14. A good account of the development of artillery through the ages can be found in Albert Manucy, Artillery through the Ages (Washington, DC: U. S. Government Printing Office, 1985).
15. Gabriel, “History of Armaments,” 8.
16. Ibid.
17. Before the increased mobility provided by horse artillery, it was common for one side or the other to overrun the opponent’s gun positions. During battle, the forces ebbed and flowed over the same position several times. Special squads of “spikers” rendered the guns useless by driving a large iron spike into the touchhole of the cannon.
18. The idea that tanks are derivative from cavalry and to be used as such is an American and Western concept. In Russia, where artillery caused great casualties during World War I, tank design and tactics were derived from artillery doctrine, not cavalry. The Russians always mounted larger, longer-range guns on their tanks and used them in large numbers to bring the enemy under fire before the enemy’s guns could engage the Russian and Soviet tanks. Right from the beginning, Russian and Soviet tanks mounted 85mm, then 120mm, and now 122mm guns, which are much larger and longer ranged than the common 105mm tank cannon used in the West.
19. A good work on the relationship of national economies to war in this period is Paul Kennedy’s The Rise and Fall of the Great Powers (New York: Random House, 1987).
20. Gabriel, “History of Armaments,” 8.
21. Dupuy, Evolution of Weapons and Warfare, 191.
22. The world’s armies were quick to realize the potential of the railway. In the Italian War of 1859, the French moved 604,000 men and 129,000 horses by rail in three months. Dupuy, Evolution of Weapons and Warfare, 202.
23. Condensed milk was developed as a military ration that would not spoil in warm climates.
24. Gabriel, “History of Armaments,” 12.
25. The process of massing artillery guns on target is called “sheaving,” after the agricultural process of gathering individual stalks of wheat together in a single bundle. Modern firing computers now make what was once an important skill a common capability.
26. Gabriel, “History of Armaments,” 13.
27. The aileron was not, however, an immediate success. In World War I, the famous German ace, Max Immelman, flew a Fokker Eindecker, a fighter aircraft that did not have ailerons. Immelman invented the complex maneuver that bears his name to this day, the Immelman turn.
28. Germany was the exception among the great powers and did not pursue colonial ambitions with any vigor. Setting German policy thirty years before, Chancellor Otto von Bismarck noted that colonies “were not worth the bones of a single Pomeranian grenadier.”
29. Gabriel, “History of Armaments,” 15.
30. These area saturation weapons inflicted most of the psychiatric casualties, as is the norm when troops in the defense are barraged with indirect fire. The Russian and German models had holes in the stabilizing fins of the rocket so that the round made an eerie, high-pitched sound as it flew toward its target.
31. Richard A. Gabriel, No More Heroes: Madness and Psychiatry in War (New York: Hill and Wang, 1987), 42.
32. Ibid., 22.
33. Ibid., 35.
34. Ibid., 27–29.
35. Ibid., 31–32.
36. Ibid.
37. Ibid., 42.
38. Dupuy, Evolution of Weapons and Warfare, 309–12. See also T. N. Dupuy, Numbers, Predictions, and War (New York: Bobbs-Merrill, 1979).
39. Dupuy, Evolution of Weapons and Warfare, 310.
40. Ibid., 170.
41. The time and expense involved in training a huge army of citizen soldiers in the sophisticated maneuver drills common to the professional soldiers of other armies largely led to Napoleon’s use of the marching column as his primary tactical formation. Like Philip of Macedonia’s early Macedonian phalanx, Napoleon’s marching column formation made it possible to use large numbers of soldiers in combat with only minimal military training.
42. Dupuy, Evolution of Weapons and Warfare, 170.
43. The exception to this trend is the rate of psychological casualties, which have increased enormously as the tempo and lethality of war have increased. See Gabriel, No More Heroes, chapter 3.
44. P. B. Adamson, “A Comparison of Ancient and Modern Weapons in the Effectiveness of Producing Battle Casualties,” Journal of the Royal Army Medical Corps 123 (1977): 93–103.
45. F. A. E. Crew, History of the Second World War: The Army Medical Services, vol. 2, Campaigns (London: Her Majesty’s Stationery Office, 1957), 31–34, table 4.
46. J. D. Hardy and E. F. Du Bois, “The Technique of Measuring Radiation and Convection,” Journal of Nutrition 15 (1938): 466.
47. G. H. B. Macleod, Notes on the Surgery of the War in the Crimea, with Remarks on the Treatment of Gunshot Wounds (London: J. Churchill, 1858), 46, table 1.
48. W. C. Moffat, “British Forces Casualties in Northern Ireland,” Journal of the Royal Army Medical Corps 112 (1976): 3–8, table 6.
49. P. Meid and J. M. Yinling, U.S. Marine Operations in Korea, 1950–1953, vol. 5, Operations in West Korea (Washington, DC: Historical Division of the HQ US Marine Corps, 1958), 140.
50. Richard A. Gabriel, Operation Peace for Galilee: The Israeli-PLO War in Lebanon (New York: Hill and Wang, 1984), 179.
51. Atul Gawande, “Casualties of War: Military Care for the Wounded in Iraq and Afghanistan,” New England Journal of Medicine, December 9, 2004, 2471–75.
52. Gabriel, No More Heroes, chapter 2. Psychiatric casualties are evident in every war for which we have a record from the earliest times.
2
THE RENAISSANCE AND THE REBIRTH OF THE EMPIRICAL SPIRIT
From a military perspective, the Renaissance can be conveniently dated from 1453— the year in which Constantinople fell to the Ottoman Turks, destroying forever the last major cultural center of the ancient world—to 1618, the beginning of the Thirty Years’ War, when the use of contract armies, or the condottieri, and mercenary forces on a large scale was coming to an end as the emerging nation states became more organized and able to raise genuine national armies.1 By 1618, European states were deploying national armies supported by regular taxation, stationed in permanent garrisons, sustained by regular pay, and directed by articulated administrative structures under the command of national sovereigns.
European culture underwent a genuine “revival of learning” during the Renaissance, a period when new methods of scientific inquiry arose. To attempt these new methods, especially with their emphasis on observation and incipient empiricism in science and medicine, and to explore new subjects, particularly those in medicine that the church and governmental edict had long forbidden or ignored as already answered by the scholastic methods of the Middle Ages, the old clerico-secular social order had to be weakened and its power to punish and censor diminished. As a prelude to change, the old alliance between secular and religious authority that for eight hundred years had sustained the feudal order and religious control of knowledge and inquiry had to be reduced.
A number of events came together to attenuate the old establishment’s traditional hold on intellectual life. A major factor was the outbreak of the bubonic plague, which first occurred in 1348 and flared again several times in the same century.2 The devastation it wrought was enormous. An estimated one in every three people in Europe died from the disease, a rate of death that sapped the physical and intellectual life of European culture. Within a century, a devastating outbreak of syphilis followed and became endemic to the European population for the next two centuries. In its wake a population already debilitated by the plague suffered an inevitable physical and mental deformation. The birth rate fell, and the population declined to where it had been a century earlier. Whole regions of Europe were almost completely depopulated. The weakened population became more susceptible to other diseases, and smallpox, influenza, measles, typhus, yellow fever, diphtheria, whooping cough, lead poisoning, and ergotism also became epidemics. Surviving rec
ords reveal that all these diseases reached pandemic proportions for the first time in European history.3
The effect of these conditions was to call into question the very basis of the clerico-secular society that had long been regarded as legitimate and ordained by god. The disease epidemics demonstrated the powerlessness of medical knowledge, and the medical profession lost status as society bristled with charlatans and quacks offering miraculous cures and amulets. The clerical elements of society were also revealed as powerless. The old doctrine that god visited death and disease as punishments for sin was hardly credible in an age when disease seemed to strike at random, when saint and sinner alike perished, and when large numbers of priests, monks, and even popes died.
The wave of epidemics also critically weakened the family’s ability to socialize its young to the ideas and values of the old order. As diseases carried off parents, older brothers and sisters, aunts, and uncles—all vital mechanisms for transmitting and enforcing traditional social norms and values—new generations grew to adulthood removed from the familial and societal strictures that were enforced in the past. The randomness of death and the shortened life spans produced in these generations an attention to the present to a degree not seen in Europe for a thousand years. Concern for one’s health provoked an emphasis on the physical body and material goods rather than on the spiritualism and eschatological views that underpinned the old clerico-secular order. The situation was not unlike those following social and military disasters in modern times. The defeats that Russia and Germany suffered in World War I produced a “lost generation” of youth that was no longer socialized to the beliefs and habits of the older Europeans who had suffered the defeats. The result in both cases was a revolution of new ideas, values, and behaviors that utterly destroyed the old orders.4 The plagues and epidemics of the early Renaissance produced similar conditions and bred generations of unsocialized, rebellious, and materially concerned youth freed from the conventional intellectual, moral, and social strictures.
The declining size and quality of the general population made recruiting talent committed to traditional institutions very difficult. The Catholic Church could no longer sustain its monasteries without lowering its admission standards and reducing the harsher aspects of monastic life. Beginning in 1517, the Protestant Reformation produced the ultimate challenge to the old order’s ability to control events. The idea of a single church exercising universal control was broken forever as Europe fragmented into scores of religious sects competing for the loyalty of a population frightened to death by death itself and desperately seeking answers to worldly concerns. The emergence of nation states encouraged secular authorities to take advantage of the religious strife by superimposing upon it an attempt to increase the scope of secular power. Religious issues became central to the dynastic wars of the period as the newly emergent national political authorities attempted to free themselves from the religious and secular power of the church. The resulting century of religious war and massacres further reduced the population and created yet more uncertainty in the world of the average citizen.
The aspirations of the new nation states’ monarchs provoked frequent wars that also facilitated the destruction of the old order. In their efforts to establish effective control within their territorial realms, the monarchs of this period clashed repeatedly with ecclesiastical authorities in an attempt to reduce the power of the clergy in secular affairs and carve out a realm of political action independent of church oversight and censure. At the same time, the cost of these wars moved the monarchs to seize the material resources of the monasteries and churches within their national borders, further reducing ecclesiastical influence and control. The religious tenor of these dynastic wars was clear from the settlement that followed the Thirty Years’ War in which national secular authorities were entitled to determine the religious loyalties of their respective subjects. That the religious loyalties of the national populations came to be regarded as a legitimate concern of the national kings was the clearest indication of the power of the new secular order.
The effect of waging more than a century of warfare further increased the uncertainty of life, forcing the individual back upon his or her own resources for survival. It was almost impossible to travel from one place to another without an armed guard. Bands of mercenaries and gangs roamed over the countryside, pillaging at will. Secular authority was often completely absent in the towns, and the citizenry was left to its own devices to secure its survival and livelihood. Sieges, attacks, and religious massacres were commonplace, and trouble in all social affairs was the order of the day. In many ways the situation was not unlike that which plagued Europe during the period of the tribal invasions that followed the breakdown of Roman authority in the sixth through eighth centuries. It was impossible for the old order to sustain its legitimacy. The time was ripe for new ideas.
Three events accelerated the search for new ideas: the Muslim armies’ capture of Constantinople, the invention of printing, and the emergence of new perspectives on surgery precipitated by the frequent warfare during this period. The fall of Constantinople to the Ottoman Turks produced a flood of Byzantine scholars and physicians fleeing the Turkish sword. These refugees carried the intellectual legacy of Greece and Rome throughout Europe. Large numbers of them settled in Italy and France, where they became members of university faculties. These scholars and physicians then shared the cultural and empirical medical knowledge of Greece and Rome in its accurately preserved form.
The manuscripts and translations of the works of Greek and Roman medicine were available in their original versions only in Byzantium. While some of this knowledge had reached the West during the Middle Ages, much of the original empirical medical knowledge of the Greek and Roman texts had been lost or distorted over the centuries by Arab and Christian scholars, physicians, and clerical authorities who, in translation after translation, had edited and reedited the texts and removed information considered dangerous to the faith. Moreover, the scholastic approach to intellectual inquiry that characterized Western and Arabic medicine during the Middle Ages emphasized logical consistency and ratiocination to the extreme detriment of empirical observation and experimentation. The resulting medical profession was mired in medical questions and treatments in which empirical evidence was largely ignored. There is no more telling example of how corrupted the traditional empirical texts became than the fact that Galen (129–200 CE), the accepted medical authority of anatomy and medical practice in the Middle Ages, was regarded as the father of the doctrine of necessary suppuration of wounds when, instead, he clearly states pursuing the opposite course in the original text.
When the Byzantine refugee scholars reintroduced classical Greek and Roman medical texts to the West, they presented physicians with a new source of empirical medical knowledge that had been lost for more than a thousand years. Most of the texts were written in Greek, and their translation required a determined effort, especially in light of the opposition to the new knowledge that came from the traditional medical and ecclesiastical authorities. A group of courageous physicians and scholars, nonetheless, attempted the task. This group of translator-physicians is known to history as the medical humanists.5 Their translations of the original classical medical texts from the Greek into Latin and then into the vernacular were directly responsible for providing Renaissance physicians with a new stock of empirical medical knowledge from which numerous further discoveries proceeded. Perhaps more important, the empirical methodology of the classical texts introduced to the Renaissance a new mode of reasoning and hypothesis testing that eventually became the new basis of medical diagnosis, treatment, and inquiry. After more than a millennium, Europe had rediscovered its empirical past.
Regaining this knowledge might have remained a useless enterprise were it not for the introduction of the printing press. Its invention in Europe has numerous claimants, but by 1454 the first printed work accomplished in any number was the Gutenberg Bible printed in Mainz,
the center of European printing.6 The guilds protected the secrets of the trade, and every effort was made to ensure that the German guilds retained a monopoly. The printing process likely would have remained in German hands for much longer than it did had not Adolf of Nassau laid siege to Mainz and captured the city in 1462. German printers fleeing the sword spread throughout Europe, taking with them the secrets of the new technology. Within a decade, Switzerland, Holland, and Italy had major printing houses. Printing was a free enterprise that remained mostly out of the hands of ecclesiastical authorities. It was free from the strictures of prior review and made the transfer of information cheaper and faster than at any time in man’s history. Compared to hand-copied manuscripts, a printed book could be purchased at half to a third the price.7 The bold, dark print was easy to read, although the introduction of the printed book seems to have coincided with the popular use of spectacles. Spectacles had been invented in the twelfth century but only gained popularity during the Renaissance.
Printing’s impact on medicine was dramatic. For the first time, medical treatises could be produced relatively cheaply and in large numbers. The press greatly reduced the cost of reproducing medical drawings, a great aid in the revival of anatomical study. Printing books in the vernacular instead of Latin made it possible for medical knowledge to spread relatively easily from one country to another. It also made compendiums of medical information available to those medical practitioners who lacked the means or social status to attend medical schools. Equally important, printing opened up a new avenue for these medical practitioners to communicate with one another and exchange experiences and treatment protocols with little official interference.
One of the more important aspects of medical publishing was the introduction of pocket compendiums of anatomy, complete with medical drawings. The Renaissance saw the rediscovery of empirical anatomy based on dissection and observation, and a number of anatomical texts were printed. Most, however, were expensive and bulky to carry, making them of little use to the military barber-surgeon who was always following the army. (Barber-surgeons were untrained practitioners of folk medicine and surgery whose status as medical practitioners lay in their old practice of cutting the tonsures of monks. They earned a living cutting hair, shaving beards, pulling teeth, dispensing folk remedies, and, later, bleeding and applying poultices to the sick.) The solution was the cheap pocket compendium that could be easily transported and referred to under field conditions. Ambroise Paré’s Anatomie Universelle probably was published in this format in 1561. In 1601 Joseph Schmidt, a German military surgeon, published his Mirror of Anatomy precisely to provide a cheap, portable medical compendium written in the vernacular for the military surgeon’s use.8 These pocket books were the first surgical manuals intended for military use that Europe had seen since the days of the Roman medical service, and military barber-surgeons used them extensively in training and practice.
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