© 1996 The Society for the Social History o/Mediane

REVIEW ARTICLE

The Medicalization of War—The Militarization of

Medicine1
By MARK HARRISON*

SUMMARY. After many yean of relative neglect, the military and militaristic aspects of
medical practice are again beginning to receive historical attention. This review indicates
some of the themes emerging from recent scholarship on medicine and war, and indi-
cates some further areas for investigation. The two most fundamental issues arising from
this scholarship relate to what might be termed, respectively, 'the militarization of
medicine' and the 'medicalization of war'. The former raises the question of to what
extent modem medicine was affected by the militarization of many advanced industrial
societies from the late nineteenth century, and by the experience of two World Wars.
The latter draws attention to the gradual incorporation of medicine within the armed
forces, and the growing influence therein of medical experts; a process arguably essential
to the prosecution of 'modern' mass warfare.
KEYWORDS: medicalisation, militarisation, war, modern, metaphor.

Paul Crook, Darwinism, War and History: The Debate over the Biology of War
from the 'Origin of Species' to the First World War, Cambridge: Cambridge
University Press, 1994. Pp. xii + 306 £45.00 (hbk) ISBN 0 521 44465 9,
£18.95 (pbk) ISBN 0 521 46645 8.
Sheldon H . Harris, Factories of Death: Japanese Biological Warfare 1932—45 and the
American Cover Up, London and New York: Routledge, 1994. Pp. xii + 297
£12.99 (pbk) ISBN 0 415 09105 5.
M. Susan Lindee, Suffering Made Real: American Science and the Survivors at
Hiroshima, Chicago and London: Chicago University Press, 1994. Pp. xi +
287 £23.95 (hbk) ISBN 0 226 48237 5.
Brendan O'Keefe and F. B. Smith, Medicine at War: Medical Aspects of Australia's
Involvement in South East Asian Conflicts 1950-1972, St. Leonards, N e w
South Wales: M e n and Unwin, 1994. Pp. xxx + 505 £40.00 ISBN 1 86737
301 9.
Michael B. Tyquin, Gallipoli: The Medical War. The Australian Army Medical Ser-
vices in the Dardanelles Campaign of 1915, Kensington, N e w South Wales:
University of New South Wales Press, 1993. Pp. xiv + 278. $ Aus. 39.95
ISBN 0 86840 189 7.

Metaphors of war abound in professional and lay discourses of disease and

medicine: germs are the 'unseen enemy'; the immune system, the body's
'defensive shield'; and doctors, 'soldiers without weapons' in the 'war against
disease'. So pervasive are these images that we scarcely notice their presence in
•Department of Historical Studies, Sheffield Hallam University,
'i wish to thank Michael Worboys for his helpful comments.
0951-631X Social History of Medicine 09/02/267-276
268 Mark Harrison

medical discourse, just as we have become accustomed to medical metaphors in

representations of warfare: the much vaunted — though often illusory - 'surgical
strike'. It is, perhaps, because the association between war and medicine is taken
for granted, that scholars have been slow to explore the significance of war and
militarism in the development of modern medicine; or, by the same token, the
role of medicine in the emergence of modern warfare.
Although most historians are only dimly aware of its presence, a large body
of literature does, in fact, exist on medicine within the armed services; indeed,
military medical officers rank highly among the more prolific and influential
historians of medicine.2 The American military doctor Fielding Garrison, for
example, played a key role in establishing the history of medicine as a specialism
in its own right.3 But with the exception of recent work on venereal disease,4
war neuroses,5 and the military aspects of 'imperial medicine',6 the military
2
Important national studies include: Sir Neil Cantlie, A History of the Army Medical Department, 2
vols. (Edinburgh, 1974); J. L. S. Coulter and C. Lloyd, Medicine and the Navy 1200-1900, 4 vols.
(Edinburgh and London, 1953—63); A. Ghosh (ed.), History of the Indian Armed Forces Medical Ser-
vices (Hyderabad, 1988); H. Fischer, Der Deutsche Sanitatsdienst 1921-1945: Organisation, Doku-
mente; und personliche Erfahrungen (Osnabriick, 1984); J. Rieux and J. Hassenforder, Centenaire
de I'Ecole d'Application du Service de Sante et du Val-de-Crice (Paris, 1951); R. C. Engelman and
R. J. T. Joy, Two Hundred Years of Military Medicine (Fort Detrick, Maryland, 1975).
See especially Fielding Garrison, Notes on the History of Military Medicine (Washington, 1922).
4
See for example F. B. Smith, 'Ethics and Disease in the Late-Nineteenth Century: the Conta-
gious Diseases Acts', Historical Studies, 15 (1971); F. B. Smith, 'The Contagious Diseases Acts
reconsidered', Social History of Medicine, 3 (1990), 197-215; H. Beardsley, 'Allied Against Sin:
American and British responses to Venereal Disease in World War I', Medical History, 20 (1976),
189-202; Suzann Buckley, 'The failure to resolve the problem of Venereal Disease among the
troops in Britain during the First World War', in B. Bond and I. Roy (eds.), War and Society: A
Yearbook of Military History, vol. 2 (London, 1977), 65—85; Bridget A. Towers, 'Health Education
Policy 1916-1926: Venereal Disease and the Prophylaxis Dilemma', Medical History, 24 (1980),
70—87; Judith R. Walkowitz, Prostitution in Victorian Society: Women, Class, and the State (Cam-
bridge, 1980); Allan M. Brandt, No Magic Bullet, A Social History of Venereal Disease in the United
States Since 1880 (New York and Oxford, 1985); Mark Harrison, 'The British Army and the Prob-
lem of Venereal Disease in France and Egypt during the First World War', Medical History, 34
(1995), 133-58; Philippa Levine, 'Venereal Disease, Prostitution, and the Politics of Empire: the
case of British India', Journal of the History of Sexuality, 4 (1994), 579-602.
'See P. J. Lynch, 'The Exploitation of Courage: Psychiatric Care in the British Army,
1914-1918', London University M.Phil, thesis, 1977; Martin Stone, 'Shellshock and the Psychia-
trists', in W. F. Bynum, R. Porter and M. Shepard (eds.), The Anatomy of Madness, vol. 2 (London,
1985), 242-71; Elaine Showalter, The Female Malady: Women, Madness and English Culture,
1830-1980 (New York, 1985), 167-94, Ted Bogacz, 'War Neuroses and Social Change in Eng-
land, 1914-22: the Work of the War Office Committee of Enquiry into "Shell-Shock", Journal of
Contemporary History, 24 (1989), 227—56; Harold Merksey, 'Shell-shock', in German E. Berrios and
Hugh Freeman (eds.), 150 Years of British Psychiatry, 1841-1991 (London, 1991), 245-67; Hans
Binneveld, 'For the Mind of Tommy Atkins', in Hans Binneveld and Rudolf Dekker (eds.), Cur-
ing and Insuring: Essays on Illness in Past Times: The Netherlands, Belgium, England and Italy,
16th-20th Centuries (Hilversum, 1993), 189-202.
6
Two useful introductions to medicine and imperialism are David Arnold (ed.), Imperial Medicine
and Indigenous Societies (Manchester, 1988) and Roy MacLeod and Milton Lewis (eds.), Disease,
Medicine and Empire: Perspectives on Western Medicine and the Experience of European Expansion (Lon-
don and New York, 1988). Some recent studies which examine the military dimension of colonial
medicine include Philip D. Curtin, Death by Migration: Europe's Encounter with the Tropical World in
the Nineteenth Century (Cambridge, 1989); David Arnold, Colonizing the Body: State Medicine and
Epidemic Disease in Nineteenth Century India (Berkeley, 1993); Mark Harrison, Public Health in British
India: Anglo-Indian Preventive Medicine (Cambridge, 1994).
 The Medicalization of War—Hie Militarization of Medicine 269
realm has been badly neglected by those who have written the 'social history of
medicine'. It may be, as Roger Cooter has suggested, that a generation brought
up in the shadow of the Vietnam War found military subjects distasteful or even
'politically suspect'.7 Or it may be that much of the theoretical work informing
the history of medicine has focused not on the military domain but on the reg-
ulations and practices of civil society; on madhouses, prisons and the like. But as
Foucault recognized, the military, along with the medical profession, were
among the first managers of 'collective space',8 and it is clear from Christopher
Lawrence's excellent study of hygiene in the Royal Navy that the military con-
text was of great significance in the development of medicine's 'governmental'
role.9
Lawrence argues that medicine was the bearer of a new disciplinary code
based on dressage and surveillance rather than physical punishment. But it was
not only as a mode of discipline that medicine contributed to the emergence of
modern forms of military organization; it was increasingly valued as an adminis-
trative and managerial resource: physical and mental standardization were essen-
tial to the functioning of mass armies, while conscription, and the destructive
power of modern weapons, encouraged the armed services to maximize their
'human resources'.10 Some of these themes are already prominent in the litera-
ture on medicine and war, particularly some recent edited collections published
in Germany;11 British historians have been somewhat slower off the mark,
although there are signs that health and medicine are at last moving centre-stage
in British military historiography.12 A more established area of interest lies in
the provisions made for sick and wounded ex-service people,13 and continuing
controversies over the effects of nuclear testing on soldiers and the defoliant
'Agent Orange'—not to mention 'Gulf War Syndrome'—will ensure that the
7
Roger Cooter, 'Medicine and the Goodness of War', Canadian Bulletin of the History of
Medicine, 12 (1990), 147-59.
8
Michel Foucault, 'The Eye of Power: a Conversation with Jean-Pierre Barou and Michelle
Perrot', in Colin Gordon (ed.), Michel Foucault, Power/Knowledge: Selected Interviews and Writings
1972-1977 (London, 1980), p. 151.
'Christopher Lawrence, 'Disciplining Diseases: Scurvy, the Navy and Imperial Expansion', in
D. Miller and P. Reill (eds.), Visions of Empire (Cambridge, 1994). See also Peter Mathias, 'Swords
into Ploughshares: the Armed Forces, Medicine and Public Health in the Late Eighteenth
Century', in Jay Winter (ed.), War and Economic Development: Essays in Memory of David Joslin
(Cambridge, 1975), 73-90; Harold Langley, A History of Medicine in the Early U. S. Navy
(Baltimore and London, 1995).
10
Roger Cooter, 'War and Modern Medicine', in W. F. Bynum and R. Porter (eds.), Compan-
ion Encyclopedia of the History of Medicine (London, 1994); Mark Harrison, 'Medicine and the Man-
agement of Modern Warfare', History of Science, forthcoming.
"See, for example, E. Guth (ed.), Vortrage zur Militargeschichle, Band II: Sanitatswesen im Zweiten
Weltkrieg (Bonn, 1990).
12
Peter Liddle and Hugh Cecil (eds.), Facing Armageddon: The First World War Experienced
(Barnsley, 1996).
13
See Antoine Prost, Les Anciens Combatants et la Socitte Francaise. 1914-1939 (Paris, 1977); R.
W. Whalen, Bitter Wounds: German Victims of the Great War, 1914-1939 Ithaca and London,
1984); Colin Jones, 'The Welfare of the French Foot-Soldier from Richleau to Napoleon', in R.
W. Whalen, The Charitable Imperative: Hospitals and Nursing in Ancien Regime and Revolutionary
France (London 1989); David Englander, 'Soldiers and Social Reform in the First and Second
World Wars', Historical Research, 47 (1994), 318-26.
270 Mark Harrison

subject continues to attract scholarly attention. The most recent work on

wartime disability has shifted the focus from war pensions and medical provi-
sions to other strategies for the re-settlement of ex-service people; not least the
perceived need to preserve the masculine identity of ex-servicemen and of the
nation's racial vigour.14
Social historians of medicine, however, are more likely to be familiar with
recent studies of the effects of war on civilian medicine and more especially
with those which focus upon medical policy. As readers of this journal will
recall from exchanges between Charles Webster and Daniel Fox some years
ago, the 'impact' of war upon medical policy is a hotly disputed area.15 Fox's
work is typical of recent 'revisionist' accounts of war and social change in that it
sees developments in medicine during the two World Wan as part of a much
larger and long-term international process, whereby health care became collec-
tivised as part of the State's response to the problems of mass industrial society.16
This broader perspective, which minimizes the effects of war on medical policy,
has been enthusiastically endorsed by Cooter.17 But, although it is helpful to
place wartime changes in this wider context, we are in danger of losing sight of
the peculiarly powerful currents for change which emerged in the First and,
more especially, the Second World War. One of the problems with much of
the recent revisionist literature on 'War and Social Change' is the undercurrent
of determinism; the tacit assumption that the developments it refers to would
have occurred regardless of the two World Wars. The clusters of reforms evi-
dent in many Western societies during, and immediately after, these conflicts
cannot be so easily explained away.
The five books reviewed below echo some of these themes but most have
rather different agendas. Some are concerned principally with medicine within
the armed forces, while others explore medicine's place in relations between
military and civilian spheres and, in particular, the abuse of military-medical
power. Paul Crook's monograph Darwinism, War and History, does not fit easily
into any of these categories, being concerned, not so much with medicine, but
with debates over the warlike propensities of human beings. Yet medical pro-
fessionals figure prominently in the book, which examines the work of many
lesser known psychologists, physicians, and eugenists, in addition to familiar fig-
4
Seth Koven, 'Remembering and Dismemberment: Crippled Children, Wounded Soldiers,
and the Great War in Great Britain', American Historical Review, 94 (1994), 1167-1202. The War
Disabled are also the subject of current work by Dr Joanna Bourke at Birkbeck College London.
15
Daniel M. Fox, 'Anti-Intellectual History?' and Charles Webster, 'Official History?', Social
History of Medicine, 3 (1990), 101-5.
16
See Daniel Fox, 'The National Health Service and the Second World War: the Elaboration of
Consensus', in Harold L. Smith (ed.), War and Social Change: British Society in the Second World War
(Manchester, 1986), 32-57; H. L. Smith, Health Policies, Health Politics: the Experience of Britain and
America 1911-1965 (Princeton, 1986). Fox's argument runs counter to the view that the sense of
national solidarity created by the war was vital to the development of the Welfare State and, in
particular, to the foundation of the National Health Service. This was, until recendy, the orthodox
interpretation of the emergence of the NHS: see Richard Titmuss, Problems of Social Policy (Lon-
don, 1950); Arthur Marwick, War and Social Change in the Twentieth Century (London, 1977); Paul
Addison, The Road to 1945 (London, 1975).
"Cooter, 'Goodness of War', p. 150.
 The Medicalization of War—The Militarization of Medicine 271

ures like T. H. Huxley. Medical men, such as the distinguished malariologist

and 'pioneer' of tropical medicine, Sir Ronald Ross, played an important part
in shaping a scientific discourse which portrayed war as inevitable and even
desirable. But an interesting feature of Darwinism, War and History is its attention
to evolutionary theories of pacifism and mutual aid, as if accepting Daniel Pick's
recent invitation for a detailed study of 'the complex ramifications of the
metaphor of war in nineteenth-century biology, anthropology and evolutionary
psychiatry'.18
'Peace biology' took myriad forms. Some of its proponents, like Kropotkin,
sought to minimize overcrowding and species struggle as factors in evolution;
evolutionary success went to the socially cohesive and not necessarily to the
strong and aggressive. An equally influential figure was the prophet of European
integration, Jacques Novicow, whose evolutionary theories pictured a comfort-
ing natural progression from brutish struggle to intellectual trial. But other
'peace biologists' such as T. H. Huxley denied that there would be a natural
trend towards pacifism. Huxley opposed the biological reductionism of both
proponents and opponents of war, arguing that man had learned to evade natu-
ral selection by using his intelligence to control the environment. Peace and
social co-operation were in the grasp of mankind but were, by no means,
inevitable.
Some of what Crook has to say will be already familiar to the readers of this
journal but his willingness to consider the less distinguished of Darwin's inter-
preters provides new insights into the ways in which evolutionary theory was
employed in debates over war and human aggression prior to, and during, the
First World War. That said, Crook has relatively little to say about the relation-
ship between evolutionary theory and war in Germany and the United States,
despite the fact that the Franco-Prussian War and the American Civil War are
generally regarded as key events in the emergence of modern warfare.19 The
discussion of Prussian militarism, for example (see especially pp. 29—35), relies
heavily on secondary sources and constitutes little more than an introduction to
Crook's lengthier discourse on Spencer and Huxley. And, although 'militarism'
is an important theme in this book there is very little reflection on the concept
itself: Crook cites some (though by no means all)20 of the most important litera-
ture in the field but fails either to engage with it or to offer a definition of his
own. But, these reservations aside, Darwinism, War and History is unlikely to be

18
Daniel Pick, War Machine: The Rationalisation of Slaughter in the Modem Age (New Haven and
London, 1993), p. 83.
" T h e best recent study is Edward Hagerman, The American Civil War and the Origins of Modem
Warfare: Ideas, Organization, and Field Command (Bloomington and Indianapolis, 1988).
On militarism see, for example: Alfred Vagts, A History of Militarism (London, 1959); John
Gooch, 'Attitudes to war in Late-Victorian and Edwardian England', in B. Bond and I. Roy (eds.),
War and Society: A Yearbook of Military History (London, 1975), 88-102; Anne Summers, 'Mili-
tarism in Britain before the Great War', History Workshop Journal, 2 (1976); Gerhard Ritter, The
Sword and the Sceptre: The Problem of Militarism in Germany, transl. C. Gables (Florida, 1970);
104-23; David Edgerton, 'Liberal Militarism and the British State', New Left Review, 185 (1991),
138-69.
272 Mark Harrison

surpassed in the near future as an account of the complex and often dissonant
interpretations of Darwin's theories in relation to war.
It is, perhaps, significant that some of those engaged in debates about the
warlike propensities of Man were medical men with strong military connec-
tions. Sir Ronald Ross who associated the 'intellectual qualities of cunning,
observation and accurate reasoning' with the warlike spirit conducted his pio-
neering work on malaria whilst serving in the Indian Medical Service.21 Like
Ross, the American military doctor and historian Fielding H. Garrison, felt that
war was a natural element of human existence, being part of 'the general phe-
nomenon' of life itself, which, 'in all its aspects, is conditioned by a conflict of
elements'.22 War, or the ever-present threat of war, dictated a state of military
readiness which had professional benefits for military doctors. During the nine-
teenth century, they had gradually extended their influence within the armed
forces by promising to improve morale and manpower efficiency, but it was not
until the First World War that medicine became an integral feature of military
planning. In previous conflicts provisions for the sick and wounded had been
rudimentary but after 1914—on the Western Front, at least—the opposing
armies developed sophisticated systems for the evacuation and treatment of the
wounded. Severe manpower shortages and fear of a public backlash meant that
governments and military commanders gave a much higher priority to the med-
ical care of their troops. Away from northern Europe, however, medical ser-
vices were far slower to evolve. This was. partly a reflection of old military
prejudices against medical staff but also of the lower priority attached to 'side
shows' such as the Mesopotamian and Gallipoli campaigns. As Michael Tyquin
argues in his book Gallipoli: The Medical War, senior commanders paid little
attention to medical services and medical officers had practically no influence
upon the planning and conduct of operations. This breakdown in communica-
tion resulted in high casualties from disease and extreme suffering among those
unlucky enough to fall sick or wounded. The Australian contingent, which
forms the main subject of Tyquin's study, was especially poorly served; the Aus-
tralians were denied control over their own medical services and did not enjoy
an easy relationship with their British superiors.
Tyquin's study is fair in its assessment of both the Australian medical services
and the role of British commanders. Though critical of the British Army's han-
dling of medical arrangements in Gallipoli, he debunks many of the popular
myths of the campaign, including that of the 'healthy bronzed ANZAC war-
rior' and the notion that the British were solely responsible for all the major
mistakes. Neither Australian medical officers, nor the Australian government,
escape some measure of blame. However, the real strength of Tyquin's study is
its emphasis on the structural and systemic weaknesses of military organiza-
tion—an approach it shares with some of the best recent scholarship on the

21
C r o o k , Darwinism, War and History, p . 138.
22
Garrison, Notes on the History of Military Medicine, p . 1.
 The Medicalization of War—The Militarization of Medicine 273

Great War. 23 The underlying theme of Gallipoli: The Medical War is that the
campaign exemplified the painful birth of a new form of warfare: officers accus-
tomed to the centralized systems of command and control typical of colonial
warfare were slow to adapt to the complexities of the modern battlefield, and
did not sufficiently appreciate the crucial role of the auxiliary and administrative
services. This was true not only of combatant officers but also of many older
medical officers, who were simply out of their depth when it came to organiz-
ing so large and complex an operation as the Gallipoli landings.
Tyquin has marshalled a considerable body of evidence to support his case,
and he has been discriminating in his handling of archival sources, particularly
the unreliable Report of the Dardanelles Commission.24 The broad range of sources
consulted by Tyquin has given him a perspective lacking in many other studies
of the campaign and which has exposed the collusion and deliberate distortion
perpetrated by witnesses to the Commission. But, though impressive empiri-
cally, Gallipoli; The Medical War is marred by its insularity. The book would
have benefited from more comparison with medical work in other theatres of
the war and from deeper reflection on the social and intellectual context in
which the General Staff operated; nor is there any attempt to make sense of the
Gallipoli experience in terms of the history of Australian medicine. In both
cases, relevant secondary material has not been cited. Another weakness- of the
book is its rather superficial treatment of the more technical aspects of military
medicine: there is a tendency to describe, rather than to analyse, the different
approaches taken by medical officers in the care of the sick and wounded;
another symptom, perhaps, of the author's lack of familiarity with current work
in the history of medicine. These criticisms aside, Michael Tyquin's contribu-
tion to the history of military medicine is a valuable one; and one which
demonstrates, albeit in a negative sense, the importance of medical services in
the organization of modern warfare.
That the Australian Medical Services had 'learned lessons' from their often
painful experiences in the First and Second World Wars is evident from Bren-
dan O'Keefe and F. B. Smith's medical history of Australia's military involve-
ment in South East Asia from 1950-72. The book is an official publication but
one in the best tradition of the Australian official medical histories, which have
consistently outshone those of the United Kingdom in their candour and read-
ability.25 Medicine at War is unusual, however, in being co-authored: O'Keefe
has written the general history of the medical services, while Smith (better
known for his work on Florence Nightingale and the Contagious Diseases Acts)
has confined his attention to the controversy over the exposure of Australian

"For example, Tim Travers, The Killing Ground: The British Army, the Western Front and the
Emergence of Modem Warfare, 1900-1918 (London, 1987).
24
T. H. E. Travers, 'Command and Leadership Styles in the British Army: the 1915 Gallipoli
Model', Journal of Contemporary History, 26 (1994), 403-42.
"See A. G. Butler, The Australian Army Medical Services in the War of 1914-1918. Vol. I: The
Gallipoli Campaign (Melbourne, 1938).
274 Mark Harrison

servicemen to 'Agent Orange'. The two sections of the book deserve to be

considered separately, especially in view of O'Keefe's intriguing comment that
Smith's chapter on Agent Orange does not necessarily reflect his own views.
One of the most striking things about the medical history of Australia's
military involvement in South East Asia is that the medical services were, by
this stage, closely integrated into military planning and given a far higher prior-
ity by combatant officers. But this is not to say that tensions between medical
and other branches of the armed forces were a thing of the past. It was some-
times difficult, in a period of small scale, conflicts, to convince senior combatant
officers and politicians of the need for well equipped medical services, and for
most the 1950s they struggled against inadequate funding. The government
tended to rely on the support services provided in Malaya by the British and,
later, by the Americans in Vietnam. This situation only began to change in the
mid-1960s when conscription and mounting controversy over Australia's
involvement in Vietnam made the government more sensitive to public opin-
ion and aware of the need to be seen to be providing for the welfare of Aus-
tralian soldiers. By 1967 most aspects of military medicine—including the
prevention of malaria, the most important medical problem in South East
Asia—were considered highly successful.
O'Keefe tells the story of Australia's medical work in Malaya and Vietnam
with sensitivity and fairness; he has also gleaned much evidence from lower
down the military hierarchy, which gives Medicine and War a perspective lacking
in most other official histories. Barry Smith's section is quite different in that it
is concerned with the aftermath of war and the ofEcial enquiry into the alleged
effects of exposure to defoliants like Agent Orange. Smith has considerable
sympathy for the much criticized report of the Royal Commission of 1985,
which concluded that there was little evidence for the alleged effects of expo-
sure to Agent Orange. He contrasts its 'tenets of classical liberalism and truth
values in scholarship and public affairs' with 'the pretensions of the Agent
Orange lobby'. The latter's campaign, according to Smith, embodied an 'uneasy
self-assertion and irrationality' imported from the United States (p. 361). This
reviewer is not qualified to pronounce on the relative merits of either the
report of the Royal Commission or the case against it, but Smith's verdict is
likely to raise a few eyebrows in the light of the recent controversy over so-
called 'Gulf War Syndrome'. However, the most significant aspect of the Agent
Orange debate is that it exemplifies the way in which service-people have come
to demand health care as a right: as part of an implicit bargain between them-
selves and the military authorities. This is not a wholly new phenomenon, for
one can see signs of such attitudes in soldiers' letters as far back as the nine-
teenth century, but the mobilization of veterans during and after the Vietnam
War did mark an important break with the past.26 As the Guardian's Martin
Walker observed when reporting on 'Gulf War Syndrome', 'The political
potential of the [American] veterans as an interest group is immense . . .

26
Harrison, 'Modern Warfare'.
 The Medicalization of War—The Militarization of Medicine 275
A Congressman ignores them at his peril.27
The last two books reviewed here deal with different aspects of the military's
relations with civilian populations. Medicine has long functioned as an impor-
tant interface between the two spheres: medical inspections regulated the intake
of recruits into the. army, while the physical distance traditionally maintained
between military and civilian environments reflects a deeply-ingrained fear of
contamination from without. But, as Sheldon H. Harris informs us in his Facto-
ries of Death, military conquest has also provided opportunities for military doc-
tors to experiment on human subjects in ways normally forbidden to them. The
subject of Harris' book is the biological and chemical warfare experiments con-
ducted by the Japanese on their prisoners in Manchuria between 1932 and
1945. One of the main instigators of this 'research' programme was the Japanese
Army doctor Major Ishii Shiro. Ishii, who had gained a doctorate in microbiol-
ogy, saw that biological weapons research could be the key to rapid professional
advancement and the army gave him carte blanche to develop such a programme
in Manchuria. His efforts concentrated on plague and anthrax, which he artifi-
cially induced in civilian prisoners; human guinea pigs were also used to test
under laboratory conditions the effects of phosgene and other gases. Later, Ishii
and his associates graduated to testing such weapons on humans in the field,
detonating bombs and artillery shells containing anthrax spores and other bio-
logical agents. Similar experiments were conducted elsewhere in Manchuria
under the direction of other medical officers.
The tally of deaths is impossible to calculate but it seems that in excess of
10,000 people lost their lives as a direct result of the chemical and biological
weapons experiments, and tens of thousands more as a result of plague epi-
demics that broke out around some of the research stations. Equally disturbing
is the fact that the American government has, until very recently, denied any
knowledge of such experiments. Harris reveals, in this gruesome though fasci-
nating book, that immunity from prosecution for war crimes was granted to
those engaged in human experimentation in China. Fear of information being
passed to the Soviets, and the deep embarrassment that revelation of events in
Manchuria would cause to senior Japanese officials (including members of the
royal family), meant that those responsible for the biological and chemical
weapons programme never came to trial. It would seem that truth and justice
were among the first casualties of the Cold War.
The paranoia of the post-war decades also looms large in Susan Lindee's
excellent study of the activities of the American-dominated Atomic Bomb
Casualty Commission in Japan, after 1945. Lindee argues that the politics and
values of the Cold War fundamentally shaped the nature of the Commission's
research and the scope of its work. As far as the US government was concerned,
the main purpose of the Commission—set up to monitor the long-term effects
of exposure to radiation—was military rather than humanitarian. As Lindee puts
it, 'Bodies scarred by radiation were a critical military commodity, so important
27
The Guardian, 20 June 1994.
276 Mark Harrison

that their acquisition . . . justified drastic measures . . . The atomic bomb cre-
ated bodies damaged by the invisible force that haunted the Cold War and its
warriors, in ways that we are only now beginning to see' (p. 258). The role of
the Commission was to translate the suffering of the Japanese survivors of the
atomic bombings into data which could be used for the protection of service
people and those working with radiation.
The research emphasis of the Commission was most visible in its policy of not
treating those suffering from the effects of exposure to radiation. Although
many of the American workers contravened this official directive, the 'no-treat-
ment' policy was the most visible focus of popular dissatisfaction with the Com-
mission, and widespread criticism of its narrow objectives eventually
contributed to the Commission's demise. Attempts to encourage the Japanese
government to fund part of the programme in 1971, following a fiscal crisis
provoked by revaluation of the yen, were unsuccessful because the Commission
had grown so unpopular in Japan. But the demise of the Commission did not
leave a vacuum: the Japanese government and Japanese medical scientists were
willing to make a large contribution to a new body—the Radiation Effects
Research Foundation—to be funded and managed equally by the USA and
Japan. Today the RERF continues the genetic research which had increasingly
come to dominate the work of its precursor.
Susan Lindee's well-researched and theoretically sophisticated book will
hopefully encourage others to look seriously at the medical aspects of war. The
military medical archive in most countries is rich enough to sustain a wide vari-
ety of historical projects. Considerable scope exists, for example, to develop the
study of masculinity through an exploration of concepts of hygiene and physical
fitness within the armed forces. Much work has still to be done on medicine
and disciplinary regimes, as well as on medicine's place in the 'morale economy'
of service life: medicine was an important part of the tacit bargain which existed
between the modern soldier and the military authorities—a kind of 'social
wage' earned in the service of his country. Another possible line of inquiry con-
cerns the 'militarization28 of civilian medicine: the relationship of civilian ser-
vices, such as the Red Cross,29 to the military machine; as well as the more
general impact of military values, metaphors, and forms of organization, on
civilian medical practice. It is, perhaps, illustrative of the ethos of modern
medicine that doctors have portrayed their profession and its achievements in
heroic and explicitly militaristic terms. Titles such as Victory with Vaccines, The
Battle Against Bacteria, and Crusading Doctor, may reveal far more about the pro-
fession of medicine than their authors had ever intended.30

28
Cooter, 'Goodness of War'.
29
S e e L e o v a n B e r g e n , De Zwaargewonden Eerst? Hel Nederlandsche Roode Kruis en het Vraagstuk
van Oorlog en verde 1867-1945 (Rotterdam, 1994); John F. Hutchinson, Champions of Charity: War
and the Rise of the Red Cross (Oxford, 1996).
30
H . J . Parish, Victory with Vaccines: The Story of Immunization ( L o n d o n , 1968); P . E . Baldry,
The Battle Against Bacteria: A History of the Development of Anti-Bacterial Drugs, for the General Reader
( C a m b r i d g e , 1965); M i c h a e l A . Shadid, Crusading Doctor. My Fight for Cooperative Medicine ( O k l a -
homa, 1992).