War’s Therapeutic History


Florence Nightingale tending the sick and wounded during the Crimean War. Lithograph E. Walker; Day & Son. Located in the Library of Congress. Copyright expired.

By A. G. Moore

It is ironic that throughout history, war has been an effective laboratory for creating advances in medicine. Human beings are the raw material of war. Injured humans, sick humans, cannot carry out the mission of their masters. They cannot win victories if they perish from wounds, or struggle with illness. It is in the interest of nations and the leaders of nations to protect soldiers. And thus, history shows, war has been the environment in which medical innovation and discovery has often occurred.

Of course, there have been idealists who labored, in war and peace, to improve medical care. No slight is here intended to these heroes. I am in awe of often unacknowledged and anonymous benefactors who give their lives to save the lives of others. But even in these instances, it has often been the case  that the work of the idealist is sponsored and supported by a less altruistic actor.

For example, Florence Nightingale traveled to the Crimea in the midst of a terrible war because she wanted to save lives. No one has ever been able to impugn the motives of this great nurse and medical innovator. Her actions saved not only British soldiers but countless soldiers of all nationalities who fought in successive wars.

As is typical of medical innovation prompted by warfare, Florence Nightingale’s insight and reforms also extended to civilian populations. She began a revolution in sanitation and nursing that has benefited every generation, civilian and military, across the world.

Not only did Florence Nightingale improve nursing and hospital practices, she also inspired a transformation in battlefield ethics. Because of her example and advice, the concept of neutrality for professional medical personnel evolved as a modern concept in warfare. The Geneva Conventions, which cemented this concept in international law, were a legacy of Florence Nightingale’s influence.

However, without the Crimean War, and without the English Crown’s need for healthy soldiers to carry on in battle, Florence Nightingale might never have gone to the Crimea. The English Crown was in crisis because of the appalling number of deaths suffered by its soldiers in the Crimea. This crisis threatened to deny the English a victory in the Crimean War.

Florence Nightingale became an angel to suffering soldiers in the Crimea and a savior to the English war effort. She became a popular figure to families in Britain whose loved ones were saved and she became a national hero because of her contribution to the war effort. Queen Victoria personally awarded Florence a unique medal, The Nightingale Jewel, in commemoration of her extraordinary service.

Medical innovation in wartime did not not begin or end with Florence Nightingale. In the ancient world, Greek, Egyptian and Indian doctors traveled to battlefields to treat the wounded. Improved surgical techniques were the result.

In more modern times, Jonas Salk worked on an influenza vaccine at the behest of the US government during WWII. It was the successful development of a flu vaccine that helped Salk to understand the direction to take in his research on a polio vaccine.

The carnage of war throughout history has been a prompt for development of therapeutic medicine. This is an opportunistic result: the attention and energies of great powers focus on medical care at these critical junctures because of battlefield imperatives. A true advance would be for state leaders to see the urgency of focusing on medical care in peacetime, when the needs of civilian populations are front and center. This would represent not only a revolution in medical science but also a essential evolution in the human condition.

Florence Nightingale’s Clean War

The picture shows Florence Nightingale tending to soldiers at Scutari during the Crimean War. Credit:Wellcome Images

Florence Nightingale is known world-wide as a nurse. She has been called The Angel of the Crimea and The Lady with the Lamp. In using these phrases, people take note of Nightingale’s compassion and service to humanity.  Often missed is her essential mission of cleaning up.  A battle for good hygiene, medical and otherwise, was at the heart of Florence Nightingale’s work.  In this week’s headlines we read about yet another antibiotic-resistant bacteria that is spreading across the globe. Overuse of antibiotics is at least partly to blame, but there is also an overlooked aspect to this threat: poor hygiene.

Modern medicine relies so heavily on treatment, anti-virals and antibiotics, that the role of prevention is often underplayed.  However, as Florence Nightingale knew, prevention is the first and best step in infection control. We may be facing a future that resembles the past, one in which infection rages unchecked with only our natural immunity and supportive care as a defense.

This is the environment in which Florence Nightingale honed her nursing skills. The nineteenth century had precious little to offer in the way of cure.  Florence Nightingale realized that the war against disease could be won in this context only if infection itself could be avoided.

Today, perhaps the clock is turning backwards.  Perhaps we, who have been spoiled by the easy access to cure, should return to the wisdom of a great nurse from the nineteenth century.  Clean up; wash hands: prevent the spread of disease.  This is the first and most effective step toward maintaining good health. It’s an old lesson, taught by a dedicated nurse.

We would do well to listen.

Florence Nightingale, Nurse Pioneer is one of the books offered in Rhythm Prism’s Skill-Building series  for young readers.