Long after the fighting has stopped, the impact of war on the health of soldiers, civilians and the environment continues.
The damage resulting from war can last a lifetime. Sometimes medicine can provide treatments and therapies to help people to adjust. But sometimes the effects of war are too chaotic and unpredictable for people to cope with the aftermath. Just occasionally some good can come from what medicine learns about the frailty of the human body and how to defend it.
In the past, most soldiers who received serious injuries simply died, if not from their wounds then from infection or loss of blood. But as military medicine improved, the number of veterans left to cope with long-term medical conditions grew.
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. But the sheer scale of industrial warfare in the First World War resulted in half a million amputees by the end of the war, all of whom had to be integrated back into society.
Orthopaedic surgery grew massively at the beginning of the 20th century, and specialist rehabilitation centres such as Queen Marys in Roehampton were set up to fit veterans with prosthetics and help them with physical and social support.
After the Second World War, faster and better treatment meant that more soldiers with serious neck and spinal injuries survived. But irreparably damaged nerves left many permanently paralysed as paraplegics or quadriplegics.
In September 1943 the government asked the spinal injuries specialist Dr Ludwig Guttmann to establish the National Spinal Injuries Centre at Stoke Mandeville Hospital. As director of the UK's first specialist unit for treating spinal injuries, he believed that sport was a major part of rehabilitation.
Sport helped veterans build up physical strength and self-respect. 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.
The Stoke Mandeville Games have been described as the precursors of the Paralympic Games, which were first open to everyone, including war veterans, in Rome in 1960 and have done a lot to raise the profile of disability around the world.
Unpredictable legacies of war
The large-scale use of chemicals in warfare can have unpredictable long-term consequences, but so can abandoned munitions and weapons.
In the First World War, the use of poisonous gases such as chlorine and mustard gas, risked the gas being blown back over your own troops if the wind changed direction, and those that were not killed by the poisonous gases went home with serious long-term damage to their lungs and nervous system.
After the First World War, unexploded shells and cannisters of chemical weapons such as mustard gas and chlorine were abandoned and left to slowly seep into the ground, contaminating the soil and ground water.
In the Second World War, after the initial destruction of the atomic bombs detonated over the cities of Hiroshima and Nagasaka, many civilians died slowly from radiation poisoning and generations to come saw birth defects and higher incidences of cancer.
Napalm, an Incendiary agent, was used for flame throwers in the Second World War, but in the Vietnam war it was dropped from the air in bombs to clear large areas of jungle and caused horrendous burns to civilians caught up in its deployment.
Chemical defoliants such Dioxin and Agent Orange were sprayed from aeroplanes over large areas of jungle and farmland during the Vietnam War to flush out guerrilla fighters and sympathisers. They also resulted in long-term damage to the environment, such as soil erosion, and exposure affected the health of the American servicemen and women who handled them and Vietnamese civilians.
After the wars in In Vietnam and Cambodia attempts to return the land to farming were disrupted by unmarked fields of landmines that added to the burden of post-war recovery by creating a generation of people with missing limbs and disfigurement.
Image: Artificial leg, for a below-knee amputee, made from a scrap metal and worn by a landmine victim in Cambodia, 1990-2002. Credit: Science Museum.
There is only so much that wartime medicine can do. The effects and damage of war are long-lasting - emotionally and physically - and some of the damage is irreparable. But the ‘hothouse’ of war medicine has resulted in medical innovations that became standard practice in peacetime.
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 condition, such as blood loss or disease such as typhoid. And the sheer numbers of one type of injury, such as facial wounds allow surgeons to gain experience and experiment with new techniques.
War can also affect how medicine is done. The First World War saw a huge increase in the numbers of female nurses and male orderlies working in field hospitals near the frontline. And with most men sent to fight, the War Office called on women to drive ambulances and women surgeons to perform surgery both in the warzone and at home.
Triage was an innovation in medical administration that was readily adopted for all emergency medicine after the war.
Governments and military authorities are more willing to fund medical research if it might give them a strategic advantage by saving the lives of highly trained troops. Penicillin was fast tracked through development and manufacture so that it could be used in the field during the Second World War.
But sometimes medical knowledge acquired in wartime can be controversial as in the Nazi experiments in concentration camps and Tuskaloosa trials with penicillin.
Technology has been used to good effect in developing portable equipment such as x-ray units that could be used as diagnostic tools in the field. Mobile laboratories provided a rapid response for identifying and controlling infectious disease such as tetanus in the First World War.
War may be a high price to pay for medical innovation, fortunately innovation doesn’t stop with the end of a war. Reconstructive surgery was established in the two World Wars but in 2006 the first successful face transplant was performed in France on Isabelle Dinoire.
Banner Image credit: © Crown copyright. IWM (OP-TELIC 03-010-30-055)