Advancing with the Army: Medicine, the Professions, and Social Mobility in the British Isles 1790–1850 (review)

Advancing with the Army is a detailed study of some 450 surgeons who joined the army medical service during the Revolutionary and Napoleonic wars. It is not primarily a history of medicine but contributes to our understanding of the development of the professions and social mobility in Britain in this era. Moreover, the insightful nature of this work is significantly increased, as the subgroup of medical practitioners examined originated not from affluent or professional families but disproportionately from urban and rural backwaters in Scotland and Ireland.

Undoubtedly, access to the collection of pro forma questionnaires instigated by the then director-general of the army medical service, Sir James McGrigor, was essential to this analysis. These were initially completed by surgeons who endured the French wars in the years following Waterloo. Later, these forms were officially supplemented with service history, date of death, and so on. Consequently, statistics based mainly on this contemporary source do abound in this study (particularly in the form of figures and tables). The potential accusation of the authors being merely "quantative historians in lab coats," however, cannot be substantiated. Data are consistently amplified by experiences penned by the doctors themselves and information provided by their relatives. In fact, approximately one sixth of the cohort appears in the text so frequently and in such detail as to almost rise "alive" from the page.

Similarly, the criticism of a disjointed approach, commonly leveled when several authors contribute to an academic study, is unsupportable. The analysis of the early history of the army medical service is "seamless," emphasizing the opportunities and enticements apparent to our surgeon cohort during the French wars but, equally, the hardships and dangers to be faced.

To further assess the degree of the development of the professions and social mobility in this epoch, a comprehensive investigation of the focus group is undertaken. The social background, education, training, patronage received, careers (including the ability to "work the system"), and life outside the army of this cohort are dissected. Enhancing this analysis are charming timepieces that frequently reflect the restrictive nature and bias of contemporary society. Notably, the army is portrayed as a form of finishing school for surgeons where uncommon conditions and wounds are encountered. The perceived quality of medical degrees and ease of achievement, vastly differing from university to university, is highlighted, as is the importance of influential connections (even outweighing ability)—something that McGrigor himself relied on to advance his own career!

Clearly, voluminous research has been undertaken by the authors. A large variety of sources has been investigated, and they are consistently cited in the text and footnotes. These, combined with the numerous statistical figures and tables evident and the ample bibliography and index provided, enable this work to operate equally well as an "abundant store of reference material" for historians and an "illuminating journey" for the wider audience.

In fact, criticisms that can be levelled at this study are few. Perhaps the illustrations included could have been more diverse in nature, and they could have been suitably interspersed within the text to further stimulate the analysis. There is also a minor tendency by the authors to drift into excessive detail.

Overall, this analytical investigation is, however, clear and concise. Conclusions reached in this study including that many of the cohort improved their social status (some dramatically) owing initially to opportunities arising within the medical profession are aptly supported. Moreover, previous studies that have focused on the development of the professions and social mobility have not concentrated on medicine, have referred to a different epoch, or been less extensive in nature. Advancing with the Army is thus undoubtedly a valuable addition to this literary category.