Between Flesh and Steel (16 page)

Switzerland, it will be recalled, had the oldest military medical service in Europe. By the Thirty Years' War, Swiss arms had sunk to a low level. The military medical service, however, endured. Muster rolls of various Swiss cantons during the war show that each company of artillery and infantry had a barber-surgeon attached to it at the state's expense. They also had regimental barber-surgeons, and those from the Zurich regiment were the best-trained surgeons in the city. Military physicians received complete medical chests supplied to them at state expense and field manuals on wound management and sanitation. Still, the Swiss military medical system does not appear to have improved much from the previous century when it was the model of European armies.
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Meanwhile, it had taken the rest of Europe almost a century to catch up.

The field hospitals of the Landsknechte in Germany became the first permanent field hospitals when, in 1620, Maximilian I, Duke of Bavaria (1573–1651), founded field hospitals for the armies of the Catholic League. One of these massive multi-storied hospitals served as a clearing station and fed casualties into a larger hospital located in a nearby town. In 1689, Konrad Behrens (1660–1736) drew up a set of regulations for these hospitals, which were situated on high ground near good water supplies and woods from which the staff could obtain firewood for heat and cooking. Patients were segregated by disease into separate wards. The staff consisted of physicians, field barbers, wound surgeons and their attendants, priests, and female camp followers. An officer supervised each entire hospital. In 1685, one of these hospitals handled eight hundred sick and wounded daily. Medical care, as in every army of the period, however, was still rudimentary.
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In the armies of Prussia, every regiment had a barber, and every company of infantry and cavalry had a field barber. When in garrison, a physician looked after the troops' sick complaints while a wound surgeon dealt with their injuries. Because of
the devastation wrought by the Thirty Years' War, the training of German field surgeons and barbers seems to have been of particularly low quality. Although regulations required military commanders to provide wagons and clean straw to transport the wounded, the Prussian armies had neither field nor permanent hospitals and simply treated the wounded in their barracks.

The English Civil Wars (1642–1651) retarded the development of military medical structures of any sophistication and scope. Oliver Cromwell (1599–1658) did provide his New Model Army with medical officers in 1645, and P. B. Adamson writes that he was the first English commander to assign such officers to the standing army on a permanent basis.
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By 1700, field medical chests were provided to the military medical service as items of regular issue.
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Military medical care during the seventeenth century was not appreciably better than that provided to the soldier during the Renaissance. Although the new nation states took the first tentative steps in recognizing an obligation to care for the wounded and disabled of war, no nation developed a system approaching even rudimentary effectiveness in accomplishing this task. The almost-two-hundred-year-old regulations of the Swiss Army were still more advanced in providing this type of care than anything developed or even contemplated in the seventeenth century. Medical care in the field remained elementary at best and lethal at worst. Separating surgery from the general practice of medicine made it impossible to develop a corps of adequately trained surgeons for the military's use; thus, most of the practitioners who treated the common soldier possessed little medical skills. The soldier was still at as great a risk from his own medical officers as from enemy bullets and perhaps more so.

In some ways medical care actually deteriorated. The increased use of firearms, their greater killing power, their higher rates of fire, and the abandonment of body armor and helmets in favor of standardized field dress exposed the soldier to a much greater risk of death and injury than he had faced a century earlier. A number of advances in medical knowledge and surgical technique, most notably ligature in amputation, were ignored in practice; consequently, the rate of amputations, infections, and resulting death increased. The provision of long-term care in permanent military hospitals did little to aid the wounded's recovery as the hospitals' filthy conditions raised the chances of incurring infection. As it had been for so many centuries, the combat soldier of the seventeenth century remained at great risk to life and limb. That some of the armies provided him with subsistence care if he was disabled did not go far to change this basic fact of military life.

1
. Garrison,
Introduction to the History
, 245–309. See the chapter on the development of medicine in the seventeenth century.

2
. Ibid.

3
. Ibid.

4
. J. R. Kirkup, “The History and Evolution of Surgical Instruments,”
Annals of the Royal College of Surgeons of England
63 (1981): 283.

5
. Ibid.

6
. Garrison,
Introduction to the History
, 283.

7
. Garrison,
Notes on the History
, 127.

8
. Ibid.

9
. Ibid., 130.

10
.
Encyclopedia Britannica
, 11th ed. (1910), 49.

11
. Garrison,
Introduction to the History
, 307.

12
. Heizmann, “Military Sanitation,” 294.

13
. Ibid.

14
. Garrison,
Notes on the History
, 130.

15
. Jay W. Grissinger, “The Development of Military Medicine,”
New York Academy of Medicine
3, no. 5 (May 1927): 316. A common form of capital punishment at this time was “to be broken on the wheel,” where the victim was strapped to a large wheel that was then rotated until his bones were broken.

16
. Garrison,
Introduction to the History
, 275–77.

17
. Garrison,
Notes on the History
, 133–34.

18
. Heizmann, “Military Sanitation,” 292.

19
. Forrest, “Development of Wound Therapy,” 270.

20
. Grissinger, “Development of Military Medicine,” 316.

21
. Roderick E. McGrew,
Encyclopedia of Medical History
(New York: McGraw-Hill, 1985), 253–54.

22
. Ibid., 315.

23
. Frank Aker, Dawn Schroeder, and Robert Baycar, “Cause and Prevention of Maxillofacial War Wounds: A Historical Review,”
Military Medicine
148, no. 12 (December 1983): 923.

24
. I am indebted to Edward Cielecki and Tom Tremonte, experts in the ballistics of black powder weapons, for these figures.

25
. Richard A. Gabriel and Karen S. Metz,
From Sumer to Rome
:
The Military Capabilities of Ancient Armies
(Westport, CT: Greenwood Press, 1991), 63.

26
. Charles G. H. West, “A Short History of the Management of Penetrating Missile Injuries to the Head,”
Surgical Neurology
16, no. 2 (August 1981): 146.

27
. D. S. Gordon, “Penetrating Head Injuries,”
Ulster Medical Journal
57, no. 1 (April 1988): 3.

28
. Allen C. Wooden, “The Wounds and Weapons of the Revolutionary War from 1775 to 1783,”
Delaware Medical Journal
44, no. 3 (March 1972): 61–62.

29
. Owen H. Wangensteen, Jacqueline Smith, and Sarah D. Wangensteen, “Some Highlights in the History of Amputation Reflecting Lessons in Wound Healing,”
Bulletin of the History of Medicine
41, no. 2 (March–April 1967): 102.

30
. James Young, “A Short History of English Military Surgery and Some Famous Military Surgeons,”
Journal of the Royal Army Medical Corps
21 (1913): 487.

31
. Wangensteen et al., “Some Highlights,” 103.

32
. Ibid.

33
. McGrew,
Encyclopedia of Medical History
, 322.

34
. Ibid. See also
Encyclopedia Britannica
, 11th ed. (1911), 128; and Robert Lawson, “Amputations through the Ages,”
Australian–New Zealand Journal of Surgery
42, no. 3 (February 1973): 222.

35
. Hargreaves, “The Long Road to Military Hygiene,” 441.

36
. Ibid.

37
. Ibid.

38
. Garrison,
Notes on the History
, 121–22.

39
. Taylor, “Retrospect of Naval and Military Medicine,” 589.

40
. Grissinger, “Development of Military Medicine,” 316.

41
. Ibid.

42
. Taylor, “Retrospect of Naval and Military Medicine,” 317.

43
. Heizmann, “Military Sanitation,” 291.

44
. Ibid., 291–93.

45
. Garrison,
Notes on the History
, 124–25.

46
. Ibid., 131.

47
. P. B. Adamson, “The Military Surgeon: His Place in History,”
Journal of the Royal Army Medical Corps
128 (1982): 47.

48
. Weston P. Chamberlain, “History of Military Medicine and Its Contributions to Science,”
Boston Medical and Surgical Journal
(April 1917): 237.

Medicine in the eighteenth century centered around the effort to develop complete theoretical systems to explain disease and other medical phenomena. This approach was the logical consequence of the nascent empiricism that had emerged two centuries earlier during the Renaissance and had been given strong scientific impetus by the success of Newtonian inductionist approaches to understanding and explaining reality characteristic of the previous century. Medical investigators attempted to systematize medical knowledge along the lines of a single major force or cause that could be demonstrated to rest at the base of all medical phenomena. Medical investigation was attempting to do for medicine what Newton had done for physics and what Thomas Hobbes (1588–1679) had claimed to do for politics.

Searching for underlying unifying principles of medical knowledge, a kind of grand theory of synthesis, helped inform Herman Boerhaave (1668–1738). This great Dutch physician and teacher explained all pathological conditions in terms of chemical and physical qualities, such as acidity and alkalinity or tension and relaxation.
¹
William Cullen (1710–1790), a Scottish physician whose thinking had a major impact on American medicine at the time, believed that disease could be explained by either an excess or an insufficiency of nervous tension in the nerve pathways of the body and brain.
²
Others argued for varying degrees of animism or excitation in the body's organs. Few of these approaches produced anything of lasting medical value, for the complexity of medical phenomena repeatedly confronted these theoretical schemas with observations that could not be explained by their premises. Nonetheless, the search for the grand medical synthesis continued throughout the century.

The search for theoretical explanations did not hinder the development of an empirical approach to medical research. Indeed, it was precisely the establishment of the empirical method that forced medical theoreticians to continually reexamine their premises as observations time and again produced discoveries that could not be reconciled with theoretical approaches. The empiricism of the Renaissance combined with the rigorous thinking of Newtonian inductionism to produce a method of medical investigation that was soundly grounded in empirical observation. Unlike the scholastic approach to medicine that had characterized the search for knowledge during the Middle Ages, an approach that for centuries permitted empirical data to be rejected on the grounds that it did not satisfy the elegance of logic, the new method did not end in the mind. The willingness of eighteenth-century physicians to attempt to integrate new medical data into mental schemata prevented the development of a complete single-cause theory of medicine from gaining acceptance precisely because such theories did not square with empirical observation. The tyranny of scholastic logic finally came to an end and in its place arose the new methods of empirical observation and experiment. In this sense, the eighteenth century can be said to have laid the methodological groundwork for the progress in medical knowledge and clinical technique that was to follow in the next two centuries.

An individualistic approach to medical investigation had marked the previous century. Much of this trend continued in the eighteenth century and produced a number of important discoveries and surgical advances. The end of the religious and dynastic wars provided some breathing space within which the medical establishment continued its work. The period of peace, interrupted nonetheless by four major wars and three revolutions, also permitted some stability to permeate the social order of the day.
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As a result, the medical profession became institutionalized and medicine became a respected profession with practices passed from father to son. University education for physicians became commonplace. Dissection became a common method of medical study, as did clinical observation in teaching hospitals. Famous professors established a number of private medical schools and gathered students to their practices as a means of providing medical education. The most noteworthy of these students was Scottish-born John Hunter (1728–1793) in England and three generations of Monros in Scotland. Eventually, both schools became associated with universities, bestowing greater prestige on the study of medical pragmatics than ever before. For the first time in history, medicine was separated from superstition and ecclesiastical control, and the foundations of medicine as a science came into being.