How were severely wounded soldiers, unable to use their GI tract
because of their wounds, provided with nutrition support during World
War II? How many might have perished from malnutrition?

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Request for Question Clarification by synarchy-ga on 22 Oct 2002 11:17 PDT

I'm pretty sure that I've got the books to answer the first part of
your question, but the references aren't likely to be available on the
web.  If you would be willing to accept my synopsis with references to
the actual textbooks, I can answer part 1.

As to part 2, would rough estimates of death due to malnutrition in
wounded soldiers work for you, or do you require more specific
numbers?

Hello tomtgs,

I'm posting this as a comment not as an answer, since it is not really
a satisfactory answer to your query.

I would guess that not much could have been done in such cases. Today,
someone who cannot use their GI tract will be given parenteral
nutrition (the nutrients will be infused through a vein directly into
the bloodstream).  Research on this type of feeding started very
early: apparently Christopher Wren attempted to feed animals in this
way with wine, opium and oleic acid.  Intravenous glucose was first
given to humans in 1896 by Biedl and Krause.  However, complete IV
nutritional support did not begin to be developed until towards the
end of World War 2 (possibly the war served as impetus for this
research).  R Ellman in 1947 published a study entitled "Parenteral
alimentation in surgery" and in 1949 HC Meng reported complete
nutritional support of dogs in his paper "Study of complete parenteral
alimentation in dogs".  However, the use of parenteral nutrition in
humans did not really start until the early 1960s. Arvid Wretlind from
Sweden was one of the pioneers, and he reported being able to achieve
a positive nitrogen balance with parenteral nutrition in 1962. The
technique only became widespread in the 1970s.

One further comment:  it is highly likely, especially in field
conditions, that such wounds would result in death from shock or
sepsis before malnutrition could set in.  Penicillin was in very short
supply at that time, until the later years of the war, when mass
production technology was developed.

As I work as a librarian, I offer my comment to GG-answers, some
partial answers to tomtgs above queries:

     Response-Q1: nutritional support for severely wounded soldiers 
"unable to use their GI tract"?
   If all GI system affected, then indeed probably "not much" could be
done especially in wartime conditions before era of mdoern intravenous
parenteral nutrition.
   However, in WW2 there were enteral nutritional supports. For a
recent historical review on what and hows, see  Pubmed record
PMID#-11902373  Harkness,-Laura. "The history of enteral nutrition
therapy: from raw eggs and nasal tubes to purified amino acids and
early postoperative jejunal delivery."  J-Am-Diet-Assoc. 2002 Mar;
102(3): 399-404
   For example Harkness writes: "During World War II, physicians in
the Soviet Union related accounts of jejunal feeding during surgery
using the Spasokukotski technique (17). Patients were fed on the
operating table with a solution of 400 cc natural milk, 50 cc sweet
butter, 2 eggs, 50 g sugar, 3 to 5 g salt, and 50 to 70 cc distilled
alcohol. The jejunal tube was removed after the single bolus
infusion."


    Response-Q2: mortality rate: see for example Pubmed record PMID
1462634, Rignault,-D-P. "Abdominal trauma in war." World-J-Surg. 1992
Sep-Oct; 16(5): 940-6   The abstract states: "In abdominal war wounds,
mortality rate dropped from 53% during World War I to 18-36% at the
end of World War II."


     SUMMARY: The above leads, among many relevant sources, are from 
http://pubmed.gov.   There are many other relevant web resources for
medical history, but Medline is a good starting point for finding
relevant abstracts and links to refereed articles, full text & holding
libraries...

  Pubmed has great support and orientation, ie HELP, FAQ, TUTORIAL. 
  MEDLINE has great indexing. for many queries the Pubmed MESHbrowser
is handy. This is the keyword/subheading query-maker, ie.
"Parenteral-Nutrition/history'[mesh] ;
"Enteral-Nutrition/history"[majr].
   And combine with freetext searching, eg. #4 AND  mortality AND
(abdominal or gastr*) And (injur* OR trauma) AND (soldier* OR war or
military)

The full and complete answer is not "18-36% at the end of World War
II" but the sharing and learning and visiting physical libraries and
web info resources.