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.
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
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
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and their widows, is withdrawn.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
In addition to static hospitals, William
1702
Flying hospitals on battlefields
Flying hospitals accompany the Duke of
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
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
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
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
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
1854
Nightingale improves conditions
Nurse Florence Nightingale and volunteer
nurses are sent to
Florence Nightingale and a staff of 38 volunteer nurses,
trained by her, are sent to Scutari in
1857
Major military healthcare reforms
The Crimean War prompts
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
1863
The
The
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