How has conflict shaped medicine?

Rohan Chavali

War and conflict have existed since as long as we can remember, as old as history itself, accompanying with it both injuries and fatalities, but also innovation. While forms of war and weaponry have been evolving and changing over time, one cannot ignore the development of military medicine alongside it as the two go hand in hand. This article will overview how the healthcare for soldiers both during and after war has changed over time, but also influenced other spheres of medicine.

Military medicine as we know it only started in the 18th century, but evidence in old civilisations can be observed. As many of us have learned from basic history, many of these age-old civilisations were not estranged from war, with tales of empires and conquests being extremely popular. However, the healthcare in these civilisations was far more advanced than you would expect, despite how crude their conflict may seem in comparison to today. A papyrus dating back to 1600 BCE describes techniques used by ancient Egyptians such as cauterisation (burning wounded areas to seal them and prevent excessive bleeding or infection) which were used for many following centuries through various eras.

But the most notable of ancient civilisations is of course the romans, who made massive strides in military healthcare which influenced centuries to come and most closely resembles modern military medicine. One of the fundamental threats to health in war are the poor conditions and lack of hygiene. Epidemics would sweep regularly across armies and their camps, effectively becoming as deadly a threat as the physical battle itself. However, the romans’ understanding of sanitation reduced the number of epidemics faced by their troops, in contrast to other armies. The appreciation of sanitation in military medicine was lost unfortunately, but roman advancement never truly died and was rediscovered millennia later.

Following the downfall of the roman empire, medicine regressed while conflict slowly grew Through the Middle Ages war advanced rapidly, due to introduction of gun powder weapons, and medicine struggled to keep pace. Greco-Roman medicinal theories were rediscovered and adapted from the 15th century onwards, as warfare advanced, with injuries becoming frequently more fatal with the use of firearms. But there was only the battlefield surgeon Ambrose Pare (1510-1590) made a real breakthrough, he rediscovered the roman treatment of using turpentine, an effective wound antiseptic. He also rediscovered the use of ligatures to tie off bleeding vessels, stepping beyond cauterisation. Pare was such an influence on medicine that published “The Method of Curing Wounds Caused by Arquebus and Firearms” in 1545, a publication which was referenced and used for following centuries. Although limited by old theories, conflict initiated both development and adaptation of practices due to the constantly evolving severity of threats and outlines the key point: conflict creates a demand for medical progression.

Healthcare progression does not only entail new methods of treatment, but also the introduction of new tools and devices. We can see the development of AI in medicine as the modern equivalent but glancing back in history we can see the origin of basic tools we take for granted, As previously mentioned the introduction of firearms changed warfare and complicated medicine by creating new challenges for medical surgeons. Although early guns and rifles could not fire numerous rounds in quick succession, nor were the firearms perfectly accurate, but they were still able to pierce metal armour and had the capability of being very deadly. The entry of the musket ball is responsible for most of the damage, which is reported to be organ damage, heavy bleeding, bones shattering or just immediate death. In the case of injury, in order to treat the physical damage, the bullet had to be removed primarily before any ligatures or cauterisation. As a result, several tools, such as the terebellum (bullet extractor screw) or forceps were invented to remove objects like bullets from the body. Tools like the forceps are now commonplace in contemporary surgery.

A rather more curious invention was designed by Napoleon’s chief surgeon. Until the 18th century, combat officers were not easily persuaded that it was worth risking healthy soldiers to retrieve wounded soldiers on the battlefield. Often the wounded were left to lie on the field and were only treated once the fighting had stopped. Dominique Larrey introduced his “brancardiers” or stretcher bearers, who were able to transport the wounded from the battlefield to be treated. But his more revolutionary idea was the “flying ambulance.” The flying ambulance was a horse drawn vehicle which functioned as a mobile treatment centre with medical staff, equipment, and a padded area to put the wounded down. The invention is a giant steppingstone into creating our modern ambulances, with the ambulance wagon acting as a field station I the war zone, treating the wounded on site then transporting the more gravely injured to field hospitals. While conflict may not always directly create the tools or services we see today, throughout history conflict creates various challenges which create the space for various creative solutions. These solutions then form the basis of what is slowly adapted into modern public healthcare.

In everything discussed so far, solutions to the problems caused by conflict never really considered the fundamental science behind treating infections. The problems in conflict of various diseases plaguing soldiers were recognised and linked to ongoing research projects during World War one. They were recognised as aiding the war effort and were therefore invested in. Laboratories in the army medical school were essential for curing tetanus and typhoid during WW1. Sir Almroth Wright was a professor of pathology who carried out research into typhoid. Typhoid was a significant cause of fatality among soldiers – in the south African war 6000 troops died from weapon injuries while 160000 died from disease – so lessons from past practices needed to be learnt and solutions needed to be devised. Armies invested in research into microbiology, allowing Sir Wright to develop a typhoid vaccine. The British army launched a public health campaign, leading to 90% of troops being vaccinated by 1916 and making WW1 the first war where fewer soldiers died from disease than wounds caused by the enemy. The mistakes in conflict offer a lot to learn from and lead to investment into existing science, as we can see here. The development of the typhoid vaccine would never have been so quickly hastened if not for conflict, and it allowed several fields of research and biomedical science to grow, eventually informing and continually creating the modern treatments we require today.

An often-overlooked effect on conflict in medicine is the increased employment of various medical professionals and requirement of new roles. War has especially created previously unfathomable opportunities for women in healthcare. During the first world war, most men were sent off to fight and with the guaranteed tidal wave of casualties, there was a high demand for healthcare. This resulted in the War Office calling on women to drive ambulances and for female surgeons to perform surgery in the war zone and also at home. Many women were never given the chance to prove their medical competency before, but the shift in opportunities caused by WW1 was instrumental to changing opinions and is arguably the start of the monumental introduction of women into senior roles in medicine.

Finally, conflict has not only impacted physical maladies, but has raised enormous awareness towards mental health and therapeutic support. War is horrific and throughout a soldier’s life they will have had many traumatic experiences which have led to psychological and psychiatric issues like shellshock, battle fatigue but most well-known: PTSD. All these disorders were poorly understood at first and highly stigmatised, but their prominence in conflict led to their investigation. Post traumatic stress disorder was a term coined by the American psychiatric association in 1980 and explained the mental effects of war and eventually trauma in general. Now PTSD covers mental trauma of all kinds, including accidents or even natural disasters. Conflict drew awareness to these disorders, and indirectly to other mental health issues too, enabling health professionals and public to understand the need for therapeutic support and to be more accepting of mental health. It is an understatement to say conflict and war is the symbol of suffering. Yet it is almost ironic how innovation in death leads to discovery of how to save lives. Innovations in health are often responsive to conflict, as the evolving challenges requires a stream of resourceful and creative thinking, which creates the perfect culture for rapid progression. These creations and discoveries are often adapted to fit previously unrealised purposes, which lead only to further advancement. Conflict has created opportunities and progression in the diversity within medicine, whether that be the roles of women, or awareness into mental health. It is undeniable how conflict has carved medicine into what it is today.