Between Flesh and Steel (14 page)

The quality of military medicine in the seventeenth century showed no great advance over that of the Renaissance, in large part owing to the rigid divorce of surgery from medicine that had begun under Galen, was maintained by the Muslims, and then standardized into law and custom by the ecclesiastical interdictions of the Middle Ages. As the rivalry among physicians, surgeons, and barbers continued unabated throughout the new century, the battlefield care of the soldier and the common people remained the province of the few qualified wound surgeons and the usual collection of quacks. The number of competent, trained surgeons was very small, or less than a dozen of any note.
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Tension in the universities between surgeons and physicians produced generally poor surgical instruction even though dissection and the clinical amphitheater had become regular features in medical education. Unifying the barbers and surgeons into common guilds, however, did nothing to reduce the tension or to raise the general status of surgery.

Much of the new anatomical knowledge had yet to be integrated into the medical profession in any practical way, and most physicians still regarded surgery as dangerous. They generally avoided difficult operations on the grounds of legal liability and potential damage to their reputations and positions. Most armies also maintained the rigid separation of physicians and surgeons, with the physician attending general internal complaints while barbers and wound doctors did field surgery.

The generally low quality of military medicine was evident in the sparse publication of new works on the subject. Given the stimuli of the Thirty Years' War and the English Revolution, one might have expected a greater number of original works on military medicine to have been published; however, for the first fifty years of the century, only eight works on surgery—none of them original or very valuable—and only nine on disease were printed. While in the previous century forty-five books
had been published on surgery alone, the seventeenth century saw the publication of only thirty-four. While the production of epidemiological works was also sparse, twenty-eight new works on the subject of diseases in the military, two on diseases associated with ship duty, and ten on particular diseases associated with ground force campaigns appeared.
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A particularly bright light was the book
Medical Observations in Hungarian Camps
(1606) by Tobias Cober, a physician with the army of Bohemia. After seeing seven years' service in the long war between the Hungarians and Turks, Tober provided the first clinical notice of the relationship between pediculosis in military camps and the outbreak of fever, probably typhus.
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Meanwhile, the era's low level of military medicine was reflected in the rise to prominence of a new breed of field medical practitioners, the executioners! Some executioners acquired medical reputations based on the knowledge they gained while practicing their trade. The idea was that because executioners knew how to break bones, in some manner they also possessed some ability to set them.
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The three noteworthy physicians in wound surgery were men who had seen extensive military service in England and Germany. Perhaps the most important was Wilhelm Fabry (also known as Fabriz von Hilden, or Fabricius, 1560–1624) of Germany, who invented a number of new surgical instruments and advocated amputation above the diseased or damaged part of the limb to ensure the stump would be suitable for prosthesis. Fabry also used a primitive tourniquet in which he twisted a strap around a stick. He described the first army field surgical chest, which was based on that first introduced by Maurice of Nassau in 1612. Another important military surgeon was Matthaeus Purmann (1649–1711), a bold German surgeon who sutured intestines and gained extensive experience with gunshot wounds. His
Fifty Strange and Wonderful Cures for Gunshot Wounds
(1693) demonstrates, however, his belief in the magical curative powers of two common but useless methods of treating gunshot wounds—the “weapons salve” and “sympathetic powder,” which were applied to the weapon and not to the wound. The greatest English surgeon of his time, Richard Wiseman (1622–1676) was also a soldier. His book
Several Chirugicall Treatises
(1672) reveals a true medical empiricist who performed amputations, treated gunshot wounds, and provided a compendium of empirical military medical knowledge to future generations.

After all is taken to account, however, the seventeenth century did not produce anyone of Paré's stature in military medicine.
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Even the most empirically oriented surgeons of the period continued to prescribe compounds that ranged from useless
to dangerous and to believe in superstitious and magical cures for all kinds of medical conditions. Whatever advances in medical knowledge had been made during the Renaissance were either forgotten or long in coming into vogue in everyday military medical practice.

For the most part, then, the soldier often received indifferent or poor medical care for his wounds. Valid theories for treating the most common military medical conditions were, at best, in their embryonic stages of development. The combination of poorly trained medical personnel, sporadic systems of casualty servicing in the armies of the day, deadly medical practices, increasingly lethal weaponry, poor diet, and a complete lack of understanding of the causes of disease and illness combined to make the lot of the wounded soldier truly pathetic. Throughout the entire century only one voice, that of Polish knight and soldier Janus Abraham Gehema (1647–1715), cried out against these conditions. A combat soldier with extensive battle experience, Gehema wrote numerous short books on caring for the military wounded. Although he himself was not a physician or surgeon, the titles of his works suggest a keen appreciation of the military medical care of his time. His
The Well Experienced Field Physician
(1684),
The Officer's Well-Arranged Medical Chest
(1688), and
The Sick Soldier
(1690) were all attacks on the contemporary military medical practices as being mostly useless, dangerous, and barbaric.
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In the spirit of the day, however, he was ignored.

The seventeenth century saw the continued evolution in weaponry and tactics that had begun during the Renaissance with the introduction of the first practical firearms. The number of firearms to pikes in infantry units increased enormously. Renaissance armies had armed between 25 and 35 percent of infantry with muskets. Gustavus Adolphus's armies almost doubled the rate of firearms to pikes during the Thirty Years' War. On average, 65 percent of his infantry forces carried muskets, and almost all the cavalry were armed with pistols.
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Swedish armorers redesigned the long heavy musket with a shooting fork to shorten it and made it lighter to allow quicker firing with better accuracy. The introduction of the paper cartridge with its standard powder load reduced the rate of misfires to practically zero, and the introduction of standard-caliber ammunition both increased the weight of the musket ball and eased supply efforts. Standardized ammunition and powder loads propelled the musket ball at a greater velocity than was possible a century earlier and, as noted
previously, resulted in bullets becoming more commonly deformed upon impact, creating more ghastly wounds.

Although a number of fundamental medical discoveries had been made in the previous century, the application of this knowledge to military surgery was marginal at best. Wound surgery remained essentially unchanged from the Renaissance. The doctrine of necessary suppuration, long in vogue and buttressed by the still prevalent belief that gunshot wounds were inherently poisonous, led to the practice of attempting to remove the bullets with probes and extractors and increased the chances of infection. Standard surgical practice was not to close the wound but to widen it, allowing the wound to become infected and drain. Surgeons often placed bits of leather and cloth in a minor wound to bring on infection. Draining infected wounds did not become standard practice until Dominique Larrey, the surgeon in chief of the Napoleonic Armies, helped establish it in the nineteenth century.

Military surgeons, faced with an almost 100 percent rate of infection of battle wounds, fell back on miraculous and spurious treatments to combat a clinical condition that rendered them powerless. Physicians of the day placed great faith in a treatment called “the sympathetic powder,” which Kenelm Digby (1603–1665), a former privateer and con man, had introduced. Digby saw an opportunity to cash in on the then current propensity of military physicians to try all sorts of pharmaceutical materials. Digby's sympathetic powder was ostensibly made from “moss scraped from a dead man's skull and mixed with powdered mummy's flesh.”
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It is a measure of the low quality of field surgery of the time that this wound treatment gained wide acceptance. No less a figure than Francis Bacon, who advocated the scientific method, included sympathetic powder in his scientific collection of drugs.

Other cures for gunshot included “the transplantation cure” in which a bit of wood was dipped in the blood or pus of the wound and wedged into a tree. If the sliver of wood took root and grew, it was believed the patient would recover. Most amazing was “weapon's salve,” an ointment that was applied to the wounded soldier's weapon in the belief that this process created some “influence from afar” that would cause the wound to heal.
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These attempts to deal with infected wounds suggest how helpless the military surgeons were when confronted with the clinical challenges that the more accurate and highly powered rifles of the period wrought.

The mystical quality of wound treatments during this period is evident from its materia medica, or what is more appropriately called a “filth pharmacopoeia.” Part of the problem was the growth of the apothecary guilds that controlled the distribution
of medicinal compounds. In 1607, James I (1566–1625) recognized the apothecaries as a special guild distinct from grocers, and throughout Europe the apothecaries soon built a rich and powerful organization. In 1682, the apothecaries won the exclusive right to supply drugs to the army and navy in England. Like any salesmen, the apothecaries needed merchandise to sell.
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The result was an explosion in spurious mixtures for which all kinds of miraculous claims were made.

The field medical chests that were routinely supplied to the armies provide an interesting glimpse into the pharmacopoeia of the day. A description of a Bavarian field chest that an artillery unit used in the Turkish campaign of 1688 notes that fully loaded the chest weighed 320 pounds and contained thirty surgical instruments. It also held the following medicinal remedies for the wound surgeon's use: powdered sandalwood, rhubarb, palm juice, spermaceti, mummy dust, scorpion oil, rain worm oil, oil of vipers, angle worms, earwigs, zinc oxide, Vigo's plaster of frog spawn, mercury, human and dog fat, aloes, tartar emetic, sugar of lead, alum, sassafras, and opium.
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Most of these concoctions were not only useless but also often deadly. Almost all provoked infection when applied to an open wound. One marvels at the poor quality of this pharmacopoeia when compared with what Roman field physicians used more than sixteen hundred years earlier. The seventeenth-century pharmacopoeia is a good example of what happens to medical science when practitioners ignore empirical observation and adopt a method of reasoning in which logical elegance and religious superstition is allowed free rein in determining the nature of medical reality.

The musket's increased power made the protective armor of the Renaissance obsolete; it could no longer protect the soldier from the penetrating power of the musket ball. The increasing national identity of the armies of the period led them to wear regulation field dress to distinguish the combatants from one another amid the smoke on the battlefield. They replaced the steel helmet and body armor with standardized uniforms, shakos, and soft hats, and the helmet did not again become a standard item of military issue until the later years of World War I.
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This change in military costume also introduced a special uniform for the army surgeon that consisted of a tight-waisted long coat reaching to the knees, the usual stockings, and buckled shoes. The civilian physician also copied the military costume as his professional dress and usually wore a red hat.

For the soldier, the disappearance of the protective helmet proved to be a medical disaster, and the rate of head injuries rose considerably. A black powder musket could
indeed fire a ball fast enough to penetrate a steel helmet but only at very close range. A musket ball produced approximately 350 foot-pounds of energy upon impact, and the amount of impact energy required to penetrate a steel helmet is approximately 300 foot-pounds. The impact energy of a musket ball, however, dissipates quickly after the first forty yards and then drops off exponentially. At a hundred yards, the impact energy is far less than that required to penetrate a steel helmet.
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Without the helmet, though, only 90 foot-pounds of energy are required to penetrate the human skull.
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The impact energy of a musket ball at even two hundred yards is easily enough to penetrate an unprotected skull but insufficient at that range to penetrate a helmeted skull. Thus, the increase in both head wounds and lethality resulted far less from technological improvements to the rifle than from abandoning the helmet and body armor.

It would still have been wise to retain the helmet if only for protection against exploding cannon fragments, grenades, and canister, all of which proved lethal to the soldier not wearing a helmet. These fragments usually did not achieve sufficient velocity to penetrate a helmeted skull, and most struck the soldier when much of their velocity was already considerably spent as a consequence of traversing some distance after the burst. Even in modern times, the helmet is designed more to prevent these kinds of secondary penetrations than to stop a direct hit from a rifle bullet. Abandoning the helmet, therefore, greatly increased the soldier's vulnerability to secondary weapons' effects. Once the idea took hold that the helmet was no longer a valuable protective device, however, the search for effective head and body armor was dropped for three centuries.