War and the Militarization of British Army Medicine, 1793–1830 by Catherine Kelly (review)

Here’s a good book that has been waiting to happen. Lots of exciting scholarship in the past forty years has increasingly pointed to the French Revolutionary and Napoleonic Wars as being key moments in transforming and professionalizing British medicine. The academic stage has been calling for a synthesis based on an empirical study. Ages ago now, for all its imperfections, David Vess’s Medical Revolution in France, 1789–1796 made a bold and most welcome attempt to do this for French medicine.¹ Since then intellectual studies of nosology, social historical accounts of medical education, colonial histories, and investigations of military and naval medicine have all pointed to the European wars of this period as not only transforming medical organization and practice in the army and navy but having seismic reverberations through the structure of the civilian professions. Most recently Marcus Ackroyd and colleagues in Advancing with the Army: Medicine, the Professions, and Social Mobility in the British Isles, 1790–1850 made a major contribution to these themes.²

The key to Kelly’s study lies in its title; the “militarization of British army medicine” rightly points to the fact that, although lots of doctors worked in the army before the revolutionary years, it was within that period that a coherent military medicine appeared, both intellectually and professionally. The long-term result, as in other areas of Victorian life, such as the civil service, was the creation of a middle-class profession with the disappearance of sinecures and nepotism and the creation of new formal and informal codes of conduct and a more meritocratic career structure. Over the period covered by her study the army medical department increased in size almost tenfold. Its project, if it can be called that, was to promote an observation-based medicine, ideologically if not politically aligned to French hospital medicine. Kelly’s empirical studies cover the Low Countries and the West Indies; the Walcheren Campaign and the Army Medical Board; Egypt, ophthalmia, and the plague; and the Peninsular War (with an additional chapter devoted to James McGrigor in that campaign). A final chapter assesses the effect of demobilized military men on medical practice in postwar Britain. A significant finding here is the increasing involvement of parliament in medical matters (which we knew already in other areas) by way of military concerns. This is a valuable book, not transforming but certainly clarifying and substantiating conclusions that the community has been adumbrating for some time.