Medicine on the Battlefield

Military medicine aims to keep soldiers and sailors fit enough to fight.


Military medicine aims to keep soldiers and sailors fit enough to fight. While it is likely that battlefield medicine has existed as long as humans have fought over territory, the subject has received comparatively little attention in the historical record. Much of this gap is attributable to poor record keeping as well as a general lack of interest; few people besides military physicians have demonstrated any interest in military medicine. Most accounts of military medicine over the centuries are found in nonmedical writings, such as memoirs, histories of battles, and diaries as well as works of art.Medicine;militaryMilitary medicineMedicine;militaryMilitary medicine


Military medicine on the battlefield cannot be viewed in the narrow confines of a field of combat. It encompasses the treatment of injuries sustained on the battlefield, from spear wounds to gunshot wounds, as well as the side effects of such injuries, such as shock and infection. Medicine on the battlefield begins with the recruitment of troops who are healthy enough to fight on the battlefield. It continues with the maintenance of the health of fighters through adequate sanitation, the provision of safe foods, and the availability of clean water. It proceeds with the treatment of the wounded on the field and in hospitals. Battlefield surgeons have also shaped public policy to ensure better treatment of the wounded.

History of Medicine on the Battlefield

Ancient World

In the Medicine;ancientancient world, killing technology and defensive technology were fairly well balanced. As a result, ancient battlefields were not more dangerous than modern battlefields. Soldiers had an excellent chance of surviving attacks by axes, swords, javelins, and spears. Nevertheless, war wounds appear to have been a constant threat for ancient men. Classical literature gives the impression of nearly continuous warfare in the ancient world. The treatment of war wounds is the only kind of medical activity mentioned in the Iliad (Homer) Iliad (c. 750 b.c.e. ; English translation, 1611), the earliest Greek source available. Hippocrates Hippocrates (460-377 b.c.e. ), the Greek father of medicine, advised that “He who would become a surgeon should join the army and follow it.”

Broken Broken bonesbones were the most common battlefield injuries. Ancient Egypt;medicineEgyptian and Sumerians;medicineSumerian medical texts discuss broken bones extensively, indicating that military physicians were quite familiar with them. The injured soldier had the greatest risk of dying from the side effects of battlefield injury: tetanus, gas gangrene, and septicemia. The Tetanustetanus bacterium is commonly present in soil and is found in greater numbers in richly manured soil, which was typical of agricultural societies of the ancient world. The ancient medical practice of leaving the wound unsutured for several days before closing was likely to produce far fewer tetanus infections than the process of rapid closure used from the medieval period to World War I. GangreneGas gangreneGangrenous wounds likely produced 100 percent mortality. Ancient military physicians repeatedly cleansed wounds for several days before closure, thereby removing necrotic (dead) tissue and greatly reducing the risk of gangrene. Again, this habit disappeared after the fall of Rome with the result of a high death rate until World War I. SepticemiaSepticemia or blood poisoning is caused when bacteria enter the bloodstream. Wounds to arteries and major veins caused the greatest risk of septicemia. Until the invention of antibiotics in the twentieth century, septicemia almost always killed.

Available data on Wound mortalitywound mortality and infection produce a rough statistical profile of the causes of battlefield death. Of 100 soldiers wounded in action, 13.8 would die of Shockshock and Bleedingbleeding within two to six hours. The numbers were lower for Rome;medicineRoman soldiers. Like other ancients, the Romans knew to use a Tourniquetstourniquet to stop bleeding and prevent shock. Unlike their peers, the Romans had the organizational skills to move the wounded quickly from the battlefield to a hospital where physicians could tie off the severed arteries. Another 6 percent of the wounded would likely contract tetanus, and 80 percent of those would die within three to six days. About 5 percent would contract gangrene, of whom at least 80 percent would die within a week. Septicemia struck less than 2 percent of soldiers but generally killed them all within ten days. Most soldiers died of disease rather than the result of combat, which would remain the case until the twentieth century: Ignorance about such dangers as typhus and dysentery, as well as improper nutrition, ensured this greater risk.

Medieval World

An illustration from an early sixteenth century German field manual for wound treatment, by Hans von Gersdorff, shows typical wounds. The image is by Hans Wechtlin.

The same four major factors–shock and bleeding, tetanus, gangrene, and septicemia–would serve as the leading causes of death among military wounded until the twentieth century. The near-total disintegration of Western culture following the fall of Rome in 476 c.e. resulted in the loss of most medical knowledge until the Renaissance. The only significant development is found in the Byzantine Empire;medicineByzantine military, which provided each battalion with its own detachment of two physicians, a general practitioner and a surgeon. The medical staff was augmented by eight to eighteen medical orderlies, who served as combat medics and stretcher bearers. The Byzantines copied the Roman practice of immediate medical treatment. Unlike the Romans, they gave medical personnel a gold bonus for every wounded soldier rescued from the battlefield and brought to the medical tent.

The Islamic medicineIslamic world practiced medicine based upon the Qur՚ān. Since the Qur՚ān[Quran];on medical treatment[medical]Qur՚ān prohibited dissection, medical personnel lacked a thorough knowledge of the body, as did physicians in the West. Fevers and infection were treated by bleeding and purging, again similar to Western practice. SurgerySurgery was akin to butchery, with amputation being accomplished by repeated blows with a short sword or mallet, after which the limb was submersed in boiling pitch or oil to cauterize the limb. Bone settingBone setting was crude, with the result that the limb was often left distorted. However, since Islamic medicine relied more upon Islamic medicinedrugs than surgery, the Arabs developed superb pharmaceutical knowledge. They used hemp fumes as anesthetics and preoperative compounds to induce sleep before surgery.

In the Renaissance, the military Surgery;RenaissanceBarber-surgeons[Barber surgeons]barber-surgeon emerged as a familiar figure in Western armies. Prior to about 1453, Western armies often relied upon Cutters“cutters,” men who followed the troops and tended the wounded for a fee extracted from the soldier himself. These cutters were typically the only source of medical care for the common soldier. The barber-surgeons, many of whom had probably begun as cutters, acquired a high level of medical craftsmanship, especially in surgery. They needed this skill to deal with the shattered bones produced by the new invention of gunpowder. Amputation proved the most common treatment for gunshot-induced compound fractures, in which there is an open wound of the soft parts leading down to the break in the bone. Such fractures became the most common battlefield injury. A French barber-surgeon, Paré, AmbroiseParé, Ambroise[Pare, Ambroise]Ambroise Paré (1510-1590), developed the best technique for performing battlefield Amputationsamputations. He used ligature prior to amputation, as the Romans had done. Instead of plunging the limb into boiling oil, Paré treated the amputation with a mixture of egg yolk, oil of roses, and turpentine. Paré’s patients had lower infection rates, but few other physicians adopted his humane techniques until the nineteenth century.

U.S. Marines get plasma transfusions during the 1945 invasion of Okinawa.

(AP/Wide World Photos)

InfectionInfectionWound dressingremained a major killer of soldiers. Often, Renaissance surgeons would remove a bullet by enlarging the wound and then probing for the missile with fingers or unsterile probes, increasing infection rates. Physicians would also stuff gunshot wounds with all sorts of foul materials to create pus that would presumably heal the injury. Infection often resulted. Gunpowder also created burns, and the most popular treatments were vegetable and animal ointments that usually induced blistering and scarring.

Modern World

Until the late eighteenth century, surgeons did some field surgery, but the wounded were typically gathered after the battle and brought to the surgeon. Military leaders feared that any attempt to remove the wounded would disrupt the fighting integrity of the unit. The wounded often lingered for hours and sometimes days before being evacuated. This situation did not improve until the Napoleonic Wars (1793-1815), whenLarrey, Dominique-JeanLarrey, Dominique-JeanBaron Dominique-Jean Larrey (1766-1842) invented AmbulancesFlying ambulances“flying ambulances” that located, treated, and evacuated the wounded under fire.

The state of medical knowledge was also advancing in the eighteenth century. SurgerySurgery stopped being a technical craft practiced by physicians of a lower order while medical publishing expanded. In this century, governments accepted the obligation to provide and pay for the military medical care of the common soldier. In 1776, military surgeon Jones, JohnJones, JohnJohn Jones (1729-1791) published the first American textbook on surgery as well as the first American medical book. Jones, who had served colonial troops during the French and Indian War (1754-1763), treated Revolutionary War soldiers as a surgeon with the Continental Army. His book Plain Concise Practical Remarks on the Treatment of Wounds and Fractures (Jones) Plain Concise Practical Remarks on the Treatment of Wounds and Fractures (1776) provided a guide to surgery and advice on hygiene. As Jones realized, in times of revolution, recruits were eager to join the fighting, with the result that large numbers of marginally healthy adults with poor sanitary habits entered military service.

Eighteenth century military medicine benefited from a number of new techniques. StypticsStyptics were commonly used to stop minor bleeding. Pressure sponges, alcohol, and turpentine were used to treat minor wounds. CauterizationCauterization of arteries was still practiced but with less frequency, since the invention of locked forceps. The Screw tourniquetscrew Tourniquetstourniquet made thigh amputations possible and greatly reduced the risk associated with amputations below the knee. Military surgeons place greater emphasis on preparing limbs for prosthesis as flap and lateral incision amputations became common procedure.

In the early nineteenth century, military doctors began to record what they observed with the aim of changing public policy and improving the health of the army. As an additional concern, the deaths of soldiers overseas proved to be a burden to the taxpayer. In 1863, the Royal Commission on India estimated that Great Britain lost £588,000 annually from sickness among the troops in India alone. The financial impact of disease prompted more governments to focus their resources on the improvement of military medical care.

The most common battlefield injury continued to be Broken bonescompound fractures from bullets and cannonballs propelled by gunpowder. Many such fractures were infected, since there was a likelihood that pieces of clothing, contaminated soil, and other substances would enter the wound. Treatment proved very difficult. During the American Indian Wars of the late nineteenth century, LaGarde, Louis AnatoleLaGarde, Louis AnatoleLouis Anatole LaGarde (1849-1920) realized that the act of firing a bullet does not, as had previously been thought, sterilize a projectile and that bullets can therefore induce sepsis from a wound. He published his discovery in 1893. In World War I (1914-1918)[World War 01];medicineWorld War I (1914-1918), the British Army began using the SplintsThomas splint and the U.S. Army employed the army leg splint. The patient was saved from shock, pain, and other symptoms that had made bone fractures frequently fatal. In 1918, the death rate from such injuries in evacuation hospitals dropped to 17.5 percent, an improvement of 40 to 50 percent over the rate in the first months of the war. In 1923, Orr, HiramOrr, HiramHiram Orr, a Nebraskan who had served with both the British and the American forces in France during World War I, proposed a “closed treatment” for broken bones by encasing the leg splint in plaster of Paris Casts (bone setting)casts. Orr’s treatment received its first military test during the Spanish Civil War (1936-1939). José Trueta (1897-1977), a Spanish surgeon, reported that of 1,073 gunshot fractures treated with casts, only six patients died. He also noted the almost complete absence of gas gangrene, a notorious killer among the wounded in previous wars.

Largely because of advances in military medicine during World War II (1939-1945)[World War 02];medicineWorld War II (1939-1945), the death rate for combatants dropped dramatically. In the 1945 Iwo Jima, Battle of (1945)Battle of Iwo Jima, 32.6 percent of the U.S. Marines became casualties, making the campaign the bloodiest in the history of the Marine Corps. If the same casualties had been suffered by Union forces in the Civil War (1861-1865), the death rate would have been 14.6 percent. The overall death rate among wounded U.S. sailors and Marines for all Pacific campaigns stood at 2.3 percent. The improved figures resulted from administering first aid on the scene of battle, speedily evacuating the wounded, providing whole-blood transfusions, and using AntibioticsPenicillinpenicillin. In 1943, wounded U.S. soldiers returning from the Pacific became the first group of soldiers to receive the newly invented antibiotic. Tests on American soldiers in 1943 and 1944 revealed that penicillin reduced the death rate from staphylococcal infections from 75 percent to 10 percent while limiting infection from wounds and burns.

In Hospitalsthe subsequent decades, military physicians improved their treatment of shock with readily available blood and transfusions. Vascular surgeons were used on the front lines for the first time during the Korean War (1950-1953). During the Vietnam War (1961-1975), helicopters with trained corpsmen aboard quickly evacuated the wounded to hospitals. Of the wounded who were still alive upon reaching a hospital, 97.5 percent survived. The Iraq War (beg. 2003) led to improvements in the treatment of combat trauma, particularly vascular injuries.Medicine;militaryMilitary medicine

Books and Articles

  • Anderson, Robert S., and W. Paul Havens, Jr., eds. Internal Medicine in World War II: Infectious Diseases and General Medicine. Washington, D.C.: Department of the Army, 1968. This textbook covers the treatment of World War II combat injuries.
  • Freemon, Frank R. Gangrene and Glory: Medical Care During the American Civil War. Urbana: University of Illinois Press, 2001. This is a heavily illustrated and highly readable account of the challenges facing Union and Confederate medical forces.
  • Gabriel, Richard A., and Karen S. Metz. A History of Military Medicine. 2 vols. Westport, Conn.: Greenwood Press, 1992. A superb survey of military medicine from the dawn of recorded time to the end of the twentieth century.
  • Griffin, Alexander R. Out of Carnage. New York: Howell, Soskin, 1945. An engaging contemporary account of World War II battlefield medicine.
  • Jadick, Richard, and Thomas Hayden. On Call in Hell: A Doctor’s Iraq War Story. New York: New American Library, 2007. Jadick is a career U.S. Marine who volunteered in 2004 to serve as a battalion surgeon in the Iraq War. Jadick and his men followed military units through the streets of Iraq in order to reach and stabilize wounded soldiers quickly.
  • Kaplan, Jonathan. The Dressing Station: A Surgeon’s Chronicle of War and Medicine. New York: Grove Press, 2001. Kaplan, trained as a surgeon in South Africa, recalls his frontline medical experiences in apartheid South Africa, Kurdistan, and other places where undeclared wars raged.
  • Littleton, Mark R. Doc: Heroic Stories of Medics, Corpsmen, and Surgeons in Combat. New Plymouth, New Zealand: Zenith Press, 2005. Littleton recounts stories of medical professionals, including nurses, from World War I to the Iraq War.
  • McCallum, Jack E. Military Medicine: From Ancient Times to the Twenty-first Century. Santa Barbara, Calif.: ABC-CLIO, 2008. This is an encyclopedia that opens with a general history of medicine before proceeding to nearly two hundred entries on various aspects of military medicine.
  • Nessen, Shawn Christian, Dave Edmond Lounsbury, and Stephen P. Hetz, eds. War Surgery in Afghanistan and Iraq: A Series of Cases, 2003-2007. Washington, D.C.: Department of the Army, 2008. The first scholarly work to cover military medicine in the Afghanistan and Iraq wars, this book covers one hundred cases of combat trauma.
  • Salazar, Christine F. The Treatment of War Wounds in Graeco-Roman Antiquity. Leiden, the Netherlands: E. J. Brill, 2000. The first book to address military medicine in the ancient world.

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