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.
In the past, most soldiers with very serious injuries were likely to die, if not from their wounds then from infections. As military medicine improved, more and more soldiers survived their injuries. 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.
The wartime experience of surgeons who dealt with huge numbers of 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.
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.
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.
War and mental health
Veterans with mental health conditions resulting from their wartime experience also 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 the debilitating stress and trauma of war. Special units were set up to receive soldiers experiencing mental trauma, some were near the war zone so soldiers could return to the front if they recovered quickly. Others were sent back to military hospitals in the UK.
Successive wars have had their own ways of describing and dealing with mental health in wartime:
Private Meek's Recovery
This short video was filmed at the military hospital at Netley during the First World War. It shows some of the two-and- a-half-year journey to recovery from shell shock for 28 year old Private Meek. [1 min. 42 secs.]
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. The development of triage, the system of prioritising multiple casualties, in the First World War was an innovation in medical administration that was adopted for all emergency medicine after the war.
The First World War also 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.
Military medicine has also influenced society in unexpected ways. The military was one of the first organisations to use assessment tests on new recruits.
Concerns about the poor performance of troops in the South African War prompted questions about the 'racial health' of the population. This eventually led to medical inspections for new recruits in the First World War.
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 filtred 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.