Necessity is the mother of invention
James Cassels | 27 March 2017

It is not my intention to downplay the disastrous consequences of war, however I will discuss the medical advancements which have war to thank. Our history is peppered with the devastation of war, from the distant An Lushan Rebellion over a thousand years ago, to the terrors of the Nazis 70 years ago. It is not often, however, that we ponder on how each of these dark corners of human history has actually provided us incredible biomedical advancement in areas such as Orthopaedics and Plastic Surgery. History is littered with medical pioneers, whose achievements have gone unrecognised in the general noise of war.


One of the most incredible lost masterminds is a French surgeon named Ambroise Paré, a “pioneer who led a revolution in surgery - one that...vastly improved prospects for the seriously wounded.” The work of this 16th century surgeon, which is still evident today, has saved the lives of countless. It may seem peculiar that one man can be singled out from a boundless history of medical entrepreneurs, however Paré undeniably revolutionised surgery. Despite vanguarding medical advancement in areas such as wound treatment and Pneumothorax, Paré’s most prominent work was in the field of amputation. In many of the surgical procedures performed to date, a form of tourniquet is utilised in order to stem or otherwise reduce bleeding in an appendage which is under operation. Paré forefronted the use of the tourniquet to hinder blood loss in amputee victims, discovering that the use of a tight cord (ligature) around an artery could moderate blood loss, and potentially save the lives of amputees. Much of the practical experience Ambroise undertook was as a field surgeon during the Siege Of Turin (1536-7). This devastating battle caused such considerable damage to the French army that the field doctors exhausted supplies to treat the gunshot wounds - Paré used this to experiment his own remedies, and in turn attained a far superior survival rate of his patients.


There is one notable war in which great a medical advancement occurred; this was not the discovery, but rather the production, of a drug that was catalysed by war. Although Fleming discovered penicillin in 1929, its demand during the Second World War was so great that it forced chemists to trial new, faster, and more atom-efficient methods of its synthesis. Howard Florey realised its potential as an antibiotic, spending time concentrating the compound and, by doing so, saved the lives of thousands of soldiers. Florey was awarded the Nobel Prize for Medicine in 1945 for his work in this field. A great example of how war has advanced medicine in innovative uses of known advancement rather than causing the discovery itself.


Medicine has had to rapidly adapt in order to keep up with weapon innovation, one such example is Biological Warfare. Biological Warfare consists simply of the use of biochemistry to cause harm to humans, which is often accomplished by the deliberate targeted or wide-scale use of deadly bacteria or toxins found in nature. There is a massive difference between treating a gunshot wound and curing a deadly virus. WWI acted as a sort of macabre clinical trial for the use of chemical weaponry which leads to the use of the infamous Mustard Gas with its horrific results. During the First World War it is estimated that there were over 88,000 fatalities due to toxic gas exposure alone. However the aim of these gases was not usually to kill but was far more devious. Much of the time, the aim was to hospitalise the enemy, causing them to use time, people, and resources to care for these patients. The effectiveness of this strategy is evident as over 1.2 million soldiers were hospitalised due to chemical gas exposure; countered only by treatments which were quickly devised by army nurses with the use of various different chemicals. This was undeniably a time of great strain on the medical profession, but the low mortality rate of the toxic gases is a credit to them.


Reconstructive surgery is an area of medicine that took huge strides forward during the strife of war. This faculty is deeply involved with orthopaedic surgery due to both its mechanical as well as aesthetic nature. Reconstructive surgery is much more than implants and reductions that we hear about in life today; the results of orthopaedic surgery in wartime were usually far more life changing for the patients. Veterans of war have been blessed with prosthetic limbs to replace those lost from the trauma caused by war with exponential advances made from the wooden leg days of the mid 19th century. However, it is not just limbs that can be replaced. Skin from one part of the body is used to heal, usually, burn injuries and reconstructive surgery is used to repair traumatised facial features.


We are all aware of the devastation that war causes which takes the lives of both the combatants but usually civilians too and shatters homes, tearing apart families. However, it is important to recognise the work done by doctors, nurses and chemists alike that help us counter the injuries of war and who take those advancements on to good use in peacetime. We need to recognise that war has been the ‘necessity’ that has caused the innovation and invention that has benefited mankind by bringing medicine to the high level of attainment that we see today. The potential for a patient to survive treatment is greater than it was 15 years ago, and infant mortality rates are 68% lower than 20 years ago. Medicine has undoubtedly advanced greatly in recent years, and, as I have discussed, we must see the effect war has had on catalysing this advancement.


"War, by producing so many and such appalling casualties, and by creating such widespread conditions in which disease can flourish, confronted the medical profession with an enormous challenge - and the doctors of the world rose to the challenge of the last war (WWI) magnificently."

- Brian J Ford.

James Routledge 2016