Military medicine

Warfare has always been both a curse and a blessing to the medical profession. It is a curse because battlefield doctors are often frustrated at being unable to prevent death, relieve suffering, or mend wounds. It is a blessing because it provides wonderful opportunities to expand medical knowledge. Surgery, especially, has advanced tremendously in times of war.

The Ancient and Medieval Eras

The detailed descriptions of wounds in the Iliad (c. 800 b.c.e.; English translation, 1616) show that the Greeks had an excellent basic knowledge of human anatomy. Ancient Chinese and Indian texts reveal similar levels of understanding. Such knowledge is a prerequisite for effective trauma surgery. This is not to say that ancient trauma surgery was effective—it usually was not. There was little a surgeon could do except pull out the arrow or spear, bandage the wound, splint or amputate the shattered limb, get the patient drunk, and hope for the best. Yet there were occasional successes, even miracles, and there is strong evidence in Greek and Roman literature that army surgeons were revered. The bravest soldiers and highest ranking officers were attended by the most skillful surgeons. Thanks to his doctors, Alexander the Great survived dozens of grim wounds before dying of fever at thirty-three. Even though ancient military surgeons frequently failed, it is obvious that they took their practical science seriously.

Medieval military surgery, like medieval medicine in general, regressed from the progress made in ancient cultures. Except for the contributions of Paul of Aegina, the Chinese, the Arabs, the School of Salerno, Lanfranc, and Guy de Chauliac, few advances in surgery occurred between the fall of Rome and about 1500. Medieval medical students learned anatomy from the works of Galen, not by direct experience. Before the laboratory dissection of cadavers began to become acceptable in the sixteenth century, studying battlefield casualties was about the only way that surgeons could gain first-hand knowledge of human anatomy.

The Dawn of Modern Military Surgery

Ambroise Paré is known as the father of military surgery. His fame was based on his reaction to a relatively new phenomenon in warfare, gunshot wounds. Earlier surgeons, such as Heinrich von Pfolspeundt, Hieronymus Brunschwig, Giovanni de Vigo, and Paracelsus, had written about gunshot wounds, but Paré was the first to discover how to treat them effectively. For two centuries after Paré, the French dominated surgery in general and military surgery in particular.

The Thirty Years’ War, the early colonial conflicts between England and France, and other seventeenth and eighteenth century European wars led to significant increases in medical and surgical knowledge. John Woodall wrote the first textbook of naval surgery, Surgions Mate: Or, Military and Domestique Surgury (1617). Johann Schultes (Johannes Scultetus) wrote the standard text of surgical instruments and procedures. Richard Wiseman added much to the knowledge of gunshot wounds. Lorenz Heister developed the use of tourniquets. François-Michel Disdier, in his Traité des bandages (1776; treatise on bandages), helped to lay the groundwork for what eventually resulted in the superior first-aid bandaging techniques of Johann Friedrich August von Esmarch. In his posthumously published Treatise on the Blood, Inflammation, and Gun-Shot Wounds (1794), John Hunter drew on insights he had gained while serving in the Seven Years’ War.

Perhaps the greatest military surgeon of all time was Dominique-Jean Larrey. A fervent Bonapartist, he accompanied Napoleon I from Egypt to Waterloo and took part in all major engagements of the Napoleonic Wars. In 1792, he invented the “flying ambulance,” by which wounded soldiers could be quickly and safely evacuated. He emphasized first aid and improved the mobile battlefield hospital. The men adored him, and Napoleon himself called him “the most virtuous man I have ever known.”

The War Against Disease

Military medicine is not only surgery. Disease is sometimes a greater threat than the human enemy. In the eighteenth century, the British began to succeed against some of the diseases that had plagued soldiers and sailors since ancient times. Observations on the Diseases of the Army (1752) by Sir John Pringle was a breakthrough text. James Lind and Sir Gilbert Blane conquered scurvy in the British navy.

Florence Nightingale founded the modern profession of military nursing during the Crimean War. Before her time, military nurses were typically camp followers, prostitutes, or girlfriends.

Major Walter Reed discovered the control for yellow fever in 1900 while stationed with the American occupation force in Cuba. Captain Edward B. Vedder, stationed in the Philippines in 1911, developed a cure for amoebic dysentery.

In eras when it was common for people to spend their entire lives within a few miles of their birthplaces, simple homesickness (then called “nostalgia”) could sap a young soldier’s or sailor’s will to live and result in his debility or even his death. In the twentieth century, this problem was eliminated by initiatives such as the United Service Organizations (USO), as well as by the fact that teens and young adults had become more accustomed to travel far from home.

The American Civil War

The American Civil War established the Americans as world leaders in military medicine. A Manual of Military Surgery (1861) by Samuel D. Gross was the standard text. The surgical potential of anesthesia, introduced in the 1840’s, was just beginning to be exploited. Throughout the war, infection and disease were more deadly than battles. Doctors began to notice that sanitation and hygiene were important to military health. New knowledge appeared in several classic works, including Outlines of the Chief Camp Diseases of the United States Armies as Observed During the Present War (1863) by Joseph Janvier Woodward and A Treatise on Military Surgery and Hygiene (1865) by Frank Hastings Hamilton.

Clara Barton attended the Union wounded as an independent nurse during the American Civil War, served with the International Red Cross in the Franco-Prussian War, and founded the American Red Cross in 1881.

The World Wars

Antisepsis, anesthesia, and hemorrhage control, the three prerequisites for complex surgical procedures, were all firm medical facts by the beginning of the twentieth century. World War I introduced the motorized ambulance and improved the field hospital. Gas warfare, artillery wounds, disease, and shell shock were the main concerns of doctors.

The American Medical Association published War Medicine in eight volumes from 1941 to 1945. This was the basic medical and surgical manual for World War II. American medical schools cooperated with the Department of War to found permanent or semi-permanent general hospitals in both the European and Pacific Theaters. Americans continued to lead the world in surgical innovations. Nazi intelligence routinely monitored Allied medical correspondence so that German military surgeons could be as up-to-date as the Americans.

Developments in the Late Twentieth Century

In the Korean War, helicopter evacuations of wounded from battlefields to mobile army surgical hospital (MASH) units became standard. This enabled the speedy application of more sophisticated care than medics could provide on the battlefield.

Challenges to military medicine at the end of the twentieth century included the chronic health problems of soldiers who were exposed to the defoliant Agent Orange in Vietnam; Gulf War syndrome (GWS), the mysterious biological ailment of veterans of that 1991 conflict; and post-traumatic stress disorder (PTSD, formerly known as “shell shock” or “battle fatigue”), psychologically damaging flashbacks to combat situations.

Bibliography

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