Military Medicine Timeline

Military Medicine Timeline

For centuries, the extreme demands of war have driven medical advance and innovation, often leaving valuable peacetime legacies. Here we chart the history of military medicine and look at the way it has helped to shape healthcare today.

The Royal Army Medical Corps (RAMC) is a specialist corps in the British Army which provides medical services to all Army personnel and their families, in war and in peace. Together with the Royal Army Veterinary Corps, the Royal Army Dental Corps and Queen Alexandra's Royal Army Nursing Corps, the RAMC forms the Army Medical Services.

1642

English Civil War breaks out

With the outbreak of civil war, Parliament recognises its duty of care towards soldiers for the first time.

With the outbreak of the English Civil War (1642-1651), MPs pass a bill that for the first time recognises Parliament's duty of care towards soldiers killed or wounded in its service. This duty also applies to their widows and orphans. The first dedicated military hospital is established in the Savoy Hospital, London. Two additional military hospitals open in London during the Civil War and the succeeding period of parliamentary and military rule (Interregnum). Nurses are recruited from among the widows of soldiers. The first military hospital regulations are enacted.

 

1653

First casualty reception stations

During the First Dutch War, a network of casualty reception stations is established by Dr Daniel Whistler and nurse Elizabeth Alkin.

Physician Dr Daniel Whistler and nurse Elizabeth Alkin establish a network of casualty reception stations for injured soldiers during the First Dutch War between the English and Dutch. The reception stations are based in Portsmouth and East Anglia. During the conflict about 2,500 Englishmen are killed.

 

1660

Military hospitals closed

The closure of Parliament's military hospitals leaves the Army without a dedicated hospital.

Parliament's military hospitals close following the restoration of King Charles II to the throne in 1660. This leaves the newly created Standing Army without a dedicated hospital. With the King now in power, funding for the hospitals, which had served the soldiers of Parliament's army and their widows, is withdrawn. Under the new regime, the healthcare of soldiers is no longer considered the State's responsibility. That charge is now left to individual regimental colonels.

 

1692

First field hospitals established

Mobile field hospitals (hospitals on the battlefield) are established by William III during the Nine Years' War.

In addition to static hospitals, William III establishes the English Army's first mobile field hospitals. These mobile medical units situated on the battlefield are introduced during the Nine Years' War of the 1690s in Ireland and Flanders. For the first time, a mobile hospital can work close to a battle, providing quick treatment for sick and wounded soldiers. Before mobile hospitals, patients had to endure a long and painful journey to a base hospital. This process contributed significantly to a battle's death toll. The first physician general, surgeon general and apothecary general positions are also created, which leads to improvements in the organisation and delivery of military healthcare.

 

1702

Flying hospitals on battlefields

Flying hospitals accompany the Duke of Marlborough's armies to war and are used to treat and transport casualties.

John Churchill, the first Duke of Marlborough, is captain general of the English and Allied Armies during the War of the Spanish Succession. He establishes flying, or marching hospitals, as part of a chain of evacuation for battlefield casualties. They are used to move injured soldiers from field hospitals in Flanders, via static hospitals, to England. They are comparable with present-day field ambulances.

 

1752

Causes of disease revealed

A major scientific report on disease prevention by Sir John Pringle gives innovative ways to reduce illness and disease among soldiers.

Sir John Pringle, a Scottish physician widely regarded as the founder of modern military medicine, publishes a major report called “Observations on the Diseases of the Army”. This is the first scientific account that outlines strategies to prevent illness, control disease and manage infected patients. Pringle recognises hospitals as among the chief causes of sickness and death in the Army.

 

1789

First permanent military hospital

The first permanent hospital for the Standing Army is established by leading surgeon John Hunter in Chelsea.

John Hunter is appointed surgeon general having held the deputy role since 1786. He's a leading anatomist and one of the first to recognise how scientific experiments can benefit medicine. He establishes the York Hospital in Chelsea as the Standing Army's first permanent hospital. This hospital is the Army's main receiving hospital for casualties evacuated from overseas throughout the Revolutionary and Napoleonic Wars. He dies in October 1793 as the result of a heart attack during an argument over the admission of students.

 

1803

Disease the biggest killer in war

Poor hygiene means disease is the main cause of death among soldiers in the Napoleonic Wars.

Disease is the biggest single killer of soldiers during the Napoleonic Wars due to a lack of understanding about hygiene and because antibiotics do not yet exist. The most common treatment for serious battle wounds is amputation. Surgeons re-use the same instruments repeatedly, and if they wash their hands it is in dirty water. According to Samuel Dumas' Losses of Life Caused by War, a staggering 505,657 people are killed by disease, while around 45,853 military personnel are killed in action, fires or drowning.

 

1847

Navy first to use anaesthetic

The first recorded use of anaesthetic in the services is in the Navy for a dental extraction by Thomas Spencer Wells.

The first recorded anaesthetic used in the services is administered by Thomas Spencer Wells, a naval medical officer, when he uses ether for a dental extraction. The use of anaesthesia in the form of ether or chloroform is adopted rapidly by the military. Prior to this, it was accepted that pain was a necessary part of any surgical operation, along with brandy or whisky.

 

1853

More than 20,000 die in Crimean War

The Crimean War sparks national outrage as the public reads about the suffering of soldiers dying in Eastern Europe.

The lack of conflict since 1815 leads to a decline in the efficiency of the Army medical department. More than 20,000 British personnel die during the Crimean War, of whom only 1,600 are killed in action. The rest die from disease and a harsh winter. The recent invention of the telegraph means scandalous news of inadequate medical provision reaches the shores of Britain relatively quickly. The Crimean War is the first major conflict in which anaesthesia is used extensively on the battlefield. Chloroform is almost always the anaesthetic used.

 

1854

Nightingale improves conditions

Nurse Florence Nightingale and volunteer nurses are sent to Turkey during the Crimean War to oversee the military hospital.

Florence Nightingale and a staff of 38 volunteer nurses, trained by her, are sent to Scutari in Turkey to oversee the nursing at the military hospital. She finds medicines in short supply, hygiene neglected and mass infections common, many of them fatal. Her presence leads to a dramatic improvement in conditions within the hospital, where the majority of soldiers were dying from disease. In 1890 there was a public outcry when it was found that many veterans at the 1854 Battle of Balaklava were poverty-stricken. A fund was set up and on 30 July 1890 Florence Nightingale recorded a speech to raise money.

 

1857

Major military healthcare reforms

The Crimean War prompts Florence Nightingale to call for a Royal Commission into military hospitals. Important healthcare reforms follow.

Following her experience of nursing wounded soldiers on the frontline, Florence Nightingale successfully calls for a Royal Commission into the military hospitals and the health of the Army. She plays an important role in introducing statistical casualty analysis, military health and hospital planning and sanitation. She also establishes a training school for nurses, the Nightingale Training School, at St Thomas' Hospital in London.

 

1863

Royal Victoria Hospital opens

The Royal Victoria Hospital is the first purpose-built military hospital and appoints its first professor of military hygiene.

The Royal Victoria Hospital at Netley in Hampshire is the first of Britain's purpose-built military hospitals to open. It is also the new home of the Army Medical School. Edmund Alexander Parkes is the school's first professor of military hygiene. His research leads to significant improvements in the health of soldiers, which earns him the reputation as the founder of modern military hygiene.

 

1881

Nursing service established

Nursing staff are organised in the first major step towards a regular, uniformed nursing service for the Army.

Nursing personnel are organised under the direction of the Army Nursing Service (ANS). This is a major step towards a regular, uniformed nursing service for the Army. Nurses see action in a close succession of conflicts including the Boer Wars (1880-81 and 1899-1902), the Egyptian Campaign (1882) and the Sudan War (1883-85). Despite this big change, nursing numbers are restricted and there is no provision for increasing nursing staff in the event of a major conflict.

 

1897

Typhoid breakthrough in Army

Sir Almroth Wright develops the typhoid vaccine at the Army Medical School in Netley.

Sir Almroth Wright successfully produces immunity to typhoid by injecting modified typhoid bacteria firstly into guinea pigs, then in human volunteers. In a paper published in the British Medical Journal in 1897, Wright shows that active immunity to typhoid can be induced in humans using dead Salmonella typhi. He conducts the first experiments on himself and his colleagues, then on volunteers from the Indian Medical Corps. After doubts about its efficacy, voluntary inoculation is re-started in 1910, and by the First World War most British troops are vaccinated against typhoid fever.

 

1898 (part one)

First X-ray machines used

Transportable X-ray machines are used for the first time in the Greco-Turkish War.

The use of transportable X-ray machines in the Greco-Turkish War means bullets and shrapnel can now be located and removed from injured soldiers more easily. The new technology means potentially infectious foreign objects can be located and removed from a wound, reducing the need for amputation.

 

1898 (part two)

New medical corps set up

The creation of the Royal Army Medical Corps leads to improved efficiency as a single organisation is now responsible for delivering medical services.

All officers and soldiers providing medical services and training are incorporated into one body, the Royal Army Medical Corps (RAMC), to improve efficiency. Medical officers are placed on an equal footing with combatant and other non-combatant branches of the Army.

 

1902

Re-organisation of nursing

The Queen Alexandra's Imperial Military Nursing Service Reserve (QAIMNS) is formed in response to the deficiencies in care highlighted during the Anglo-Boer War.

Nursing deficiencies highlighted during the Anglo-Boer War result in the re-organisation of nursing services and the formation of the Queen Alexandra's Imperial Military Nursing Service (QAIMNS). This is accompanied by a sister organisation, the Queen Alexandra's Imperial Military Nursing Reserve. This nursing reserve force is to be used during times of war and was not available previously under the Army Nursing Service (ANS).

 

1907

Military medical college opens

A new medical institution for research and teaching, The Royal Army Medical College, officially opens.

King Edward VII and Queen Alexandra officially open the Royal Army Medical College at Millbank, London. It goes on to become a centre for research, and it is here that a vaccine against typhoid is developed and early gas masks are designed for use in chemical warfare.

 

1908

New voluntary forces set up

The Territorial Force and Territorial Force Nursing Service are created.

The voluntary Territorial Force and the Territorial Force Nursing Service are created. The contribution made by volunteers and reservists will be significant in the defence medical services.

 

1914 (part one)

The First World War starts

The First World War is the first major conflict in which mortality from battle injuries exceeds deaths from disease.

Mortality from battle injuries exceeds deaths from disease for the first time. This is due to better sanitation, preventative medicine and casualty evacuation procedures, as well as the increased killing power of weaponry. The increasing mechanisation of war brings with it some horrific new injuries, including wounds caused by land mines, mortars, grenades, tanks, flame-throwers and gas attacks. Trench warfare meant that heads are especially exposed, and severe face and jaw injuries are common. Their treatment leads to the modern specialism of maxillofacial and plastic surgery.

 

1914 (part two)

First use of poison gas

Poison gas is used for the first time in war. Troops are ill-equipped to deal with its effects.

Poison gas (in this instance, chlorine) is used for the first time in war, at the Second Battle of Ypres in April 1915. Within seconds of inhaling its yellow-green vapour, the chlorine destroys the victim's respiratory organs and causes an attack of choking. The protection available to troops is basic, such as cotton pads dipped in a solution of bicarbonate soda and held over the face. By the end of the war both sides are far better equipped. Soldiers use highly effective filter respirators, using charcoal or antidote chemicals. The horror at the wartime use of poison gases means their use is banned in 1925.

 

1915

New splint reduces deaths

The introduction of a new splint by Robert Jones dramatically reduces soldier deaths from upper leg fractures.

Advances are made in surgery and physiotherapy for the treatment of bone injuries suffered by soldiers. Robert Jones, considered to be the father of modern British orthopaedics, introduces the Thomas splint for fractures of the femur (thigh bone). The splint, devised by his uncle, Hugh Owen Thomas, dramatically reduces mortality caused by femoral fractures during the First World War.

                                                           

1917 (part one)

Advances in plastic surgery

A new hospital devoted to soldiers' facial injuries opens in Sidcup, Kent, with over 1,000 beds available.

The Queen's Hospital opens in June 1917 in Sidcup, Kent, specialising in the treatment of facial injury. Sir Harold Gillies pushes for the opening of the hospital following his experience of treating soldiers on the frontline. Gillies develops new techniques to treat the injuries caused by a new industrialised style of warfare. He uses tubular “pedicles” (flaps of skin) to retain blood flow to the flesh while it is grafted from the undamaged area on to the injured area. Gillies and his colleagues carry out more than 11,000 operations on 5,000 men at the Queen's Hospital.

 

1917 (part two)

First plastic surgery patient

Naval officer Walter Yeo, injured in the Battle of Jutland, is the first person in the world to undergo plastic surgery.

Two months after Gillies opens his specialist hospital, Walter Yeo is the first person to undergo plastic surgery. Yeo was horrifically wounded while manning the guns aboard HMS Warspite during the naval Battle of Jutland in 1916. Warrant officer Yeo, aged 26, is the first patient to benefit from Gillies' newly developed skin grafting technique, known as a “tubular pedicle”. The naval officer, from Plymouth, Devon, is given new eyelids and a “mask” of skin grafted across his face and eyes. After the procedure Yeo is improved but still has severe disfigurement.

 

1917 (part three)

Advances in storage of blood

The first successful attempts to store human blood for transfusion are made by the Allies on the battlefields of northern France.

The first successful attempts to store human blood are made on the Western Front thanks to earlier developments in anti-coagulants and blood-typing. The Army uses these advances to create the world's first blood depot, which leads to improved survival rates. The blood depots lead to the creation of civilian blood banks in 1921, which evolve into today's National Blood Transfusion Service. The first blood banks stored O type blood – suitable for all recipients. Before the invention of blood storage, blood transfusion was supplied directly from the vein of another patient, using a portable transfusion kit.

 

1918

Shell shock’s heavy toll

By the end of the war, the British Army has dealt with 80,000 cases of shell shock, and many soldiers continue to suffer from its effects many years after coming home.

Thousands of soldiers return from the war with shell shock but the Army has little sympathy for them. By the end of the war, the British Army has dealt with 80,000 cases of shell shock, and many soldiers suffer from its effects years after returning from the front. Symptoms include hysteria, anxiety, paralysis, limping, muscle contractions, nightmares and insomnia. At first, shell shock is thought to be caused by exposure to warfare, but many soldiers have symptoms without having been on the battlefield. Early treatments range from solitary confinement, disciplinary treatment, electric shock treatment, shaming and physical re-education.

 

1921

Creation of Army Dental Corps

The creation of the Army Dental Corps is prompted by the number of face and jaw injuries and dental problems in the First World War.

Although army regimental surgeons have been providing dental care to soldiers since about 1660, it is not until 1901 that a dental service branch is established under the Royal Army Medical Corps (RAMC). In 1921, dentists of the RAMC are split into a separate Army Dental Corps (ADC). The Corps is awarded the “Royal” prefix and becomes the Royal Army Dental Corps in November 1946 in recognition of its service in the Second World War.

 

1939 (part one)

The Second World War starts

The advent of mobile medical units leads to a reduction in the number of fatalities compared with previous wars.

The use of mobile medical units, where surgery can be performed, means casualties receive treatment much faster in The Second World War than in any previous conflict. It will prove to be arguably the most important change in military medicine during the six years of the Second World War.

 

1939 (part two)

Fatalities from disease drop

Immunisation programmes and the widespread availability of antibiotics are significant in the fight against disease among Allied Forces.

Immunisation programmes and the widespread availability of antibiotics, including penicillin and sulphonamides, are significant in the fight against disease and infections among the Allied Forces. Fewer than 1 in 10 deaths in the British Army are attributable to disease. Some historians argue that this medical superiority gave the Allies an advantage over the Axis powers.

 

1944

Motorised ambulances used

Evacuation of casualties improves with the widespread use of ambulances and aeroplanes.

Most casualties are receiving treatment within hours of being injured due to the increased mobility of field hospitals and the extensive use of motorised ambulances. Aeroplanes are also used as ambulances to evacuate the most serious casualties.

 

1946

Rehabilitation centre for RAF

A dedicated rehabilitation centre opens at Headley Court in Surrey, for RAF pilots and aircrews.

Headley Court in Epsom, Surrey, opens as a rehabilitation centre for Royal Air Force (RAF) pilots and aircrew who are injured during the Second World War. It will go on to become the Defence Medical Rehabilitation Centre (DMRC), offering treatment for injured service personnel from across the armed forces.

 

1949

QARANC is established

Queen Alexandra's Royal Army Nursing Corps (QARANC) is formed.

The Queen Alexandra's Imperial Military Nursing Service (QAIMNS) becomes the Queen Alexandra's Royal Army Nursing Corps (QARANC). The re-organisation of nursing services means QARANC becomes a distinct corps within the regular and territorial armies.

 

1950

Helicopters used in evacuations

The first co-ordinated use of helicopters for evacuation of casualties takes place in the Korean War.

Flight nursing officers are posted to Korea to work on board the helicopters being used to airlift casualties to the British Field Hospitals and US Mobile Army Surgical Hospitals (MASHs). These medical units serve as fully functional hospitals in combat areas. Long-haul evacuation of seriously wounded service personnel by aeroplane is also in operation.

 

1953

New limb-saving technique

New surgical techniques to repair damaged blood vessels in field hospitals dramatically reduces the need for amputation.

With the development of new techniques to repair damaged veins and arteries, the number of wounded soldiers requiring amputation is dramatically reduced during the Korean War. The use of the helicopter to reduce the time between wounding and repair of the damaged blood vessel proves invaluable. The amputation rate resulting from vascular injuries drops from about 50% during the Second World War to about 10% in Korea.

 

1980

PTSD recognised for first time

American psychiatrists recognise post-traumatic stress disorder (PTSD) as a diagnosable psychiatric disorder.

American psychiatrists recognise that post-traumatic stress disorder (PTSD) is a diagnosable psychiatric disorder. It is used to describe the psychological symptoms experienced by some Vietnam War veterans after their military service. Since 1905, combat-related psychological trauma has been increasingly recognised and described by terms such as shell shock and battle fatigue.

 

1982

The face of Falklands War

Simon Weston becomes the public face of soldiers injured in the Falklands War after he is hit by a missile and suffers severe burns.

Simon Weston becomes the public face of injured soldiers when he experiences terrible burns during the Falklands War. The Welsh Guardsman, aged 20 at the time, was aboard the Sir Galahad when it was hit by an Argentine missile in June 1982. Weston survived but with 49% burns, which left physical and psychological scars. He subsequently endures years of reconstructive surgery, with over 75 major operations or surgical procedures. Skin from his shoulders is used to make eyelids, and skin from his buttocks forms a new nose. After the war, Weston uses his public profile to support a number of charitable causes and his efforts are recognised in 1992 with an OBE.

 

1994

Closure of military hospitals

The phased closure of military hospitals is announced as part of a re-organisation of military healthcare.

The end of the Cold War prompts a review of defence spending. The resulting report, “Front Line First: The Defence Costs Study” announces a re-organisation of the Defence Medical Services. The review leads to the closure of military hospitals and closer co-operation with the NHS, including the creation of military wings in NHS hospitals.

 

2001

New unit for seriously wounded

The Royal Centre for Defence Medicine (RCDM) opens and becomes the main receiving unit for casualties from Iraq and Afghanistan.

The Royal Centre for Defence Medicine (RCDM) opens at Selly Oak Hospital, part of University Hospitals Birmingham (UHB). UHB is the main receiving unit for seriously wounded casualties flown home from operational theatres in countries such as Iraq and Afghanistan. With soldiers surviving injuries that would have killed them in the past, surgeons are now dealing with some of the most complex cases ever faced. Among some groundbreaking procedures is the rebuilding of a soldier's hand in 2006 using three of his ribs and muscle from the right side of his torso.

 

2003

New life-saving equipment

Advances in the treatment of trauma wounds in Iraq and Afghanistan lead to a reduction in the number of fatalities.

New life-saving equipment and techniques for combat casualties are introduced during operations in Iraq and Afghanistan. With catastrophic haemorrhage being the main cause of death on the battlefield, soldiers are equipped with new blood-stemming products such as the HemCon bandage. The bandage, made partly from crushed shellfish, becomes sticky on contact with blood, helping clots develop and rapidly stopping severe bleeding. Intraosseous needles, which inject liquids straight into the bone, are used when inserting into a vein is difficult. The standard ABC protocol for checking vital signs (airway, breathing, circulation) are updated to CABC (the initial C standing for catastrophic haemorrhage).

 

2007 (part one)

Last military hospital closes

The last military hospital in the UK to be decommissioned is the Royal Hospital Haslar in Gosport, Hampshire.

The last dedicated military hospital, the Royal Hospital Haslar, is decommissioned. Treatment and training of military personnel is transferred to units within the NHS, known as Ministry of Defence Hospital Units, and to the Royal Centre for Defence Medicine (RCDM) in Birmingham. Under this arrangement, military medical personnel work alongside NHS staff to provide medical, nursing and other clinical treatments to both NHS and military patients. British military hospitals are still in operation in Cyprus and Gibraltar.

 

2007 (part two)

Soldiers fitted with bionic limbs

Amputee soldiers are fitted with the latest in artificial limb technology at Headley Court, the UK's main military rehabilitation facility.

Amputee soldiers are fitted with the latest in artificial limb technology at Headley Court, the armed forces' rehabilitation centre, which has one of the most advanced prosthetic workshops in the UK. Cutting-edge prosthetics include the British-designed iLimb, a “bionic hand” with five motors (one for each artificial finger), giving it a more sophisticated grasp than most prostheses. A number of patients are fitted with the CLeg, a computerised false leg controlled by Bluetooth remote control and with a range of settings such as walking and cycling. Headley Court became the UK's main military rehabilitation facility for the Army, Royal Navy and Royal Air Force, and is officially known as the Defence Medicine Rehabilitation Centre (DMRC).

 

2008  

Field hospital gets £10m refit

The field hospital at Camp Bastion, Afghanistan, re-opens following a £10m refit.

New facilities replace the tented unit that had been in service at Camp Bastion, Helmand Province, Afghanistan, since the start of operations in 2003. The solid structure has 37 patient beds and state-of-the-art equipment including a £500,000 CT scanner and two mobile digital Dragon X-ray machines. The field hospital has 100 tri-service (Army, Navy and Air Force) staff and treats 2,000 casualties a year, including armed forces personnel, members of the Afghan security forces and civilians.

 

2010

New state-of-the-art facilities

The Royal Centre for Defence Medicine (RCDM) will move to new, purpose-built facilities in Birmingham.

The Royal Centre for Defence Medicine will move to a new home in the £545m Birmingham New Hospital. The new military ward will be in a designated trauma and orthopaedics unit where up to 30 military patients will be cared for in single rooms or four-bed bays. To meet the special requirements of service men and women, the ward will have additional features for their exclusive use, including a quiet room for relatives, a communal space for patients to gather and a physiotherapy centre.

 

NHS Choices 2011

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