J.T.H. Connor, Ph.D., Assistant Director, National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, DC

Overview Twentieth-century warfare started a little ahead of schedule with America's war with Spain, which began with the Cuban Campaign in 1898.  While this conflict shared important features with the Civil War – notably more men dying from disease than of battlefield trauma – it can be characterized as the first 'modern' war with respect to military medicine. Full aseptic technique and X-ray technology were employed for the first time during a war, thereby greatly enhancing the surgeon's skill in locating and removing bullets and metal fragments and minimizing the chances of infection. Hospital ships were designed and built to treat wounded personnel in a timely way. And the tools and techniques of the bacteriology laboratory were later deployed to determine the cause of tropical diseases such as yellow fever that afflicted so many servicemen and civilians alike.  Beginning with this conflict, warfare, too, became 'modern.' Small arms ammunition now included metal-jacketed bullets that moved faster and further than their Civil War counterparts; but the new type of rounds often were less destructive to tissue upon impact. Just as armament manufacturers undertook research to perfect their products and undertake studies to refine the science of ballistics, research undertaken by army doctors such as Louis LaGarde helped change the study of gunshot injuries and their treatment from an empirical art into a medical science.

As medicine and warfare were becoming modernized at the turn of the twentieth century, so too were developments in the political/diplomatic arena – the third leg of the tripod of war. In many respects the activities of diplomats and councilors during the late 1890s were stimulated by developments in military technology and the biomedical sciences as they extended and further defined the concept of 'conventional' warfare.  When delegates at the 1899 Hague Peace Conference agreed to prohibit the "launching of projectiles from balloons, or by other new methods of a similar nature" and abstain from using "bullets which expand or flatten easily in the human body [so-called dumdum bullets]" as well as "projectiles the object of which is the diffusion of asphyxiating or deleterious gases," they were trying to contain fast-moving modern technological developments within the harness of the rules of civilized engagement first promulgated thirty years earlier. (The Declaration of St Petersburg of 1868 stated that the "progress of civilization should have the effect of alleviating as much as possible the calamities of war [such as] the employment of arms which uselessly aggravate the sufferings of disabled men, or render their death inevitable...")

By the onset of the twentieth century then, the heightened tension between improved ways of injuring men and repairing them was much in evidence. Throughout this century, probably more than any era before, the role of the physician and biomedical technology and science in general, became ambiguous. During the 1900s, the laboratory bench was the site of countless miraculous discoveries that saved and prolonged the lives of soldiers and civilians. But the same knowledge that gave these people a fighting chance to survive also could be used against them as, for example, when compounds toxic to the nervous system and bacteria became weaponized. As the noted military historian, John Keegan, states in his The Face of Battle, "military surgeons [once] so successful¼have thus now to meet the challenge of wounding-agents deliberately conceived to defeat their skills" (p.326).

This presentation will examine this fundamental twentieth-century dilemma by exploring selected historical episodes in which the technology of modern medicine and unconventional and conventional warfare often intersected, if not collided. Examples to be discussed include the early use of radiology in military surgery; gunshot wounds and their management; and gas poisoning. In so doing, participants should:

• Gain an understanding of the evolution of medical technology
• Reflect on the interconnections between medicine and society
• Appreciate the links between military and civilian medicine
• Pose questions about how such matters will evolve in this century

Further Reading Every nation has gone to war; most armed forces have their own official histories. Accounts of and by victors and vanquished abound, thus the field of military history is rich and varied. A useful introduction to military history and the writing of military history, however, is John Keegan, The Face of Battle (London: Penguin Books, 1978). The history of military medicine is a similarly rich field, which includes many first hand accounts by military surgeons, medics, and nurses. A good starting point for the study of twentieth-century issues is Roger Cooter, Mark Harrison, and Steve Sturdy (eds.), Medicine and Modern Warfare (Amsterdam: Rodopi, 1999) which contains ten useful essays that also cite a great deal of the standard works dealing with war and medicine. Perhaps the most encyclopedic source is the multi-volume Textbook of Military Medicine published by the Office of the Surgeon General of the United States Department of the Army. Individual volumes in this series such as Conventional Warfare: Ballistic, Blast, and Burn Injuries and Medical Aspects of Chemical and Biological Warfare, in addition to presenting current knowledge, also contain much useful historical information.