Health for HeroesPrior to the early 20th Century the majority of

casualties were not due to hostilities but sufferingillness or death from disease often as the result of

poor hygiene or debilitating parasitic infestation. Aseach of these were conquered the efforts turned to thecombating the effects of blood loss.

Prevalent Diseases

No Aseptic TechniqueJoseph Lister had not yet popularised the use of antisepticsin surgery.

• Doctors ignored the cleanliness of their surgical instrumentsand wounds became infected during surgery.

Crimean War 1854-1856• Within a few weeks of the British Army’s arrival in the Crimea,

around 8,000 soldiers had contracted cholera or malaria

• The swift spread of disease amongst wounded soldiers was mainlydue to insanitary conditions in the hospitals

• Most lacked effective sewerage and ventilation

• Severe overcrowding

• Many more soldiers died from cholera and dysentery than battle wounds

As the incompetence of the medicalservices in the Crimea became commonknowledge, EA Parkes was appointed totake charge of a temporary hospital atRenkioi in the Dardanelles to relievepressure on the hospitals in Scutari.

1858 RoyalSanitaryCommissionAs a result of the glaring faultsof organisation in the ArmyMedical Department, a RoyalCommission was convened.

• Parkes served on theCommission, which includedFlorence Nightingale, toinvestigate the healthof troops

• The establishment of aArmy Medical School with abrief to instruct youngMedical Officers inmedicine, surgery, hygieneand sanitary science

• The first Army MedicalSchool was set up at Fort Pittin Kent

• Parkes became the firstProfessor of Military Hygiene

• After three years the ArmyMedical School moved to the1000 bedded Royal VictoriaHospital at Netley nearSouthampton Water

• 1863, Parkes produced hisManual of Practical Hygienewhich was to run to eighteditions 1864 –1891

After TheCrimean WarThe Royal Commissionhighlighted issues that needed tobe addressed: the commissionordered that sanitary expertsshould report on the suitabilityof proposed sites for Armyhospitals and barracks: moresuitable sanitation facilitiesshould be supplied (e.g. properlydug sewers). The inadequateprovision of medical transportwhich was run by veterans ofprevious campaigns. Many ofthese veterans were in ill healthand consequently helped tospread infections such ascholera. Soldiers’ exposure toextreme cold resulted in illhealth. The commission orderedthe provision of suitableuniforms for different climates.

South African War 1899-1902The main killer in the war was again not the enemy but disease; 6,000 British soldiers were killed inaction whilst 14,000 died of disease (8,000 from Typhoid: 74,000 were treated). The advice of the newHygiene Officers was ignored, resulting in poor sanitation and drinking water. One problem was the longevacuation chain for casualties. Each soldier carried a field dressing which he was to apply to himself if wounded.

Pure DrinkingWaterColonel William Horrocks RAMCdeveloped the Horrocks Box.This device filtered waterthrough sand in order to providea portable method of purifyingdrinking water. It was particularly beneficial duringWW1 in keeping Allied forceslargely free from water bornediseases. Dr (Later Colonel)Sims Woodhead introduced chlorination of water in bowsersand devised a test for residualchlorine in the water. Its successlaid the foundations for continuous water treatmentuntil this day.

Health &Fitness OfRecruits• Of great concern at induction

was the general bad health ofthe nation

• Recruits were alreadyweakened by poor nutrition,tuberculosis or typhoid andwere susceptible tofurther disease

• High priority given to raisingthe nutrition and the fitnessof civilian population toprovide suitably fit men todefend the expanding empireand fight future wars

IBMS History Committee - Health for Heroes

• Typhoid

• Syphilis

• Yellow Fever

• Tuberculosis

• Malaria

• Undulant Fever

• Kala-azar

• Sleeping sickness

Edmund AlexanderParkes (1819 - 1876)

Lesson FromThe SouthAfrican WarThe high number of deaths dueto disease highlighted the needfor strict hygiene proceduresto be introduced into the hospitals. Sir Almroth Wrightand Captain Leishman (who later became DirectorGeneral of the Army MedicalServices) started work on an anti-typhoid vaccine.Resultant vaccination of 10million troops in WW1 largelyeliminated typhoid casualties.

Antibacterial revolution• In the decade from 1935-1945, a new class of medicines

capable of controlling bacterial infections launched atherapeutic revolution that continues today. It began inthe mid-1930's with the use of sulphonamides

• Penicillin was first used to great effect in the NorthAfrica campaign

• Both carried the main therapeutic burden in bothmilitary and civilian medicine