War and medicine Lecture 18 Medicine, Disease and Society in Britain,

Roger Cooter: Why did earlier historians of medicine shy away from war? Early historians of medicine were more interested in public health, mental health, hospitals and other features within the expanding domain of the social history of medicine. War was unfashionable in the 1970s and 1980s – shadow of Vientam. Reluctance to pursue a contradiction to the idea that war was destructive of civilisation.

Cooter: Why is it important for historians of medicine to examine war and modern medicine? To question the notion of war as good for medicine. Theatres of war and medicine must be studied as part and parcel of the societies and cultures in which they are set. To understand how military medicine existed in wartime and peacetime, and how it interacted with civilian medicine. The history of medicine and war might reveal much about the construction of disease, the structuring of medical institutions, and the daily practice of medicine.

Trench warfare

Vaccine for dysentary 1917

Positive effects: professional opportunities War provides a large, captive group of patients, specialised facilities and financial resources from the state to support specialisation. As increasing numbers of male doctors went to war, women doctors got their first real chance to prove themselves. There was work in general practice on the home front and abroad with the Red Cross. 3,000 female medical graduates by the end of the war. Also huge opportunities for nurses.

Endell Street Hospital 1917

Positive effects: public health J. Winter: the health of the poorest sections of British society improved during the First World War. Infant mortality declined. Mortality declined for a number of diseases. Better nutrition cited as the cause of diminished mortality. Resources often better distributed in wartime

Positive effects: science and technology New technologies such as X-ray equipment. The First World War exposed doctors to new surgical techniques. Wartime conditions promoted the principles of modern management and efficiency.

Negative effects: professional opportunities Specialties such as plastic surgery had to wait until WW2 to find a demand for their skills. After the war, women doctors were forced into retirement or back into traditional areas of medical work accorded to women.

Negative effects: public health First World War dampened down, rather than intensifying the pre-war social welfare movement. Weak and vulnerable groups (e.g. disabled) lost out in reallocation of scarce medical resources.

Harold Gillies became proficient at the reconstruction of noses, mouths, eyelids and ears using skin flaps.

Shell shock Craiglockhart Hospital (Edinburgh)

Shell shock Two categories: hysteria (soldiers) and neurasthenia (officers). Symptoms: nightmares, hallucinations, shakes, tremors, palpitations, muteness, trembling hands and paralysed limbs. Attitudes to shell shock were closely interwoven with complex masculine codes – honour, self-control, comradeship etc. Shell shock had wider repercussions for society and culture, and for psychiatrist’s understanding of mental illness.

Effects on Civilian Health (Winter, Titmuss) Reduction in maternal and infant mortality Female employment Better food distribution Improved services for mothers and babies Reduction in maternal and infant mortality Reduced alcoholism Higher mortality for elderly Stress Increase in smoking and respiratory TB. Also dangers at workplace

Medicine on the frontline

Conclusion On the one hand, the integration of medicine within the military required its subordination to the larger and more powerful institution. On the other hand, medicine was empowered to intervene in people’s lives. War is good for medicine? – generalisation is impossible. Medicine must be seen as constitutive of the process of militarisation. Also learning process from war to war but also warfare changed so some progress becomes irrelevant.