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Britain’s medical war: a brief comparison of health and medicine on several fronts

The First World War marked a turning point in military medical history. Among other things, it was the first major conflict – with the partial exception of the Russo-Japanese War (1904–1905) – in which there were more deaths from wounds inflicted in battle than were due to disease. The figures for all armies are not reliable, but from British figures alone, we can see that the disease–battlefield casualty ratio was dramatically reduced to 0.7:1 from 2:1 during the South African War (1899–1902) and 5:1 during the Crimean War (1854–1856). While the killing power of modern weaponry had increased, the relative decline of disease-related deaths reflected dramatic improvements in sanitation and hygiene, aided by some new technologies such as inoculations against typhoid and paratyphoid fevers. At the same time, there were significant improvements in casualty evacuation and treatment, which allowed a far higher proportion of soldiers to survive their wounds, and in many cases to return to battle. This was partly due to reduced evacuation times in theatres such as the Western Front, in which there was extensive use of ambulance trains and motor ambulances, as well as continual improvement of surgical procedures and the treatment of wound shock. Most combatant nations – with the exception of the Ottoman and Russian armies – experienced these improvements. It was a measure of both improvements in medicine and hygiene and of rising expectations. Over the previous 20 or 30 years, most advanced industrial nations had experienced falling mortality rates and there was a sense that deaths from infectious diseases – or even from wound infection – were no longer inevitable. The rise of humanitarian organizations such as the Red Cross contributed to this mood and led many to believe that care on the battlefield was a duty which the state owed to those who risked their lives for the benefit of the nation. By the time the First World War broke out, care-giving and medical relief were among the most visible aspects of propaganda. There were large donations towards medical aid and thousands were enlisted as nurses, doctors and medical orderlies. At the same