Medicine, Disease and Society in Britain, 1750 - 1950
War and medicine
Lecture 17
Roger Cooter, ‘Medicine in war’, in Deborah
Brunton (ed.), Medicine Transformed
(Manchester, MUP), pp. 331-333:
• The relations between war and medicine have only recently been
seriously discussed by historians.
• Early historians of medicine were more interested in public health,
mental health care, hospitals and other features within what they
perceived as the expanding social domain of medicine. Fear of
endorsing ‘militarism’.
• War also ‘unfashionable’ in 1970s and 1980s- shadow of Vietnam, war
must relate to welfare.
• It was only in the 1990s that historians of medicine begin to tackle the
subject. War ceased to be seen as something separate from the rest
of society and culture. IWW seen as the crucible of modernity;
interest in Nazi medicine
• Now includes, disablement and rehabilitation, nursing, shellshock,
masculinity, civilian health
Lecture Themes and Outline
• The relations between medicine and
war: positive and negative
• Crimea, Boer, WW1
• Military medical services
• New technologies and advances
• Nursing
• Civilian health
‘Progress through bloodshed’
• War provides a large, captive group of patients, and that
doctors see many similar cases, need to be treated in
emergency conditions and effectively- the ideal being that
go back to the front to fight.
• War stimulates medical research and must lead to significant
advances. E.g. First World War introduced blood transfusions,
hastened developments in reconstructive or plastic surgery,
launched aviation medicine, and promoted research into
wound-shock and management, shell-shock, gas-asphyxia,
etc; while the 2nd World War saw introduction and mass
production of ‘miracle drug’ penicillin and further
developments in orthopaedics, treatment of burns and plastic
surgery.
• Represents a Whiggish, progressive and older view of
medicine
Problems with positive relationship
• Reallocation of resources
• Military medical innovations don’t translate into civilian
life, e. g. Lind’s treatment of scurvy
• Specialised treatment needed for wounds is sometimes so
specific that it does not apply to peace-time health
needs, e.g. amputations, gas attacks, gunshots
• Often very chaotic in practice
• Conditions are different in war and peace, e.g. during
war, injuries in filthy trenches had dangers of infection,
meaning surgeons more likely to amputate rather than to
treat in a more conservative way
• Role of a military surgeon is an ambiguous one. An officer
meant to keep discipline as well as a humane medical
practitioner
Global estimates of the average
annual military deaths in wars, by
century:
Century
17th
18th
19th
20th
Military deaths
(per million population per year)
19.0
18.8
10.8
183.2
(Data from Garfield and Neugent (1991, p. 689)
Relative deaths: Disease and Wounds
(Brunton (ed.) Medicine Transformed (2004) p.335).
‘000s Deaths from disease
Napoleonic (1793- 1815)
195
wounds
8
ratio
24:1
(British only)
Crimean (1854-66)
474
99
5:1
14
7.5
1.9:1
113
167.0
0.67:1
(French, British & Russian)
Boer (1899-1902)
(British only)
First World War
(British & empire only)
James Lind (1716-94), A Treatise of
the Scurvy (1753)
• As sea voyages lengthened in
C17 and C18, the impact
increased e.g. over half died in
Lord Anson’s voyage round the
globe
• 1747: experiment on the
Salisbury- those fed oranges
and lemons fit
• 1795 naval authorities
distributed lemon juice to sailors
of salt rations > 6 weeks . Not
introduced in Merchant navy
until 1845.
Witness Accounts
• ‘Saw about two hundred wounded soldiers waiting to have their limbs
amputated, while others were arriving every moment. It would be difficult
to convey an idea of the frightful appearance of these men; they had
been wounded on the 5th and this was the 7th; their limbs were swollen to
an enormous size, and the smell from the gunshot wounds was
dreadful...as many of them were wounded in the head as well as in the
limbs, the ghastly countenances of these poor fellows presented a dismal
sight...The surgeons ‘stripped to their shirts and bloody...to the right were
arms and legs, flung here and there without distinction and the ground
was dyed with blood’. (Peninsular Wars)
• Sir Charles Bell, (1814) - reported at Waterloo.
‘All the decencies of performing surgical operations were soon neglected;
while I amputated one’s man’s thigh there lay at one time thirteen all
beseeching to be taken next. It was strange to see my clothes stiff with
blood and my arms powerless with the exertion of using my knife’.
Joan Lane, A Social History of Medicine (London: Routledge, 2001), p. 174:
Photo of camp of the 3rd Grenadier Guards with the barracks, Scutari by
James Robertson photo (1854). The early photographer James Robertson
took some remarkable photographs at Scutari in 1854, while the British Army
paused there on the way to the Crimea and encamped to the south of the
Barrack Hospital.
Poor physical state of recruits- 1917
• 1-fit for active
duty
• 2-some disability
but suitable for
garrison duty
• 3-unfit – worked
in auxiliary
services- non
combatant roles
• 4- unfit
(Parliamentary
papers, 1917)
H.R. Mackey, The RAMC on Active Service
Military doctors: ambiguous roles
Matthew Thompson, ‘Status, Manpower and Mental Fitness: Mental
Deficiency in the First World War’ in Roger Cooter, Mark Harrison and
Steve Sturdy (eds.), War, Medicine and Modernity (Thrupp: Sutton
Publishing,1998) 149-66):
• High proportion of officers among the shell-shocked indicates that
diagnosis was a sign of patient-power (a way to escape the
horrors of the trenches) as much as medical control
• In a 1918 sample of officers only 6 per cent were sent back to
duty. By contrast, among the lower ranks, 48 per cent were sent
back to the front
• Even if the war was a watershed in attitudes and standards of
care, it was a watershed which was differentiated according to
status, benefiting the neurotic but leaving a ghetto of neglect for
the defective and the chronic and incurable mentally ill
• The shell-shock-dominated story of First World War psychiatry – of
new knowledge and more sympathetic attitudes inaugurating an
era of mental hygiene – is flawed: it focuses too exclusively on
high-status individuals; lower-status groups experienced very
different fortunes
Mobile bacteriological laboratory, 1912-13. Mobile labs such as this were used
in the First World War to identify diseases and infections among sick and
wounded soldiers.
Henry Tonks was a surgeon who became an artist, returning to medical work
during the First World War. These two pastel drawings by Tonks show a
patient before and after plastic surgery.
VAD Nurses on parade at a camp at Osborne during the First World War.
Effects on Civilian Health (Winter, Titmuss)
• Reduction in maternal and infant mortality
–
–
–
–
–
Female employment
Better food distribution
Improved services for mothers and babies
Reduction in maternal and infant mortality
Reduced alcoholism
• Higher mortality for elderly
– Stress
• Increase in smoking & respiratory tb. Also
dangers at workplace
Carnegie Trust Report on Maternal
and Child Welfare in 1917:
‘The value of population has never been
appreciated as it is today, and regrets at the
unheeded wastage of infant life in bygone
years are as sincere as they are useless, a
simple calculation shows that had the annual
wastage of male infant life during the last 50
years been no greater than it is at present, at
least 500,000 more men would have been
available for the defence of the country
today.’
With imports of food
declining because of the U
boat attacks on shipping
and the advance of the
German army across
Europe , the British
government set up a
committee of nutritional
experts to advise the War
Cabinet on a strategic food
policy.
A typical ration book during World War Two.
The committee issued a
report with the effect that
each person in Britain
could easily survive on
twelve ounces of bread, six
ounces of vegetables, a
pound of potatoes, two
ounces of oatmeal, an
ounce of fat, and six-tenths
of a pint of milk per day,
supplemented either by
small amounts of cheese,
pulses, meat, fish, sugar,
eggs and dried fruit.
Conclusion
• Cooter’s ‘balance sheet’ of war and medicine
• An existing abundant literature on medicine in wartime pays little
attention to the wider context in which war was waged, or of the role
of war in the making of modern society. Until very recently, this
literature has been overwhelmingly dominated by practitionercentred accounts of how medicine has benefited from and been
advanced by war.
• While it is widely recognized that research into preventive and
therapeutic medicine has often intensified during wartime, how did
these transfer into civilian population? Complex. Pressing questions
about the impact of the war on the aims, concerns and social
configurations of medicine have been ignored in favour of simple
and self-serving narratives of technical and organizational
advancement.
• Military medicine – a contradiction? Health of individual vs objectives
of overall mission