War, Health, and Medicine

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War, Health, and Medicine

• A Comparison of Heath and Medicine on Several
  Fronts 1914-1918

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Casualty retrieval Western Front
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A turning point

• Disease to combat fatality ratios
• Crimean War (all combatants) 51
• American Civil War 51
• South African (British) 21
• World War I (British and Dominion) 0.71
• World War II (British and Dominion) 0.11

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Health in the different theatres

• Percentage of non-battle casualties (deaths and
  hospital admissions)
• France and Flanders 56 non-battle
• Dardanelles 68 non-battle
• Mesopotamia 91 non-battle
• n.b. 85-90 of all non-battle casualties
  typically from disease

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Casualty disposal

• Admissions to hospital and disposal of British
  casualties, Western Front 1914-18
• 5,517,455 admitted to hospital
• 183,454 died (wounds and sickness)
• Returned to duty in theatre 2,981,232 (54)
• Evacuated overseas 2,279,695

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Casualty Clearing Station
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Key factors

• 1. Geographical climate, terrain, disease
  ecology
• 2. Operational mobility, complexity (LofC)
• 3. Morale and discipline of troops
• 4. External scrutiny and assistance
• 5. Resources
• 6. Relations between MOs and other officers

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1.i Anti-typhoid inoculation
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1.ii Geographical factors levelling effects of
technology? (typhoid)
Theatre Year Incidence per 1,000 Deaths per 1,000
France 1914
1915 4.0 0.22
1916 2.0 0.02
1917 0.61 0.012
1918 0.12 0.007
Mesopot. 1916
1917 14.4 1.08
1918 6.0 0.55
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1.iii Louse-borne diseases
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1.iv Malaria
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1.v Evacuation over harsh terrain - Gallipoli
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1.v How much did geography matter?

• Each theatre presented with unique challenges
• But, on balance, greater difficulties faced
  outside Western Europe
• Levelling effects of medical technology limited
  largely to typhoid

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2.i Operational factors

• 1. Advantages of static warfare on the Western
  Front
• 2. Infrastructure
• 3. Difficulties of combined operations
• 4. Extended lines of communication
• 5. Operationally-generated medical problems
  e.g. shellshock, gas poisoning and asphyxia,
  trench diseases
• 6. Enemy attack/interdiction

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2.ii Lines of evacuation
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2.iii Sinking of H.S. Anglia
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2.iv Shell-shock
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3.i Ottoman army
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3.ii Hospital transports - Dardanelles
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4.i Scrutiny

• War reporting less important than other factors
  (precedent of SA War)
• Return of casualties to home countries
• Visits by dignitaries and politicians
• Presence of civilian volunteers
• High command and government acutely conscious of
  need to keep up public morale imperial political
  dimensions

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4.ii Sir John Frenchs sister - VAD
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5.i Relations between COs and MOs

• Professionalization in C19th
• Foundation of RAMC 1898
• South African War
• Post-war reforms and R-J War
• Training of COs
• Volunteers/conscripts

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5.ii Arthur Sloggett Alfred Keogh
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5.iii Hamilton and Birdwood at Gallipoli
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5.iv COs and MOs Mesopotamia

• Exclusion of MOs from Nixons HQ little though
  given to logistical aspects or sanitation
• Culture of Indian Army deference of MOs
• Temporary MOs change culture Horsley
• Change of command
• Massive improvement in sickness rates, evacuation
  and treatment

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5.v Non-battle casualties in Mesopotamia
(British)

• 1914-15 10,518 (1,297 per 1,000)
• 1916 75,111 (1,558 per 1,000)
• 1917 114,412 (1,364 per 1,000)
• 1918 98,733 (919 per 1,000)
• Total British 298,774 (90.5)
• Comparison total Indian 521,644 (91)

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5.vi Palestine
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Conclusions

• 1. Differences between theatres not simply due to
  geographical/operational factors
• 2. Sanitary and medical conditions were improved,
  even in unpromising conditions
• 3. Main reasons for this were external scrutiny
  better resources better CO-MO relationships
• 4. Manpower economy a strong stimulus to good
  medical arrangements
• 5. But morale of troops and families equally
  important hence importance of external scrutiny
• 6. Medical and sanitary advances in advanced
  nations diminished fatalism, while
  democratization and class politics increased
  political stakes