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INTRODUCTION

Surely, an important question for history is "What causes innovation?"  What makes a society discover new and better ways?  The medical arts and sciences are key areas for this question.   Why can centuries go by with little advancement, and then in a few years new ways to treat illness and/or injury are discovered and put into good use?  The answers are no doubt complex, but I have learned that, when a society has 1) strong motivation to search for improvements, 2) many opportunities to try new ideas, and 3) an adequate level of organization, then medical innovations often occur.  One phenomenon that brings these three conditions together is warfare.  This site explores several examples of how warfare can result in powerful new medical innovations.
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SITE CONTENTS
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Medical Innovations and War

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Overture: Introduction and Contents

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Understanding WHY War Can Lead to Medical Innovations

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Understanding the TYPES of War-Based Innovations
 

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Wars in the Ancient World Lead to Improved Medical Practices

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Ancient Egypt and the Treatment of Skull Fractures

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Ancient Rome and the Advent of Sophisticated Medicine
 

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The American Civil War Changes American Medicine

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Improved Surgical Technique and the Birth of Neurology

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Ambulances, Hospitals, and New Medical Practices
 

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The Spanish-American War, Yellow Fever, and Dr. Walter Reed

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World War II and the Miracle of Penicillin
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Finale
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Bibliography and Links
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Understanding WHY War Leads to Medical Innovations
(as you read the example stories)

Ralph Major, M.D., author of Fatal Partners: War and Disease, sums it up nicely:

An army <at war> is a vast laboratory of medical research where disease and injuries are seen on a far larger scale than in peacetime.  The intelligent, courageous and altruistic efforts of the medical officers in all belligerent armies form an epic in the history of medical science...   Many improvements in the treatment of infections, of wounds and of fractures have come from experiences on the battlefield.

As I explored the history of war and medicine it became clear to me that three big factors can help in causing medical innovations and that these three factors often combine during war more than during peacetime.  These factors are:

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Opportunity:   Sadly, wars cause many people to suffer serious wounds in a short period of time.   Further, throughout history, war is known for breeding disease in epidemic proportions.  At least five times as many people died during the American Civil War from disease than in combat.  The unsanitary conditions of soldiers grouped in masses, often with rotted food, polluted drinking water, and living in their own filth, gives rise to much illness.  Also, soldiers traveling great distances may be exposed to diseases for which they have never acquired any immunity.These traveling soldiers themselves could even bring new diseases to vulnerable local populations.  There is no doubt that wartime doctors are confronted with huge numbers of sick and broken bodies, a sad laboratory, but well stocked indeed with subjects.   Further, in the absence of adequate time and normal supplies, wartime doctors often are forced to "make do" with whatever they can think of, or even try new, unfamiliar methods used by the local population. Clearly, war provides ample opportunity to explore new medical techniques.  Look for examples of this throughout this website, such as with Head Injuries in Ancient Egypt and improvements in medicine as a result of the gruesome American Civil War.
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Motivation:   Wartime can be very motivating!  Individuals often do everything they can to help a war effort, perhaps out of patriotism, a desire for glory, or maybe from just the simple drive to survive!  This extends easily to a motivation to provide the best possible medical care to one's soldiers.  This is both out of compassion, and to keep them fighting better and longer.  Governments and military organizations, if well-organized (see below) and somewhat enlightened, can be very motivated to ensure the health and survival of their fighters, and so may sponsor rapid research programs.   Consider the extremely rapid discovery of ways to manufacture penicillin during World War II and fight yellow fever in the Spanish-American War .
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Organization:   Apparently, not all wars lead to significant medical innovations.  If no medic or doctor is assigned to troops, and soldiers treat their own wounds, how easily will any successful methods be passed on?  Even if doctors are in attendance, if there is no system of communication between them, how will any discoveries be spread around?  No better example than Ancient Rome shows that when a government and an army become organized, and when that organization dedicates time and resources to the best medical care that it can provide, wars do lead to innovation.

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Understanding TYPES of War-Based Medical Innovations
(as you read the example stories)

As stated above, the coditions for wartime medical innovations are 1) the opportunities for doctors to uncover new methods, provided by large numbers of wounded and diseased people, and 2) the motivation that arises in the life-and-death struggle of war, when combined with 3) a level of organization that can provide resources and pathways for communication to support new discoveries.  These conditions also dictate the types of innovations that are likely during wartime and which fall within two large categories: dealing with disease and dealing with injuries:

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Dealing with diseases:   Throughout history, more soldiers are killed by disease during war than by combat, typically by massive epidemics, like typhoid fever and yellow fever, that strike the densely packed warriors.  Estimates range as high as ten to one for some wars (Crimean and Mexican Wars), a ratio of five to one has been typical.  Only since World War I has medical science learned enough to reduce disease-based war deaths to fewer than the number of combat deaths.  There are at least three different ways that wartime doctors have sought to fight disease:

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Prevention:  Nowhere is the organizational level of an army more reflected than in its understanding that disease CAN be prevented, typically by appropriate sanitation.  Consider the Roman Army's priority of discovering what actually prevents disease.

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Transmission:  Many early armies believed that the epidemics that hit them were indications of the disfavor of the gods.  More recently, military doctors have pushed for a more realistic understanding of what actually causes disease to spread, so that it can be stopped.   Consider the U.S. Army's Dr. Reed stopping yellow fever as a result of the Spanish-American War.

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Cures:  Clearly, the level of motivation can be quite high to find and distribute cures for diseases that strike wartime soldiers.  Consider how fast World War II pushed penicillin into production.
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Dealing with injuries:   Although disease has historically killed more soldiers during war, wounds from battle are perhaps more dramatic and immediately disabling.  War may be associated, mentally, more with severe injury, and historically wartime doctors have been recruited to tend to wounded warriors.  It is not surprising that many of the battlefield medical innovations have been about how to rapidly and effectively deal with injured bodies.

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Surgery:  Techniques to close wounds, repair fractures, remove dead and dying tissue (via amputation), and the like, and to do so without overwhelming pain, have always been sought by the battlefield doctor.  Many innovations have occurred in this area during war.  Consider changes in surgical practices as a result of the War Between the States.

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Ambulances and Hospitals:   Doctors that know how to treat a wound must get to those that have those wounds, and they must be able to treat them in an appropriate environment.  Major medical innovations have included how to transport patients and doctors quickly and efficiently, and how to provide intelligent shelter and resources, then to facilitate good medical care.   Consider the effects of the Civil War on ambulances and hospitals.

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War-Specific Injuries:   Different kinds of warfare produce different kinds of injuries.  Take for example the ancient Egyptian doctors, who learned much about head injuries from treating their helmetless soldiers (and nothing at all about bullet wounds!).

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by Tanya Marton, ©1999, tanya@mcatmaster.com