Between Flesh and Steel

Between
Flesh
and
Steel

Also by Richard A. Gabriel

Man and Wound in the Ancient World: A History of Military Medicine from Sumer to the Fall of Constantinople

Hannibal: The Military Biography of Rome's Greatest Enemy

Philip II of Macedonia: Greater than Alexander

Thutmose III: A Military Biography of Egypt's Greatest Warrior King

Scipio Africanus: Rome's Greatest General

The Battle Atlas of Ancient Military History

The Warrior's Way: A Treatise on Military Ethics

Muhammad: Islam's First Great General

Soldiers' Lives Through History: The Ancient World

Jesus the Egyptian: The Origins of Christianity and the Psychology of Christ

Empires at War: A Chronological Encyclopedia

Subotai the Valiant: Genghis Khan's Greatest General

The Military History of Ancient Israel

The Great Armies of Antiquity

Sebastian's Cross

Gods of Our Fathers: The Memory of Egypt in Judaism and Christianity

Warrior Pharaoh: A Chronicle of the Life and Deeds of Thutmose III, Great Lion of Egypt, Told in His Own Words to Thaneni the Scribe

Great Captains of Antiquity

The Culture of War: Invention and Early Development

The Painful Field: Psychiatric Dimensions of Modern War

No More Heroes: Madness and Psychiatry in War

Military Incompetence: Why the American Military Doesn't Win

To Serve with Honor: A Treatise on Military Ethics and the Way of the Soldier

With Donald W. Boose Jr.

Great Battles of Antiquity: A Strategic and Tactical Guide to Great Battles That Shaped the Development of War

With Karen S. Metz

A Short History of War: The Evolution of Warfare and Weapons

History of Military Medicine, Vol. 1: From Ancient Times to the Middle Ages

History of Military Medicine, Vol. 2: From the Renaissance Through Modern Times

From Sumer to Rome: The Military Capabilities of Ancient Armies

A HISTORY
of
MILITARY MEDICINE
from the
MIDDLE AGES
to the
WAR
in
AFGHANISTAN

RICHARD A. GABRIEL

Copyright © 2013 Potomac Books, Inc.

Published in the United States by Potomac Books, Inc. All rights reserved. No part of this book may be reproduced in any manner whatsoever without written permission from the publisher, except in the case of brief quotations embodied in critical articles and reviews.

Cover image: This Civil War cartoon depicts the military surgeon in his most-feared role as the amputator of limbs. The term “sawbones” to describe a surgeon dates from this period when the most common military surgical procedure was amputation. Original artwork by James Dunn; color rendition by Daniel Pearlmutter.

Library of Congress Cataloging-in-Publication Data

Gabriel, Richard A.

Between flesh and steel: a history of military medicine from the Middle Ages to the war in Afghanistan / Richard A. Gabriel. — 1st ed.

      p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-61234-420-1 (cloth: alk. paper)

ISBN 978-1-61234-421-8 (e-book)

I. Title.

[DNLM: 1. Military Medicine—history. 2. History, Early Modern 1451–1600. 3. History, Modern 1601–. 4. War. 5. Weapons—history. 6. Wounds and Injuries—surgery. WZ 80]

616.9'8023—dc23

2012039781

Printed in the United States of America on acid-free paper that meets the American National Standards Institute Z39-48 Standard.

Potomac Books
22841 Quicksilver Drive
Dulles, Virginia 20166

First Edition

10 9 8 7 6 5 4 3 2 1

for
Jude Alfred Nurik and the miracle of life

and

for
Suzi, my beloved wife, whose pretty blue eyes warm my soul

List of Illustrations

1
The Emergence of Modern Warfare: 1453 to the Twenty-First Century

2
The Renaissance and the Rebirth of the Empirical Spirit

3
The Seventeenth Century: Gunpowder and Slaughter

4
The Eighteenth Century: The First Effective Military Medical Systems

5
The Nineteenth Century: The Age of Amputation

6
The Twentieth Century: The Emergence of Modern Military Medicine

7
The Twenty-First Century: Unconventional Warfare

8
Some Thoughts on War

Bibliography

Index

About the Author

1   Weapons Lethality and Dispersion over History

2   Battle Casualties: 1600–1973 CE

1   Historical Army Dispersion Patterns for Units of 100,000 Troops

2   Battle Mortality from Antiquity to the Korean War

3   Anatomical Distribution of Injuries from High-Explosive (HE) Fragments and Gunshot Wounds (GSW)

4   Mortality from Head Injuries from GSW and HE Fragments

5   Mortality from Penetrating Injuries of the Skull

6   Lethality of War Wounds among U.S. Soldiers from the Revolution to the Afghan War

7   Major Medical Advances of the Nineteenth Century and the First Half of the Twentieth Century

8   Special Causes of Death in the Union Army

9   Wounds and Sickness in the Union Army

10 Amputations in the Union Army

Death came quickly to soldiers wounded on the battlefields of antiquity. The muscle-powered weapons that tore at their flesh inflicted death suddenly. Bodies pierced by spears or hacked by swords lingered in agony for only a short time until the loss of blood brought on shock and the merciful unconsciousness that precedes death. The lethality of the ancient soldier's weapons and the primitive condition of military medical care, where it existed at all, ensured that death could not be protracted. The stricken soldier did not suffer long before slipping away.

With the appearance of gunpowder, wounding took on a more terrible character. Bullets drove fragments of clothing deep into the body, broke the long bones, and caused tracking wounds that, unless extensively incised and cleansed of loose tissue, became seats of infection. Gunpowder-driven projectiles instantly amputated arms and legs, grossly disfigured the face, laid open the skull to expose the brain, and caused multiple penetrations of the intestines. The new weapons caused terrible wounds that stimulated the search for medical techniques to deal with them. But medical innovation was unable to keep pace, and its treatments served mostly to prolong the suffering of the wounded without ultimately preventing their death from shock, blood loss, or infection. The wounded now simply took longer to die. The Middle Ages brought with it the introduction of new medical techniques that held out the promise, mostly unfulfilled, of saving the soldier's life. But this progress was only a glimpse into the medical future and the beginning of the long road to effective military medical care.

The armies of the Middle Ages were a reflection of the political, social, and economic decentralization of the larger feudal social order. Most wars in this period
were fought not by nation states but by rival monarchs that raised armies by levying requirements for soldiers and arms upon their vassals. Centralized arms industries, permanent standing armies, and logistical organizations or trained armies did not exist.
¹
Military doctrine and tactics of the day were almost nonexistent, and battles revealed the low sophistication of armed scuffles among groups of mounted men. It was, as has been remarked, “a period of squalid butchery.”
²
The knights returned home under the command of their local lords, and the armies disbanded after each battle. Tax collections for military purposes were sporadic, usually taken in-kind, and left to local military commanders, who were also the political officials of the realm. As the fourteenth century dawned, Europe found itself in a period of political, economic, social, and military transition between feudalism and the rise of the embryonic nation state.

The decentralization of feudalism placed the armored knight at the pinnacle of the socio-military order, and the form of individual mounted combat at which the knight excelled had swept infantry from the field almost a thousand years earlier. The last time Europe had seen a disciplined infantry force command the battlefield was under the Roman Empire. At the start of the Hundred Years' War (1337–1457), the supremacy of the mounted knight remained unchallenged. When this series of dynastic wars ended, new military forms were emerging that signaled that supremacy's decline.

To counter the power of the mounted knight, the infantry had to be able either to withstand the shock of a mounted assault or to deliver sufficient missiles from a distance great enough to inflict casualties on the mounted formation and prevent it from closing with the infantry. At the Battle of Laupen (1339) Swiss infantry annihilated a force of mounted French knights by reinventing the Macedonian phalanx, complete with eighteen-foot-long pikes similar to the
sarissae
that Alexander the Great's infantry had used sixteen hundred years earlier.
³
Comprising sturdy and disciplined citizen soldiers, the Swiss infantry stood its ground against the mounted charge, stopping the French cavalry with their pikes. With the cavalry halted before the wall of pikes, Swiss halberdsmen and ax throwers attacked, chopping off the legs of the horses and butchering the fallen knights as they lay helpless on the ground. At Crécy (1346) the English reinvented the second solution for confronting a cavalry charge and destroyed a force of French knights with hails of metal-tipped arrows fired from longbows.
⁴
In both instances, the solutions represented the rediscovery and reapplication of long-forgotten techniques that Alexander and the Romans once
had used for defeating cavalry. For the first time in more than a thousand years, disciplined infantry forces again began to appear on the battlefields of Europe.

The Hundred Years' War witnessed the beginning of national identity and loyalty as a series of dynastic wars crystallized national identities. The need for large military forces, including mercenary contingents, gave rise to the replacement of in-kind taxes with regular tax collections of specie. This effort required developing a centralized governmental mechanism, and the embryonic nation states began to build governmental infrastructures under the national monarchs' control. Both during the war and for more than a hundred years afterward, bands of demobilized ex-soldiers who fought for pay and constantly switched sides plagued Europe. The rulers' problem was how to bring these military bands under the authority of a national army. Their solution was to offer permanent pay, to build regular garrisons, to enforce strict codes of military discipline, and to establish military rank and administrative structures. By the 1600s, for the first time since the collapse of Rome, Europe began to develop stable, permanent armed forces directed by central national authorities and supported by taxation.

The emergence of national authorities spurred the organizational, tactical, and technological development of armies during this period and set the pattern for the next four centuries. A standing army of professionals could be disciplined, schooled in new battle tactics, and trained to utilize the new firearms with great effect. This preparation, in turn, helped stabilize the new role of infantry, whose musket and pike tactics permitted thinner linear formations of infantry on the battlefield. The appearance and evolution of the firearm increased the demand for a disciplined soldier, and this requirement ushered in a permanent and articulated rank and administrative structure to train and lead the soldier. Permanent rank and military organization reappeared, and by the time of the Thirty Years' War (1618–1648), all the major elements of the modern army were in place.