Between Flesh and Steel (24 page)

41
. Taylor, “Retrospect of Naval and Military Medicine,” 596.

42
. Lawson, “Amputations through the Ages,” 223.

43
. Taylor, “Retrospect of Naval and Military Medicine,” 600.

44
. Ibid., 601.

45
. Howell, “Story of the Army Surgeon,” 327.

46
. Taylor, “Retrospect of Naval and Military Medicine,” 603.

47
. Howell, “Story of the Army Surgeon,” 321.

48
. Chamberlain, “History of Military Medicine,” 240.

49
. Nonetheless, armies persist in defining medical conditions as discipline and morale problems. Soviet frostbite casualties were so high during World War II that Joseph Stalin issued an order that any soldier careless enough to get frostbite would be shot. In Vietnam, American soldiers who contracted venereal disease were subject to punishment. Psychiatric conditions of the “silent” type often are still treated as discipline problems.

50
. Howell, “Story of the Army Surgeon,” 332.

51
. Paul E. Kopperman, “Medical Services in the British Army, 1742–1783,”
Journal of the History of Medicine and Allied Sciences
34, no. 4 (October 1979): 428–29.

52
. Howell, “Story of the Army Surgeon,” 332.

53
. Ibid., 331.

54
. Ibid.

55
. Kopperman, “Medical Services,” 430.

56
. Ibid., 437.

57
. Ibid., 438, citing Robert Jackson,
A System of Arrangement and Discipline for the Medical Department of the Armies
(London: J. Murray, 1805), for these figures.

58
. Taylor, “Retrospect of Naval and Military Medicine,” 596.

59
. Kopperman, “Medical Services,” 454.

60
. Garrison,
Notes on the History
, 138.

61
. Edgar Erskine Hume, “The Days Gone By: Military Medicine in the Eighteenth Century,”
Military Surgeon
, October 1929, 563.

62
. Ibid.

63
. Chamberlain, “History of Military Medicine,” 240.

64
. Ibid.

65
. Louis S. Greenbaum, “Science, Medicine, and Religion: Three Views of Health Care in France on the Eve of the French Revolution,”
Studies in Eighteenth-Century Culture
10 (1981): 373–91.

66
. Heizmann, “Military Sanitation,” 299.

67
. Hume, “Days Gone By,” 564.

68
. Heizmann, “Military Sanitation,” 298.

69
. Garrison,
Notes on the History
, 139.

70
. Ibid.

71
. Ibid.

72
. Ibid., 141.

73
. Taylor, “Retrospect of Naval and Military Medicine,” 606.

74
. Ibid.

75
. It should not be assumed, however, that the physician and surgeon came to military service with the same educational background. The most that can be implied is that both received the same military medical training after entering military service.

76
. Taylor, “Retrospect of Naval and Military Medicine,” 607.

77
. Garrison,
Notes on the History
, 142.

78
. Taylor, “Retrospect of Naval and Military Medicine,” 566.

79
. The best English work on military medicine in Russia during this period is John T. Alexander's “Medical Developments in Petrine Russia,”
Canadian-American Slavic Studies
8, no. 2 (Summer 1974): 207.

80
. Ibid.

81
. Ibid.

82
. Ibid., 210.

83
. Ibid.

84
. L. G. Eichner, “The Military Practice of Medicine during the Revolutionary War,” lecture presented at the Tredyffrin Easttown History Society, Pennsylvania, October 2003, 25.

85
. Edwin P. Wolfe, “The Genesis of the Medical Department of the United States Army,”
Bulletin of the New York Academy of Medicine
5 (September 1929): 823.

86
. See Ibid., 613; and Taylor, “Retrospect of Naval and Military Medicine,” 627.

87
. Wolfe, “Genesis of the Medical Department,” 613.

88
. M. A. Reasoner, “The Development of the Medical Supply Service,”
Military Surgeon
63, no. 1 (July 1928): 7.

89
. Taylor, “Retrospect of Naval and Military Medicine,” 613.

90
. David B. Davis, “Medicine in the Canadian Campaign of the Revolutionary War,”
Bulletin of the History of Medicine
44, no. 5 (September–October 1970): 461.

91
. Reasoner, “Medical Supply Service,” 7.

92
. Ibid., 9.

93
. William Shainline Middleton, “Medicine at Valley Forge,”
Annals of Medical History
3, no. 6 (November 1941): 465.

94
. Ibid.

95
. Eichner, “Military Practice of Medicine,” 27, for a list of the specific medical conditions that caused death.

96
. Howard Lewis Applegate, “Preventive Medicine in the American Revolutionary Army,”
Military Medicine
126 (May 1961): 380.

97
. Blair O. Rogers, “Surgery in the Revolutionary War: Contributions of John Jones, M.D. (1729–1791),”
Plastic and Reconstructive Surgery
49 (January 1972): 3.

98
. Davis, “Medicine in the Canadian Campaign,” 461.

99
. Eichner, “Military Practice of Medicine,” 26.

100
. Rogers, “Surgery in the Revolutionary War,” 9.

101
. The name was changed from King's College to Columbia University during the Revolutionary War.

102
. Jones had been a military surgeon in the French and Indian War, an experience that prompted him to write his manual for wound treatment. The practical value of his manual, appearing as it did at the outbreak of the war, is obvious from the table of contents. Jones's book contains chapters on inflammation, superficial wounds, general wounds, penetrating wounds, simple fractures, compound fractures, amputations, head injuries, concussions, skull fractures, gunshot wounds, and how to set up and manage a military field hospital.

103
. Applegate, “Preventive Medicine,” 551.

104
. Allen C. Wooden, “Dr. Jean François Coste and the French Army in the American Revolution,”
Delaware Medical Journal
48, no. 7 (July 1976): 398. While Brown's work was the first of its type written by an American in the colonies, Coste had authored a small military pharmacopoeia for the French troops' use that had gained wide readership among American physicians.

The nineteenth century was the period in which the principle of empirical observation finally triumphed in medical matters over the influence of cosmological theorizing. As the century progressed, medical clinicians and researchers gradually worked out the methodological problems associated with discovery, innovation, and verification; abandoned old theories of disease; and established criteria of proof for new medical information. While the century was replete with new approaches and discoveries, the evolution and systematic application of new methodologies marked the century as the true beginning of modern scientific medicine.
Table 7
presents a list of the most important medical advances and innovations relative to the wars that occurred in the nineteenth century.

The century was also marked by significant contributions that military physicians made to medical advances and the development of military medicine along modern lines. Military physicians applied to the battlefield various medical discoveries and techniques that the civilian medical establishment developed and greatly improved the organizational structures required to deliver effective medical care to the soldier in the field. Few armies began the period with anything approaching a systematic military medical service, but by the century's end, all major combatants had set up independent military medical departments capable of dealing with mass casualties. The stimulus for these developments was, of course, the frequency of wars.

The wars of the nineteenth century were fought with increasing ferocity and lethality as a consequence of the technological advances in the killing power of weaponry. The French Revolution had created a new kind of army, an army of citizens, who, in exchange for the burden of conscription, expected better military medical care. The extremely high casualty rates caused by more lethal weapons forced political and military authorities to improve medical care as a way of conserving expensive manpower. Although few armies at the start of the period had learned these lessons, all major combatants had institutionalized their practices to establish adequate military medical services by the end of the century.

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

Few periods can compare with the nineteenth century in terms of the sheer frequency and destructiveness of warfare. The century began with the decade-long wars of the French Revolution only to witness, after a short respite, their continuation in the guise of the Napoleonic Wars. Across the Atlantic, the Americans fought the War of 1812 and the Mexican War of 1846–1848, both significant conflicts for the emerging United States. The Crimean War, which pitted the Russian Empire against a European alliance, caused so many casualties from weapons and disease that the public outcries of the combatants' civilian populations forced significant military and medical reforms. The American Civil War, the world's first truly modern war, shocked not only the United States but also caused European leaders to search for ways to increase the combat power and manpower assets of their own armies in anticipation of having to fight such wars themselves. France's wars with Italy and Germany were bloodbaths, revealing the West's complete inability to avoid horrific slaughter in its own backyard. In the end, the strategists and tacticians abandoned the search for solutions and resigned themselves to the fact that slaughter could not be avoided. Unwilling to abandon the structures and tactical principles, along with the accompanying privileges and social status, that had marked the military establishments of Europe for a century, the military thinkers of the late nineteenth century seem to have comforted themselves with more traditional doctrines of war fighting. When once again the major powers of Europe stumbled into conflict in the early twentieth century, these illusions evaporated overnight and left in their wake the most horrible slaughter ever wrought between contesting armies.

If war provided the stimulus for improved military medical care, the technological innovations of the Industrial Revolution provided the opportunity. The wars of the French Revolution and the Napoleonic era that followed interfered with the transfer of medical knowledge across national borders. The location of these wars and their long duration effectively forced medical research and discovery back within respective national borders. After 1815, wars of the period were fought on the periphery of Europe (Crimea) and outside Europe (the Mexican War, the Civil War) and were of short duration (France-Italy, Franco-Prussian War). The period following the
Napoleonic Wars also saw great improvements in travel and communication. Medical discoveries and new treatment techniques were shared through printed books, newspapers, and medical and scientific journals, often transmitted telegraphically or through regular mail service that spanned the oceans in a few weeks. For the first time since the Roman Empire, the development of medicine could be viewed as a coherent whole rather than applying only to separate countries. A general commonality of medical knowledge and practice began that connected the efforts of researchers and practitioners across national boundaries. Only Russia—because of its geographic and, to some degree, cultural isolation—and Germany, because of its political fragmentation, remained apart from the stream of medical discovery and practice.

Neither medical nor military men could have anticipated the changes that occurred in warfare and military medicine during the nineteenth century. When the century began, the long-established tensions among the physician, surgeon, and barber-surgeon that had retarded the application of practical medicine to the soldier continued to strangle the medical profession. By the end of the century, except in Russia, the military barber-surgeon had disappeared, and surgery had finally established itself as an equal partner in the medical profession. A similar status was finally conferred upon military medical officers for the first time.

When the nineteenth century dawned, medical practitioners believed that the suppuration of wounds was a natural, inevitable, and beneficial part of the healing process, and they accepted the deaths of thousands of soldiers to wound infection as an unavoidable cost of war. By century's end, however, discoveries in bacteriology made antiseptic and, later, aseptic surgery a common practice, and the death rate to wound infection dropped dramatically. Also at the beginning of the century, pain was the expected price of surgical application. Within fifty years, the introduction of anesthesia banished pain from the operating room and gave birth to the new science of anesthesiology. With pain alleviated, the necessity for surgical speed was reduced, opening up the possibility of more complex surgical procedures. Most military surgeons at the turn of the eighteenth century had not yet mastered ligature or the tourniquet; thus, amputation, the most common surgical procedure performed on the wounded, remained a traumatic and risky business. By the end of the nineteenth century, however, both ligature and tourniquet applications were normal practice, as was the use of the hemostat and surgical clip. Cautery was finally banished from the surgeon's kit.