The history of medics in warfare

A number of wars are currently raging around the world: most notably in Gaza, Ukraine and Yemen. As many people are forced to flee the fighting, teams of medics often run towards unimaginable horrors to help the injured. But what role can (and should) the medical profession play in conflict? Michael Brown is a lecturer in modern British history at Lancaster University and an expert on war and surgery.

Michael - Well, there had long been medical practitioners attached to military forces. You know, throughout human history, you know, the Romans, Greeks had physicians and surgeons in attendance. And throughout the mediaeval and early modern periods, we also see medical practitioners attending to the wounded and war. Most famously, in terms of the history of surgery, we had the French surgeon in the 16th century. He was a pioneer of surgical techniques, including things like tying off blood flow in cases of amputation. But in terms of the sustained provision of medical care to personnel in war, I think it's really the kind of revolutionary Napoleonic wars of the late 18th and early 19th centuries that mark a significant change. Prior to that, regimental surgeons had largely been appointed by the commanders on an individual basis. But in the latter part of the 18th century and going to the early 19th century, we see an increasing kind of provision of structured medical services. A Frenchman, Dominique Jean Larrey who served as Surgeon General of the Imperial Guard. He is responsible for a number of innovations in the medical care of wounded servicemen, including, for example, the introduction of ambulances or flying ambulances, modelled on the example of the horse artillery. As well as kind of a train core field litter bearers to kind of collect the wounded. And this is where we really start to see kind of innovation, I think in the field of medical care and war.

Chris - Back in history, the reason that surgeons pride themselves on calling themselves Mr. or Mrs, is because they were barbers back in the day and they had sharp knives, <laugh>. So is that sort of what started out as military medical intervention and then it became medicalized more professionally later, or was it different?

Michael - As a historian, really, of the early 19th century, I would argue that the level of professionalism among late the early 19th century section was actually exceptionally high, and in many ways actually war created opportunities for education. In a famous example, Charles Bell celebrated early 19th century Scottish surgeon, despite being a civilian, he actually travelled to the battlefield of Waterloo after the battle in 1815 to get experience of working with war wounds. And it was a formative experience for him, both intellectually and emotionally. So no, I mean, I think in many ways you could say that war was, you know, central to the professionalisation of surgical training in this period. And it's often been suggested that this kind of war is a driver of change. And I think there have been arguments made that actually, you know, this kind of structured provision of medical care for our first service personnel actually made a big impact on surgical training, more generally.

Chris -  You mentioned the Napoleonic war. What happened then, the mark to step change, and what drove that step change?

Michael -  Two things really. One is the scale of the conflicts. So, you know, this is a conflict involving much kinda larger forces than have been seen in previous conflicts. I mean, notably the French, for example, basically introduced universal male conscription, the so-called living on mass as part of their war effort. So there's a kind of growth of what we might now think of as a kind of total war, you know, as a phenomenon that civilian resources can be mobilised towards military and strategic ends. And I think that's what's really going on. But also I think the period is one in which the state is taking an increasingly structured approach to how it organises war, how it organises conflict, and a much sort of less decentralised approach to the fighting of wars. So I think, you know, by no means perfect medical military services, particularly Britain and other European countries, are subject to criticism. Throughout the 19th century, we were beginning to see a kind of increasing interest in the state in sort of providing these services for soldiers and sailors.

Chris -  Would they have put their practitioners right up close to the front line so that you can get your people out urgently or did they just wait until everything was done and dusted and then they did what they could?

Michael -  Larrey had kind of pioneered a concept of triage during the Napoleonic Wars, and that's really developed in the early 20th century. So you kind of, you know, you determine who needs treatment most immediately. It's really a kind of product of 20th century developments, the much more structured chain of treatment that one begins to see, particularly around the time of the first World War where, you know, you'd have kind of first aid posts, you've got, you know, kind of regimental aid posts, advanced dressing stations, casualty clearing stations, and finally kind of get to a hospital. So you can kind of basically treat people at various stages in that process. And that really is the kind of product of a much more structured intervention that you begin to see in the early 20th century.

Chris -  Is it fair to say then that pretty much all facets of conflict these days are gonna have a massive medical component to them?

Michael -  In more recent conflicts in the early 21st century, particularly in the West, you see this help for heroes phenomenon that soldiers deserve all possible medical care in return for their sacrifice. And I think there's been a great deal of both, you know, popular and charitable interest in wounded men coming back from Afghanistan and Iraq. And of course, you know, it's simply the fact that because of medical and surgical advances, wounds are far more survivable now than they were in the past as well. So, you know, that level of care has to be provided in the way they might not have done in the early 19th century or the 18th century, where the state had relatively little long-term commitment to the care of the wounded.