Between Flesh and Steel (36 page)

133
. John F. Fulton, “Medicine, Warfare, and History,”
Journal of the American Medical Association
153, no. 5 (October 1953): 180.

134
. Brooks,
Civil War Medicine
, 106.

135
. Taylor, “Retrospect of Naval and Military Medicine,” 615.

136
. Brooks,
Civil War Medicine
, 41.

137
. Miller J. Stewart,
Moving the Wounded: Litters, Cacolets & Ambulance Wagons, U.S. Army, 1776–1876
(Johnstown, CO: Old Army Press, 1979), 26.

138
. Ibid., 33.

139
. Ibid., 36.

140
. Taylor, “Retrospect of Naval and Military Medicine,” 617.

141
. Stewart,
Moving the Wounded
, 182.

142
. Brooks,
Civil War Medicine
, 37.

143
. Estelle Brodman and Elizabeth B. Carrick, “American Military Medicine in the Mid-Nineteenth Century: The Experience of Alexander H. Hoff, M.D.,”
Bulletin of the History of Medicine
64 (Spring 1990): 71.

144
. Brooks,
Civil War Medicine
, 37.

145
. Brodman and Carrick, “American Military Medicine,” 72.

146
. Philip A. Kalisch and Beatrice J. Kalisch, “Untrained but Undaunted: The Women Nurses of the Blue and the Gray,”
Nursing Forum
15, no. 1 (1976): 21–22.

147
. Chamberlain, “History of Military Medicine,” 248.

148
. Reasoner, “Medical Supply Service,” 17–18.

149
. Burns, “Early Medical Photography,” 1447.

150
. Brooks,
Civil War Medicine
, 24.

151
. Burns, “Early Medical Photography,” 1450–57.

152
. Brooks,
Civil War Medicine
, 28.

153
. Blaisdell, “Medical Advances,” 1048.

154
. Brooks,
Civil War Medicine
, 46.

155
. Ibid.

156
. Ibid., 47.

157
. Kalisch and Kalisch, “Untrained but Undaunted,” 24–25.

158
. Blaisdell, “Medical Advances,” 1046.

159
. Richard B. Stark, “The History of Plastic Surgery in Wartime,”
Clinics in Plastic Surgery
2, no. 4 (October 1975): 511.

160
. Ibid.

161
. Leonard D. Heaton and Joe M. Blumberg, “Lt. Colonel Joseph J. Woodward (1833–1884): U.S. Army Pathologist-Researcher-Photomicroscopist,”
Military Medicine
131, no. 6 (June 1966): 534.

162
. Burns, “Early Medical Photography,” 1463.

163
. Ibid., 1464.

164
. Frank R. Freeman, “Administration of the Medical Department of the Confederate States Army, 1861–1865,”
Southern States Medical Journal
80, no. 5 (May 1987): 632.

165
. Gordon E. Dammann, “Dental Care during the Civil War,”
Illinois Dental Journal
(January–February 1984): 14–15.

166
. Burns, “Early Medical Photography,” 1464–65.

167
. Peter D. Olch, “Medicine in the Indian-Fighting Army, 1866–1890,”
Journal of the West
21, no. 3 (1982): 32.

168
. Ibid.

169
. Ibid., 34.

170
. Grissinger, “Development of Military Medicine,” 338.

171
. As noted in
chapter 2
, for example, the British did not have a comprehensive pension system even after the Crimean War.

172
. For more on the general subject of military psychiatry, including its history and development, see the following from Richard A. Gabriel:
No More Heroes
;
Soviet Military Psychiatry: The Theory and Practice of Coping with Battle Stress
(Westport, CT: Greenwood Press, 1986);
Military Psychiatry: A Comparative Perspective
(Westport, CT: Greenwood Press, 1986); and
The Painful Field: The Psychiatric Dimension of Modern War
(Westport, CT: Greenwood Press, 1988).

173
. Albert Deutsch, “Military Psychiatry: The Civil War,” in
One Hundred Years of American Psychiatry
, ed. J. K. Hall, G. Zilboorg, and H. A. Bunker (New York: Columbia University Press, 1944), 367.

174
. Dorothea Dix was a major force in encouraging humane treatment for the insane in the United States.

175
. Germany and Russia were the home of nosological biological psychiatry, and Russian neurologists serving in the Crimean War were the first to take systematic notice of psychiatric casualties. This interest was continued after the war and eventually resulted in the first military medical system for dealing with psychiatric casualties on the battlefield during the Russo-Japanese War of 1905.

176
. Donald Lee Anderson and Godfrey Tryggve Anderson, “Nostalgia and Malingering in the Military during the Civil War,”
Perspectives in Biology and Medicine
28, no. 1 (Autumn 1984): 156. See also George Rosen, “Nostalgia: A ‘Forgotten' Psychological Disorder,”
Psychological Medicine
5 (1975): 340–41.

177
. Gabriel,
No More Heroes
, 57.

178
. Rosen, “Nostalgia,” 342.

179
. Gubbins, “Life and Work of Jean Dominique,” 188. Larrey treated the disorder by offering officers suffering from nostalgia bribes and better food if they would remain at their posts.

180
. Deutsch, “Military Psychiatry,” 377.

181
. Ibid., 370–72; and Weir, “Remarks on Gunshot Wounds,” 393, for the tendency to confuse psychiatric symptoms with malingering.

182
. Ibid., 377.

183
. Ibid., 372.

184
. Ibid., 384.

185
. McGrew,
Encyclopedia of Medical History
, 323.

186
. Halperin, “Nikolai Ivanovich Pirogov,” 348.

187
. Aldea and Shaw, “Evolution of the Surgical Management of Wounds,” 599.

188
. Halperin, “Nikolai Ivanovich Pirogov,” 348.

189
. Fraser, “Doctor's Debt to the Soldier,” 65.

190
. After the Prussian defeat at Jena in 1808, the army was reformed under the direction of Gerhard von Scharnhorst, who invented the prototype of the German general staff system that became the hallmark of German military efficiency for the next hundred years.

191
. Garrison,
Notes on the History
, 168.

192
. Ibid., 163.

193
. Ibid., 169.

194
. Stewart,
Moving the Wounded
, 18.

195
. Fielding H. Garrison, “The Statistics of the Austro-Prussian War (‘7 Weeks'), 1866, as a Measure of Sanitary Efficiency in Campaign,”
Military Surgeon
41 (1917): 711.

196
. The German Army, along with others, sent observers to the respective sides in the Civil War. These observers prepared staff reports on various aspects of the war.

197
. Garrison, “Statistics of the Austro-Prussian War,” 711–13.

198
. Ibid., 713.

199
. Ibid.

200
. Sieur, “Tribulations of the Medical Corps,” 219.

201
Fraser, “Doctor's Debt to the Soldier,” 65.

202
. Lawson, “Amputations through the Ages,” 225.

203
. McGrew,
Encyclopedia of Medical History
, 23.

204
. Sieur, “Tribulations of the Medical Corps,” 219.

205
. Valentine A. J. Swain, “The Franco-Prussian War, 1870–1871: Voluntary Aid for the Wounded and Sick,”
British Medical Journal
29, no. 3 (August 1970): 514.

206
. Chamberlain, “History of Military Medicine,” 246.

207
. Swain, “Franco-Prussian War,” 512.

208
. Ibid.

209
. Henry E. Sigerist, “War and Medicine,”
Journal of Laboratory and Clinical Medicine
28, no. 5 (February 1943): 535.

As the twentieth century began, general and military medicine stood on the threshold of remarkable progress in their ability to save lives. The period witnessed the most important advances in disease prevention and surgical knowledge in human history. Medicine had become fully integrated into the larger web of general scientific exploration and discovery to where it finally stood as an equal partner in developing and sharing new scientific discoveries. This trend toward the integration of science and medicine, first begun by the Germans in the 1870s, has become the major characteristic of modern medicine in all developed societies. The walls between academic and scientific disciplines have largely crumbled, and the old prejudices between surgeon and physician have finally disappeared.

The advancement in medical knowledge and technique characteristic of postindustrial societies was already evident at the turn of the century and has resulted in the rapid application of these discoveries to military medicine. In turn, the press of war and the social organization of research increased the military medical establishment's ability to make contributions to general and specialized medicine that would have probably taken years to occur in peaceful times. For example, military doctors achieved almost all the early advances in immunization and the prevention of communicable disease.
¹
The general mobilization of civilian medical resources for wartime use brought many new problems to the attention of the civilian medical establishment and at the same time provided its practitioners the opportunity and resources to address them through wartime service. Except for social rank, now no significant differences remain between military and civilian medical practitioners.
Moreover, neither medical establishment is able to generate significant new knowledge without quickly attracting the attention of the other.

As the century began, however, military medicine differed only marginally from what it had been in 1870. The great achievements in military health care and the organizational sophistication needed to deliver that care to the wounded were far from certain; indeed, the belief in the inevitable progression of science to produce social betterment is a relatively new phenomenon, dating only from the close of World War II. The wars that occurred in the early part of the twentieth century—Spanish-American War, Boer War, and Russo-Japanese War—experienced the same familiar failures that had reduced military medicine's effectiveness for a hundred years. Most of these failures can be attributed to the unwillingness of armies to take military medicine seriously as a means for salvaging manpower.

On the eve of World War I, the armies of Europe remained as unprepared to meet the challenge of saving lives on the battlefield as they had been for a hundred years previously. At the turn of the century, most medical service corps had officially existed for only a few years, none had sufficient manpower or supplies, military physicians lacked standing in their own armies, and surgeons continued to use techniques that most previous wars had demonstrated were ineffective. The rise of the industrial state and the integration of civilian populations into the armies serving as reserve forces, coupled with the increased destructive power of new weapons, convinced most governments that slaughter on the battlefield was an inevitable condition of modern warfare.
²
Although the progress in military medicine seems obvious today, as the nations of the twentieth century lurched from one war to another—the Boer War, Russo-Japanese War, World Wars I and II, Korean War, and Vietnam War—that development was always in doubt when each war began. Any progress must have surely seemed less certain for the wounded and dying than we see it today.

The Boer insurrection in South Africa lasted from October 1899 to May 1902 and saw a Boer force of 87,000 mounted guerrillas confront a British Army of 450,000 men and 520,000 horses. In this war Mohandas Gandhi (1869–1948), then a young lawyer, served as a stretcher bearer, which the troops called “bodysnatchers,” and Arthur Conan Doyle (1859–1930), the creator of Sherlock Holmes, was knighted for his service as a civilian contract physician serving with the British medical corps in 1900.
³
British casualties amounted to six thousand dead from
enemy fire and another sixteen thousand dead from disease, mostly typhoid and dysentery. Four thousand Boer soldiers were killed, and twenty-six thousand Boer women and children died in British concentration camps of disease and starvation.
⁴
As in so many previous wars, disease was the primary killer of the armies. Only twenty-two thousand British soldiers were treated for wounds, injuries, and accidents during the thirty-one-month-long war, but twenty times that number were admitted to hospitals for disease. Seventy-four thousand British troops suffered from typhoid and dysentery alone, and eight thousand died from the former.
⁵
In the spring of 1900, the British Army halted at Bloemfontein, and during the single month of November, there were both five thousand disease cases and forty deaths a day in the hospital.

The British Army Medical Corps had officially existed for only a year before the war broke out, and it was critically short of personnel. Even so, it deemed the initial deployment of medical resources as adequate to support a force of two army corps and one cavalry division. Eight hundred and fifty medical officers were sent to staff seven “stationary hospitals” and three general hospitals located along the lines of rail communication.
⁶
In addition, 40 warrant officers, 240 sergeants, and 2,000 enlisted men were assigned to the medical corps.
⁷
Within a few months the military clearly saw that these assets were sorely inadequate and hired seven hundred civilian contract physicians and surgeons. As casualties mounted, the British medical corps continually augmented these numbers until, at war's end, 8,500 personnel were assigned to the medical corps, including 151 staff and regimental medical units, 19 bearer companies, 28 field hospitals, 5 sanitary disease hospitals, 16 general hospitals, 3 hospital trains, 2 hospital ships, and 3 advance and 2 base depots for medical supplies.
⁸
A total of twenty-one thousand hospital beds scattered over southern Africa were available, and eight hundred trained female nurses served these facilities.
⁹
The centuries-old problem of medical unpreparedness evident at the start of the war required more than a year before adequate medical assets were in place.