War and Medicine

Disqualifying Diseases...186
A Doctor's Memories:...189
Circular Letter No. 36...191
Medical Intelligence...196
Sorting of Casualties...198
Anthrax as a Biological Weapon: Medical and Public Health Management...201
Médecins Sans Frontières (Doctors Without Borders)...203

The following section regarding war and medicine touches on a special subdivison of clinical medicine, the treatment of soldiers, and war-related injuries and diseases. War is inherently destructive: knives, bullets, bombs, and radiation exposure all wound and maim. These injuries often require immediate emergency medical attention in the form of surgery.

In the chaos of combat, medical care can be difficult to provide. Then, as now, a key task for physicians and nurses is the sorting of casualties by priority of treatment (triage), so that medical resources can be used most effectively and the most lives saved. In some conflicts, as was the case in the Spanish-American War, the toll from disease can be higher than that caused by battle.

Soldiers are not the only casualties of war. Civilians are often unintended victims as well. Additionally, war often results in large numbers of refugees that live in crowded, makeshift conditions that help breed disease. Medecins Sans Frontiers (Doctors Without Borders), an international aid organization founded in 1971 (and which received the 1999 Nobel Peace Prize) continues to provide medical services worldwide to victims of war or internal conflicts, as well as in the wake of natural disasters.

War has spurred the development of significant advances in medical techniques and medicines. For example, penicillin was first mass produced for troops during World War II (1938–1945). Also during that war, dried plasma, which could be preserved longer than the liquid version, was used for the first time, saving the lives of thousands of allied soldiers. Since the Second World War, significant military resources have been devoted to "medical intelligence," understanding the medical and health needs of soldiers in the field.

While biomedical science has been used to save lives at risk due to war injuries, it has also been used to create weapons of war. The use of disease-causing (pathogenic) bacteria and other microorganisms as weapons of war has been practiced for centuries. However, beginning in World War I (1915–1918), their use became more sophisticated. Microorganisms that can be easily dispersed in the air are potential biological weapons, especially microbes such as Bacillus anthracis (the cause of anthrax) that form structures called spores. Spores can persist in the environment for extended periods (at least a century) and, when inhaled or exposed to a wound, can germinate into the growing and pathogenic form of the organism. These conveyers of anthrax have been a biological weapon for centuries, but, as occurred in the aftermath of the September 11, 2001 terrorist attacks in the United States, can now be deployed in a much more directed and sophisticated way.

The genetic era has also influenced war and medicine. In countries that include the United States, dedicated military research facilities currently work on the genetic aspects of microbial diseases. In the case of the United States, this research is presently aimed mostly at developing vaccines, although in the past, countries including the United States, Britain, and Canada maintained offensive biological warfare programs.