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.
Title: The
Great Influenza: The Story of the Deadliest Pandemic in History
