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Reconstructing soldiers

Hospital bed cycle, England, 1949

Hospital bed cycle, England, 1949

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Reconstructing soldiers

Medicine performs several functions for the military. In addition to treating the wounded, doctors also work to treat and prevent disease and also establish standards for soldiers who are fit enough to be used in battle.

A fit force

War has often highlighted problems with the health of the men and women who either volunteered or were conscripted for the services. Fitness was important to ensure that there were plenty of soldiers to keep fighting. Medical examinations for soldiers were introduced widely in 1790. However, constructing a fit force was still problematic, even into the late 1800s and the 20th century. By the time of the South African War (1899-1901), 40% of British volunteers were unfit: many had rickets, skin diseases and chronic bronchitis and a number had teeth too rotten to chew properly. The authorities were alarmed and established the Physical Deterioration Committee in 1904.

First World War fitness

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In the First World War (1914-18) almost half the conscripted men were considered unsuitable. Many were given ‘Grade III’, which meant that they had marked physical disabilities and were considered fit only for clerical work. Grade IV meant the man was totally and permanently unfit for military service. Pilots had to be of the highest standards of fitness. Eye tests and ear, nose and throat examinations for pilots, called Flack tests, were introduced from 1917 as it was costly to train pilots. The fitness of the fighting forces was still an issue after the First World War and ‘Sub-standard Recruit Depots’ were established to ensure that a certain number of men remained fit. They provided a combination of healthy meals, exercise and rest. Although these were disbanded in 1939, they were soon re-established as fitness in the military continued to be a problem.

Plastic surgery and repairing the body

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War ensured that doctors were kept busy repairing bodies damaged by fighting. Certain medical specialities were established to treat different types of injury. In both world wars plastic surgeons worked to repair bodies, particularly faces, damaged by gunshot and burns. Work by plastic surgeons such as Harold Gillies and Archibald McIndoe ensured that soldiers felt they could present their faces in public and did not have to live in isolation. The enormous number of amputations resulted in the establishment of specialist centres such as Queen Mary’s Hospital Roehampton, where many amputees went to be fitted with new limbs and to learn how to use them. There were fewer amputations in the Second World War (1939-45), but Roehampton was still vital in limb manufacture and fitting. Elsewhere, the 'Jaipur foot' was designed in India in 1968. At first it was specifically made for land-mine victims in less wealthy nations. It was light, durable, inexpensive and more suited to warmer climates and for people working outdoors.

Addressing emotional damage

Psychiatry, previously a small specialist area, grew during the First World War. Doctors at various specialist hospitals worked to repair the emotional and psychological damage caused by war - in particular shell shock. In the Second World War exhaustion and battle fatigue affected men and women who were involved in combat, and psychiatrists used new practices and drugs on their patients.

Rehabilitation: providing a programme of support to enable recovery

One of the most important medical innovations of the Second World War was rehabilitation. This was an organised system of hospitalisation, physical exercises and sport, followed by work which ideally resulted in the speedy return of men to the front line. By the second Iraq War, surgeons were able to save approximately 90% of all wounded service personnel, despite the horrendous injuries caused by highly damaging weaponry. For many of these men and women, rehabilitation will be a lifelong process.

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Bibliography

H Alper (ed.), A History of Queen Mary’s University Hospital Roehampton (Roehampton: The Trust, 1997)

J Anderson, ‘Turned Into Taxpayers: Paraplegia, Rehabilitation and Sport at Stoke Mandeville, 1944-56’, Journal of Contemporary History, 38/3 (July 2003), pp 461-476

J Barclay, In Good Hands: The History of the Chartered Society of Physiotherapy, 1894-1994 (Oxford: Butterworth-Heinemann, 1994)

R Battle, ‘Plastic surgery in the two World Wars and In the years between’, Journal of the Royal Society of Medicine, 71 (November 1978), pp 844-848

E Bishop, McIndoe’s Army (London: Grub Street, 2001)

P Brickhill, Reach for the Sky (Hertfordshire: Odhams Press, 1955)

W F Bynum and H Bynum (eds), Dictionary of Medical Biography (Westport: Greenwood Press, 2007)

R Cooter, Surgery and Society in Peace and War: Orthopaedics and the Organisation of Modern Medicine, 1880-1948 (Hampshire: Palgrave, 1993)

L Gillies, ‘Fifty years of rehabilitation at Queen Mary’s Hospital Roehampton’, Rehabilitation, 61 (April-June 1967), pp 5-20

B J S Grogono, ‘Changing the hideous face of war’, British Medical Journal, 303/21-28 (December 1991), pp 1586-1588

L Guttmann, Textbook of Sport for the Disabled (Aylesbury, HM+M, 1976)

‘In Memoriam: Reginald Watson-Jones 1902-1972’, The Journal of Bone and Joint Surgery, 54B/4 (November 1972), pp 1591-1592

E R Mayhew, The Reconstruction of Warriors (London: Greenhill, 2004)

L Mosley, Faces From the Fire (London: Weidenfield and Nicholson, 1962)

Oxford Dictionary of National Biography (OUP, 2005)

P H Schurr, ‘The Evolution of Field Neurosurgery in the British Army’, Journal of the Royal Society of Medicine, 98 (September 2005), pp 423-427

J Scruton, Stoke Mandeville: Road to the Paralympics (Aylesbury: The Peterhouse Press, 1998)

‘The Treatment of Burns in Large Numbers’, Proceedings of the Royal Society of Medicine, Vol. 44, No 581 (1951), pp 13-28

Glossary:

Bronchitis

Inflammation of one or more bronchi (one of the larger air passages in the lungs), usually a result of infection. It is characterized by intense coughing.