1916 — The Year the Nobel Prize Was Suspended

What You Will Learn in This Article

Learn how the fundamental principles of modern emergency medicine — triage, shock management, and war neurosis — were established during the year the Nobel Prize was suspended.

1916: A Stress Test

If you were to design an extreme load test for the global medical system, it would be hard to create a more challenging scenario than 1916.

• Verdun: February 21 to December 18, 10 months. Over 300,000 deaths, over 400,000 wounded.
• Somme: July 1 to November 18, 4 months. On the first day alone, the British army suffered 58,000 casualties. A total of over 1 million casualties.
• Eastern Front, Brusilov Offensive: A major Russian offensive, putting the Austro-Hungarian army on the verge of collapse.

Humanity had no precedent for how to handle this scale of casualties. Previous wars had been brutal, but never at this density, for this duration, and with this type of injuries (artillery, machine guns, poison gas).

Under this extreme stress, the medical system began to rewrite emergency protocols. The Nobel Prize was suspended, but in the backyards of field hospitals, the foundations of today’s emergency medicine were being laid through trial and error.

The Landscape of the Time: A Year When War Became Everything

In 1916, Europe was in a state where nothing remained but war. Men were sent to the front lines, women were mobilized in munitions factories and field hospitals, and children were put to work. Universities and laboratories were no exception.

In France, the Pasteur Institute devoted all its efforts to the mass production of tetanus antitoxin. In Germany, the Kaiser Wilhelm Institute was assigned to both the development and defense of chemical weapons (the fact that Fritz Haber, who would receive the 1918 Nobel Prize in Chemistry, was a key figure in German chemical warfare during this period symbolizes the moral complexity of the Nobel Prize). Britain reorganized its government-science advisory system to focus on war R&D.

One of the most notable events of this period was the Easter Rising in Ireland (April). While the British Empire was preoccupied with the war in continental Europe, Irish nationalists seized the center of Dublin and declared an independent republic. The six-day uprising was suppressed, but it became the spark for the subsequent Irish War of Independence. It was the first sign that the imperial system itself was slowly beginning to crumble.

In parallel with Korean history, 1916 was the year the Japanese colonial government completed the land survey of Korea. Land owned by Koreans was nationalized and redistributed to Japanese and Korean landowners. This survey created a landlord-tenant structure that became the root of fundamental social conflicts in Korea for the next half-century. While Europe was developing new medical practices on the front lines, Korea was being forced to undergo a fundamental reorganization of its modern property rights system.

Yet, Science Did Not Stop

Establishment of Triage Principles

The concept of casualty sorting existed before 1916. Dominique Larrey, a surgeon in the Napoleonic era, created the prototype. However, it was the experiences at Verdun and the Somme that established it as a systematic protocol.

The principle of triage, derived from the French word "trier" (to sort):

1. Those who can be saved with immediate treatment — highest priority.
2. Those who will die even with treatment — lower priority (cruel, but the cold reality of resource allocation).
3. Those who will survive without treatment — wait.

This principle may sound harsh, but in a situation with limited resources, it is the optimal strategy for saving as many lives as possible. In CS terms, this is a priority queue for a load balancer. It evaluates the expected utility and cost of processing each request (casualty) as a function, and processes the requests in descending order of that value.

Today, when we enter the emergency room, the triage nurse assigns color-coded tags (red, yellow, green, black). This procedure is the direct descendant of the protocol established in French field hospitals in 1916.

Understanding and Management of Shock

The clinical concept of shock was also established during this period. An unprecedented number of casualties died without obvious bleeding or infection. Initially, the cause was unknown, but it soon became clear that this was a condition of acute circulatory failure.

Key observations:

• Pale, cold skin
• Rapid, weak pulse
• Low blood pressure
• Decreased level of consciousness

Once it was understood that these were different manifestations of the same pathological condition, countermeasures were developed: protocols to lay casualties down, elevate their legs, keep them warm, and administer fluids or blood if possible. The roots of the "ABCs" (Airway, Breathing, Circulation) principle, which we learn in emergency first aid today, lie in this period.

The Emergence of the Concept of War Neurosis

One of the key psychological discoveries of 1916 was the recognition that neurosis can be caused by psychological factors alone.

Large numbers of soldiers exposed to repeated artillery explosions were observed to suffer from tremors, paralysis, aphasia, and nightmares without any obvious physical trauma. Charles Myers, a military psychologist in the British Army, named this "shell shock." Initially, the hypothesis of micro-damage to the brain prevailed, but in many cases, no abnormalities were found in brain examinations. Gradually, it became accepted that this condition was a physical manifestation of psychological trauma.

This was a fundamental shift in the understanding of psychiatry. Until then, mental illness was understood as a genetic or organic problem. After shell shock, the concept that experience can make the mind sick was established, and this became the precursor to today's PTSD (post-traumatic stress disorder) diagnostic concept.

In CS terms, this is similar to the discovery that a software system can fail due to state corruption even without hardware defects. The recognition that the cause can be logical rather than physical — without this recognition, we would still be asking trauma patients today, "If your brain is fine, why are you like this?"

Connections

The developments of 1916 are connected to the following Nobel Prizes:

• 1930, Karl Landsteiner, Nobel Prize in Physiology or Medicine for the discovery of human blood groups — The Somme and Verdun were the backdrop for the establishment of large-scale blood transfusions as a clinical norm.
• 1949, António Egas Moniz, Nobel Prize in Physiology or Medicine for lobotomy — While controversial today, the establishment of his approach was based on the war neurosis psychiatry of the time.
• Late 20th Century PTSD Research — Although there is no Nobel Prize, this concept is now a major pillar of modern psychiatry.

In CS terms, 1916 is a case where an extreme load test forced the evolution of new protocols. In software, we often only understand the necessary refactoring after seeing how the system fails in a load test. The triage, shock management, and shell shock protocols were all born in this way.

The dark side of this analogy: the stress test was not planned, but the burden of 1916 was paid for with the bodies and minds of human beings. When we receive a triage tag in the emergency room today, we must not forget that the learning data for that protocol was 1 million casualties.

Emergency Medicine Established Under the 1916 Downtime: The Nobel Prize was suspended, but three major pillars of emergency medicine were established: triage, shock management, and shell shock. These became the roots of emergency room protocols for the next half-century.

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