Keeping troops fighting fit means preventing and dealing with outbreaks of disease, and each theatre of war brings its own challenges.
Malnutrition and exhaustion played a part in making soldiers susceptible to illness. But poor sanitation and living in close quarters were responsible for the rapid spread of infectious diseases among the troops. Diseases such as typhoid, dysentery and cholera, which could bring down an army as effectively as any weapon.
Florence Nightingale and the Crimean War
Disease had a major impact in the Crimean War (1853 - 1856). In one winter during the war for example, only 9,000 troops were fit to fight, while 23,000 were reported unfit due to sickness.
When Florence Nightingale arrived at the military hospital in Scutari, near Constantinople (now Istanbul), with 38 volunteer nurses, she found the hospital in a dreadful state.
Soldiers lay on the ground in the clothes in which they arrived. Many were malnourished and dehydrated because of water and food shortages. The wounded were mixed in with the infected and open latrines helped to spread infection. If a soldier didn’t have a disease when he arrived, he could certainly catch one at the hospital.
Nightingale believed that sickness among the wounded was largely the result of exhaustion and poor nutrition and set about feeding and tending the wounded. But military surgeon James Barry argued that poor sanitation and bad ventilation were responsible for deaths from infectious disease and criticised Nightingale for not addressing the problem of poor hygiene.
Medical staff had very little influence in the Crimean War, and lacked the influence and resources to run an effective service. But a combination of negative reports in newspapers back home on the plight of the injured and Nightingale's ministerial and Royal support achieved what the doctors could not: it provoked the authorities into action.
In 1855 an official Sanitary Commission arrived in Crimea and, with Nightingale's cooperation, they ensured that toilets and washing facilities were upgraded, ventilation was improved and overcrowding reduced. The mortality rate at the military hospitals went from 41% when Nightingale arrived to 2% by the end of the war.
Influenced by her experience during the Crimean War, Nightingale campaigned for better sanitation in all hospitals when she returned to Britain.
Medical training and research in the military
One of the lessons from the Crimean War (1853–56) was that effective medical provision was not only essential for both morale and wartime propaganda at home, it also made good military sense.
In response to that war, the Royal Victoria military hospital was established at Netley, near Southampton. The hospital included an Army Medical School where army doctors were trained for the Army Medical Service and later the Royal Army Medical Corps (RAMC). From 1863 until its closure in 1966, the military hospital became the centre of treatment for troops returning from war.
The laboratories at the Army Medical School also made a valuable contribution to medical research into infectious diseases. Before and during the First World War, it was instrumental in developing vaccines and bacterial antitoxins for typhoid and tetanus.
In the Second World War, new pharmaceuticals such as sulphonamides revolutionised infection treatment. They were dusted into wounds as a powder and also used in tablet form for diseases such as pneumonia.
Once penicillin was found to be an effective antibiotic treatment for infections, laboratory research on large scale production was prioritised in Britain. By 1940, researchers at Oxford university developed a method of mass production, which they took to several pharmaceutical companies in the United States. Once mass production began the US War Production Board drew up a plan for distribution to the Allied troops fighting in Europe. The first penicillin supplies were in the field by 1943.
Antibiotic drugs reduced levels of sepsis and gangrene, and allowed more operations to be carried out in mobile surgical units in the field. Before penicillin, major chest and head surgery was avoided because the patient would have died from infection in any case.
Antibiotics also made a huge difference to treating sexually transmitted infections (STIs) among the troops. STIs had a significant impact on the health and availability of soldiers in both World Wars.
Microbiological and pharmaceutical research transformed military medicine. With mass vaccination in the First World War and antibiotics in the Second World War, fewer soldiers died from infection than from enemy fire.
Suggestions for further research
- Between Flesh and Steel by Richard A Gabriel, Potomac Books, 2013
- War Medicine and Modernity edited by R Cooter, M Harrison and S Sturdy, Sutton Publishing UK, 1998
- Wars, Pestilence and the Surgeon's Blade by T Scotland and S Heys, Helion and Company Ltd, 2013
- Description of a series of watercolour drawings executed by the Late Sir Charles Bell, text by Deputy Inspector General T. Longmore, after 1860 (ebook)
- IBMS History Committee, Health for Heroes - Typhoid Vaccine, 2018 (pdf)
- History of the Royal Army Medical Corps, Museum of Military Medicine (website accessed 2018)