Guest Editorial

This year, you could hardly have missed it: It is 100 years since the First World War started. We have already seen many services of remembrance, commemorations, conferences and exhibitions. At the same time, there has been increasing attention paid to re-evaluating the role of medical aid during the war, not only in medical history magazines, but also in more generalist journals like First World War Studies, which has regularly published medicine-related articles. A book on British medical aid has recently been published (Harrison 2010), as has a book containing chapters on medical aid in Germany and the Austro-Hungarian Empire (Hofer, Prüll, and Eckart 2011).

This is not surprising, for the subject is anything but exhausted. Nor can it be, because the war was too varied, medicine was too varied and as a consequence medical aid during the war was certainly too varied. It differed from country to country, from army to army and from frontline to frontline. Take, for instance, the role of psychiatry in Austria-Hungary. Because of its multi-ethnic, multi-lingual army, the mostly German-speaking psychiatrists and neurologists used the – relatively mute – ‘quick cures’, such as electric current, longer and more harshly than their German, French or British colleagues (Hofer, Prüll, and Eckart 2011, 49–71).

Medical care also differed according to whether a wounded or sick soldier was treated in an official military medical ambulance, an ambulance provided by Quakers or by a neutral country. And then there was the huge variation in the personal convictions, attitudes and characters of the individual doctor or nurse providing the care. Did he or she embrace war as the ‘doctor of doctors’, strengthening the mind and body of the people or race? Or did he or she curse war for all the physical and mental damage it inflicted on the individual?

It is clear from this that war not only influences medical practice, but also medical thinking. This is, however, not to say – as is frequently claimed – that ‘war is good for medicine’. On the contrary, medicine – certainly for the First World War – was good for war. Without medical care, the different battles would have had to be waged with fewer soldiers and as a result, would not have lasted so long. As a consequence, medical aid not only saved lives; it also cost lives. Not for nothing did the war give rise to voices calling for a medical strike, for that would be more in keeping with the Hippocratic oath than the constant patching up of the wounded, only to return them to a new baptism of fire.

But war also indirectly influenced medical decision-making. It is, for instance, not a coincidence that after decades of deliberation, in 1917 – the year the United States entered the war – it decided to build a leprosarium on the mainland, in addition to the already existing one in Hawaii. The debate was decided by the fear that ‘strange, coloured troops’ from Asia and Africa would contaminate American soldiers who would then re-introduce the dreaded disease into America (Gussow 1989, 11).

The many books, articles and lectures written and given on medical care during the First World War overwhelmingly concentrate on one country, one front, one hospital or even one doctor. But what does this mean, I thought, when asked by the Editors of Medicine, Conflict and Survival to put together this special issue on medical care and the First World War, if the findings are not compared with other countries, other fronts, other hospitals and other doctors? In pursuit of such insights, we asked researchers to combine their strengths, to put their expertise and their research findings together in order to produce contributions that try to explain the differences and similarities between cases.

Heather Perry and Julie Anderson have researched orthopaedics and disabled soldiers in Germany and Britain, respectively, and they reflect on their findings in their joint article ‘Rehabilitation and Restoration’. They conclude, for instance, that both British and German orthopaedists wanted to speed up the recovery of the wounded (and as a result, the re-deployment of healed soldiers) and therefore, both exemplify the usefulness of medicine to war. However, due to the more desperate manpower situation and because – unlike Britain – it had a civilian labour draft on the home front, in Germany, even those with multiple amputations became part of this process of healing and re-deployment in either the military or civilian mobilisation programmes. Furthermore, in Germany, more effort was put in trying to retrain them as much as possible for jobs useful for the war effort, whereas in Britain, their part in the war was over. Retraining was focused on civilian life.

In ‘Shell Shock and the Kloppe’, Fiona Reid and Christine van Everbroeck think through the differences between (and similarities in) the medical reaction to war neuroses in Britain and Belgium. To name but one difference, they conclude that the significant differences in approach, leaving aside obvious reasons, such as the scale of the problem and the different contexts of occupied Belgium versus unoccupied Britain, were due to the fact that, unlike in Belgium, after the war, shell shock became part of British national debate and identity.

Susanne Michl is one of the few scholars who has taken a comparative approach in her own research (for more examples, see the article by Perry and Anderson). In her book Im Dienste des ‘Volkskörpers’ (In the service of the ‘People’s body’) (Michl 2007), she compared French – highly centralised – and German – much more decentralised – medical discourse. In her article in this issue, ‘Mapping the War: Gender, Health, and the Medical Profession in France and Germany, 1914–1918’, she goes into the medical profession’s reaction to two war-related health conditions (sexually transmitted diseases and war neuroses), focussing in particular on the ways in which the medical profession, like the military, divided the world into a male combat zone and a female home front. She concludes that one of the main reasons for differing medical politics between France and Germany was that the male war zone was within French and not within German borders. Therefore, the ‘German’ female home front included occupied France, making possible experiments that would never have been allowed in Germany itself.

In his essay, Mark Harrison shows and explains the differences between medical aid in one and the same fighting force, the British, on different fields of battle. Of course, this is partly due to local circumstances, but differences in the personal attitude of commanding officers and the distance from the home front also played a role.

Finally, as a – most valuable and interesting – addendum, we have also included a commentary from Nick Wilson and George Thomson, ‘The First World War: Ten Artworks Illustrating Some Key Health Impacts’, on pieces of art picturing medical activities in the years 1914–1918. For not only archives, diaries, newspaper articles and so forth, shape our understanding and knowledge of the past. Art – such as literature, music, dance, fashion, sculptures and paintings – does this as well; and in some respects, even more so.

We are certain that this approach and the variety of subjects covered will turn this issue of Medicine, Conflict and Survival into a valuable contribution to the existing literature on healthcare in what Mark Harrison has called ‘the medical war’.

Notes on contributor

Leo van Bergen is a medical historian, currently working at the Royal Netherlands Institute of South East Asian and Caribbean Studies on a book on leprosy in the Dutch East Indies. He has also extensively researched the relationship between war and medicine, with an emphasis on the First World War. His published works include Before my Helpless Sight: Suffering, dying and military medicine on the Western Front (Farnham: Ashgate, 2009); ‘Military Medicine’ in Jay Winter (ed.), The Cambridge University History of the First World War. Part 3: Civil Society (Cambridge: CUP, 2014); and ‘Medicine and Medical Services’ for 1914–1918 Online, International Encyclopaedia of the First World War (http://encyclopedia.1914-1918-online.net/article/Medicine_and_Medical_Service).

Leo van Bergen
Guest editor