New Maine Times Book Review:Between Flesh and Steel

Posted Tuesday, December 10, 2013 in Culture

New Maine Times Book Review:Between Flesh and Steel
BETWEEN FLESH AND STEEL:  A HISTORY OF MILITARY MEDICINE FROM THE MIDDLE AGES TO THE WAR IN AFGHANISTAN
By Richard A. Gabriel.
Potomac Books, 2013.
300 pages, $34.95.
ISBN 978-1-61234-420-1.
 
Reviewed by William D. Bushnell
 
Hippocrates once wrote:  “War is the only proper school of the surgeon.”  Sadly, history has proved him right, for war not only drives developments in weapons and technology, it also provides essential incentives for the development of military medical innovations that actually benefit all society.
 
BETWEEN FLESH AND STEEL is New Hampshire author Richard Gabriel’s marvelous history of military medicine in war, from the “squalid butchery” of the Middle Ages to the increased lethality of today’s modern weapons.  Gabriel is a prolific historian, author of numerous non-fiction books, including biographies of ancient historical figures like Carthage’s Hannibal and Rome’s Scipio Africanus.
 
Much has been written about war, weapons, and technology, but few books cover the advent and development of military medicine as succinctly and completely as Gabriel’s new book.  This is a comprehensive, revealing (and occasionally gruesome) look at military medicine through the ages, as it struggled vainly to keep pace with the lethality of modern weapons, especially gunpowder and bullets over swords and spears.  As Gabriel shows, early military medicine could not prevent battlefield deaths, and its primitive methods actually prolonged the agony of the wounded.
 
He examines war and armies from the Middle Ages to today, describing in vivid detail the military medical theory and practice of the day, from the early “cutters” and barber-surgeons of the 17th and 18th centuries, and Napoleon’s innovative “flying ambulances” for battlefield casualty evacuation, to Korea’s MASH units and today’s fascinating treatment of trauma wounds and PTSD.
 
Gabriel also describes the medical quackery, superstition, and religious dogma that impeded advances in military medical care.  For example, in the Middle Ages and even later, surgeons had no formal training and often were self-taught barbers.  Physicians were held in high esteem, but barber-surgeons were considered low-class “cutters.”
 
Additionally, monarchs and military commanders had little regard for the care of their soldiers, such consideration was viewed as an unnecessary, needless expense.  It was only after the formation of national armies that rulers saw the value in providing medical care to their troops.  Still, military medical care was rudimentary at best, focusing on treatment of wounds, and ignoring the biggest casualty producer – disease.
 
Gabriel explores the nature of warfare and casualties through time, highlighting individual wars and armies, and how military medical care improved through experience and innovation.  The Swedish army under Gustavus Adolphus was one of the first national armies to assign barber-surgeons to regiments and individual companies of infantry and artillery.  The 18th century saw the French create the first formal training of military barber-surgeons, surgeons’ mates, and medical orderlies.
 
He goes on to tell of prominent medical men who revolutionized the treatment of wounds and battlefield stress, the creation of military hospitals (that initially were merely “nests of infection, filth, and death”), and the development of effective field sanitation to reduce disease.  Up until the Russo-Japanese War in 1904-1905, for example, disease accounted for more military deaths and casualties than any battlefield weapons.
 
Most revealing, however, is Gabriel’s telling descriptions of remarkable military medical breakthroughs like improvements in battlefield wound and burn treatment, psychiatric care, advances in personal hygiene, antiseptic surgery, vaccinations, anesthesia, intravenous blood transfusions, shock treatment, bacteriology, casualty evacuation, hemostatic forceps, hypodermic syringes, new drugs, and the introduction of soldiers’ first aid kits.
 
Gabriel offers no solution to the destructiveness of war, but he clearly explains the fervent desire of military medicine over the years to relieve the suffering and pain of the dying and wounded.  This is graphic, colorful history well told.  And Hippocrates was right once again.
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