Sickness in the ranks | Science Museum

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.

The new barracks hospital at Scutari, Crimean War — The New Barracks Hospital at Scutari, base hospital for the Crimean War. Wellcome Collection, CC-BY

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.

Royal Victoria Hospital at Netley, 19th century. — The Victoria Hospital and the Army Medical School at Netley. Wellcome Collection, CC-BY

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.

Sir Almroth Wright (1861–1947), Professor of Pathology at the Military Hospital in Netley, carried out his research on typhoid at the Army Medical School. He developed an effective typhoid vaccine, which was tested on soldiers in the colonial Indian Army.

In the South African War (1899-1902), 6,000 British troops died from weapons injuries and 160,000 from disease, mainly typhoid and dysentery. Waterborne diseases such as typhoid and dysentery spread rapidly among the troops.

Lessons learned from the Crimean War put sanitary regulations in place but these were rarely enforced by combat officers. Water supplies were not boiled, and water carriers and bottles were not regularly cleaned.

The typhoid vaccine was offered to troops going the South African War on a voluntary basis, but because of the severe side-effects of the early vaccine, only 5% took up the offer.

Several research teams were working on a typhoid vaccine at around the same time as Almroth Wright. Richard Pfeiffer, a German bacteriologist and a student of Robert Koch, also developed a vaccine, so when the First World War started, typhoid vaccination was well established on both sides.

As a result of their experience in South Africa, the British Army carried out a public health campaign, urging troops to have the typhoid vaccine. Although it was never made compulsory, vaccination rates were at 90% by 1916. Vaccines were one of the reasons why the First World War was the first war in which fewer soldiers died from disease than from enemy fire.

Trench warfare conditions in Northern Europe brought a new risk of infection. The moist, richly manured soil of Flanders led to high rates of tetanus infection. But by the early 20th century, the RAMC was equipped to respond quickly.

A mobile bacteriology laboratory from the First World War — A mobile laboratory used in the First World War.

Mobile bacteriology laboratories collected samples in the field and send the results to bacteriologists back home, who developed a tetanus antitoxin to treat the infected. Tetanus deaths had fallen to almost zero by the end of the First World War.

Wartime pharmaceuticals

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.

Second World War advert about the benefits of penicillin showing American soldiers in the South Pacific — Schenley Laboratories was one of 20 labs in the US producing penecillin for the war effort. Wellcome Collection CC-BY

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.

Medical research for the war effort

Some medical research such as the development and use of vaccines and the industrial production of penicillin received a boost during wartime because it was recognised as contributing to the war effort.

Mass typhoid vaccination of troops during the First World War.
Wellcome Collection

Ampule of typhoid vaccine, France 1915.
Science Museum Group Collection

Bottle of tetanus vaccine, Germany, 1911-15.
Science Museum Group Collection

Prontosil was the first commercial sulphonamide antibacterial to be manufactured in 1935. These ampoules were possibly intended for use in the Middle East by the German Army during the Second World War.
Science Museum Group Collection

A fermentation vessel used for the early mass production of penicillin antibiotics by the Glaxo chemical company in 1943.
Science Museum Group Collection

An ampoule of penecillin manufactured by Merck &Co for early clinical trials before distribution to the military in the Second World War. The powder would have been diluted then injected.
Science Museum, London|Sir William Dunn School of Pathology, Oxford

Wooden chest used by Major Scott Thomson, RAMC, to transport penicillin supplies to North Africa during the Second World War.

Science Museum, CC-BY 4.0
Science Museum Group Collection

A Second World War public health poster warning against the risk of sexually transmitted infections. STIs were a significant problem for the military, making soldiers unavailable for active duty until antibiotics provided an effective treatment.
Wellcome Collection

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)

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