Between Flesh and Steel (12 page)

The siege provides an example of what happened when one army made attempts at military sanitation and the other did not. Charles V laid siege to the town on October 20 with a force of almost 220,000 men going against the city's force of fewer than 6,000 troops commanded by Francis, Duke of Guise. The besieging army conducted sanitary affairs as usual, and by December 26 it had lost more than 20,000 men to disease. The main killers were typhus, dysentery, and scurvy.
⁵¹
Although the losses to disease were not unusually large as a percentage of force for that time, they were great enough to force Charles V to abandon the siege.

Within the walls of Metz, the Duke of Guise proved himself a first-rate medical officer who succeeded in keeping his losses to disease relatively low through applying basic rules of field sanitation. Guise increased expenditures for rations to ensure his troops ate well. Water points were checked for purity and placed under guard. Any soldier who fell ill was immediately isolated from the rest of the garrison in hospitals provided at remote spots within the city. Special units of pioneers cleaned and swept the city streets. Any human waste or animal carrion was thrown over the city walls.
⁵²
Barber-surgeons were hired to attend the sick within the garrison and in the hospitals, the first time that the physicians of nobles were placed at the regular disposal of the common soldier.
⁵³
Physicians were appointed to oversee the quality and distribution of the food supply. No one was permitted to eat fish, venison, or game birds for fear that they might carry disease.
⁵⁴
These efforts were so successful that not a single serious outbreak of disease occurred during the sixty-five-day siege.

The siege of Metz is also known for the first instance of the period when a commander showed basic humanity to prisoners. It was common practice to butcher prisoners, especially the sick and wounded, who fell into enemy hands. Guise instead ordered that the enemy sick camps not be burned and that the captured sick prisoners be taken to hospitals within the city and given medical treatment. He communicated with the enemy commander, suggesting safe passage to units designated to police the area for additional wounded and sick, and supplied wagons for this purpose. A number of boats to transport the enemy sick to their home units were supplied, marking the first time since Rome that “hospital ships” were used to evacuate and treat the wounded.
⁵⁵
Guise's clemency, however, proved a disaster. Once he had transported the enemy sick to the city's hospitals, an epidemic of typhus spread from the prisoners to the larger population, killing hundreds.

Guise's example of humane treatment provoked a remarkable change in the treatment of the wounded that other armies gradually adopted. At the siege of Therouanne in 1553, Spanish troops who had fought at Metz remembered the French example of merciful treatment and did not kill a single prisoner. Again at Thionville in 1558, both sides followed Guise's example. The common practice of massacring those prisoners not reserved for ransom gradually declined. By the seventeenth century, the combatants themselves had established the custom of sparing prisoners, and from it sprung the idea that the wounded and sick should be treated as noncombatants. This idea was codified into international law centuries later in the Geneva Convention.

The Renaissance was more than a “revival of learning” insofar as it saw the discovery and promulgation of new medical knowledge. More important, the period produced a new type of medical practitioner, the military barber-surgeon, who could apply the new empirical medical knowledge on the battlefield. For the first time in a millennium, the soldier had access to some effective empirical medical talent to save his life. At first this talent was reserved for the nobility, but as the feudal armies gradually became national armies drawn from the citizenry, the leadership paid more
attention to the medical needs of the common soldier. The first embryonic stirrings of regular medical establishments in the armies of all the major states appeared, and the gradual introduction of humane rules and practices for dealing with the captured, sick, and wounded probably went some distance in reducing casualty rates. The first permanent military hospitals appeared, as did greater concern for caring for the disabled after their return from military service. Yet, it is important to remember that in all these aspects the Renaissance represented only the germination of new military medical ideas and practices. It took another three centuries before any of these ideas were carried to fruition in a manner sufficient enough to make a real difference in the quality of military medical care available to the soldier.

1
. The dates used here to define the Renaissance period encompass the most important military and medical events of the period. From a literary, cultural, and artistic perspective, however, the Renaissance can be said to have begun much earlier, perhaps as early as the twelfth century.

2
. The first outbreak of the Great Plague in Europe occurred in 1348. Outbreaks of lesser intensity occurred in 1361–1363, 1369–1371, 1374–1375, and 1390–1400. Historians have generally come to accept Jean Froissart's estimate that as much as a third of the population of Europe succumbed to the disease.

3
. Fielding Garrison,
Notes on the History of Military Medicine
(Washington, DC: Association of Military Surgeons, 1922), 107.

4
. The effects of disease and social disorder as they affected socialization mechanisms are found in John Rathbone Oliver, “Medical History of the Renaissance,”
International Clinics
1 (March 1928): 239–62.

5
. Among the more important medical humanists are Niccolò Leoniceno (1428–1524), who translated the aphorisms of Hippocrates and corrected the botanical errors in Pliny's
National History
; Thomas Linacre (1460–1524), who translated the major Galenic treatises on hygiene, therapeutics, temperaments, natural faculties, and the pulse; and François Rabelais (1490–1553), who translated the other major works of Hippocrates.

6
. It is probable that the first European press was not invented by Johannes Gutenberg but by Laurens Coster of Haarlem in 1440.

7
. Fielding Garrison,
Introduction to the History of Medicine
(London: W. B. Saunders, 1967), 193.

8
. Le Roy Crummer, “Joseph Schmidt: Barber Surgeon,”
American Journal of Surgery
4 (February 1928): 237.

9
. Charles L. Heizmann, “Military Sanitation in the Sixteenth, Seventeenth, and Eighteenth Centuries,”
Annals of Medical History
1 (1917–1918): 283.

10
. Garrison,
Introduction to the History
, 239.

11
. Ibid.

12
. For the dynamics of bullet flight and impact, see D. A. W. Hopkinson and T. K. Marshal, “Firearm Injuries,”
British Journal of Surgery
54, no. 4 (May 1967): 344–53.

13
. Firearms experts estimate the muzzle velocity of a black powder smoothbore musket firing
a half-ounce .50-caliber ball at standard charge to be approximately 1,100 to 1,350 feet per second, providing an impact energy of 350 foot-pounds at 50 yards. For comparisons with modern military firearms, see E. Stephen Gurdjian, “The Treatment of Penetrating Wounds of the Brain Sustained in Warfare,”
Journal of Neurosurgery
39 (February 1974): 157–66.

14
. See Robert D. Forrest, “Development of Wound Therapy from the Dark Ages to the Present,”
Journal of the Royal Society of Medicine
75 (April 1982): 269. Remarkably, the debate on whether gunshot wounds were poisonous continued until at least the early twentieth century, when in a curious twist it was held that the temperatures generated in firing modern weapons made bullet wounds essentially aseptic! See F. P. Thoresby and H. M. Darlow, “The Mechanism of Primary Infection of Bullet Wounds,”
British Journal of Surgery
54 (1967): 359–69.

15
. Henry E. Sigerist, “Ambrose Paré's Onion Treatment of Burns,”
Bulletin of the History of Medicine
15, no. 2 (February 1944): 144.

16
. Ibid., 143.

17
. Ibid., 148.

18
. Garrison,
Notes on the History
, 115.

19
. The best short history of Paré's contributions to Renaissance medicine is Owen H. Wangensteen, Sarah D. Wangensteen, and Charles F. Klinger, “Wound Management of Ambroise Paré and Dominique Larrey: Great French Military Surgeons of the 16th and 19th Centuries,”
Bulletin of the History of Medicine
46, no. 3 (May–June 1973): 207–34.

20
. Ibid., 214.

21
. J. S. Taylor, “A Retrospect of Naval and Military Medicine,”
U.S. Naval Medical Bulletin
15, no. 3 (1921): 575–76. Thomas Gale (1507–1586) of England performed similar experiments with firearms at about the same time.

22
. Wangensteen et al., “Wound Management,” 213.

23
. Ibid., 214.

24
. Garrison,
Notes on the History
, 99. Some famous physicians who served in military campaigns were Nicholas Colnet and Thomas Morestede with Henry V at Agincourt, Hans von Gersdorf with the Swiss at Grandson, Gabriel Miron with Charles VII at Naples, Marcello Cumano with the Milanese armies at Novara, and Symphorien Campier with Francis I at Marignano.

25
. Heizmann, “Military Sanitation,” 284.

26
. The only extant work on the subject of Swiss military medicine in the Renaissance was written by Dr. Conrad Brunner,
Die Verwundeten in den Kriegen den alten Eidgenossenschaft
(Tübingen, 1903).

27
. Ibid., 57.

28
. Ibid., 52–54.

29
. Ibid.

30
. The Soviet Army used the term “feldscher” as an official title for its combat medics at least until 1990.

31
. Modern weaponry's increased killing power necessitated tacticians' spreading out their forces, and the consequential dispersal of the wounded still bedevils modern medical planners. Using medevac helicopters as a solution works only if one controls the air over the battlefield. Otherwise, the helicopters are themselves vulnerable to new long-range weapons, as the Soviets found to their dismay in Afghanistan.

32
. The Landsknechte were heavy infantry armed with muskets, halberds, and bows. The state
partially provided their pay, and they were permitted to loot and keep the booty as a supplement to their pay.

33
. Heizmann, “Military Sanitation,” 284. These early regulations are regarded as the birth of the German military medical service.

34
. Ibid., 281–83.

35
. Ibid., 284.

36
. Ibid.

37
. Garrison,
Notes on the History
, 103–4.

38
. The thousands of female camp followers who usually attended the armies of the period certainly contributed to the spread of syphilis, which was epidemic.

39
. Heizmann, “Military Sanitation,” 285.

40
. Garrison,
Notes on the History
, 104.

41
. Heizmann, “Military Sanitation,” 284.

42
. Garrison,
Notes on the History
, 105.

43
. Ibid.

44
. Taylor, “Retrospect of Naval and Military Medicine,” 598.

45
. Ibid.

46
. Ibid.

47
. Some idea of how slowly the notion of providing long-term care to veterans developed can be obtained from noting that the disabled veterans of the famous Light Brigade at Balaclava during the Crimean War were not provided any care at all. In desperation, the disabled veterans sent representatives to their commander, Lord Cardigan, and asked him to plead their case with the government. Cardigan sent them away, promising to ask the government to grant a special dispensation so that his troops might be given preference in obtaining beggar's licenses!

48
. This remained the case until the Franco-Prussian War of 1870–1871 in which for the first time more men were lost to enemy fire than to disease. The low loss rate to disease resulted in large part from the discoveries of Robert Koch, who developed the theory of the etiology of disease and established regular sanitation officers in German units.

49
. Reginald Hargreaves, “The Long Road to Military Hygiene,”
The Practitioner
196 (March 1966): 441.

50
. Heizmann, “Military Sanitation,” 281.

51
. Carey P. McCord, “Scurvy as an Occupational Disease: Scurvy in the World's Armies,”
Journal of Occupational Medicine
13, no. 12 (December 1971): 588.

52
. Heizmann, “Military Sanitation,” 285.

53
. Garrison,
Notes on the History
, 106.

54
. Heizmann, “Military Sanitation,” 286.

55
. Ibid., 287.

The new empirical spirit of the Renaissance threatened much more than the storehouse of knowledge inherited from the Middle Ages. The spirit of empirical inquiry was rooted in new notions of individualism, themselves products of the wide-ranging social disruption that the plagues and wars of the period engendered. The same spirit of individual inquiry that made the new knowledge possible also undermined the collectivism that had underpinned the European social order for more than a millennium. It was this “spirit of individual disorder” as much as the plagues, wars, and new technologies of the seventeenth century that weakened the social institutions of the old order.

The old intellectual tradition of inquiry based on scholastic reasoning, first principles, and absolute causes remained strongly in place as the new century dawned. The new empirical knowledge had not yet achieved a level of generalization or acceptance capable of challenging the old approaches to medicine and science on any scale. At the same time, the new knowledge was sufficiently accurate to seriously call into question the ability of scholastic assumptions and methods to explain the physics, science, and medicine of the day. As the intellectuals of the seventeenth century conceived it, the challenge was not to discard the age-old idea of a universal order but to utilize empiricism to demonstrate the validity of that order.