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Long after the fighting stops, war continues to impact on the health of soldiers, civilians and the environment.

For some people, the physical and mental damage caused by war lasts a lifetime. Medical teams have had to develop methods to help them adjust to living with disability and illness. 

But sometimes innovations in military medicine result in better ways to treat an injury or advance fields of medicine, such as plastic surgery, psychiatry and emergency medicine.

Soldiers and civilians walking through a war-torn town © Crown copyright. IWM (OP-TELIC 03-010-30-055)
Operation in Telic: British Forces in Iraq, 2003. Image source: Imperial War Museum

 

Rehabilitation

The wartime experience of surgeons who dealt with numerous limb injuries contributed to the grown of orthopaedic surgery (the branch of surgery concerned with the musculoskeletal system)  in the first decades of the 20th century.

In the past, most soldiers with serious wounds would have died, if not from their wounds then from infections. As military medicine improved, more and more soldiers survived. But many war veterans were left to cope with long-term physical and mental medical conditions.

The loss of a limb was one of the earliest and most visible disabilities for war veterans. Although rates of amputation declined with improved surgical techniques and the introduction of antisepsis in the 19th century, the sheer scale of industrial warfare in the First World War (1914–18) resulted in large numbers of amputees.

Specialist rehabilitation centres such as Queen Mary's Hospital in Roehampton were set up to fit veterans with prosthetic limbs and help them with physical rehabilitation and social support.

Military surgeons have always been involved in the rehabilitation of war veterans, designing prosthetic limbs, and developing expertise in fields such as plastic surgery, neurology and psychiatry.

After the Second World War (1939–45), faster and better treatment meant that more soldiers with serious neck and spinal injuries survived. But irreparably damaged nerves left many permanently paralysed with paraplegia (impairment in the legs) or quadriplegia (impairment in all four limbs).

In September 1943, the government asked the spinal injuries specialist Dr Ludwig Guttmann to establish the National Spinal Injuries Centre at Stoke Mandeville Hospital, the UK's first specialist unit for treating spinal injuries. It became a leading centre for neurosurgery.

After surgery, the long process of rehabilitation began. Guttmann believed that sport was a major part of rehabilitation. Sport helped veterans build up physical strength and self-confidence.

Ludwig Guttmann organised the first Stoke Mandeville Games for disabled patients on 28 July 1948, the same day as the start of the London 1948 Summer Olympics. His Games are often regarded as the forerunners to the modern Paralympic Games.

Dr Ludwig Goodman at the Paralympic Games in Tel Aviv Australian Paralympic Committee Image source
Australian Paralympian Tony South receives his gold medal for archery from Dr Ludwig Goodman at the 1968 Paralympics.

 

War and mental health

Veterans with mental health conditions resulting from their wartime experience often needed continuing treatment and support after the war. 

Both World Wars impacted the fields of psychology and psychiatry, as specialists were called upon to treat soldiers suffering from debilitating stress and trauma. Special units were set up to receive soldiers experiencing mental trauma, some centres were near the war zone so soldiers could return to the front once they recovered. More serious cases were sent back to military hospitals in the UK.

Successive wars have had their own ways of describing and dealing with mental health conditions resulting from war:

Private Meek's Recovery

This short video was filmed at the military hospital at Netley during the First World War. It shows Private Meek, a 28 year old soldier during his two-and- a-half-year journey to recovery from shell shock. [1 min. 42 secs.]

This is an extract from a longer promotional film directed by neurologist Major Arthur Hurst. Patients such as Private Meek participated in reconstructions in order to demonstrate the results of their treatment.

Wartime medical innovation

There is a lot of debate about how much war and medicine have influenced each other. Sometimes war adds to medical knowledge by drawing attention to a particular injury, such as the loss of a limb. 

Military medicine has also influenced how medicine is done. Triage, the system of prioritising multiple casualties, has been adopted for all emergency medicine ever since the First World War.

Labels used to assign priority to injuries in World War One Science Museum, CC-BY 4.0
Book of wound tags, used by the British Army in the First World War for triage.

War has also created new roles and opportunities in medicine. The First World War saw a huge increase in the number of female nurses and male orderlies working in field hospitals near the front line. And with most men sent to fight, the War Office called on women to drive ambulances and female surgeons to perform surgery both in the war zone and at home, giving them a chance to prove their competence.

Sketch of women surgeons operating at Endell Street Hospital Wellcome Collection, CC-BY
Women surgeons doing an operation at the Military Hospital, Endell Street, London. By Francis Dodd, 1920.

Military medicine has also influenced society in unexpected ways. The military was one of the first organisations to use physical and phychological assessment tests on new recruits.

Concerns about the poor performance of troops in the South African War prompted questions about the national efficiency and 'racial health' of the population. This eventually led to medical inspections for new recruits in the First World War.

An army medical examination World War I Imperial War Museum © IWM
A recruit having an eye test as part of a medical examination, 1917.

Towards the end of the war, a physiologist working for the military, Group Captain Martin Flack, used his knowledge of respiratory and circulatory physiology to create tests for Royal Air Force recruits. His tests were designed to select the recruits that were most suitable for training as pilots.

Psychological evaluation was added to the assessment process in the Second World War. The idea of assessing and evaluating applicants gradually filtered into civilian recruitment and is now used for all kinds of jobs.

Suggestions for further research

  • M R Howard, 'British medical services at the Battle of Waterloo' in British Medical Journal, 24 December 1988 (pdf ejournal)
  • H Graeme Anderson, 'The medical and surgical aspects of aviation' [with chapters on applied physiology of aviation, by Martin Flack],  Hodder & Stoughton, 1919. [ebook]
  • J Laffin, 'Combat Surgeons'; Wiltshire: Sutton, 1999.
  • J Scruton, 'Stoke Mandeville: Road to the Paralympics'; Aylesbury: The Peterhouse Press, 1998.