Wars, Pestilence and the Surgeon's Blade - Thomas Scotland and Steven Heys

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. 

The production value of this book is superb. The authors have incorporated a commendable series of endnotes for each chapter for further study but no overall bibliography. They have also provided for each of the focus wars, a brief synopsis of the what transpired. It is not particularly detailed but enough that it provides context without detracting from the focus of the book. I believe that it would have been very beneficial had they provided an organization chart of the command structure of the British military medical services for the periods covered as it was, as previously noted, rather convoluted and difficult to follow. The book is noteworthy however, for how readable and accessible the authors have made this subject to the reading audience.  Scotland and Heys are outstanding medical historians and are to be commended for their work in this book.