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Surgeon Soldier in Iraq – Part 2: Exsanguinating Hemorrhage

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Edited by Jonathan Vernon, Sunday, 30 Dec 2012, 12:50


My lines of enquiry can take me in some peculiar places.

All I wanted to do was write a 60 second piece on the assassination of Archduke Franz Ferdinand on the streets of Sarajevo on the morning of Sunday 28th June 1914. (Around 300 words to read, 260 or so out loud for video, even less with pauses)

Not a simple issue, and after a day of reading and several thousand words and enough for a 20 minute documentary I conclude that the story has to begin centuries before with the conquest of the Balkans by the Ottoman Empire ... then first ideas for a Greater Serbian State free not just of the Ottoman Empire, but also of the Austro-Hungarian Empire from around 1901.

There were seven assassins on the street - trained, armed with revolvers and hand-thrown bombs ready to act. It was well organised, the target agreed many months before, the nationalist group behind it already with a successful regicide on its books.

Had the Archduke listened to advice he would not have been in Sarajevo and he most certainly would not have returned to the streets after the first failed attempt on his life when a bomb was thrown at this car but ended up under the vehicle behind seriously wounded several and injuring many more.

The vital thing for all students to understand is that treaties, the Great Powers taking sides, and agitations of many kinds had the players on the field eager to get started. When you've got a fight brewing in the playground and the kids, teachers and authorities are all shouting 'Fight! Fight! Fight!' that is what will happen. The assassination by a lone killer of the leader of the French Socialist Party Jean Jaures, who was determined to find a peaceful solution in late July 1914 indicated the mood - the assassin was considered heroic.

I've been through the sixty minutes that take the 19 year old Gavrilo Princip from one side of the Quay Appel at around 10.15 am as the entoruage pass to the opposite side of the Street and the Rue Frans Joseph where he is standing with a revolver by the side of the road when the entourage returns stops in front of him and starts to reverse putting the assassin less that 5ft away from the Archduke and Duchess at around 10.50 am. Princip is a good shot, he's been practising for months. He shot twice - once at the Archduke, then at the Duchess. The first bullet entered the Archduke's neck. piercing the external jugular and lodging itself in his spine. At this short range it suggests that the bullet 'mushroomed' on impact, otherwise it would surely have penetrated the rear seat of the vehicle. The second bullet entered the Duchess's abdomen.

Curious to see it all in my mind's eye I Google away and have ample to read on gunshots to the neck - including medical and surgical papers I can read through the OU Library. A hundred years on a surgeon on hand and a dash to the hospital and the Archduke may have survived - though damage to his spine would have left him a quadriplegic. 65-60% fatality even today. Also a 30% chance of brain damage. Ligation of the vein. Count Harrac was at the Archduke's side put a handkerchief against the wound, what he needed to do was reach in and grip either side of the severed vein.

To save the Duchess it sounds as if a laparotomy would have been required urgently using procedures to control the damage done to the abdomen - such surgery only started to become common place in the 1950s. An 'abbreviated laparotomy with physiologic resuscitation in the intensive care unit and staged abdominal reconstruction' would have done the job - indeed I've just read about people with multiple shots across the abdomen from a machine gun who survive - in 2011. So fly in the air ambulance time machine and bring her out ... or just get there a few moments earlier and stop the whole shenanigans.

This below, for a contemporary take on field surgery in a war zone is a gripping, heartwarming, informed read. I guess after 6 weeks in somewhere like Iraq an US surgeon is ready for Chicago or the Comptons, Los Angeles.

Surgeon Soldier in Iraq – Part 2: Exsanguinating Hemorrhage


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