinsky in the west of Russia.

Gedroits installed physiotherapy equipment and an X-ray machine – absolutely state-of-the-art for the time

According to an article in Russian about her career there, her work was transformative. She planned to set up a proper hospital factory and before long had installed physiotherapy equipment and an X-ray machine – absolutely state-of-the-art for the time. X-rays were discovered in 1895, less than a decade earlier. In her first year, 103 surgical patients were treated in her hospital; only two died.

Workers at the factory were tasked with physically exhausting work. There was lots of heavy lifting and, in one section that made glass, manual glass-blowing. In her reports, Gedroits noted that this sort of work would gradually weaken the abdominal muscles. That was why she ended up operating on so many patients with hernias, she supposed.

A focus on the abdomen was unusual at the time – and it was going to benefit her in the future in ways she couldn’t possibly have imaged. Just a couple of years later, the Russo-Japanese War broke out. Gedroits volunteered for the Red Cross.

The war was a very bloody and miserable one. It is often described as a kind of mini premonition of WWI, which would begin about a decade later. Both featured trench fighting, plenty of stalemate and numerous battle “victories” in which both sides lost thousands of men. Ultimately, around 100,000 people were killed in the Russo-Japanese War and Russia was effectively defeated – a shock since Japan was a much smaller and, at the time, economically troubled nation.

There are very few sources in English that detail Gedroits’ activities during the war. However, in 1997, British military physician John Bennett wrote a journal article in which he provided a translated summary of Gedroits’ own report on the conflict. Bennett’s article appears to have never been published but a draft was sent to Yuri Kolker, to a former producer of Russian features at the BBC World Service, who kindly shared the letter with BBC Future.

On 26 September, Gedroits found herself setting up a field hospital at a tiny village near the town of Mukden, which is nowadays known as Shenyang in China. This was to be a key strategic location for Russian forces in the coming months. Gedroits’ train was the core of her detachment at the site, but the hospital itself was not confined to the carriages. It expanded onto the ground nearby in rows of tents. Peasant huts also were taken over and converted into an operating theatre as were some storehouses.

For the operating theatre, interior thatched walls were covered in clay and then white-washed. Sterilised bedsheets further enclosed the room to make the space as hygienic as possible.

In her first month, Gedroits and her team found themselves treating an incredible variety of brutal injuries. Most involved bullet wounds and shell fragments. There were more than 700 instances of such injuries in limbs, 143 in the chest and 61 in the abdomen, for example.

Gedroits noted the case of one man who came in with shell fragments lodged in his head. The injury had caused a loss of control on the left side of his body. Gedroits made an incision through the skin on his head, prised the wounds open slightly with forceps and picked out three large pieces of shrapnel. A handful of other small splinters was also removed. After the operation, the patient begged for a cigarette. “Here – try with your left hand,” said Gedroits. To her satisfaction, he was able to hold it.

Gedroits made extensive notes about the injuries she treated, and what she could determine about the weapons that had caused them. For example, she found that shell fragments and explosive hand bombs left a yellow tinge on the skin.

As the months wore on, the weather got colder. One of the compounding factors for Gedroits and her colleagues on their hospital train was the severely low temperature that troubled patients in tents or wounded soldiers returning from the front. Some developed frostbite.

But in January, an operating theatre carriage was added to the train – a huge upgrade in its facilities. The following month, the mobile hospital was sent along the railway from Mukden to the mines near Fushan, where many wounded men were gathering. In the first four weeks or so, Gedroits performed no fewer than 56 operations. Patients recovering from surgery were able to make use of yet more additional carriages – heated wagons where they could recuperate in greater comfort than the outdoor tents.

But it was around this time that the Russian army’s grip on territory in this region began to loosen. The Japanese unleashed a clever, five-pronged attack during the famous Battle of Mukden. By 22 February Gedroits and her train were ordered to retreat. That was when the daring escape run at night had to be made, shells whistling overhead.

In her report, Gedroits had described the difficulty presented by abdominal injuries in particular.

Military physicians were familiar with this problem at the time, says retired surgeon and historian Michael Crumplin. In many cases, surgeons opted not to intervene – instead, soldiers with abdominal wounds would simply be monitored in the hope that their condition would improve. Often, the patient died instead.

“When you haven’t got blood transfusion properly sorted, drips and antibiotics and things, you can understand the philosophy,” says Crumplin.

But Gedroits did try to intervene in some cases, performing laparotomies – exploratory incisions of the abdomen – to see if she could stop bleeding or drain excess fluids, for example. According to Bennett, Gedroits described the advantages of doing so in her writings over the following years, emphasising that examinations of wounded abdomens should always be completed as soon as possible.

Crumplin explains that because the abdominal wall muscles are so tight, anaesthetic must be used to relax them during operations. It’s possible to mop up bleeding and faeces that may have spilled from the intestine, but there is still a huge risk of infection. There are also large blood vessels supplying the bowel; cutting these erroneously can be fatal. And many vital organs – such as the pancreas – are nearby, risking potentially life-threatening damage should the operation harm them.

Not only that, once the bowel has been interfered with, it’s not always a given that it will recover.

“The whole gut goes into resignation and stops working, the belly gets distended, you vomit and die of dehydration,” says Crumplin. “There are huge challenges to operating in the belly.”

Gedroits appears to have understood much of this but remained undeterred by it.

Her work was mentioned in a British report on the Russian medical service during the Russo-Japanese War, but there is almost no detail. In failing to document Gedroits’ activities fully, “we missed a huge opportunity”, says Steven Heys, head of the school of medicine at the University of Aberdeen.

Gedroits discovered that getting the hospital train as close to the front as possible was crucial – as was assessing certain injuries within specific timeframes. Three hours or less for abdominal wounds, for instance. And she even made notes on the best type of bandages to use at what stage of treatment.

Had others paid attention to these insights, casualties during WWI could perhaps have been reduced, adds Heys: “She did, after all, publish in 1905, 10 years before the start of the war.”

Gedroits once shoved Grigori Rasputin into a corridor when he refused to get out of her way

Things by no means calmed down for Gedroits after the war. She returned to her factory post and increased the scale and scope of the hospital she ran there. A few years later, she entered the employment of the Russian royal family. Working as a surgeon in the Tsarskoye Selo palace hospital, she even involved the Empress Alexandra and her daughters Tatiana and Olga, teaching them the basics of surgery. In one photo, the Empress herself is seen handing Gedroits instruments as she performs an operation.

But Gedroits was no royal sycophant. There is a report that she once shoved the Empress’s confidant Grigori Rasputin into a corridor when he refused to get out of her way. By 1917, revolution threatened the Russian royal family’s very existence and Gedroits left to work as a battlefield surgeon once again in WWI. She was wounded herself, however, and eventually ended up in Kiev.

There, Gedroits was hired to teach paediatric surgery and was eventually appointed a professor.

But medicine was not her only pursuit. She became a poet, publishing multiple volumes. In Kiev, her eccentricity was noted by locals. Gedroits was known for her masculine attire, her deep voice and her close relationships with women. Many assume she was gay.

In 2007, an article in the journal Clinical and Investigative Medicine lamented the fact that the world seems to have forgotten about Gedroits. She is a classic example of how knowledge and experience clearly of benefit to others can get lost. Partly because of sheer circumstance, but also, perhaps, because society chooses to more commonly pay attention to certain kinds of people over others.

“We’re celebrating a lot of people these days but we have forgotten about this incredibly accomplished, very interesting woman,” Wilson says.

The odds were stacked against her, says his friend and colleague Melanie Stapleton.

“She was allied with the royal family, she was female, she definitely bucked social norms – she was publishing in Russian. Any one of those things would have held her back,” she explains.

“All of them together have really prevented her from getting recognition.”

Vera Gedroits died in 1932 and was buried in Kiev. According to one source, her grave was tended for many years by an archbishop whom she had treated when he was a young man. When he died, he chose to be buried beside her.

It seems a shame that Gedroits’ fascinating life story isn’t more widely known. Stapleton’s first thought, when discovering Gedroits’ extraordinary story, still seems perfectly apt: shouldn’t there be a movie of all this?

In the course of researching this article, BBC Future found that there was a paucity of information about Gedroits online and in English libraries. If any Russian speakers are able to share access to Russian hard copy sources, we would be most grateful.

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