Two decades ago, historians of military medicine started asking, ‘Is war good for medicine?’ Mark Harrison has made important conceptual and methodological contributions towards answering this question.In particular, he has helped develop a Weberian approach, which examines the complex interchange between industrial, military and medical discourses, practices and institutions in the prosecution of modern warfare. The Medical War marks the culmination of this project, which has already yielded a monograph on the Second World War and two pioneering collections. Bringing to bear a sociological history on the organisation, development, and role of British military medicine in the First World War, Harrison shifts concern from war as a vehicle for medical modernisation, to argue that, between 1914–18, modern medicine became crucial to waging modern war. This book redresses the relative lack of historical work on this relationship and, in rich empirical detail, explains how it was forged. Harrison convincingly shows that British military success (and failure) cannot be fully understood without taking into account organisational and technical innovations in military medicine. The book’s broad scope, examining the workings of the medical machine in different theatres, represents a major rewriting of the official medical history of the War.
As late as 1914, British military planners resisted the idea that medicine was crucial to the war machine. Harrison attributes this situation to the recalcitrance of Victorian military attitudes, poor professional relations between medical and military officials, and a general lack of foresight about the unique demands of modern warfare. The shock of the Western Front prompted the reconstruction of military medicine based on a highly integrated, hierarchical, and increasingly specialised system of forward medical provision and casualty evacuation. This system became the benchmark for the organisation of medicine in other theatres, and Harrison justly devotes almost half the book to its development, highlighting innovations and changes in surgery, wound treatment, disease prevention, orthopaedics, cardiology, physiology, and psychiatry. Much of this story is well known, but Harrison’s synthesis of existing studies should be welcomed. What he also provides is an explanatory framework that traces the roots of the new system to the conditions of trench warfare and changing battlefield tactics; the demands of manpower economy and keeping soldiers fighting fit; and the increasingly important role of medicine in maintaining morale among troops and civilians. This last point is especially important, as it sheds light on how medicine was mobilised as a vital symbolic resource for humanising the War, and also how it became the target of far-reaching criticisms of the War’s management.
Particularly salient is the contrast between the new administrative rationality orchestrated by the War Office and the hard realities of implementing the medical system. Professional tensions between civilian consultants and enlisted practitioners had to be overcome, as did worries over bringing women – primarily as nurses – into the ranks. Harrison’s narrative comes alive when he turns from high-level organisational politics to the view from the ground, where administrative decisions both saved and cost lives. His use of medical officers’ diaries and personal accounts to reconstruct the challenges of putting the new system into action makes for compelling reading. Stories of ambulance and frontline services struggling to retrieve and attend to thousands of injured, humanise the rational schemes of medical planners. Harrison’s discussion of the uniquely British problem of building an effective medical system out of services drawn from across the Empire is especially significant, as it sheds new light on the peculiar difficulties of incorporating Indian soldiers and medics into the war machine.
When Harrison shifts from the Western Front to campaigns in Gallipoli, Mesopotamia, Salonika, and East Africa, the story of medical success also shifts to one of near calamitous failure. By examining these campaigns a comparative perspective is introduced, illuminating the different environments in which the War was waged, and the varied demands they placed on medical organisation. This perspective gives insight into the difficulties of adapting the medical system to other contexts. Much of the analysis in these chapters revises historical accounts of official commissions into mismanagement and failures in medical provision during the first years of the War. Harrison shows how the commissions drew attention to perilous medical conditions in theatres far from home, and how subsequent public and political pressures factored into efforts to improve the system. While Harrison reserves making strong retrospective judgements, he nonetheless argues that failures to provide effective casualty evacuation, control measures against malaria and other tropical diseases, and adequate supplies of water in these theatres, were rooted in incoherent command structures in which individual generals and senior medical officers lacked accountability.
This analysis will be of interest to military historians. But it is rather traditional, largely concentrating on rewriting official history. More generally, The Medical War is not especially innovative historiographically. It makes sparing use of a large body of gender and cultural history of the War. Cultural questions about military medicine as an institution are taken up in terms of the familiar problem of citizenship, and framed around examples such as hygiene duties to ward off venereal diseases.
In this respect, The Medical War reveals a key limitation with the sociological history of military medicine that Harrison has helped to pioneer. For although this approach provides a powerful tool for reconstructing the organisational rationality underpinning war medicine, it offers correspondingly little insight into its subjects – the sick, the wounded, or the dying soldier. Harrison’s narrative recapitulates the brutal logic of the manpower economy that military medicine served to maintain. But rarely does one encounter the suffering body to which medical officers, surgeons, nurses, and stretcher-bearers had to tend, and around which medicine was organised. Harrison acknowledges this limitation, but there remains a significant gap in the story of how medicine became essential to the making and success of the British war machine. For surely soldiers’ experience of medicine had a crucial bearing on their perceptions and performance, and is thus central to understanding the relationship between military medicine and the prosecution of the War.
So while The Medical War is essential reading for military and medical historians of the First World War, and most certainly will become a standard teaching text, the soldier’s experience in military medicine still needs to be written into the story.
