Surgeons at War: Medical Arrangements for the Treatment of the Sick and Wounded in the British Army during the Late Eighteenth and Nineteenth Centuries (review)

Matthew Kaufman, a professor of anatomy at the University of Edinburgh, offers an account of British Army military medicine that documents the general indifference of Britain and its army toward the medical care of its soldiers for the period he addresses. A forty-four-page introduction outlines well-known material on wound care, disease management, the training and appointment of surgeons and physicians, and the Army Medical Board and politics. Brief biographies of the usual suspects—Pringle, John Hunter, Guthrie, Charles Bell, McGrigor—are given, and medicine in the Royal Navy is mentioned. It is clear that surgery, as such, did little or nothing to save lives; the title notwithstanding, it was disease that killed.

The twenty-two-year war with France (1793-1815) is allocated fifty-three pages. The medical disasters of Flanders, the West Indies, and Egypt are commented on, but the principal narrative is of the Peninsular Campaign under Wellington. McGrigor is justly praised, and his eventually useful medical arrangements are well presented. The continuing lack of a structured forward treatment and evacuation system is compared to the functional system of the French under Larrey. The Crimean War (1854-56) is well summarized: Miss Nightingale gets her due, and the British Army remains content to have its soldiers die of neglect and disease. Following the war, the political pressures of Nightingale and others led to reforms and an improved Army Medical Department with formal education of medical officers in an Army Medical School, an enlisted Hospital Corps, better food and housing for the soldiers, and so on, and eventually improved the health of soldiers.

There is new material, from Edinburgh archives, about the Regius Chair of Military Surgery (1806-55) at the University of Edinburgh and its most famous occupant, George Ballingall, whose appointment was opposed by the faculty. It may be fairly said that during his tenure (1822-55) he founded military surgery as a discipline in Britain, published a number of papers, and taught many medical students and army and navy officers. His textbook, An Outline of Military Surgery (1833), a compilation of his lectures, went through five editions to 1855. There are good data on class sizes, the politics of the chair and of the army, and lists of the university medical degrees of army medical officers.

One does not have to accept the "long eighteenth century" to find it odd that the War for American Independence (1775-83) is not included in the book. There are enough contemporary and secondary sources to provide a chapter, but perhaps the author wished to discuss only the wars that Britain won. The book relies very heavily on secondary sources, especially Neil Cantlie's magisterial two-volume History of the Army Medical Department (1974). Except for the Ballingall section, there is nothing new here for anyone who is familiar with the military and medical history of the period. Small errors (Countess of Chinchon, Minié "rifle," etc.) will jar the knowledgeable. For neophytes, it has some utility as an outline of the material and as a guide to helpful secondary sources.