Title:
Wars, Pestilence and the Surgeon's Blade
Authors:
Thomas Scotland and Steven Heys
ISBN:
978-1-909384-09-5
Publisher:
Helion and Company Ltd
Hardback
Pages:
407
Photos:
78
There
are two things guaranteed when it comes to warfare: death and injury. The
authors, following on their extremely informative first book "War Surgery
1914-1918", have undertaken to shed light upon the development of surgical
and medical practices throughout the 19th Century; focussing particularly upon
three capstone events: the Peninsular war of 1808 -1814, the Crimean War 1853
-1856 and the Boer War of 1899 -1902. Each is studied in detail with a view
towards determining where things had improved, stayed the same or regressed.
Concurrent to this they highlight the activities of individuals who made
significant contributions in a variety of areas that moved both knowledge and
yardsticks relating to medicine and the administration thereof.
Scotland
and Heys's evaluation falls into five distinct categories: medical surgery,
administration and bureaucracy, logistics, lessons learned and statistical
analysis. Each played a significant part in the expansion of knowledge and
competency. The approach taken by the authors is to integrate the five together
within the narrative in order to facilitate a multi-dimensional picture for the
reader of the advancement (and regression) of medical support to the military.
It is
both fascinating and disturbing to read about the lack of appreciation by
British military (and civilian) leaders of the importance that a sound medical
support system had for the successful execution of campaigns. It was only with
the Peninsular campaign and the appointment of Dr James McGrigor as
Wellington's Chief Medical Officer that the first steps in the formalization of
medical care were taken. It was McGrigor who introduced the maintenance of
patient records, standardized hospital care and recovery of wounded from the
battlefield. He also established basic standards of training and education for
those wishing to become military medical officers. Through his efforts, the
first steps in the universality of care and the professionalization of the
medical branch were taken.
McGrigor
and his colleagues are also remembered as the individuals who initiated not
only the maintenance of statistics relating to illness, injury and a myriad of
other information tracking for the British army but also, and just as critical,
the interpretation of those statistics as a means of recognizing efficiencies
and deficiencies of care. It is estimated that his ability to track and advise
Wellington on the health of his army provided him an additional divisions worth
of soldiers at a critical time during the war.
Crimea,
which occurred almost fifty years after the conclusion of the Napoleonic Wars,
was, from a medical perspective, a story of forgotten lessons and needless
suffering and loss. A failure of effective reconnaissance, not enough time and
effort put into preparation, a continued lack of appreciation of the importance
of medical administration and provision and a complex and inefficient command
structure all contributed to terrible losses resulting from illness and
treatment deficiencies.
The
Boer war continued to be characterized by the shortcomings of the previous
conflicts, despite noteworthy advancements in medical intervention techniques,
knowledge of hygiene, administrative practices and doctrinal maturity. Death
and personnel shortfalls due to illness continued to outnumber those caused by
combat by a significant margin; again much of it preventable. For example,
despite the fact that a vaccine for typhoid existed and was known to the army,
it was decided not to inoculate the soldiers before departure. The net result
was that during the Second Boer war 7,782 died of wounds while 13,139 died of
disease.
The
authors also look at smaller wars throughout the 1800's and the impact of
operational geography upon death and illness rates (providing copious
statistics for deaths per thousand in different regions as examples). They provide
outstanding analysis of the complex intersection of scientific advances (such
as the discovery of germs, anaesthetic and disinfectant), surgical, statistical
and support techniques (of such pioneers as Keough, McGrigor, Ogston,
NIghtingale and Guthrie) plus the military and political paradigm changes
necessary to enact the changes required to see improvements in support to
soldiers well being and health.
The
British Army of the 19th century was old and steeped in its own traditions and
foibles that set it apart from the civilian community it served. These
traditions serves as strengths building regimental loyalties and comradeship;
however, the also acted as impediments to change and a bulwark against what
many perceived as interference from their political (read civilian) masters.
Those promoting change within the medical services had to overcome the bias
afforded to 'outsiders' in addition to learning and applying the lessons of
hygiene, surgery and long term care. Each of these trials would have been
formidable in and of themselves; together, as Scotland and Heys point out, they
were decades in overcoming.
One of
the real strengths of this book lies in the attention that it draws to the
plight of the soldier in undertaking his trade. The average reader can pick up
any one of thousands of books written that outline tactics, weapons
capabilities, weapons production or any one of the many facets of warfare, but
very few discuss the grim details of the human toll of fighting; and they are
indeed grim. The present day soldier owes an immeasurable debt to those poor
souls who served as the means for learning the art of healing and supporting
the recovery of those wounded in combat or ill as a result of geographic
location. We owe an equal debt to those doctors and practitioners who through
their efforts and study advanced the medical trade in a military context.
Chris, Thanks for your review and the format. Clear, concise and easy to follow. I'm writing six book reviews in a class I'm in and now have a much greater appreciation for not just what you review, but how you review. Merry Christmas to you and your family.
ReplyDeleteI like the suggestion on how to improve the book.
ReplyDelete